1. Orthosis

2. Orthosis
 Definition: Orthosis is an orthopedic
appliance or apparatus used to support,
align, prevent, or correct deformities or
to improve function of movable parts of
the body.
 Purpose:
1. To lend stability to a weak joint.
2. Correct or maintain alignment.
3. Correct skeletal deformities, etc.

3. Principles in designing orthosis
 Three point pressure.
 Total contact.
 Partial weight relieving.

4. Three point pressure
 "The sum of the forces and the bending
moments created is equal to zero.“
 A single force is placed at the area of deformity;
two additional counter forces act in the opposing
direction.
 During "quiet" standing, line of gravity (weight
line) passes through:
◦ posterior to hip joint
◦ anterior to knee joint and
◦ anterior to ankle joint

5. Total contact
 “Pressure is equal to the total force per unit area. “
 The greater the area of a pad of an orthosis, the less
force will be placed on the skin.
 P = force
Area of application

6. Partial weight relieving
 “The farther the point of force from the
joint, the greater the moment arm and
the smaller the magnitude of force
required to produce a given torque at
the joint.”
 The greater the length of the supporting
orthotic structure, the greater the
moment or torque that can be placed on
the joint or unstable segment.

7. Types of orthosis
 Upper limb orthosis.
 Lower limb orthosis.

8. Lower limb orthosis
 Purpose: For supporting lower limbs.
 Materials used:
◦ Plastic (recently in demand). e.g. polypropylene,
polyethylene.
◦ Metal: aluminum-light weight, stainless steel, etc.

9. Materials used
 Metal
◦ Traditional orthosis were made from metal.
◦ Metals like aluminum-light wt, stainless
steel-durable.
 Plastic
◦ Plastic orthosis are formed from a single
piece of thermoplastic.
◦ Plastic components like polypropylene,
polyethylene.

10. Types of lower limb orthosis
 Ankle foot orthosis (AFO)
 Knee ankle foot orthosis (KAFO)
 Knee orthosis (KO)
 Hip knee ankle foot orthosis (HKAFO)
 Hip orthosis (HO)

11. AFO
 Ankle-foot orthosis is a brace, usually
plastic, worn on the lower leg and foot
to support the ankle, hold the foot and
ankle in the correct position, and
correct foot drop.
 Purpose:
◦ To control alignment and motion of the
joints of foot and ankle.
◦ For patients affected with muscular
dystrophy, cerebral palsy, etc.
 Construction:
◦ Consists of a shoe attachment, ankle
control, uprights and a proximal leg
band.

12.  Parts:
◦ Calf bands
◦ Metal uprights
◦ Ankle joint
◦ Shoe attachments
◦ Stirrup
Calf band
Metal upright
Ankle joint
Shoe
attachments
Stirrup

13. Types of AFO
 Dorsiflexion assist AFO:
◦ In case of moderate foot drop.
 Plantar flexion assist AFO:
 Posterior leaf spring AFO:
 Patellar tendon bearing AFO:
 Spiral AFO:
 Solid AFO:
◦ In case of severe foot drop.

14. Knee Ankle Foot Orthosis (KAFO)
 A KAFO is a long-leg orthosis that spans
the knee, the ankle, and the foot in an
effort to stabilize the joints and assist
the muscles of the leg.
 Material for fabrication: metals, plastics,
fabrics, and leather.

15. Parts
Hip joints and locks
 Controls for abduction, adduction and
rotation.
 Controls for hip flexion when locked.
 2 position hip locks are also available.
 Pelvic band
 To stabilize the hip joint.
 There are two types unilateral pelvic band
and bilateral pelvic band.
 It adds weight and increases overall energy
expenditure during ambulation.

16. Types of KAFO
 Supracondylar plastic orthosis.
 Scott-Craig orthosis.

17. Knee orthosis
 A knee orthosis (KO) extends above and below
the knee joint.
 Design to control the ligament deficiencies
around the knee.
 Provide functional support and rehabilitation
after injury & surgery of the knee.
 Parts:
 Double uprights
 Free or adjustable knee joint
 Thigh and calf cuffs

18. Types of knee orthosis
 Dynamic patellar orthosis:
 It consist of an elastic sleeve with patellar cutout.
 Its purpose is to prevent the dislocation of
patella.
 Traditional knee orthosis
 It consists of leather thigh, calf cuffs and metal
side bars.
 Pressure pad may be applied to generate medial
or lateral forces.
 Swedish knee cage
 It used in the management of knee
hyperextension.
 Two anterior pads and adjustable posterior
pressure pad at the attachment to the upright .

19. Types of knee joints
 Free motion knee joint:
allows unrestricted flexion & extension.
 Off-set knee joint:
the hinge is located posterior to the
knee joint stabilize knee during stance.

20. Hip Knee Ankle Foot Orthosis (HKAFO)
 Hip joint and pelvic band attached to the lateral
upright of a KAFO converts it to a HKAFO.
 Purpose:
◦ Hip flexion/extension instability
◦ Hip adduction/abduction weakness
◦ Hip internal rotation/external rotation
instability

21.  Parts:
◦ Sole plate extending to the metatarsal
heads with a crossbar added to the
metatarsal heads area for mediolateral
stabilization.
◦ Ankle joint set at 10° of dorsiflexion
◦ Anterior rigid tibial band (patellar tendon
strap)
◦ Offset knee joint with bail lock
◦ Proximal posterior thigh band

22. Types of HKAFO
 Reciprocal Gait Orthosis (RGO)
 It is used for upper lumbar paralysis in
which active hip flexion is preserved.
 RGO consists of bilateral HKAFO with
offset knee joints, knee drop locks,
posterior plastic AFO, thigh pieces,
custom molded pelvic girdle, hip joints,
and a thoracic extension with Velcro®
straps, in addition to the control
mechanism

23. Hip orthosis
 Purpose:
◦ To resist femoral adduction.
◦ Mostly in elderly patients who have had total
hip joint replacement.
 Parts:
◦ Two position lock which permits full extension
and 95 degree of hip flexion and adjustable
adduction stop.