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    Orthosis Dan Prosthesis

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    dimas
    The document discusses orthosis (orthotics), which are devices worn on the body to correct deformities, assist with growth, provide treatment or protection, and improve function. It describes common uses of orthotic devices such as reducing pain, limiting movement, correcting deformities like scoliosis, and supporting muscles and joints. The document outlines design considerations for orthotics including weight, adjustability, function, cost, and durability. It also discusses types of orthotics for different body parts, common materials used, principles of orthotic design, benefits and limitations, and the role of physical therapists in prescribing and fitting orthotics.

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    © All Rights Reserved
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    Orthosis Dan Prosthesis

    Uploaded by

    dimas
    93 views39 pages
    The document discusses orthosis (orthotics), which are devices worn on the body to correct deformities, assist with growth, provide treatment or protection, and improve function. It describes common uses of orthotic devices such as reducing pain, limiting movement, correcting deformities like scoliosis, and supporting muscles and joints. The document outlines design considerations for orthotics including weight, adjustability, function, cost, and durability. It also discusses types of orthotics for different body parts, common materials used, principles of orthotic design, benefits and limitations, and the role of physical therapists in prescribing and fitting orthotics.

    Original Description:

    Orthosis dan prosthesis fisioterapi

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    The document discusses orthosis (orthotics), which are devices worn on the body to correct deformities, assist with growth, provide treatment or protection, and improve function. It describes common uses of orthotic devices such as reducing pain, limiting movement, correcting deformities like scoliosis, and supporting muscles and joints. The document outlines design considerations for orthotics including weight, adjustability, function, cost, and durability. It also discusses types of orthotics for different body parts, common materials used, principles of orthotic design, benefits and limitations, and the role of physical therapists in prescribing and fitting orthotics.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    93 views39 pages

    Orthosis Dan Prosthesis

    Uploaded by

    dimas
    The document discusses orthosis (orthotics), which are devices worn on the body to correct deformities, assist with growth, provide treatment or protection, and improve function. It describes common uses of orthotic devices such as reducing pain, limiting movement, correcting deformities like scoliosis, and supporting muscles and joints. The document outlines design considerations for orthotics including weight, adjustability, function, cost, and durability. It also discusses types of orthotics for different body parts, common materials used, principles of orthotic design, benefits and limitations, and the role of physical therapists in prescribing and fitting orthotics.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 39

    Orthosis dan Prosthesis

    dr. Ronald V Munthe SpOT

    Orthosis
    Orthosis (orthotic) merupakan alat yang dikenakan pada bagian
    tubuh manusia.
    Berasal dari kata ortho, berarti lurus.
    Orthoses juga disebut orthotics
    Koreksi deformitas (kelainan bentuk)
    Membantu pertumbuhan pada posisi yang benar (splint)
    Treatment devices
    Protection device
    Assistive device

    Indikasi penggunaan
    orthotic devices:
    Mengurangi nyeri.
    Membatasi pergerakan

    immobilization after surgery

    immobilization after traumatic injury


    penanganan fraktur kompresi tulang belakang
    Kinesthetic reminder to avoid certain movements

    Koreksi deformitas e.g. Scoliosis management


    Mengatasi beberapa gejala penyakit by supporting or assisting the
    musculo-neuro-skeletal system

    Mengurangi beban tekanan, mechanical unloading


    Memperbaiki fungsi dalam segmen tubuh tertentu

    Assist and improve movement and function


    Reduce muscle tone.
    Protect against injury.
    Provide proprioceptive feedback.
    Provide rest.

    Design characteristics of an orthotic device:


    Most important features include the following:
    Weight of the orthosis
    Adjustability
    Functional use
    Cosmoses
    Cost
    Durability
    Material
    Ability to fit various sizes of patients
    Ease of putting on (donning) and taking off (doffing)
    Access to tracheostomy site, peg tube, or other drains
    Access to surgical sites for wound care
    Aeration to avoid skin maceration from moisture

    Duration of orthotic use:


    It is determined by the individual
    situation.
    In situations where instability is not an issue,
    recommend use of an orthosis until the patient can
    tolerate discomfort without the brace.
    When used for stabilization after surgery or acute
    fractures, allow 6-12 weeks to permit ligaments and
    bones to heal.

    Effects of the orthosis may lead to:


    Decrease pain
    Increase strength
    Improve function
    Increase proprioception
    Improve posture
    Correct of spinal curve deformity
    Protect against spinal instability
    Minimize complications
    Assist healing of ligaments and bones

    Associated drawbacks of the use of


    an orthotic device:
    Discomfort
    Local pain
    Skin breakdown
    Nerve compression
    Muscle atrophy with prolonged use
    Decreased pulmonary capacity
    Increased energy expenditure with ambulation
    Difficulty donning and doffing orthosis
    Difficulty with transfers
    Psychological and physical dependency
    Increased segmental motion at ends of the orthosis
    Poor patient compliance

    Benefits of orthosis:
    Improve function.
    Save energy.
    Increase endurance.

    The main aim of orthotic intervention is to


    function without dis-function.

    Disadvantages and limitations of


    orthoses.
    Limit mobility and ROM of the joint.
    Restrict rotation around a joint.
    Movement is usually limited to certain direction.
    Weakness of other muscles in opposite direction.
    The device is exposing to wear and tear.
    It needs maintenance, care, cleaning, repairing, and
    frequent changing of shoes.

    Principles and considration for


    orthoses:
    Orthosis should :
    provide support and stability to the hip, knee and ankle joints.
    be designed to permit safe and effective ambulation by patients.
    Provide the need and requirements of the patient to support or to
    mobilize.
    Correlate to the findings of tests & measurements.
    Correlate with pateint personality and the impact of device upon him.
    Prevent the development of deformity and require modifications in
    design.
    Orthosis is only one component of the treatment and is not the whole
    treatment.
    Conserve the time and energy of the patient.
    The materials used should be light, sturdy and resistance to wear.
    It should meet the functional requirements of the client.
    So each client should be evaluated individually.

    Role of physical therapist


    Identify functional problems of the patient.
    Determine orthotic needs.
    Prescribe the orthoses according to each patient problems and
    requirements.
    Evaluate orthotic adequacy.
    Teach the patient to don and doff the orthoses.
    Train the patient for proper use of the orthoses.

    Maintenance of orthosis:
    Orthosis should be simple and durable as possible.
    Patient should be taught for:
    Cleaning the leather.
    Oiling the joints.
    Wash the orthosis if possible.

    Types of orthoses
    Temporarily orthoses: Used for certain time
    after injury or operation.
    Permanent orthoses: Used for ever when
    there is muscle weakness, paralysis or
    deformity cannot be corrected.
    Or,
    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,
    such as thermosetting and
    thermoplastics, are the materials
    most commonly used in the
    orthotic industry.

    Plastics
    Thermosetting materials can be molded into permanent
    shape after heating. They do not return to their original
    consistency even after being reheated. Thermoplastic
    materials soften when heated and harden when cooled.
    Low-temperature thermoplastics can be fabricated easily
    and rapidly with hot water or hot air and scissors, but
    they are used mainly in low stress activities.
    High-temperature (polypropylene) thermoplastics require
    higher temperature (150C) to mold, but they are ideal
    for high stress activities.

    Leather
    such as cattle hide, is used for shoe construction
    because it conducts heat and absorbs water well.

    Rubber
    Rubber has tough resiliency and shock-absorbing
    qualities.
    Rubber is used for padding in body jackets and
    limb orthoses.

    Metal
    Metals, such as stainless steel and aluminum
    alloys, are adjustable, but they are heavy and
    not cosmetically pleasing.
    Metals can be used for joint
    components, metal uprights, sprints,
    and bearings.

    Selecting the appropriate material characteristics for fabrication of an


    orthotis device requires careful consideration of a number of factors

    Strength: the maximum external load that can be sustained


    by a material.
    Stiffness: the amount of bending or compression that occurs
    under stress. e.g. when greater support is required, a stiffer
    material is used; when a more dynamic orthosis is desired, a
    more flexible material is used.
    Durability (fatigue resistance): the ability of a material to
    withstand repeated cycles of loading and unloading.
    ( selection of a material for orthotic appliances is based on
    the ability of the material to withstand the day-to-day stresses
    of each individual client.

    Density: the greater the volume or thicker a


    material the more rigid and more durable. (this
    usually increases the over all weight of the orthosis.
    Corrosion resistance: the material may be affected
    by chemical degradation. Most materials will exhibit
    corrosion over time, metal will rust and plastics
    become brittle. Contact with human perspiration and
    environments such as dirt, temperatures and water
    accelerate the wearing effect on the materials.
    Knowing the clients daily environment can assist in
    material selection.
    Ease of fabrication: the equipments needed for
    fabrication of orthosis

    General othotic considerations:


    The forces at the interface between the orthotic materials and the skin.
    The degrees of freedom of each joint.
    The number of joint segments.
    The neuromuscular control of a segment, including strength and muscle
    tone.
    The material selected for orthotic fabrication.
    The activity level of the client.
    The goal of orthotic fitting is to meet the functional requirements of the
    client with minimal restriction.

    Functional orthotic considirations


    1)

    Alignment: The correction of a deformity or maintenance of a body segment. e.g.


    a) Musculoskeletal disorders:
    Milaukee brace for scoliosis.
    Dynamic splint to prevent scar shortening in burns.
    b) Neurological disorders:
    Tone reducing AFOs in patient with cerebral palsy.
    CTLSO to prevent motion of cervical region.

    2)

    Movement: a joint may require assistance with motion or resistance to excessive motion:

    Assistance with joint motion.

    example.

    a) Muscloskeletal disorders:
    AFO with dorsiflexion assist for dorsiflexor weakness.
    b) Neurological disorders:
    RGO assist with spinal cord injury with ambulation.

    Resistance with joint motion:


    a) Muscloskeletal disorders:
    Shoe insert for a patient with foot deformity.
    Finger splints for arthritic hand.
    b) Neurological disorders:
    Arm sling for neurological disorders.
    Swedish knee cage for unstable knee.

    3) Weight bearing: to reduce axial loading and reduce the forces placed
    on a joint.
    a)

    Muscloskeletal disorder
    Shoe insert with metearsal pad for a diabetic patient with foot
    deformity.
    b) Neurological disorders
    Heel wedge for a child with cerebral palsy.

    4) Protection: protect a segment against further injury or pain.


    Examples
    a) Muscloskeletal disorders:
    Functional knee brace.
    b) Neurological disorders;
    Cock-up splints for post spinal cord injury.

    Orthoses are named by the joints they


    encompass
    Ankle-foot orthosis
    Knee-ankle foot orthosis
    Hip-Knee-ankle foot orthosis
    Reciprocal Gait orthosis

    AFO
    KAFO
    HKAFO

    Foot orthosis
    Knee orthosis

    RGO

    Hip orthosis

    Cervical-Thoracic orthosis
    Cervical-Thoracolumbosacral
    orthosis
    Thoracolumbosacral orthosis

    AFO
    KAFO
    HKAFO
    RGO

    Lumbosacral orthosis
    Wrist-Hand orthosis
    Elbow-Wrist-Hand orthosis
    Shoulder-Elbow orthosis
    Shoulder-Elbow-Wrist-Hand
    orthosis

    WHO
    EWHO
    SEO
    SEWHO

    LL orthoses
    FO
    KO
    HO

    Cervical orthosis
    Thoracic orthosis
    Sacral orthosis

    Spinal orthoses
    CO
    TO
    SO

    Sacroiliac orthosis

    SIO

    Hand orthosis
    Wrist orthosis
    Elbow orthosis

    UL orthoses
    HdO
    WO
    EO

    Shoulder orthosis

    SO

    TYPES OF ORTHOSES
    LOWER LIMB

    Insoles - These are used to help cushion the feet,


    reduce high pressure areas or alter the biomechanics
    of the feet are abnormally shaped so do not fit ordinary
    footwear.
    Footwear adaptations - Adaptations are made to either
    compensate for a leg length discrepancy or to alter the
    angles of the feet when walking.

    Ankle Foot Orthoses - (plastic or


    conventional metal) These can be supplied
    to help control or stabilise the ankle and
    foot. For example, for controlling foot drop
    or stabilising an osteoarthritic ankle.
    Knee Ankle Foot Orthoses - (plastic or
    conventional metal) These are used to
    help control or stabilise the knee, ankle and
    foot.
    Knee braces - There are various types to
    help control the knee joint.
    Stockings - These are used to help control
    swelling, help improve circulation and help

    TRUNK
    Corsets and Abdominal Supports - A fabric support to
    provide some support to the back or stomach.
    Plastic Spinal Supports - Provides firmer support than
    the corset. They will control movement, as well as
    support the body to prevent surgery, or after surgery.
    Collars - Varying types to provide different degrees of
    support and control to the neck.

    UPPER LIMB
    Wrist Splints - To support or control movements of the
    wrist and help reduce pain.
    Some of our supports are stock items but most are
    custom made devices to suit the individual needs of the
    patient. This is why you are usually required to have
    more than one visit to the department.

    FOOTWEAR
    These are supplied to those patients who are either
    diabetic, have a biomechanical need for additional
    control of the foot and ankle or whose feet no longer fit
    into conventional footwear.
    Repairs to this footwear are only carried out through
    the hospital if a war pensioner wears them or if the
    shoes are have adaptations

    Functions of Prosthesis
    Restores function (Weight Bearing)

    Restores Shape ( Cosmetic )

    Stump

    Is the part of the limb remaining following


    amputation

    Weight bearing is normally NOT at the end of


    the stump

    Stump

    In Above Knee amputation weight bearing is at Ischial


    Tuberosity

    In Below Knee amputation weight bearing is at Patellar


    Tendon and upper flare of tibia

    The Socket

    The socket is the immediate part the stump has


    to be placed

    It is usually made of plastic material and padded


    at pressure points

    A venting opening is made at the end to ease


    getting stump in

    Lower Limb Prosthesis

    May be Below knee or Above knee

    It consists of the socket and the additional part

    Picture shows above knee artificial limb


    ( Above Knee Prosthesis)

    Weight bearing is at the Ischial Tuberosity

    Ideal Orthosis / Prosthesis


    Functional
    Fits well
    Light in weight
    Easy to use
    Cosmetically acceptable
    Easily maintained/repaired
    Ideally locally manufactured

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