*Orthotics* - - Know the general categories to describe orthotics and the purpose of each type
- Recommend orthotics for painful joints, tissue
... [Show More] protection and immobilize for healing
- Understand principle of splinting fewest joints possible
- Describe appropriate angle of pull (90 degree) and rationale
- Understand principles related to materials, fit, and safety
What is the purpose for splinting? - 1. Support a painful joint
2. Immobilize
3. Protect healing or damaged tissue
4. Provide stability
5. Restrict unwanted motion
6. Substitute for weak/absent muscles
7. Prevent contractures
8. Correct contractures
9. Increase passive motion
10. Modify tone
Primary Purpose: Immobilization (static) orthosis - Primary Purpose: provide support, stabilization, protection or immobilization
-Communicate purpose to patient
-can be for fractures
-serial static orthosis/casting
Ex: hand based thumb spica, short opponents, short thumb (HFO)
Primary Purpose: Serial static orthosis/casting - "Low load", prolonged duration stretch, remolding or refabricaiton of orthosis/cast as ROM increases
-communicate purpose to patient 10 to 15 minutes four times a day 10 to 15 degree at a time
-If wear longer than 10 to 15 it can become more painful
Primary Purpose: Mobilization static orthosis - *-Anything used to stretch/facilitate motion
-Purpose is to promote ROM using screws, velcro, hinges*
-includes nonelastic components such as screws, Velcro, turnbuckles, or hinges used to promote ROM
-adjustments can be made easy by the user typically
Primary Purpose: Mobilization elastic orthosis - *-Use moving parts to permit, control, or restore movement with components such as rubber bands, elastic or springs *
Ex: dynamic dorsal block, Kleinert (WHFO)
-Radial nerve palsy orthotics (WHFO)
Primary Purpose: Peripheral nerve injuries orthotics - 1. Keep denervated muscles from remaining in an overstretched position
Ex: prevent wrist drop
2. Prevent joint contractures (Nerve damage, so muscles cant fire like they are supposed to)
3. Prevent development of substitution patterns
4. Maximize function
Primary Purpose: Status post burn orthotic fabrication - -based on direction and line of pull of scar
-where is the scar?
-dorsal hand burns have specific protocols due to close proximity to extensor tendons
-can use scar inserts to elongate tissue
-may begin using 5 days (7-10 is recommended) post grafting
Recommend orthotics for painful joints, tissue protection and immobilize for healing - - Immobilizer orthotic is best for pain especially CMC thumb arthritis (thumb spica)
- Resting hand orthotic: burns for skin protection and maintenance and pain
- See notes for list of orthotics and specific associated conditions
Understand principle of splinting fewest joints possible - - You do not want to immobilize joints unless absolutely necessary. It can cause more harm that good in terms of decreasing joint mobility, increasing stiffness and potential contractures
Persevering:
muscle strength
muscle integrity
bone intensity
Describe appropriate angle of pull (90 degree) and rationale - - The direction and magnitude of the forces applied to a joint or finger are important when applying force to increase passive ROM. The direction of pull must be at a 90-degree angle to the axis of the joint and perpendicular to the axis of rotation.
-As ROM increases adjustments can be made to the outrigger to maintain the 90-degree angle. You don't want the line of pull to be in a medial or lateral direction and disturb the mobilization of the joint
Understand principles related to materials, fit, and safety: *Materials* - 1. low temperature thermoplastic
-width preference
-perforated vs non perforated
-highly elastic vs stiff
2. Hybrids (orficast)
3. Plaster of Paris
4. Taping: kinesiotape
5. Neoprene
Understand principles related to materials, fit, and safety: *Fit* - -molding contours: use of skin creases as guidelines for boundaries
-ID bony prominence and take care to dome out or avoid these areas
-reduce pressure to skin through long lever (long splint)
-support arches both longitudinal and transverse with proper alignment
-if using forces, ensure bone being mobilized is perpendicular to the outrigger
-should rise 2/3 up limb supported
Understand principles related to materials, fit, and safety: *Safety* - -check for latex free materials
-skin precautions
-pressure precautions
-nerve irritation
-blood vessel irritation
-perfusion: capillary refill
-cognitive status influence compliance
-sensory status
-ability to don/doff
*Neurodegenerative Conditions: GB, MS, ALS, PD* - - Describe priorities and role of OT
- Apply precautions for treatment based on disease condition
- Apply specific strategies to enhance performance
- Know guidelines for exercise and strengthening
- Understand patient education needs
Guillian Barre Syndrome: What is it? - -Everyone has weakness
-It's attack on the bodies nerves
-Quadraplegia (LE & UE weakness)
-Areflexia
-Parasthasia
-Sensory loss
-Sphincter involvement
-Oropharyngeal weakness
-Pain (neurogenic & neuropathic)
-Respiratory failure
-Oculomotor weakness
-Ataxia
-speech & swallowing
-Usually are continent in bowel and bladder
-weakness proximal more than distal
-quadraparesis
-respiratory failure [Show Less]