orthosis

1. BY DR. SANDHYA DHOKIA PT

2. Content
 Definition
 Classification
 Principles
 Type
 Indication
 Contraindication
 Disadvantage

3. Definition
 Derived from the greek worth ORTHO meaning straight,
upright or correct.
 It is a mechanical device fitted to the body to maintain it
in an anatomical and functional position.
 It is an external device design to apply, distribute or
remove forces to or from the body in a controlled manner
to perform one or both the basic function of –
1) control body motion

4. Classification
 Regional Classification
 Functional Classification

5. Regional Classification
 They are classified according to the anatomical area fitted with the
orthosis:
 Cervical Orthosis
 Head-Cervical Orthosis
 Head–Cervical-Thoracic Orthosis
 Sacral Orthosis
 Lumbo-Sacral Orthosis
 Thoraco Lumbo- Sacral Orthosis

6.  Upper Extremity Orthosis:
 Shoulder and Arm Orthosis
 Elbow Orthosis
 Wrist Orthosis
 Hand Orthosis
 Lower Extremity Orthosis:
 Foot Orthosis(FO)
 Ankle-Foot Orthosis (AFO)
 Knee-Ankle-Foot Orthosis (KAFO)
 Hip-Knee-Ankle-Foot Orthosis (HKAFO)

7. Functional Classification
 Supportive: It stabilises the joints and supports the body in
its anatomical position,
 e.g. Calipers
 Functional: It stabilises the joint and also makes up for lost
function,
 E.g. Foot drop splint in common peroneal nerve palsy
 Corrective: To correct deformities
 E.g. Club foot boot in CTEV

8.  Protective: To protect a part of the body during its
healing.
 E.g. rigid four post collar for fracture cervical
vertebrae.
 Prevent substitution of function:
 In a full length caliper, substitution of hip flexors by
Abductors or adductors of hip and other similar trick
movements are prevented.
 Orthosis which strengthen certain group of muscle
 E.g. Tenodesis Splint

9.  Relief of pain:
 e.g. Lumbosacral corset supports lower back,
preventing painful movement.
 Prevent weight bearing:
 A weight relieving orthosis, prescribed for conditions
like fracture calcaneum will take weight away from
injured site into proximal site like the patellar tendon
bearing area.

10. Principles of Orthosis
 PRINCIPLE OF JORDAN:
 The basic mechanical principle of orthotic correction is
the “Three Point System of Jordan”.
 This system applies corrective or assistive forces,
which are implemented at the surface of the orthosis
through the skin and are transmitted to the underlying
soft tissues and bones.
 To remain stable, the body has to have one point
of pressure opposed by two equal points of
counter pressure in such a way that F1 = F2 + F3.

11. General Principles
 Use of forces:
 Orthosis utilises forces to limit or assist movements
for example.
a. Rigid material spanning a joint prevents motion,
e.g posterior tube splint
b. A spring in a joint is stressed by one motion and
then recoils to assist, the opposite desired motion.
E.g. leaf spring orthosis

12.  Limitation of movement: Limiting motion may reduce pain.
 Correcting a mobile deformity: a flexible deformity may be
corrected by an orthosis. Corrective forces must be balanced
according to principle of jordan.
 Fixed deformity: if the fixed deformity is accommodated by an
orthosis, it will prevent the progression of deformity.
 Adjustability: orthotic adjustability is indicated for children to
accommodate their growth and for patients with progressive or
resolving disorders.

13.  Maintenance and cleaning: the orthosis should be simple
to maintain and clean.
 Application: the design should be simple for easy donning
and doffing.
 Sensation: An orthotic device does not provide sensation,
in fact it often covers skin areas and decreases sensory
feedback.
 Gravity: Gravity plays an important role in upper limb
orthosis, especially in those joints where the heaviest
movement masses are present.

14.  Comfort: The Orthosis should be comfortable. Pressure
should be distributed over the largest area possible.
 Utility: the Orthosis must be useful and serve a real purpose.
 A well functioning opposite extremity is a major deterrent to
the use of an upper extremity orthosis as most activities
can be performed with the good hand.
 If the orthosis does not add significance to their function,
the patients typically discontinue its use.
 Cosmesis: Cosmesis is important especially in hand
orthosis. A functional but unsightly orthosis is often rejected if
the patient values appearance over function.

15. Types of orthosis
 Temporarily orthosis: Used for certain time after
injury or operation.
 Permanent orthosis: Used for ever when there is
muscle weakness, paralysis or deformity cannot be
corrected.
 Static orthosis: does not allow movement.
 Dynamic orthosis : allows movement.

16. MATERIALS
 An orthosis can be constructed from metal, plastic,
leather, synthetic fabrics, or any combination.
 Plastic materials are the materials most commonly
used in the orthotic industry.

17. Indications and clinical
implications
 To relief pain.
 To limit motion (immobilization after surgery, after traumatic injury, Compression # management
& Kinesthetic reminder to avoid certain movements).
 To correct deformity e.g. Scoliosis management
 To relieve symptoms of a disease by supporting or assisting the MSk & neural systems.
 To reduce axial loading, mechanical unloading
 To improve function in a certain segment of the body.
 Assist and improve movement and function
 Reduce muscle tone.
 Protect against injury.
 Provide proprioceptive feedback.
 Provide rest

18. Contraindications
 Skin infections
 When the muscle power is very much affected by the weight of the
orthosis.
 In case of severe deformity which cannot be accommodated in the
orthosis.
 If it limits the movement at other normal joints
 Where the orthosis interferes grossly with clothing or limits other functions
 Lack of motivation or other psychological problems
 Very young or old patients

19. Disadvantages
 Loss of skin integrity due to compressive forces
 Weakening of axial muscles
 Increased movements at ends of immobilised segments
 Physical and psychological dependence.
 Osteopenia
 Lack of cosmesis