Spinal Orthosis Mechanics - SportsEngine
Spinal Orthosis Mechanics
End-point control – has top & bottom to semi-immobilize joints/areas
Total contact – whole surface touched…decreases rotation
3-point system – 2 forces on direction, 1 force opposite in middle
Counter-pressures – brace contact doesn’t allow movement in a given direction
Cervical Orthoses
Soft foam – kinesthetic reminder
Rigid plastic – mild control for soft tissue injury…no rotation control
Philadelphia – soft tissue damage up to C4 or stable Fx
2 & 4-poster – adjustable limits…endpoint control
SOMI – endpoint control…don in supine…can’t put into MRI
Minerva CTO – total contact, extra-stable Philadelphia…hot & hard to don
HALO – can do distraction…limits ALL mvmt…invasive
History of Orthotics
Back to 5th Dynasty
Scoliosis bracing early 1900s
Certifying Organizations – ABC or BOC
Perry – Biomechanical abnormalities of Post-Polio patients and the implications for orthotics management
Post-Polio Pts have normal sensation & motor control
Only need orthoses if substitutions are inadequate / cause joint overuse
Most common is drop-foot…substitution taken is excessive hip flexion ( use dorsi-assist device
Goals of LE Orthoses
( P! by ( forces around joint (try to distribute forces over as great an area as possible
Assist locomotion & stability
Maintain deformity correction
Influence muscle tone
Shoewear
Environmental protection…support…shock absorption
Good shoe needed for many orthoses…and for efficient gait
Poor shoe may ( shearing…cause deformity…lead to fall
Sole – welt, outsole, inner sole, shank
Upper – vamp, tongue, rear quarters
Heel – cushioned or beveled
Reinforcements – widen toe box, shank, counter
Lifts for leg length discrepancy of it locked KAFO on one side
Heel wedge for varus/valgus
Rocker bottom for improved rockers
Beveled/cushioned heel for ( lever arms for ( force on LR
Heel flares for rolling medial or lateral
Metatarsal pad for pressure shifting
Metatarsal bar for ( pressure during toe-off
Metal vs. Plastic Considerations
Edema / swelling (use metal) Heat resistance & environmental temp.
Sensation / skin integrity Cosmesis (usually prefer plastic)
Weight limit 180lbs for plastic Shoe choice
Weight of brace for metal
KAFOs
3-point system controls excess knee flexion in stance
Use anterior offset joint for genu recurvatum (usually Post-Polio)
Useful in unlocked position for ( proprioception or severe medial-lateral instability
Bilaterally…( energy cost…( velocity (more than wheelchair)…( shoulder forces
Drop locks vs. bail locks
AFOs
Ground reaction ( knee extension moment during stance
For weakness/spasticity…( stability…indirectly stabilize knee
Rigid for…severe PF spasticity/tone…mild gastroc tightness…( DF/KF moment…( tibial
progression…use cushioned/beveled heel
Articulating to control DF/PF
Dorsi Stop / Dorsi Assist – weak PFs, excess DF stance, excess PF swing, ( tibial control
Leaf spring is dorsi assist – correct foot drop, no tibial control, mild calf weak/tight
Polyarticulating for more precise adjustment
Beekman – Effects of a DFstopped AFO on walking in incomplete SCI patients
DFstop AFOs don’t disrupt calf muscle recovery postSCI
DFstop AFOs ( gait speed & step length
DF stop AFOs better knee position ( ( stance limb stability
No change in PF or Quad function…but ( pretibial function
Lehmann – Gait abnormalities in hemiplegia: correction by AFO
Main AFO benefits: ( speed & normalize heel strike via PFstop
Poorly adjusted/locked AFO ( ( difficulty of gait…(KF moment ( knee instability
Rancho ROADMAP
KAFOs & RGOs ( ................
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