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Orthosis by Dr. Sandhya Dhokia

This document defines orthotics as external devices that apply forces to the body to control motion or maintain proper positioning. It classifies orthotics by region of the body and function. The principles of orthotics include using forces like rigidity or springs to limit or assist movement according to Jordan's three point system. Orthotics are made of materials like plastic, metal, or leather and are used temporarily or permanently to relieve pain, correct deformities, protect injuries, and improve function. Contraindications include infections and devices that limit normal motion or interfere with clothing. Disadvantages can include skin problems, weakness, increased adjacent joint motion, and dependence.

Healthcare◦
BY DR. SANDHYA DHOKIA PT
Content  Definition  Classification  Principles  Type  Indication  Contraindication  Disadvantage
Definition  Derived from the greek worth ORTHO meaning straight, upright or correct.  It is a mechanical device fitted to the body to maintain it in an anatomical and functional position.  It is an external device design to apply, distribute or remove forces to or from the body in a controlled manner to perform one or both the basic function of – 1) control body motion
Classification  Regional Classification  Functional Classification
Regional Classification  They are classified according to the anatomical area fitted with the orthosis:  Cervical Orthosis  Head-Cervical Orthosis  Head–Cervical-Thoracic Orthosis  Sacral Orthosis  Lumbo-Sacral Orthosis  Thoraco Lumbo- Sacral Orthosis
 Upper Extremity Orthosis:  Shoulder and Arm Orthosis  Elbow Orthosis  Wrist Orthosis  Hand Orthosis  Lower Extremity Orthosis:  Foot Orthosis(FO)  Ankle-Foot Orthosis (AFO)  Knee-Ankle-Foot Orthosis (KAFO)  Hip-Knee-Ankle-Foot Orthosis (HKAFO)
Functional Classification  Supportive: It stabilises the joints and supports the body in its anatomical position,  e.g. Calipers  Functional: It stabilises the joint and also makes up for lost function,  E.g. Foot drop splint in common peroneal nerve palsy  Corrective: To correct deformities  E.g. Club foot boot in CTEV
 Protective: To protect a part of the body during its healing.  E.g. rigid four post collar for fracture cervical vertebrae.  Prevent substitution of function:  In a full length caliper, substitution of hip flexors by Abductors or adductors of hip and other similar trick movements are prevented.  Orthosis which strengthen certain group of muscle  E.g. Tenodesis Splint
 Relief of pain:  e.g. Lumbosacral corset supports lower back, preventing painful movement.  Prevent weight bearing:  A weight relieving orthosis, prescribed for conditions like fracture calcaneum will take weight away from injured site into proximal site like the patellar tendon bearing area.
Principles of Orthosis  PRINCIPLE OF JORDAN:  The basic mechanical principle of orthotic correction is the “Three Point System of Jordan”.  This system applies corrective or assistive forces, which are implemented at the surface of the orthosis through the skin and are transmitted to the underlying soft tissues and bones.  To remain stable, the body has to have one point of pressure opposed by two equal points of counter pressure in such a way that F1 = F2 + F3.
General Principles  Use of forces:  Orthosis utilises forces to limit or assist movements for example. a. Rigid material spanning a joint prevents motion, e.g posterior tube splint b. A spring in a joint is stressed by one motion and then recoils to assist, the opposite desired motion. E.g. leaf spring orthosis
 Limitation of movement: Limiting motion may reduce pain.  Correcting a mobile deformity: a flexible deformity may be corrected by an orthosis. Corrective forces must be balanced according to principle of jordan.  Fixed deformity: if the fixed deformity is accommodated by an orthosis, it will prevent the progression of deformity.  Adjustability: orthotic adjustability is indicated for children to accommodate their growth and for patients with progressive or resolving disorders.
 Maintenance and cleaning: the orthosis should be simple to maintain and clean.  Application: the design should be simple for easy donning and doffing.  Sensation: An orthotic device does not provide sensation, in fact it often covers skin areas and decreases sensory feedback.  Gravity: Gravity plays an important role in upper limb orthosis, especially in those joints where the heaviest movement masses are present.
 Comfort: The Orthosis should be comfortable. Pressure should be distributed over the largest area possible.  Utility: the Orthosis must be useful and serve a real purpose.  A well functioning opposite extremity is a major deterrent to the use of an upper extremity orthosis as most activities can be performed with the good hand.  If the orthosis does not add significance to their function, the patients typically discontinue its use.  Cosmesis: Cosmesis is important especially in hand orthosis. A functional but unsightly orthosis is often rejected if the patient values appearance over function.
Types of orthosis  Temporarily orthosis: Used for certain time after injury or operation.  Permanent orthosis: Used for ever when there is muscle weakness, paralysis or deformity cannot be corrected.  Static orthosis: does not allow movement.  Dynamic orthosis : allows movement.
MATERIALS  An orthosis can be constructed from metal, plastic, leather, synthetic fabrics, or any combination.  Plastic materials are the materials most commonly used in the orthotic industry.
Indications and clinical implications  To relief pain.  To limit motion (immobilization after surgery, after traumatic injury, Compression # management & Kinesthetic reminder to avoid certain movements).  To correct deformity e.g. Scoliosis management  To relieve symptoms of a disease by supporting or assisting the MSk & neural systems.  To reduce axial loading, mechanical unloading  To improve function in a certain segment of the body.  Assist and improve movement and function  Reduce muscle tone.  Protect against injury.  Provide proprioceptive feedback.  Provide rest
Contraindications  Skin infections  When the muscle power is very much affected by the weight of the orthosis.  In case of severe deformity which cannot be accommodated in the orthosis.  If it limits the movement at other normal joints  Where the orthosis interferes grossly with clothing or limits other functions  Lack of motivation or other psychological problems  Very young or old patients
Disadvantages  Loss of skin integrity due to compressive forces  Weakening of axial muscles  Increased movements at ends of immobilised segments  Physical and psychological dependence.  Osteopenia  Lack of cosmesis
Orthosis by Dr. Sandhya Dhokia