This document provides definitions and information about orthotics. It defines orthotics as externally applied devices that modify the structural and functional characteristics of the neuromuscular and skeletal systems to enable better use of the body part. The document then discusses principles, functions, indications, prescription processes, and nomenclature of various orthotic devices for the spine, upper limbs, lower limbs, knees, and hips. Examples and purposes of different orthotic devices are provided for each body region.

1. Dr. Sujit Kumar Singh
PG- Orthopedics
PGIMS, Rohtak

2. Definition
 ORTHO ≈ “to straighten” or
“align”
 Speciality concerned with
design, manufacture and
application of Orthoses
 Externally applied device
used to modify the
structural and functional
characteristics of
neuromuscular and skeletal
system
 To enable better use of the
body part

3. Principle
 Three point pressure
principle

4. Functions
 Prevent deformity
 Provide stability
 Overcoming weakness
 Relieving pain
 Assist in function
 Maintain alignment
 Allows maximal functional independence

5. Indications
 Post Polio paralysis
 Nerve injuries
 Stroke and trauma brain injury
 Spinal cord inury
 Deformities
 Burns
 Sports Injuries
 and many more…

6. Prescription
 Technical analysis form
 Nomenclature

12. Nomenclature

13. Spinal Orthoses
 2 groups- Supportive and
Corrective
 Mechanical deficiencies are
present eg. Taylor brace, short
spinal brace
 Inspite of deficiencies, patients
obtain symptomatic relief-
psycological, abdominal
compression, support of
pendulous abdomen, decrease
in lumbar lordosis,decrease in
movement,activity, support of SI
joint and ilio-lumbar ligaments

14. Supportive Spinal Orthoses
 Fabric Spinal orthoses(jean, coutil,canvas, duck,rayon,nylon,airtex)
 SacroIliac Orthosis (SIO)
 LumboSacral Orthosis (LSO)
 ThoracoLumbar/ThoracolumbarSacral Orthosis (TLSO)
 Immediate Lumbar Orthoses
 Rigid Spinal Orthoses
 Taylor Spinal Brace (TLSO)
 Fisher Spinal Brace (TLSO)
 Thomas/Jones Spinal Brace (TLSO)
 Anterior Spinal Hyperextension Brace (ASH) (TLSO)
 Moulded Spinal Orthoses

15. SacroIliac Orthosis

16. LumboSacral/Knights Orthosis

17. ThoracoLumbar/ThoracoLumbarSacral Orthosis

18. Immediate Lumbar Orthoses
 Cheap and instant
 Tubigrip body
bandage used
 Rolled from nipples
to upper thighs
 POP is rolled over it

19. Rigid Spinal Orthosis
 All are constructed on the basis of a metal frame which
takes firm support from pelvis(except anterior
hyperextension orthosis)
 Pelvic band/ Moulded pelvic corset
 Metallic uprights are present over the base and
connected by crossbars
 Abdominal plate
 Padded shoulder or clavicular straps

20. Taylor Spinal Brace
 1863, by CF Taylor
 Used in treatment of TB
Spine
 Limits forward flexion,
extension, lateral flexion
and to some extent
rotation of the lumbar
and lower thoracic
regions of spine
 Increases movements at
LumboSacral junction

21. Fisher Spinal Brace

22. Jones Spinal Brace

23. Anterior Spinal Hyperextension brace

24. Jewett type Cruciform type

25. Corrective Spinal Orthoses
 Milwaukee brace
 Boston brace

26. Milwaukee Brace
 CTLSO
 Ambulant treatment of
scoliosis
 Worn for a number of
years
 23hrs/ day
 S/E-Meralgia
Paraesthetica

27. Boston Spinal Brace

28. Orthoses for Cervical Spine
 Head is balanced on Cx Spine by action of neck
muscles
 Considerable range of movement in all directions
 Inflammatory conditions or mechanical derangements
require immobilisation + support of head to relieve
pressure upn vertebrae, discs, joints and Cranial
nerves
 External support must fit the contours
 Forehead must also be included in lesions of upper Cx
spine

29. Soft Cervical Collar
 Extends from base of
bandible, superior nuchal
line to manubrium and C7
spine inferiorly
 Mild soft tissue strain,
sprain, spasm
 Kinesthetic reminder
 Heat retention
 Motion Control
 Flexion- 26%
 Extension- 20%
 Lateral bending- 8%
 Rotation- 17%

30. Hard Cervical / Thomas Collar
 Hugh Owen Thomas
 Originally made from
metal sheet covered with
felt
 made from hard
polyethylene
 Some more restriction of
movement
 Indications- same as Soft
collar

31. Moulded Cervical Orthoses
 Philadelphia Collar
 Made of Plastazone/
Polyethylene foam
 2 separate pieces
 Motion control
 Flexion- 70%
 Extension-60%
 Lateral flexion- 35%
 Rotation- 60%
 Most effective in injury above
C3

32. SOMI Brace
 Sterno- Occipito-
Mandibular- Immobilizer
 Indications- stable spinal
fracture dislocations and
moderate to severe soft
tissue damage
 Motion control
 Flexion- 95%
 Extension-40%
 Lateral flexion- 35%
 Rotation- 70%

33. Four-Poster Cervical Brace
 Similar to SOMI brace
 Except Posterior post and
extra axillary straps
 Motion control
 Flexion- 90%
 Extension-80%
 Lateral flexion- 55%
 Rotation- 70%
 Modification- chest and
back plates extend further
down
 more effective in controlling
flexion and rotation

34. Cervical Halo Orthosis
 Rigid Invasive bracing system
 Maximum motion control, but
less used due to its invasive
nature
 Indication- unstable fracture
dislocation of spine
 Motion control
 Flexion- 95%
 Extension-95%
 Lateral flexion- 95%
 Rotation- 99%
 Ability to provide distracting
forces

35. Cervicothoracic Orthoses
 Minerva Jacket
 Rigid frame, custom
made, total contact
 Covers entire skull except
face, extending upto
inferior costal margin
 Indications- Traumatic
and Pott’s spine
 Maximum motion control
at lower cervival and
cervicothoracic juntion

36. Cervicothoracolumbosacral Orthosis
 Halo Pelvic brace
 Rigid, invasive brace
 Historical importance only
 Four spring loaded
distraction bars
 Indication- Immobilisation
in Pott’s spine and deformity
correction of spine
 Functions- limits all spinal
movements

38. Upper Limb Orthoses
Classification
 Static
 Serial Static
 Serial motion blocking
 Static progressive
 Dynamic
 Motion Blocking
 Traction
 Tenodesis
 Continuous Passive Motion Orthoses
 Adaptive Orthoses

39. Hand Orthoses
 Finger Cot
 Long finger
extension splint

40.  Mallet finger splint
 Ring and figure 8 splint
 Capner’s spring coil splint

41. Wrist Hand Orthoses
 Wrist hand stabilizer

42. Cock up Splint
 Static
 Dynamic

43.  Knuckle bender splint
 Kleinert splint

44. Elbow Orthoses
 Elbow ROM
 Elbow Extension
orthosis

45. Shoulder Orthoses
 Air-Plane splint
 Figure of 8 brace

46.  Sling and Swathe Immobilizer
(Universal Shoulder Immobiliser)

47. Turn-Buckle Splint
 Produce gradual
stretching over a
contracted joint. Eg-stiff
elbow, VIC
 Corrects contracture
very fast
 Decreases rehabilitation
time’
 Excellent patient
compliance

48. Lower Limb Orthoses
 Foot orthosis
 Purpose of shoe modification
 Restoration of normal gait
 Proper distribution of wt
 Balancing while standing
 Component of calliper

50. Hallux Valgus correcting brace

51. Ankle Foot Orthoses
 Support ankle and foot
 Maintains ankle stability
 Prevent equinus contracture
 Heel stop is attached to limit
excessive dorsi/plantar flexion
 Weak plantar flexors-
front/calcaneous stop
 Weak dorsiflexors-
back/equinous stop
Disadvantage- Axis of movement of
appliance dosnot correspont with
that of ankle, thereby stress is
imposed on heel and shoes

52. Toe raising devices
AFO Dorsi A

53. Foot Drop Splint
 AFO Plantar R- Ankle foot orthosis plantarflexion resist

54. T straps
 T-strap is cut from leather.
 Vertical limb is attached at the
junction of the upper with the sole
 The strap encircles both the ankle
and the side bar
 The t-strap may be attached either
inside or outside of the shoe
 Weak TA and TP->foot valgus-
>Outside iron and inner T-Strap
 Weak Peroneal muscles-> foot varus-
>inside iron and outside T-strap

55. Knee Orthoses
 Knee Immobiliser
 From mid thigh to mid leg
 Maintains knee in extension
 Indications
 Post-operative knee
 Sprains and strains

56.  Knee ROM brace
 Provides protected and controlled
knee motion
 Used in cases of Periarticular
fracture fixation, ligamentous
reconstruction
 Valgum Varus brace
 Gaining popularity
 Corrects deformity around knee

57.  Mermaid splint
 Nonarticular orthosis
 Keeps both knee solidly in
the night
 Used when disease is in
active phase and
deformity is mild
 Knee Gaiter
 Maintains knee in
extension
 Used in spastic conditions
like CP

58. Knee joints in lower limb orthoses
 Single axis knee
joint
 Restriction in
hyperextension
 Drop lock
 Variant- Posterior
offset type
 Stance control
knee joint
 No flexion during
weight bearing

59.  Polycentric knee
joint
 Closer to anatomic
knee joint
 Lock-in variable
flexion type knee
joint
 Removable hold in
sagital plane which
functions in full
extension and can be
released for flexion

60. Knee Ankle Foot Orthoses
 Conventional
 Prevent buckling of knee and
facilitate ambulation, eg PPRP
 Maintain stability of knee, eg
neuropathic joint
 To relieve weight on bone and joint

61. Total contact KAFO
 Made up of thermoplastics attached
with the knee joint
 Variant- ischial weight bearing type
PTB type

62. Hip Knee Ankle Foot Orthoses
 Maintain standing
posture and ensure
mobility
 Maintain stability of hip
jouint
 Variant- Reciprocating
gain Orthosis
 Used in Spina Bifida and
spinal cord injury
 Combines flexion of one
hip with extension of
opposite hip

63. Thank You