1. SCI Orthotics
SCI Orthotics

2. Review Nomenclature Spine support orthoses Joint support orthoses
Neck, ThoracoLumbarSacral
Joint support orthoses
Typically lower limb motor loss adaptations
Motor augmentation orthoses
Typically upper limb motor presence augmentation
Protection orthoses

3. Orthotic Definition
Device used to assist, resist, align or simulate function of a body part or system.
Typically applies forces to affected extremity.
Force has magnitude, direction and application point.
Effectiveness depends on all 3.
Movement = rotation, translation or combination of 2.
Torque is strength of rotational force.

4. Orthotic Nomenclature
1971 – American Orthotic and Prosthetic Association promoted standardized nomenclature
1972 – new language put into use

5. Committee on Prosthetic-Orthotic Education of the National Academy of Sciences
All exoskeletal devices called orthotics
Described by joints they encompass
Abbreviate each joint name to 1 letter
Combination of symbols to indicate desired control of designated function

6. Orthotic Materials Thin metal, plastic, foam, epoxy, plaster.
Short use = low durability need
High frequency & load = high durability need

7. Spine Support Goal is stabilization in desired plane of motion
Flex/ext, sidebending, rotation
Absolute vs. relative restriction

8. Cervical Orthoses Halo SOMI, molded MINERVA cervical orthosis
ASPEN, Miami, PHILLY
MNDA for weak extensors (ALS)
Headmaster collar
Soft collar

9. Cervical Orthoses
Philly: AP motion limited to 30% normal, 43% rotation, 67% side bend.
SOMI: 13-27% sagittal motion, 34% rotation, 66% side bend
HALO: believed most restrictive, least overall C-spine motion but individual “snaking” of vertebrae.
Koch – 31% sagittal motion reduction in tetraplegia, suggested intimate fit body vest was best. 1978

15. ASPEN Collar

16. Miami collar

18. MNDA

20. ThoracoLumbarSacral Orthoses
3 point force application theory
No true immobilization, just limitation of interspinous motion
Limited sagittal control
For effectiveness, must provide “inhibitory feedback signal” over bony prominences to reduce patient movement efforts.

21. LS Orthoses Commonly used for back pain syndromes
Little consistent data to support idea that disk pressures reduced in lifting tasks.
Nachemson A.

22. TLSO types
Jewitt
Knight-Taylor
LS corsett
Clamshell or turtleshell

29. Limb Support Orthoses
Reciprocating gait orthosis
HKAFO
KAFO
AFO

41. Motor Augmentation Orthoses
Cervical deficits can use substitution or enhancement
Upper limb’s job = terminal device (hand) placement in environment
Feeding most important!
Balanced forearm orthosis (BFO), tenodesis devices, hand & digit flexion or extension assist orthoses, built up grips for grip loss.
General environmental control units
Oromotor adaptive equipment

47. Static Position Maintenance Orthoses
Common use in SCI, CVA
Prevent contracture, maintain functional position of hand.

53. Interface technology for high cervical injuries
Eye movement tracking
Sip & puff
Voice recognition

54. Eye Movements During Visual Scan
Typical eye movement behavior while looking at a face
- Note the extent to which fixations occur around the eyes
- The eye movements are again voluntary and involve the saccadic system
- People are generally not aware of these movements and as I have found later, verbal descriptions do not always agree with actual eye movement response.
- The advantage of objective measurement techniques.

55. Eye Movement Measurement Techniques
EOG
Photoelectric
Pupil Corneal Reflection
Scleral Search Coil

56. Electrooculography (EOG)
Cornea Positively Charged
Relative to Retina - A Rotating Dipole

57. Contact Lens with Embedded Induction Coil
Scleral Search Coil
Contact Lens with Embedded Induction Coil

58. Infrared Reflectance Technique
Photoelectric
Infrared Reflectance Technique
Limbus Eye Tracker

59. Pupil Corneal Reflection System “Dark Pupil”
IR Image of the
Eye
Estimate of
Pupil Center &
Corneal
Reflections
“Original” Hockey Helmet System
Mapping of Eye onto 2D CCD Array

60. Human-Machine Interfaces
Visual control of movement, function or processes
Visual control of systems from a remote location
Combined Control

61. Protection Orthoses Skin protection
PRAFO, multi-Podus – many brand names
Not = heel pads, key is suspension of calcaneal posterior surface in space, no contact!
Risk of Achilles tendon irritation