Orthotic Services

Understanding Orthotics

Orthotics is a medical specialty that focuses on the design and application of orthoses. An orthosis (plural: orthoses) is “an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system“. An orthotist is the primary medical clinician responsible for the prescription, manufacture and management of orthoses. An orthosis may be used to:

spina bifida or cerebral palsy, or have experienced a spinal cord injury or stroke. Equally, orthoses are sometimes used prophylactically or to optimise performance in sport.

  • Control, guide, limit and/or immobilize an extremity, joint or body segment for a particular reason
  • Restrict movement in a given direction
  • Assist movement generally
  • Reduce weight bearing forces for a particular purpose
  • Aid rehabilitation from fractures after the removal of a cast
  • Otherwise correct the shape and/or function of the body, to provide easier movement capability or reduce pain

Orthotics combines knowledge of anatomy and physiology, pathophysiology, biomechanics and engineering. Patients who benefit from an orthosis may have a condition such as spina bifida or cerebral palsy, or have experienced a spinal cord injury or stroke. Equally, orthoses are sometimes used prophylactically or to optimise performance in sport.

Lower Limb Orthotics

A lower-limb orthosis is an external device applied to a lower-body segment to improve function by controlling motion, providing support through stabilizing gait, reducing pain through transferring load to another area, correcting flexible deformities, and preventing progression of fixed deformities. 

 

Types of Lower Limb Orthoses

  • Innersoles (Custom/ Prefabricated)
  • Foot Orthosis (FO)
  • Supra Malleolar Orthosis (SMO)
  • Ankle Foot Orthosis (AFO)
  • Knee Orthosis (KO)
  • Knee Ankle Foot Orthosis (KAFO)
  • Hip Orthosis (HO)
  • Hip Knee Ankle Foot Orthosis (HKAFO)

Upper Limb Orthotics

 Upper-limb (or upper extremity) orthoses are mechanical or electromechanical devices applied externally to the arm or segments thereof in order to restore or improve function, or structural characteristics of the arm segments encumbered by the device. In general, musculoskeletal problems that may be alleviated by the use of upper limb orthoses include those resulting from trauma or disease (arthritis for example). They may also be beneficial in aiding individuals who have suffered a neurological impairment such as stroke, spinal cord injury, or peripheral neuropathy.

 

Types of Upper Limb Orthoses

  • Upper-limb orthoses
  • Clavicular orthoses
  • Shoulder orthoses
  • Arm orthoses
  • Functional arm orthoses
  • Elbow orthoses
  • Forearm-wrist orthoses
  • Forearm-wrist-thumb orthoses
  • Forearm-wrist-hand orthoses
  • Hand orthoses
  • Upper-extremity orthoses (with special functions)
  • Crancial Bracing (Cranial Remolding/ Protective Bracing)

Spinal Bracing

Spinal bracing utilizes these primary objectives:

 

  • Controlling back pain by limiting motion and unloading discs, vertebrae and other spinal structures by compressing the abdomen.
  • Stabilizing weak or injured structures by immobilizing the spine.
  • Providing three-point force systems to provide correction or prevent progression of a deformity.

The segment of the body that is being controlled generally classifies spinal bracing terminology.

 

  • Sacroiliac (SIO)
  • Lumbosacral (LSO)
  • Thoracolumbosacral (TLSO)
  • Cervicothoracolumbosacral (CTLSO)
  • Cervicothoracic (CTO) orthoses. Control is described in terms of spinal flexion, extension, rotation and lateral bending.
  • Cervical (CO)

Spinal orthoses are categorized as flexible, rigid or semi-rigid.

 

Flexible orthoses or corsets are prescribed for relief of low back pain associated with degenerative disc disorders, trauma, or postural deformities. Corsets are typically made of cotton and nylon materials. Corsets are used to de-weight spinal structures by increasing abdominal compression. Rigid stays and inserts can be added to restrict motion and act as a postural reminder. Most corsets are pre-fabricated and custom fit and modified to the patient’s specific needs.

 

Rigid orthoses are commonly custom fabricated and provide the most support to the area being treated. A body jacket or TLSO controls motion in all planes. Depending on the goals of the TLSO, design can be modified accordingly. A two piece front and back design is commonly used post operatively for ease of application while a front or back opening single piece design is commonly utilized when treating scoliosis. Velcro™ straps are most commonly used to fasten the closure on all orthoses today.

 

When indicated, orthotic management of the spine can be very successful. When orthotic care is needed, it is important that the health care professional providing these services is properly credentialed.

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