بسم الله الرحمن الرحيم ORTHOTICS AND PROSTHESIS MUHAMMAD FARRUKH BASHIR FCPS(ORTHO) MUHAMMAD FARRUKH BASHIR FCPS(ORTHO)

The word is derived from ortho, meaning straight. Orthoses are sometimes called orthoticsorthotics Brace: is a device that corrects irrigularities. Splint: usually used after surgry and does not allow for movement. The orthotist is the person who designs, fabricates and repair the orthotic device. An orthosis (orthotic) is a device that is applied externally to a part of the body.body

 To relief pain.  To limit motion,  immobilization after surgery  immobilization after traumatic injury  Compression fracture 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 musculo-neuro-skeletal system.  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.

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

 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.

 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

DDiscomfort LLocal pain SSkin breakdown NNerve compression MMuscle atrophy with prolonged use DDecreased pulmonary capacity IIncreased energy expenditure with ambulation DDifficulty donning and doffing orthosis DDifficulty with transfers PPsychological and physical dependency IIncreased segmental motion at ends of the orthosis PPoor patient compliance

 Improve function.  Save energy.  Increase endurance.  The main aim of orthotic intervention is to function without dis-function.

 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.

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

 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.  Static orthosis does not allow movement. Dynamic orthosis allows movement.

 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 (150°C) to mold, but they are ideal for high stress activities.

LLeather ssuch as cattle hide, is used for shoe construction because it conducts heat and absorbs water well. RRubber RRubber has tough resiliency and shock-absorbing qualities. R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.

 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 client‘s daily environment can assist in material selection.  Ease of fabrication: the equipments needed for fabrication of orthosis

 The biomechanical principles of orthotic design assist in promoting control, correction, stabilization, or dynamic movement.  All orthotic design are based on three relatively principles: These principles are: PressureequilibriumThe lever arm

Types of orthosis Upper limb orthosis Trunk orthosis Lower limb orthosis

Ankle-foot orthosis Knee-ankle foot orthosis Hip-Knee-ankle foot orthosis Reciprocal Gait orthosis AFO KAFO HKAFO RGO Foot orthosis Knee orthosis Hip orthosis LL orthoses FO KO HO Cervical-Thoracic orthosis Cervical-Thoracolumbosacral orthosis Thoracolumbosacral orthosis Lumbosacral orthosis AFO KAFO HKAFO RGO Cervical orthosis Thoracic orthosis Sacral orthosis Sacroiliac orthosis Spinal orthoses CO TO SO SIO Wrist-Hand orthosis Elbow-Wrist-Hand orthosis Shoulder-Elbow orthosis Shoulder-Elbow-Wrist-Hand orthosis WHO EWHO SEO SEWHO Hand orthosis Wrist orthosis Elbow orthosis Shoulder orthosis UL orthoses HdO WO EO SO

 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.

 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.

 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.

 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