This orthosis is biomechanically and neuro-physiologically (facilliation and inhibition) effective ankle foot orthosis which is basically indicated for central narvous system disorder and it will provide dynamic ankle dorsiflexion and plantarflexion. It provides independent movement of ankle knee and hip.
This document discusses different types of prosthetic knee joints, including mechanical single-axis and polycentric knees, and computerized knees that use microchips, hydraulics, or pneumatics to control motion. It describes the evolution of prosthetic knees from simple pendulums to advanced mechanisms with microprocessor control. Key factors in prescribing the appropriate knee include the user's ability to control stability, flex the knee in swing phase, and walk at different speeds.
The document discusses the alignment of a trans-tibial prosthesis (TTP). It defines alignment as the spatial relationship between prosthetic components and the amputee's body. Proper alignment is important for comfort and a natural gait. There are three types of alignment discussed: bench, static, and dynamic. Bench alignment sets the initial positioning before fitting. Static alignment evaluates alignment while standing or sitting. Dynamic alignment observes the user walking to further refine the alignment based on gait analysis and user feedback. The goal is smooth, natural walking with even weight distribution and less energy expenditure.
This document discusses prosthetic gait patterns and deviations. It begins by explaining that amputee gait varies from normal gait, with increased energy expenditure and use of different muscle groups. Gait analysis is needed to identify deviations and their causes. Key aspects of transtibial and transfemoral gait patterns and common deviations are described, including excessive or insufficient knee flexion, lateral thrust, and vaulting or hip hiking during swing phase. Gait training involves static and dynamic evaluation, starting with activities off the prosthesis and progressing to ambulation with or without aids on different surfaces.
Socket variants in upper extremity prosthesis.pptx1POLY GHOSH
The document discusses various socket designs for different levels of upper limb amputations. It describes the key factors in socket design such as maximizing range of motion, stability, and force distribution. For transradial amputations, common socket designs include supracondyler brims, external suspension sleeves, and internal roll-on locking liners. The Munster and Northwestern sockets are described as examples of supracondyler designs. For transhumeral amputations, designs include open shoulder above elbow sockets and closed encasulated designs. The document also discusses some novel designs like the TRAC, CRS, and ACCI sockets that aim to improve suspension, reduce motion at bone-socket interface, and control rotation.
Clinical consideration of quadrilateral socket 2000POLY GHOSH
The document discusses the quadrilateral socket for transfemoral amputees. It describes the socket as having four walls - medial, lateral, anterior, and posterior - which provide stability and function. Each wall is contoured to stabilize specific muscles and bones. The quadrilateral socket allows for a narrow base of gait and medio-lateral stability when coupled with proper alignment. It remains the most commonly used socket design despite new techniques because it is biomechanically proven to be stable.
The document discusses the biomechanics of the hip joint and total hip arthroplasty (THA). It begins by defining biomechanics and describing the normal anatomy and biomechanics of the hip, including the forces acting on it. It then discusses the biomechanical considerations for THA, including restoring the hip center, lengthening the abductor lever arm, and decreasing the body weight lever arm to reduce joint reaction forces. The history of applying biomechanics to THA is reviewed, highlighting key concepts. Component position, size, and orientation are described as important biomechanical factors for ensuring stability and reducing wear.
The document discusses the biomechanics of transtibial prostheses. It explains that comfort, stability and function depend on applying biomechanical principles like distributing pressure evenly over the stump. Socket contours can be modified to accommodate differences in tissue firmness and pressure tolerance by adding reliefs and bulges. The inclination of supporting surfaces also influences pressure, with more vertical surfaces requiring greater counterforces to support weight. A patellar tendon-bearing area provides stable but inclined weight support that requires a posterior counterforce to prevent sliding.
The document discusses prosthetic knee joints, classifying them based on axis type and control mechanisms. It describes single-axis knees that provide stability but lack swing phase control and polycentric multi-axis knees that more closely mimic natural knee motion. Control mechanisms include manual and automatic locking, hydraulic/pneumatic resistance, and microprocessor units that sense gait to adjust resistance for different surfaces.
This document discusses different types of prosthetic knee joints, including mechanical single-axis and polycentric knees, and computerized knees that use microchips, hydraulics, or pneumatics to control motion. It describes the evolution of prosthetic knees from simple pendulums to advanced mechanisms with microprocessor control. Key factors in prescribing the appropriate knee include the user's ability to control stability, flex the knee in swing phase, and walk at different speeds.
The document discusses the alignment of a trans-tibial prosthesis (TTP). It defines alignment as the spatial relationship between prosthetic components and the amputee's body. Proper alignment is important for comfort and a natural gait. There are three types of alignment discussed: bench, static, and dynamic. Bench alignment sets the initial positioning before fitting. Static alignment evaluates alignment while standing or sitting. Dynamic alignment observes the user walking to further refine the alignment based on gait analysis and user feedback. The goal is smooth, natural walking with even weight distribution and less energy expenditure.
This document discusses prosthetic gait patterns and deviations. It begins by explaining that amputee gait varies from normal gait, with increased energy expenditure and use of different muscle groups. Gait analysis is needed to identify deviations and their causes. Key aspects of transtibial and transfemoral gait patterns and common deviations are described, including excessive or insufficient knee flexion, lateral thrust, and vaulting or hip hiking during swing phase. Gait training involves static and dynamic evaluation, starting with activities off the prosthesis and progressing to ambulation with or without aids on different surfaces.
Socket variants in upper extremity prosthesis.pptx1POLY GHOSH
The document discusses various socket designs for different levels of upper limb amputations. It describes the key factors in socket design such as maximizing range of motion, stability, and force distribution. For transradial amputations, common socket designs include supracondyler brims, external suspension sleeves, and internal roll-on locking liners. The Munster and Northwestern sockets are described as examples of supracondyler designs. For transhumeral amputations, designs include open shoulder above elbow sockets and closed encasulated designs. The document also discusses some novel designs like the TRAC, CRS, and ACCI sockets that aim to improve suspension, reduce motion at bone-socket interface, and control rotation.
Clinical consideration of quadrilateral socket 2000POLY GHOSH
The document discusses the quadrilateral socket for transfemoral amputees. It describes the socket as having four walls - medial, lateral, anterior, and posterior - which provide stability and function. Each wall is contoured to stabilize specific muscles and bones. The quadrilateral socket allows for a narrow base of gait and medio-lateral stability when coupled with proper alignment. It remains the most commonly used socket design despite new techniques because it is biomechanically proven to be stable.
The document discusses the biomechanics of the hip joint and total hip arthroplasty (THA). It begins by defining biomechanics and describing the normal anatomy and biomechanics of the hip, including the forces acting on it. It then discusses the biomechanical considerations for THA, including restoring the hip center, lengthening the abductor lever arm, and decreasing the body weight lever arm to reduce joint reaction forces. The history of applying biomechanics to THA is reviewed, highlighting key concepts. Component position, size, and orientation are described as important biomechanical factors for ensuring stability and reducing wear.
The document discusses the biomechanics of transtibial prostheses. It explains that comfort, stability and function depend on applying biomechanical principles like distributing pressure evenly over the stump. Socket contours can be modified to accommodate differences in tissue firmness and pressure tolerance by adding reliefs and bulges. The inclination of supporting surfaces also influences pressure, with more vertical surfaces requiring greater counterforces to support weight. A patellar tendon-bearing area provides stable but inclined weight support that requires a posterior counterforce to prevent sliding.
The document discusses prosthetic knee joints, classifying them based on axis type and control mechanisms. It describes single-axis knees that provide stability but lack swing phase control and polycentric multi-axis knees that more closely mimic natural knee motion. Control mechanisms include manual and automatic locking, hydraulic/pneumatic resistance, and microprocessor units that sense gait to adjust resistance for different surfaces.
In this ppt, there is various types of hip orthoses were disscussed according to various types of hip pathologies like developmental dysplasia of hip, legg calve perthes disease, spina bifida, cerebral palsy, lower extremity weakness and paralysis, torsional deformities.
also various types hip orthoses with HKAFOS were discussed from the conventional design to most advanced design like post operative hip orthoses for hip reconstruction surgery etc.
This document discusses advances in hip disarticulation prostheses. It begins by describing hip disarticulation amputation and challenges with prosthetic fitting at this level. It then covers the evolution of prosthetic designs including traditional tilting-table models, the seminal Canadian design, and more recent designs incorporating lightweight materials and anatomical shaping. Key components like the socket, hip joint, and suspension methods are examined. The document emphasizes ongoing efforts to improve mobility, comfort and long-term prosthetic use for individuals with hip disarticulation amputations.
In this presentation detailed discussion about the amputation and syme amputation and biomechanics are there. also alignment of symes prosthesis is discussed.
Hip Disarticulation Prosthetic ManagementRavi kumar
This document provides information about hip disarticulation prostheses. It begins by defining hip disarticulation as the surgical removal of the entire lower limb through the hip joint. It then discusses some key challenges with hip disarticulation including reduced mobility and increased energy expenditure during walking. The document outlines the main causes of hip disarticulation amputation and notes that only 20% of patients use a prosthetic leg full time. It provides an overview of the evolution of hip disarticulation prosthesis designs. The document details important considerations for prosthetic management of hip disarticulation including patient evaluation, casting techniques, socket design, components, alignment, and training.
An Immediate Post operative Prosthesis (IPOP) or Immediate Post-surgical fitting is a device that is applied before or after wound closure that protects the suture site and allows limited weight bearing and gait training. It serves as a bridge between surgery and a definitive prosthesis. IPOPs can be custom fabricated or prefabricated and are commonly used at the transtibial and transradial levels. Advantages include reducing phantom limb pain and sensations, earlier weight bearing and rehabilitation, and shorter recovery times. Air splints are a type of non-custom IPOP that provide uniform pressure distribution, easy inspection of incision sites, and partial weight bearing ability.
The knee is made up of four bones that interact in two joints: the tibiofemoral and patellofemoral joints. These joints allow flexion/extension, rotation, and translation while providing load transfer. The knee flexes from 0-135 degrees, and the femoral condyles translate posteriorly during flexion. The tibia externally rotates in extension and internally rotates in flexion, locking the knee. Larger Q angles increase risk of lateral patellar subluxation. Forces through the knee increase with activity from 0.3 times body weight while walking to 7 times body weight while squatting.
Thoracolumbar braces are commonly used to treat adolescent idiopathic scoliosis. While braces aim to control curve progression through applied forces over time, their effectiveness is disputed due to inconsistent patient populations and evaluation methods across studies. Ideal candidates are those with curves between 30-40 degrees or less than 30 degrees who are at high risk of progression. Studies found braces successful in preventing progression over 6 degrees in right thoracic curves 25-35 degrees. However, wrong indications or inadequate forces can lead to treatment failure. Further research on brace biomechanics aims to better understand correction effects and pressure distributions to optimize brace design and prescription.
Lower Limb Orthotics - Dr Rajendra Sharmamrinal joshi
This document provides information on lower limb orthotics. It defines an orthosis and describes their clinical objectives in treating conditions like pain, deformities, abnormal range of motion, etc. It discusses different types of orthoses like foot, ankle-foot, knee-ankle-foot orthoses. Principles of bracing like distributing forces over large areas and applying forces to control joints are covered. Characteristics of an ideal orthosis in terms of function, comfort, cost are outlined. The document also discusses shoes, foot orthoses, ankle-foot orthoses made of plastic, metal and patellar tendon bearing designs.
This document discusses shoe modifications for lower extremity orthotics. It begins by outlining the purpose of shoes and modifications, which aim to restore normal gait and weight bearing. Key points include:
1) Shoe styles like the blucher and convalescent shoe provide easy access for patients with foot issues. Upperc like chukkas help prevent piston motion in patients with limited ankle motion.
2) Brace attachments must be rigidly attached to solid sole shoes to prevent undesirable ankle motions. Reinforcements may be needed to prevent shoe distortion from brace stresses.
3) Proper placement of steel shanks is important to allow natural dorsiflexion without depressing arches or shifting weight bearing
presentation is about Orthosis and prosthesis. It gives Classification of Orthosis. It describes structure, function, Indication and uses of Orthosis. Also describes different types of Prostheses, their parts and function.
This document discusses different methods of alignment for a transfemoral prosthesis. It describes three main alignment methods: bench alignment, static alignment, and dynamic alignment. Bench alignment involves initially setting the socket flexion at 5 degrees and adduction at 7 degrees for stability and function. It also involves aligning the prosthetic knee and foot in relation to the socket in the anterior-posterior and medial-lateral planes using different standardized systems like the German, U.S., and modified systems. The goal of alignment is to provide support, a natural gait, and efficient ambulation for the transfemoral amputee.
Upper Limb Prosthetics - Dr Om Prakashmrinal joshi
This document provides information on upper limb prostheses. It discusses the history of prosthetics, levels of amputation, types of prosthetic systems (passive, body-powered, externally powered, hybrid), components (socket, suspension, control mechanisms, terminal devices), and considerations for prosthetic selection and use. The key points are that upper limb loss can be devastating, prosthetics can replace some hand functions but not sensation, and the appropriate prosthesis depends on the amputation level, expected use, and individual factors.
1. An ankle-foot orthosis (AFO) is an externally applied brace that controls and supports the ankle and foot. AFOs are commonly used after ankle injuries to immobilize or support the joint during rehabilitation.
2. AFOs can be custom-fit or pre-fabricated. Custom AFOs are molded specifically for each individual while pre-fabricated AFOs come in standard sizes. The document discusses various types of AFOs including solid, hinged, and air-stirrup designs.
3. AFOs are used to treat acute ankle injuries, during rehabilitation to prevent re-injury, prophylactically in high-risk patients or activities, and
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
Tone is a normal characteristic of muscle physiology and defined as “ normal degree of vigour and tension: in muscle, the resistance to passive elongation or stretch”. Increase in tone known as hypertonocity. The problem like C.P and stroke are basically suffer hypertonicity. The orthoses help to reduce the tone is known as tone reducing orthoses. These orthosis are follows the principles of NDT mechanism and neurophysiology, so its also known as neurophysiological AFO.
The document discusses muscle tone and how it relates to movement and rehabilitation. It summarizes that tone assists with balance and posture development in infants and diminishes as higher movement skills develop. For neurologically impaired patients, high muscle tone presents challenges for rehabilitation professionals. The document then discusses various tone-reducing techniques that have been used in casts and orthoses, including applying pressure to specific areas of the foot or leg to inhibit reflexes. It provides examples of ankle-foot orthosis designs that aim to reduce tone through biomechanical alignment and pressure on muscle insertions.
Hypertonicity is a upper motor neuron lesion basically found in cerebral palsy and hemiplegia. The orthosis help to reduce the tone are known as tone reducing orthosis follows the principles of Neurodevelopmental technique and neurophysiology.
In this ppt, there is various types of hip orthoses were disscussed according to various types of hip pathologies like developmental dysplasia of hip, legg calve perthes disease, spina bifida, cerebral palsy, lower extremity weakness and paralysis, torsional deformities.
also various types hip orthoses with HKAFOS were discussed from the conventional design to most advanced design like post operative hip orthoses for hip reconstruction surgery etc.
This document discusses advances in hip disarticulation prostheses. It begins by describing hip disarticulation amputation and challenges with prosthetic fitting at this level. It then covers the evolution of prosthetic designs including traditional tilting-table models, the seminal Canadian design, and more recent designs incorporating lightweight materials and anatomical shaping. Key components like the socket, hip joint, and suspension methods are examined. The document emphasizes ongoing efforts to improve mobility, comfort and long-term prosthetic use for individuals with hip disarticulation amputations.
In this presentation detailed discussion about the amputation and syme amputation and biomechanics are there. also alignment of symes prosthesis is discussed.
Hip Disarticulation Prosthetic ManagementRavi kumar
This document provides information about hip disarticulation prostheses. It begins by defining hip disarticulation as the surgical removal of the entire lower limb through the hip joint. It then discusses some key challenges with hip disarticulation including reduced mobility and increased energy expenditure during walking. The document outlines the main causes of hip disarticulation amputation and notes that only 20% of patients use a prosthetic leg full time. It provides an overview of the evolution of hip disarticulation prosthesis designs. The document details important considerations for prosthetic management of hip disarticulation including patient evaluation, casting techniques, socket design, components, alignment, and training.
An Immediate Post operative Prosthesis (IPOP) or Immediate Post-surgical fitting is a device that is applied before or after wound closure that protects the suture site and allows limited weight bearing and gait training. It serves as a bridge between surgery and a definitive prosthesis. IPOPs can be custom fabricated or prefabricated and are commonly used at the transtibial and transradial levels. Advantages include reducing phantom limb pain and sensations, earlier weight bearing and rehabilitation, and shorter recovery times. Air splints are a type of non-custom IPOP that provide uniform pressure distribution, easy inspection of incision sites, and partial weight bearing ability.
The knee is made up of four bones that interact in two joints: the tibiofemoral and patellofemoral joints. These joints allow flexion/extension, rotation, and translation while providing load transfer. The knee flexes from 0-135 degrees, and the femoral condyles translate posteriorly during flexion. The tibia externally rotates in extension and internally rotates in flexion, locking the knee. Larger Q angles increase risk of lateral patellar subluxation. Forces through the knee increase with activity from 0.3 times body weight while walking to 7 times body weight while squatting.
Thoracolumbar braces are commonly used to treat adolescent idiopathic scoliosis. While braces aim to control curve progression through applied forces over time, their effectiveness is disputed due to inconsistent patient populations and evaluation methods across studies. Ideal candidates are those with curves between 30-40 degrees or less than 30 degrees who are at high risk of progression. Studies found braces successful in preventing progression over 6 degrees in right thoracic curves 25-35 degrees. However, wrong indications or inadequate forces can lead to treatment failure. Further research on brace biomechanics aims to better understand correction effects and pressure distributions to optimize brace design and prescription.
Lower Limb Orthotics - Dr Rajendra Sharmamrinal joshi
This document provides information on lower limb orthotics. It defines an orthosis and describes their clinical objectives in treating conditions like pain, deformities, abnormal range of motion, etc. It discusses different types of orthoses like foot, ankle-foot, knee-ankle-foot orthoses. Principles of bracing like distributing forces over large areas and applying forces to control joints are covered. Characteristics of an ideal orthosis in terms of function, comfort, cost are outlined. The document also discusses shoes, foot orthoses, ankle-foot orthoses made of plastic, metal and patellar tendon bearing designs.
This document discusses shoe modifications for lower extremity orthotics. It begins by outlining the purpose of shoes and modifications, which aim to restore normal gait and weight bearing. Key points include:
1) Shoe styles like the blucher and convalescent shoe provide easy access for patients with foot issues. Upperc like chukkas help prevent piston motion in patients with limited ankle motion.
2) Brace attachments must be rigidly attached to solid sole shoes to prevent undesirable ankle motions. Reinforcements may be needed to prevent shoe distortion from brace stresses.
3) Proper placement of steel shanks is important to allow natural dorsiflexion without depressing arches or shifting weight bearing
presentation is about Orthosis and prosthesis. It gives Classification of Orthosis. It describes structure, function, Indication and uses of Orthosis. Also describes different types of Prostheses, their parts and function.
This document discusses different methods of alignment for a transfemoral prosthesis. It describes three main alignment methods: bench alignment, static alignment, and dynamic alignment. Bench alignment involves initially setting the socket flexion at 5 degrees and adduction at 7 degrees for stability and function. It also involves aligning the prosthetic knee and foot in relation to the socket in the anterior-posterior and medial-lateral planes using different standardized systems like the German, U.S., and modified systems. The goal of alignment is to provide support, a natural gait, and efficient ambulation for the transfemoral amputee.
Upper Limb Prosthetics - Dr Om Prakashmrinal joshi
This document provides information on upper limb prostheses. It discusses the history of prosthetics, levels of amputation, types of prosthetic systems (passive, body-powered, externally powered, hybrid), components (socket, suspension, control mechanisms, terminal devices), and considerations for prosthetic selection and use. The key points are that upper limb loss can be devastating, prosthetics can replace some hand functions but not sensation, and the appropriate prosthesis depends on the amputation level, expected use, and individual factors.
1. An ankle-foot orthosis (AFO) is an externally applied brace that controls and supports the ankle and foot. AFOs are commonly used after ankle injuries to immobilize or support the joint during rehabilitation.
2. AFOs can be custom-fit or pre-fabricated. Custom AFOs are molded specifically for each individual while pre-fabricated AFOs come in standard sizes. The document discusses various types of AFOs including solid, hinged, and air-stirrup designs.
3. AFOs are used to treat acute ankle injuries, during rehabilitation to prevent re-injury, prophylactically in high-risk patients or activities, and
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
Tone is a normal characteristic of muscle physiology and defined as “ normal degree of vigour and tension: in muscle, the resistance to passive elongation or stretch”. Increase in tone known as hypertonocity. The problem like C.P and stroke are basically suffer hypertonicity. The orthoses help to reduce the tone is known as tone reducing orthoses. These orthosis are follows the principles of NDT mechanism and neurophysiology, so its also known as neurophysiological AFO.
The document discusses muscle tone and how it relates to movement and rehabilitation. It summarizes that tone assists with balance and posture development in infants and diminishes as higher movement skills develop. For neurologically impaired patients, high muscle tone presents challenges for rehabilitation professionals. The document then discusses various tone-reducing techniques that have been used in casts and orthoses, including applying pressure to specific areas of the foot or leg to inhibit reflexes. It provides examples of ankle-foot orthosis designs that aim to reduce tone through biomechanical alignment and pressure on muscle insertions.
Hypertonicity is a upper motor neuron lesion basically found in cerebral palsy and hemiplegia. The orthosis help to reduce the tone are known as tone reducing orthosis follows the principles of Neurodevelopmental technique and neurophysiology.
Rohan_Gupta_Orthotic Management of Physioneurological AFO_Assignment.pptxRohan Gupta
This document describes an ankle-foot orthosis (AFO) designed based on neurodevelopmental concepts to address gait concerns in neurologically impaired patients. The AFO incorporates biomechanical and neurophysiological forces including a three-point pressure system to control calcaneal varus, forces on the medial and lateral aspects of the foot to facilitate reflexes, and a metatarsal arch to inhibit the toe grasp reflex. It is prescribed for patients with minimal to moderate spasticity to improve ankle positioning and weight bearing during gait.
Orthopedic Surgeries and Physiotherapy in Cerebral PalsySreeraj S R
This document discusses orthopaedic surgeries and physiotherapy for cerebral palsy, focusing on spine/scoliosis, hips, knees, and lower legs. For scoliosis, conservative treatments include bracing and physical therapy while surgical treatment is posterior spinal fusion. For hips, soft tissue releases and osteotomies are used to treat subluxation/dislocation, while contractures may be treated with botulinum toxin or soft tissue lengthening. Knee flexion contractures are treated first with stretching and bracing but may require hamstring lengthening, capsulotomy, or femoral osteotomy. Post-operative rehabilitation focuses on range of motion, stretching, strengthening, and functional training.
This document provides definitions and descriptions of various hip, knee, ankle, and foot orthoses. It describes a hip-knee-ankle-foot orthosis (HKAFO) as an orthosis that stabilizes or locks the hip, knee, and ankle. The typical HKAFO consists of two knee-ankle-foot orthoses linked above the hip with a pelvic band or lumbosacral orthosis. It also discusses indications, principles, components, and fabrication of HKAFOs as well as other orthoses like reciprocal gait orthoses and hip orthoses.
orthotic use in neurological disorders.pptxibtesaam huma
Orthotics used in Neurological dysfunction
-Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (PhD, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Orthotics used in Neurological dysfunction
objectives
At the end of this seminar the students would have understood
Principle of orthosis and its function
Types of orthosis
Different types of orthosis used in neurological disorder.
Recent advances.
Principle of orthosis
Three point pressure principle:
1) forms the mechanical basis for orthosis correction
2) single force is applied at the area of deformity or angulation
3) two additional counter forces act in the opposing direction.
Functions of orthosis
Prevent deformity
Assist function of a weak limb
Maintain proper alignment of the joints
Inhibit tone
Protect against injury of a weak joint
Allow for maximal functional independence
Facilitates motion
Lower limb orthosis
ANKLE FOOT ORTHOSIS (AFO)
It consist of shoe attachment, ankle control, uprights and a proximal leg band.
Ankle Control
Ankle control – 1) by assisting motion
2) by limiting motion
Weak dorsiflexor dorsiflexion assistance Posterior leaf spring
Ankle control
Limited motion ankle control
Anterior Stop (dorsiflexion stop): determines the limits of ankle dorsiflexion.
Posterior Stop (plantarflexion stop): determines the limits of ankle plantarflexion.
Robinson et al (2008) carried out a randomised controlled trial (RCT) to compare the effectiveness of a temporary night splint with prolonged standing on a tilt table to prevent loss of ankle movement early after stroke in 30 people. Results suggest that a night splint in this cohort of people was as effective as the tilt table in maintaining range of movement. Compliance was 87% in the people who used the tilt table and 73% in the people who wore splints. It is suggested that an ankle splint can be used for preventing the loss of range of movement at the ankle joint (in people with stroke) when positioned at plantar grade.
Knee-Ankle-Foot Orthoses
Individuals with more extensive paralysis or limb deformity may benefit from KAFOs, which consist of a shoe attachment, foundation, ankle control, knee control, and superstructure.
Recent advances
An active knee orthosis for the physical therapy of neurological disorders
-Elena Garcia, Daniel Sanz-Merodio et al
This paper presents the design of a new robotic orthotic solution aimed at improving the rehabilitation of a number of neurological disorders (Multiple Sclerosis, Post-Polio Stroke and Spinal cord injury)
A KAFO with electronic knee control enables some patients with stroke
and other neuropathies to walk.
Hip knee ankle foot orthosis
Specialized thkafo
Contains a trunk band added to a HKAFO
Reciprocating gait orthosis:
The hips are connected by steel cables
which allow for reciprocal gait pattern.
When the patient leans on the supporting
The document discusses rehabilitation for amputee patients. It describes how the rehabilitation team approach was developed after WWII to treat injured soldiers. The team includes various medical professionals who work cooperatively. Rehabilitation involves evaluating patients' physical and emotional status, type of amputation, and fitting appropriate prosthetics such as those for below knee, above knee, or hip disarticulation amputations. Newer prosthetics like the C-Leg use microprocessors and sensors to dynamically adapt to a patient's gait.
1. Rehabilitation after lower limb amputation involves pre-op, post-op, and long-term phases aimed at preventing complications, educating the patient, and improving functional mobility and independence.
2. The post-op phase focuses on managing pain, increasing range of motion and strength, promoting wound healing, and training the patient in mobility and prosthetic use.
3. Long-term rehabilitation involves community and vocational reintegration, lifelong prosthetic management, and psychological support through follow-ups and support groups.
Total knee arthroplasty (TKA), also known as total knee replacement, involves replacing the knee joint with prosthetic components. It is commonly performed in older patients with severe knee osteoarthritis to relieve pain and improve physical function. The knee joint is made up of the femur, tibia, and patella bones. During TKA, the ends of the femur and tibia are reshaped and metal and plastic implants are attached. Rehabilitation after TKA follows three phases - maximum, moderate, and minimum protection - focusing on restoring range of motion, strengthening muscles, and retraining walking. The goals of TKA are to reduce pain and improve quality of life.
This document provides an overview of the history and types of spinal orthoses. It begins with a brief history of spinal orthotic use dating back to ancient times. It then describes various types of cervical, cervicothoracic, and thoracolumbosacral orthoses, including their indications, biomechanics, design features, and how they control spinal motion. Examples of custom-fit and prefabricated options are discussed. The document concludes with descriptions of specific orthosis designs like the halo, SOMI, and TLSO and how they immobilize different spinal regions.
This document provides an overview of hip dislocations and femoral head fractures. It discusses the anatomy of the hip joint, mechanisms of injury, classification systems, evaluation, management, and treatment options. The key points are:
- Hip dislocations are usually caused by high-energy trauma and often involve other injuries. They can damage the blood supply to the femoral head.
- Reduction of the dislocated hip should be done emergently to restore blood flow and reduce the risk of avascular necrosis. Closed reduction under anesthesia is preferred but surgery may be needed for irreducible or unstable cases.
- Associated injuries like femoral neck fractures or large bone fragments require operative treatment. The goal is to achieve a stable, congr
An HKAFO is an orthosis that stabilizes the hip, knee, and ankle. It consists of an AFO connected to thigh sections and a pelvic band. The orthosis applies corrective forces at the skin surface that are transmitted through soft tissues to bones. Forces are balanced at joints to control movement. HKAFOs assist with gait and decrease weight bearing in conditions like paraplegia. Reciprocating gait orthoses use cables to induce reciprocal hip flexion/extension between sides, enabling paraplegic ambulation. Hip orthoses control movement after injuries or surgeries. Pediatric hip orthoses treat developmental dysplasia of the hip and cerebral palsy, maintaining hip ab
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
Osteoarthritis of the Knee Joint is a quite common condition found in Indian Population. This presentation is made to understand how this condition affects patients and what are the different Physiotherapy measures to make the patient functionally independent.
1. The document discusses various types of osteotomies performed around the hip joint to correct deformities and improve biomechanics. It describes pelvic osteotomies like Pemberton, Salter, and Ganz osteotomies which reorient the acetabulum.
2. Femoral osteotomies discussed include varus, valgus, and rotational osteotomies. Varus osteotomies elevate the greater trochanter medially to improve joint congruity. Valgus, or abduction osteotomies, tilt the distal fragment away from the midline to increase femoral neck angle.
3. The principles, indications, techniques and outcomes of
This document provides information about Achilles tendinopathy, including:
- It is a common overuse injury among athletes and the general public.
- It can be classified based on its location as insertional, non-insertional, or proximal tendinopathy.
- Risk factors include excessive loading, tight calf muscles, foot abnormalities, and medical issues.
- Diagnosis involves physical exams like the Arc sign and imaging like ultrasound or MRI.
- Treatment begins with rest, bracing, eccentric exercises, and other conservative methods, with surgery reserved for severe cases.
1) The document discusses arthroplasty and physiotherapy management for arthroplasty procedures like total hip replacement and total knee replacement.
2) It covers topics like indications, types, surgical approaches, complications and post-operative physiotherapy management for regaining range of motion, strength and ambulation abilities.
3) The goal of physiotherapy is to achieve a pain-free and stable joint to allow for lower extremity weight bearing and functional activities.
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Neuro physiologic afo
1.
2. INTRODUCTION
HISTORY AND DEVELOPEMENT
TONE AND SPASTICITY
SPASTICITY ASSESSMENT
TREATMENT GOALS
PRESCRIPTION CRITERIA
DESIGN RATIONALE
FABRICATION PROCEDURE
DISSCUSSION
REFERENCES
3. The NEUROPHYSIOLOGICAL AFO
(NP-AFO) is biomechanically and
neurophysiologically effective ankle-
foot orthosis that is appropriate for
creating a functional gait in the patient
with a central nervous system disorder.
The design allows for independent motion
at the ankle, knee, and hip joints in a
lightweight and cosmetic custom-made
orthosis.
4. The concept began in the late 1960s by Bobath and Utley
with the introduction of thermoplastic molded orthoses and
design possibilites afforded by total contact.
This design is developed to Handling techniques which
counteract patterns of abnormal tonic reflex activity, reduce
spasticity and allow facilitation (activation) of normal
postural reactions through stimulation of key points of
control, which include points on the foot and ankle.
Recent advances incorporating neurophysiological principles
of inhibition and facilitation into the design of ankle-foot
orthoses make possible tone-reducing devices with specific
areas of pressure or contact to inhibit abnormal hypertonicity.
5. Previously tone-reducing AFO was mostly used and
prescribed to the patients with CVA, CP etc. but it is found
with some disadvantages:-
1. Limited ankle PF and DF.
2. Affects the normal hip and knee function.
3. Decreases the smoothness of gait.
Hence for all these gait concerns NP-AFO is designed based
upon the NDT technique as described by Bobath and Utley.
6. Tone is a normal characteristic of muscle physiology and
defined as “ normal degree of vigour and tension: in muscle,
the resistance to passive elongation or stretch.”
Muscle tone also contributes to control, speed and amount of
movement we can achieve.
7. Low muscle tone also known as HYPOTONIA is seen in
lower motor neuron disease like poliomyelities.
Hypotonia can present clinically as muscle flaccidity,
where the limbs are floppy, stretch reflex responses are
decreased, and the limb’s resistance to passive movement
is also decreased.
Higher muscle tone also known as HYPERTONIA is
seen upper motor neuron disease like pyramidal tract
and extra pyramidal tract. Hypertonia can present
clinically as either spasticity or rigidity.
8. A motor disorder characterized by a velocity dependent
increase in tonic stretch reflexes (muscle tone) with
exaggerated tendon jerks, resulting from hyperexcitability of
stretch reflex….”
SCI
Closed head injury
Stroke
Cerebral palsy
9.
10. The stretch reflex or myotatic reflex refers to the contraction
of a muscle in response to its passive stretching. When a
muscle is stretched, the stretch reflex regulates the length of
the muscle automatically by increasing its contractility as
long as the stretch is within the physiological limits.
Process
Stretching the muscle activates the muscle spindle.
Excited gamma motor neuron of the spindle cause the
stretched muscle to contract.
Afferent impulses from the spindle result in inhibition of
antagonist.
11. Ex:- Patellar reflex
a. tapping the patellar
tendon stretches the
quadriceps and starts the
reflex action.
b. The quadriceps contract
and the antagonistic
hamstrings relax
12. Increased tone
Decreased ROM
Involuntary movements
Increased autonomic reflexes
Exaggerated reflexes
Muscle weakness
Muscle fatigue
Muscle control
Balance problems
Abnormal bone stress
13. MODIFIED ASHWORTH SCALE
0= no increase in muscle tone.
1= slight increase in muscle tone (catch or minimum
resistance at end range).
1+ = slight increase in muscle resistance throughout the
ROM.
2= moderate increase in muscle tone throughout the
ROM, PROM is easy.
3= marked increase in muscle tone throughout the ROM,
PROM is difficult.
4= marked increase in muscle tone, affected part is rigid.
14. A design configuration intended to utilize both biomechanical
principles to limit calcaneal varus and neurophysiological
principles (of facilitation and inhibition) to obtain dynamic
ankle dorsiflexion and plantar flexion.
Improvement in position
Mobility
Pain
Contracture prevention
Ease of donning for one-handed patient.
15. The NP-AFO is designed for use in the treatment of the
patient with :-
central nervous system disorder, such as a cerebral vascular
accident or closed head injury.
Assessment should include analysis of the individual's tone or
spasticity, range of motion, and the availability of follow-up
by members of the clinic team familiar with a
neurophysiological approach to care.
16. Spasticity has been classified as minimal, moderate, or severe
in terms of function of the foot and ankle during gait.
Minimal spasticity allows the patient to land on a stable
calcaneus without excessive supination of the forefoot and
then shift the body weight over the heads of the metatarsals,
although during swing phase the foot assumes a varus or
supinated posture.
17. Moderate spasticity causes the calcaneus to assume a position
of varus with excessive supination at initial contact; however,
during mid-stance some pronation occurs and the body weight
can again be transferred normally across the forefoot.
Severe spasticity is characterized by the foot and ankle being
held rigidly in a position of equino-varus throughout stance so
that the body weight remains on the lateral aspect of the
forefoot with little or No-weightbearing through the heel or
medial metatarsal heads. This varus position persists
throughout swing phase also.
18. Patients exhibiting minimal or moderate spasticity are
excellent candidates for the NP-AFO.
Patients with severe spasticity are candidates only if their tone
can be modified through handling techniques and/or
inhibitive casting.
In order for the NP-AFO to function appropriately, the patient
must have at least 15 degrees of passive dorsiflexion with the
knee in flexion.
19. Three-point force system:-
a) A three-point pressure system to
biomechanically control calcaneal varus.
b) A biomechanical force medial to the achilles
tendon to counterbalance and prevent
excessive pronation and rotation of the
orthosis in the shoe.
c) A neurophysiological force on the medial
aspect of the calcaneus, extending to the
plantar surface of the longitudinal arch
without creating pressure under the navicular
itself. This facilitates straight plane
dorsiflexion.
d) A biomechanical force lateral to achilles
tendon to balance the above forces for
correction of calcaneal varus.
20. Eversion Reflex:-
a) The eversion reflex (peroneals) is triggered
by NP- presuure over the fifth metatarsal
head along the foot’s lateral border (i.e:- the
lateral plantar aspect of the foot).
b) The amount of dorsiflexion assist may be
graded by adjusting the width of the
segment joining the heel cup and the
metatarsal arch.
21. Plantar Reflexes:-
A neurophysiological force to
inhibit the toe grasp reflex (toe
flexors and gastrocnemius- soleus)
by unweighting of the metatarsal
heads through use of a metatarsal
arch
22. Biomechanical function through flexibilty of the
foot and ankle due to the trimlines and
configuration of the plastic NP-AFO
23.
24. The casting technique is similar to that described in Lower
Limb Orthotics, A Manual and is a procedure commonly used
by orthotists.
The cast must be taken in a position of maximal dorsiflexion,
preferably 20 degrees.
The calcaneus, midfoot, and forefoot should be in a neutral
position. It has been our experience that tone-reducing
handling activities performed by a physical therapist just prior
to casting will help assure an optimal position.
These activities include forefoot, midfoot, and hindfoot
mobilizations.
25. The cast is removed upon hardening and filled with plaster to
create a positive model for use in vacuum-forming of the
orthosis.
The positive model is now ready for modifications to create
the necessary biomechanical and neurophysiological forces.
26. As the key to function of the orthosis
is selective inhibitive and facultative
forces, accurate cast modification is
essential.
Plaster removal is performed in the
following areas to a depth of 0.5 to 1
cm depending upon the
compressibility of the patient's
extremity.
1. Medial and lateral to the achilles
tendon using a Scarpa's knife to deeply
groove the modification.
27. 2. Medial aspect of the calcaneus
extending to the plantar surface of the
longitudinal arch without creating
pressure under the navicular itself that
would stimulate mid and forefoot
supination.
3. Along the lateral plantar surface of the
mid- and forefoot, excluding the base and
head of the fifth metatarsal.
4. Create a metatarsal arch 6mm.
Proximal of the metatarsal heads for the
inhibitive function of unweighting the
metatarsal heads and thereby reduce tone.
5. Smooth entire cast
28. Leather, nylon, or rope
cording is applied to the cast
to create strengthening
corrugations in the orthosis
after molding.
A separating agent or
material is used between the
positive model and the hot
plastic to create adequate
vacuum and to leave a
smooth inner surface.
29. The orthosis is removed from the positive model using a
cast cutter and is sanded to finish according to the
following trimlines:-
1. Overall height of the orthosis is equal to the distance from
the plantar surface of the calcaneus to the flare of the achilles
tendon as it meets the gastrocnemius soleus group, multiplied
by 2. An average overall length for a 175cm. (5'9") adult is
25.5cm. (10").
2. Length of the plantar extension is terminated 6mm.
proximal to the metatarsal heads for comfort.
30. 3. The lateral trimlines come as far
anterior as possible and still allow
passage of the leg into the orthosis.
The posterior trimline approaches
the lateral margin of the achilles
tendon.
Note :- that flexibility is
enhanced by the narrowing
anteriorly and posteriorly as the
lateral side meets the heelcup.
31. 4. The achilles tendon is left exposed to
the point of flare with the gastronemius
soleus.
32. 5.The medial margin is
trimmed so as to provide the
appropriate forces and yet
avoid contact on the medial
malleolus and under the
navicular. The open area
provides for lack of resistance
to dorsiflexion and plantar
flexion.
33. The plantar extension may be varied
in width depending upon the size of
the patient and flexibility desired, but
as it serves only to join the
metatarsal arch to the heelcup, it
should remain as flexible as possible.
The distal aspect, including the
metatarsal pad, should span the
distance between the shaft of the first
metatarsal and the extreme lateral
margin of the foot to allow
maximum facilitation of the eversion
reflex.
34. A full 1/8" plastazote liner is glued to
the inner surface of the orthosis, with
the exception of the areas contained by
the patient's shoe to allow ease of
donning the same size shoe previously
worn by the patient. A Velcro strap of
2" width is applied to the proximal
anterior calf. A lace-tied or Velcro-
closed shoe is recommended to
maintain the critical fit of the NP-AFO.
35. The movement allowed by the NP-AFO encourages dynamic
control of the entire lower extremity. When sitting, normal
weight-bearing attitude can occur with the foot remaining in
full contact with the floor throughout a full range of knee
flexion.
The ability to assume a normal weight-bearing surface in a
position of power as allowed by the NP-AFO encourages
weight-bearing on the affected extremity throughout all
activities of daily living.
36. Further, dynamic control of the pelvis and knees are
encouraged during ambulation by eliminating floor reaction
forces inherent in other AFO's. Without these abnormal forces
the patient experiences the normal movement of the pelvis
and knee over the foot, allowing development of a propulsive
toe-off with the NP-AFO.
Progressing from use of the NP-AFO to being independent of
assistive devices is more feasible, as the patient has the
opportunity to gain control of muscles through the normal
range of movement.
37. The adequacy of traditional AFO's to provide a safe functional
gait pattern is irrefutable. However, experience with patients
who sustained a CVA five to fifteen years ago and received a
traditional metal or plastic AFO reveals they now present
problems related to overuse of the sound side: the
pathomechanics resulting from a rigid ankle and/or increasing
hypertonicity from abnormal weight-bearing patterns.
As more patients have increased lifespans following a CVA,
treatments and orthotic care which assure prolonged quality of
life become increasingly important. Neurophysiological
treatment attempts to do this through emphasis upon normal
movement patterns and integration of the affected and
unaffected sides.
38. Yates, G., "A Method for Provision of Lightweight
Aesthetic Orthopaedic Appliances," Orthopaedics:
Oxford, 1:2, pp 153-162, 1968
Lehneis, H.R., "New Concepts in Lower Extremity
Orthotics," Medical Clinics of North America, 53:3:3,
pp. 585-592, 1969.
Bobath, K., "The Problem of Spasticity in the
Treatment of Patients With Lesions of the Upper
Motor Neurone," The Western Cerebral Palsy
Centre, London,England.
Utley, J., NDT Adult Hemiplegia and Closed Head Injury
Certification Course, Columbus, Ohio, July, 1982.