ORTHOTICS & PROSTHETICS

SNEHAL DESAI.Associate Professor Occupational Therapy

DEFINITIONS

Orthotics - The science that deals with orthoses designed to provide external control, correction, and support. (orthoses = braces)

Orthosis is an appliance used to support part of a body or perform certain function.

Splint is an appliance used to support / assist /immobilize part of a body.

Caliper is a device which is applied to lower limb to give support or control a joint while walking

FUNCTION OF ORTHOSES

Prevents deformity Corrects deformity Maintains correction Corrects instability Relieves pain Relieves weight bearing Facilitates ambulation

General classification

❖ Static orthoses: As the word static implies, these devices do not allow active motion. They serve as a rigid support in stable fractures, inflammatory conditions of tendons and soft tissue,

❖ Dynamic orthoses: These devices do permit active motion. These types of upper extremity orthoses are used primarily to assist movement of weak muscles and to augment motion of joints.

STATIC SPLINTS STATIC : Given for rest/

immobilization.Ex. Straight gutter splint, stax splint

STATIC SERIAL: Correction of contractures. Ex. Low Temperature Thermoplastic splints which are remolded periodically

STATIC PROGRESSIVE: Augments motion by inbuilt mechanism in the splint. Ex bunnel’s splint, web strap, Robert Jones s, turn buckle

Name Use

Cervical collar Neck immobilization Philadelphia collar Neck immobilization

Four- post collarSOMI Brace

Cervical spine injury

Halo vest Cervical spine injuryTB cervical spine

Cervical Collar

neck pain cervical spondylosis

Philadelphia collar Upper cervical Immobilization Very Light Weight & washable Front And Back Durable Plastic

Limits Motion Ant. Opening Provides Easy Access

For Carotid Pulse And Tracheotomies

Basic Indications: upper cervical spine

Stable/Simple Fractures Reduced Dislocations Transitioning From Halo Body Jacket

Philadelphiacollar

prevents flexionmaintains neck contour

mentosternal contracture release

FOUR POST COLLAR. (CO) The Four-post

cervical orthosis is an occipital and Mandibular immobilizing orthosis

Function: Immobilization of Mid Cervical Spine less effective for lower Cx spine unless modified

Indication: for stable fractures , Pre & Post Operatively

The SOMI is a rigid, 3-(adjustable )poster CTO that has an anterior chest plate extending to the xiphoid process, as well as metal or plastic bars that curve over the shoulder. Straps from the metal bars go over the shoulder and cross to the opposite side of the anterior plate for fixation. Occipital piece is attached to ant. Chest piece. A removable chin piece attaches to the chest plate with an optional headpiece that can be used when the chin piece is removed for eating. 

SOMI: Sternal Occiputal Mandibular Immobilizer. (CTO)

The SOMI controls flexion and rotation at the Higher cervical segments very effectively.. . Less control on extension than the other bracesIndication-, higher Level cervial trauma or arthritis

Ideal for bed ridden pt & FIRST AID

MENERVA CAST. (CTO)

FUNCTION: Rigid immobilization of cervical Spine

INDICATION:Stable Cx spine

undisplaced fracture s

Compressed fracture vertebral bodies

HALO VEST IMMOBILIZATION

FUNCTION : Rigid immobilization for C1 through C8 cervical spine

INDICATION : Unstable cervical spine injuries, AAD,

As well as (only if conserved)Undisplaced fracture sCompressed fracture vertebral bodiesT.B Cervical spine

L.S.BELT & L.S.FRAME (LSO)

L.S.BELT & L.S.FRAME

L.S.BELT: Back ache

L.S . FRAME: rigid support to the lumbo sacral region.Control Chronic low back pain with or without sciatica.

ASH (Anterior spinal hyper extension) brace (TLSO)

Fn: prevents flexion of Middle & lower thorasic Lumbosacral spine

INDICATIONS: Adlolescent Kyphosis

Compression Fractures

T.B. Spine, where there is no marked deformity

Senile Osteoporosis. To prevent flexion

post operatively 

TAYLOR’S BRACE (TLO)Consists of spring

steel pelvic band extending upto ASIS

2 Post uprightsCross bar at just

below scapular L.Shoulder straps

going through axilla

Abd. Rigid Support below umbilicus

TAYLOR’S BRACE WITH OR WITHOUT AXILLARY CRUTCHES (TLO)

FUNCTION: limits flexion, extension &lateral flexion of Thoraco-lumbar spine .D4 TO L2.

Prevents Kyphosis INDICATION: Conservative

management of Kochs Mild Thoraco- Lumbar

injuriesPost operative rehabilitation.

Milwaukee brace for Scoliosis(CTLSO)

Boston brace for Scoliosis (TLSO)

For the treatment of Adolescent Idiopathic Scoliosis & Juvenile idiopathic scoliosis - occurs in children between the ages of 3 to 10 .  

TOTAL CONTACT BRACE

INTERNATIONAL Nomenclature Common name

AFO KAFO HKAFO THKAFO

Surgical shoe (FO)

Below knee caliper Above knee caliper

Posterior/spring Leaf splint

Dennis Brown Splint

a splint for the correction of clubfoot, composed of a curved bar attached to the soles of a pair of 

 shoes.  External Rotation is adjusted by butterfly

nuts on soleFore foot abduction possible due to shape

of the foot Givenafter

 manipulation have effectively reduced the deformity.

DENNIS BROWN SPLINT FOR CTEV

Ext. Rot. 70 degrees for affected leg

20 degrees for non affected

Abd. Of fore foot In shoe design

Up to age of 2 years

For maintaining corrected feet in position

Worn at night

Steenbeek brace

 The Steenbeek brace developed in Uganda by Michiel Steenbeek and David Okello, is made with local tools (leather sewing machine, metal-working equipment, welding tools) and materials (leather, lining, plywood, mild steel rod stock).

Low cost splint

Parts of shoe

Outer sole Heel Upper: vamp

and quarter

Lace stays Tongue Toe box: counter

Usual Shoe modifications

Heel Raise Total Raise Arch Support Thomas

Heel(C&E ) Reverse C&E

Heel MT Bar Outside heel

float

Thomas heel for pes planovalgus  shoe correction consis

ting of a heel one half inch longer and an eighth to a sixth of an inch higher on the medial side

  brings the heel of the foot into varus and  prevents 

depression in the region of the head of the talus.

METATARSAL BAR

Ideal for treating metatarsalgia - a common foot disorder that causes pain in the metatarsal area

Outside heel float

FUNCTION: Prevents inversion injury

INDICATION: Repeated inversion Injury to lateral ligament of ankle

Splint for Hallux valgus

Floor Reaction Orthosis (KAFO)

FLOOR REACTION ORTHOSIS

Long knee brace (KO)Function:

Immobilizes knee in ext.

Indication: Fractures around

knee post operatively

Lat. Dislocation of patella post manupulation

Hinge knee brace (KO)

Supports knee laterally throught out the knee range

Indication: Knee instability

due to med. & lateral ligament injury

Post operative rehabilitation

Splint with de-rotation strap(KO)

Provides Lateral and rotational stability to knee

Used post Anterior cruciate Ligament repair

Multiple ligament instability

KO

Post. Guard

Push knee splint

Knee cage/ turn buckle

Serial splinting

Knee flexion deformity up to 15 degrees

15 to 35 degrees

More than 35 degrees

Soft tissue contracture

PTB Brace with foot plate

Fracture tibia middle third

Foot plate is given in lower third Tibial fracture

It Relives weight partially

Hip abduction orthosis(HO)

INDICATION: Bilateral THR Perthes disease Post burn

contracture release of inguinal region

Congenital dislocation of hip (CDH)

B.K.& A.K.Prosthesis

Components Suspension Socket Shank/Shin

piece Ankle foot

assembly

Components Suspension Socket Knee Joint Shank/Shin

piece Ankle foot

assembly

Suspension

Suction Thigh corset Silesian belt Pelvic belt with hip joint Shoulder suspendor

B.K.PROSTHESIS

End Bearing stump

Side bearing or Total Contact

PYLON

Ankle Foot Assembly

Non Articulated Articulated

Jaipur footmadras foot Single Axis Multiple Axis

SACH SAFE Dynamic response foot

Jaipur foot Sach foot

Cheap, durable ,water resistant ,

Madras foot

It is modified SACH foot Gives T.A. like look posteriorly Sponge between heel and ground

SACH (solid ankle-cushion heel)

non-articulated foot. The keel is rigid. Ankle action is provided by the soft

rubber heel which compresses under load during the early part of the stance phase of walking..

The rubber heel wedges are available in three densities: soft, medium, and hard

SAFE: stationary attachment flexible endoskeletal

," a foot whose arrangement of several flexible, internal keels permits triplanar movement.

SAFE: stationary attachment flexibleendoskeletal

ability for the sole to conform to slightly irregular surfaces

easier for the amputee to walk over uneven terrain.

Feet of this type make walking easier because of the flexibility,

ALSO called "flexible keel" feet. 

DYNAMIC RESPONSE FEET

The Flex-Foot Cheetah

. It is made from carbon fibrereinforced polymer,

 it stores kinetic energy from the wearer's steps as potential energy, like a spring, allowing the wearer to run and jump

used by athletes

Upper Limb Prosthesis Components

Socket Suspension system Elbow unit for A.E. Forearm Wrist Unit Terminal device : HAND /HOOK Power transmission system

Contd..

AE PROSTHESIS

PROSTHESIS FOR BE PROSTHESIS

VOTD & VCTD,COSMETIC HAND

Myoelectric B.E.Prosthesis

Smart phone embeded

Thalidomide baby

Bilateral A.E.Prosthesis

Bilateral hip disarticulationprosthesis

Name Use

Volkmann's splint I Turnbuckle

Volkmann's ischaemic contracture (VIC)

Cock-up splint Radial nerve palsy

Aeroplane splint Brachial plexus injury

Elbow turn buckle splint

Humeral Brace

Sarmianto’s principle

Simple mid humeral fractures

 Isolated ulnar fractures which are inherently stable (if the radioulnar joints are not disrupted

BRACES WITH HINGE