1. Basic Structure & Function of Human Joints
-A joint: the junction or pivot point between two or more bones. Also transfer & disperse forces produced by gravity & muscle activity -Arthrology: the study o the classification, structure, and function of joint.
-Structure & ultimate joint function affect by:
1-Aging, Long-term immobilization,
3- Trauma, Disease -These Factors also significantly influence the quality and quantity of human movement.

2. -Most effective rehabilitation
specific Anatomy & detailed Function of the individual joints throughout the body must been well known.
-This is a prerequisite or understanding: --Impairments
-Most effective rehabilitation

4. Classification of joints based on motion:
Synarthroses:
Synarthrosis: junction between bones allows slight to essentially no movement.
Classified as:
1- fibrous
2-cartilaginous.
1-Fibrous joints are stabilized by specialized dense connective tissues, usually with a high concentration of collagen.

5. 2-Cartilaginous joints, in contrast, stabilized by varying forms of flexible of:
fibrocartilage or
hyaline cartilage,
often mixed with collagen.
-generally exist in the midline of the body, such as the symphysis pubis, the interbody joints of the spine
-The function strongly bind and transfer forces between bones.
-well supported by periarticular connective tissues
-Allow very little movement.

6. Acute trauma : - detectable pathology.
-A torn or severely stretched tissue causes an acute inflammatory reaction, which involves a predictable inflammatory mediators(cytokines)
Cytokines have important implications in both joint pain and exercise.
current research suggests that components of exercise prescription intensity, duration, & mode are influential cytokine levels than the exercise-induced muscle damage (and resultant inflammation) itself.

7. Brief overview of joint pathology
1- A single overwhelming event
(acute trauma)
2- Response to an accumulation of lesser injuries over an extended period
(chronic trauma).

8. Acute trauma :
- Greater understanding of anti-inflammatory cytokines may prove useful in optimizing exercise prescription, especially in post-operative phases of rehabilitation. -Careful reduction or realignment of the fractured fragments helps to restore congruity to the joint and thereby facilitate smooth, low- friction sliding functions of articular surfaces
-This critical to maximal recovery of function.

9. Chronic trauma :
classified (overuse syndrome) & accumulation of unrepaired, relatively minor damage.
-Chronically damaged tissu lose restraining functions, although the instability of the joint masked by a muscular restraint substitute.
-cause abnormal loading conditions on tissues, which lead to their mechanical failure. Two disease states that commonly cause joint dysfunction are osteoarthritis (OA) and rheumatoid arthritis (RA).

10. Orthosis :
-Orthosis: A force system designed to control, corrects, or compensates bone deformity,
deforming forces or forces absent from body.
-An orthotic device: an external device applied on the body to limit motion, correct deformity, reduce axial loading, or improve function in a certain segment of the body. -A Splint: orthopedic device use to immobilize & support the body part.
-A Brace: device fitted to the body part which is weak & injured to give support. Knee brace.

11. Characteristics of an orthotic device :
1- Weight of the orthosis Adjustability
3- Functional use Cosmetic
5- Cost Durability
7- Material
8-Ability to fit various sizes of patients
9- Ease of putting on (donning) and taking off (doffing)
10-Access to tracheostomy site & other drains
11-Access to surgical sites for wound care
12-Aeration to avoid skin maceration from moisture

12. Indications orthotic devices
1- Pain relief
2- Mechanical unloading
3- Management
4- Immobilization after surgery
5- Immobilization after traumatic injury
6- Compression fracture management
7- Kinesthetic reminder to avoid certain movements

13. Duration of orthotic :
- In situations where bone instability is not an issue, 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.

14. Drawbacks of an orthotic:
1- Discomfort Local pain
3- Osteopenia Skin breakdown
5- Nerve compression
6-Ingrown facial hair for men
7-Muscle atrophy with prolonged use
8-Decreased pulmonary capacity
9-Increased energy expenditure with ambulation
10- Difficulty donning and doffing orthosis
11- Difficulty with transfers
12-Psychological and physical dependency

15. Drawbacks of an orthotic:
13- Increased segmental motion at ends of the orthosis
14-Unsightly appearance
15-Poor patient compliance

16. Orthosis success leading to :
1- Decreased pain
2- Increased strength
3- Improved function
4- Increased proprioception
5- Improved posture
6- Correction of spinal curve deformity
7- Protection against spinal instability
8- Minimized complications
9- Healing of ligaments and bones

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

18. BIOMECHANICAL PRINCIPLES :
1) Three Point Pressure
2) Mechanical Advantage
3) Torque
4) Degree and Duration of Stress
5) Repetitive stress
6) Control Normal force across the joint
7) Control Axial Force across the joint
8) Control line of action of Ground reaction force

19. Orthosis design: : 1-Static Splint 2-Serial Static Splint
3-Drop out Splint
4-Dynamic Splint
5-Static Progressive Splint

20. Static Splint :
For stabilization and protection joint in particular position.

21. 2- Serial Static Splint
This type of orthosis helps in regaining movement reducing pain with not over stressing the tissue.

22. 3- Drop out Splint
This type of splint blocks one movement and enhance other

23. 4-Dynamic splint:
For mobility and enchasing function.

24. 5- Static Progressive Splints
Stress and tension adjustment and movement enchasing splint. Used nowadays to avoid splint complication.

26. LL orthosis Spinal orthosis UL 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 orthosis FO KO HO
Cervical-Thoracic orthosis
Cervical-Thoracolumbosacral orthosis
Thoracolumbosacral orthosis
Lumbosacral orthosis
CTO
CTLSO
TLSO
LSO
Cervical orthosis
Thoracic orthosis
Sacral orthosis
Sacroiliac orthosis
Spinal orthosis 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 orthosis
HdO WO EO

27. I-Shoulder 1- FIGURE OF EIGHT AXILLA WRAP
-common name: Axilla Wraps, clavicle strap brace
Objectives:
-To retract the scapulae
-To apply pressure to the axilla to prevent or correct hypertrophic scar.
-To maintain and restore shoulder mobility
-To stretch contracted tissue around anterior chest
-To prevent and correct Kyphotic Posture.

28. I-Shoulder 1- FIGURE OF EIGHT AXILLA WRAP Indication:
1.) Axilla Burns or skin grafting
2.) Shoulder Adduction Contracture
3.) Kyphotic Posture
4.) Clavicle Fracture

31. 2.) Lateral Trunk Based Static Shoulder- Elbow-Wrist Orthosis
Common Name: Shoulder/Gunslinger Splint
Objectives:
1) To fully immobilize the shoulder and sometimes Elbow to promote healing
2) The elbow and wrist are immobilize to maintain full control on shoulder.
Indications:
1) In Posterior Glenohumeral Instability.
2) Partial Brachial Plexus injury and brachial neuritis
3) Rotator cuff repair

33. 3- AIRPLANE SPLINT
Common Name: Axilla/ Airplane splint/Conformer Objectives:
1) To elevate hand and prevent edema
2) To prevent and reduce an axilla contracture
3) To maintain and restore Shoulder Mobility
4) To immobilize upper extremity after skin grafting
5) To apply pressure to prevent or reduce hypertrophic scaring
Indication:
1) Brachial plexus injury
2) Shoulder Adduction Contractures
3) Complete supraspinatus tear
4) Axilla burns or skin grafting

35. 4) Static Shoulder Elbow Wrist Sling
Common Name: Hemi arm sling
Objectives:
1) To immobilize Shoulder and Elbow
2) To support the weight of the upper extremity across the contralateral shoulder, without stress on neck and back
3) To prevent Brachial Plexus Traction
4) To prevent pain and shoulder subluxation
Indication:
1) Shoulder subluxation caused by flaccid hemiplegia
2) Brachial plexus injury
3) Rotator Cuff injury
4) Upper Extremity Trauma
5) Shoulder surgery

37. 5) Circumferential Nonarticular Humerus- Stabilizing Orthosis
Common Name: Humeral Fracture/ Function Brace/ Sarmiento Brace
Objectives: To stabilize Fracture to promote healing without immobilizing any joint
Indications: Humeral Shaft Fracture