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

1. ORTHOTICS USED IN
NEUROLOGICAL
DYSFUNCTION
-Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (PhD, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy

2. ORTHOTICS USED IN
NEUROLOGICAL
DYSFUNCTION

3. 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.

4. 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.

5. 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

6. LOWER LIMB
ORTHOSIS

7. ANKLE FOOT ORTHOSIS (AFO)
•It consist of shoe attachment, ankle control, uprights and a proximal leg band.

8. ANKLE CONTROL
• Ankle control – 1) by assisting motion
2) by limiting motion
•Weak dorsiflexor dorsiflexion assistance Posterior leaf spring

11. ANKLE CONTROL

12. LIMITED MOTION ANKLE CONTROL
•Anterior Stop (dorsiflexion stop): determines the limits of ankle dorsiflexion.
•Posterior Stop (plantarflexion stop): determines the limits of ankle
plantarflexion.

13. 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.

14. 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.

16. 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)

17. •A KAFO with electronic knee control enables some patients with stroke
and other neuropathies to walk.

18. HIP KNEE ANKLE FOOT ORTHOSIS

19. 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
hip it forces it into extension while opp.
leg is pushed into flexion allowing limb to
advance.

20. SPINAL ORTHOSIS
CORSETS:
It provides abdominal compression,
• increases intrabdominal pressure,
• assists in respiration in individuals with SCI
• relieves pain in low back disorders

21. THORACOLUMBOSACRAL
ORTHOSES
Controls or limit thoracic and lumbosacral motions
•Plastic Thoracolumbosacral jacket:
1) provides maximum support and controls of all motions
2) Used in individuals recovering from SCI
3) Allows for early mobilization out of bed and functional training
•Jewett (TLSO): limits flexion and encourages hyperextension
used for compression fractures of spine.

23. CERVICAL ORTHOSIS
•Cervical orthosis:
1) Soft collar
2) Four collar orthosis
3) Halo orthosis
4) Minerva orthosis

25. SCOLIOSIS ORTHOSIS

26. UPPER LIMB ORTHOSIS
• Airplane splint
• According to the nerve lesions in ulnar nerve lesions:
1. Static ulnar nerve splint
2. Dynamic ulnar nerve splint
3. MCP flexion stretch splint

27. For Median Nerve Lesion
1. Static thumb web spreader
2. Opponence splint short and long
For Radial Nerve Lesion
1. Static wrist extension splint (cock up splint)
2. Oppenheimer splint
3. Radial bliss splint

28. RECENT ADVANCES
•New design of dynamic orthoses for neurological conditions
Henry B. Hoffmann and Glyn L. Blakey stated Repetitive task specific
training appears to improve upper extremity function among individuals with
neurological injuries. However, treatment options are limited for neurological
patients who cannot effectively incorporate their hand consistently for
functional grasp and release/prehension activities. The vast majority of
stroke survivors, head injury and incomplete spinal cord Injury patients do
not exhibit sufficient wrist and/or finger extension to qualify for CIMT.

29. RECENT ADVANCES

31. REFERENCES
Akhoury Sinha; Orthoses, Prostheses and Assistive Devices;1st Edition.
Susan B. O’Sullivan; Thomas J. Schmitz; Physical Rehabilitation; 6th Edition.
Elena Garcia, Daniel Sanz-Merodio et al; An active knee orthosis for the physical
therapy of neurological disorders.
Henry B. Hoffmann and Glyn L. Blakey; New design of dynamic orthoses for
neurological conditions; Neuro Rehabilitation 28 (2011) 55–61 55.

32. THANK YOU

33. Questions???