This document provides an overview of orthosis and prosthesis. It begins with introducing orthosis, discussing their functions, biomechanics, classifications, and examples of common lower and upper limb orthoses. It then introduces prosthesis, discussing the components and types of lower limb prosthesis, including different sockets, suspension methods, knee and terminal devices. Examples of both immediate post-op and long-term lower and upper limb prosthetic options are outlined.

1. Basics of Orthosis & Prosthesis
1

2. Outline
• Introduction to orthosis
• Functions of orthosis
• Biomechanics of orthosis
• Lower limb orthosis
• Introduction to prosthesis
• Lower limb prosthesis
• Upper limb prosthesis
• References
2

3. Objectives
• To know the basic designs, function and
applications of orthosis
• To understand basic principles of common
prosthetic devices
3

4. Introduction
Reviewing orthoses
Orthosis is an orthopaedic appliance or
apparatus used to support, align, prevent,
or correct deformities or to improve
function of movable parts of the body.
Orthotics
Orthotist
4

5. Function of orthoses
Corrects flexible deformities
Prevents deformity and progression of
fixed deformities
Maintains correction
Corrects instability
 Relieves pain
 Relieves weight bearing
 Facilitates ambulation
5

6. Characteristics of an Ideal
Orthosis
 Meets the individual’s mobility needs and goals
 Maximizes stance phase stability
 Minimizes abnormal alignment
 Minimally compromises swing clearance
 Effectively prepositions the limb for initial contact
 Should be simple, lightweight, energy efficient, adjustable,
strong, durable, and cosmetically acceptable, Cheap, easily
donned and doffed
6

7. Biomechanichal Principles in
orthosis design
Based on three principles:
Three point pressure- Sum of the primary force
and opposing counterforces of each control
system equals zero
Total contact- Forces are distributed over large
surface areas to minimize pressure on skin and
soft tissue
The lever arm principle-The forces are applied
in such away that a large moment arm reduces
the amount of force needed to control the joint
7

8. Orthopedic indications
of Orthosis
 Trauma:
• Fracture
• Dislocation
• Ligament injuries
• Disc lesions
 Post operative conditions as
fracture fixation,
menisecotomy
 Arthritis: as osteoarthritis and
rheumatoid arthritis
 Deformities
• Scoliosis
• Congenital hip dislocation
• Talipes equino valgus varus
Classifications of orthosis
 Static Vs dynamic
 Temporary Vs permanent
 Lower limb / upper limb/ trunk
8

9. 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 orthoses
FO
KO
HO
Cervical-Thoracic orthosis
Cervical-Thoracolumbosacral
orthosis
Thoracolumbosacral orthosis
Lumbosacral orthosis
CTO
CTLSO
TLO
LSO
Cervical orthosis
Thoracic orthosis
Sacral orthosis
Sacroiliac orthosis
Spinal orthoses
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 orthoses
HO
WO
EO
SO
9

10. Disadvantages & limitations of
orthosis
 Limit mobility and ROM of the joint
 Restrict rotation around a joint
 Movement is usually limited to certain direction
 Weakness of other muscles in opposite direction
 Wear and tear of the device
It needs maintenance, care, cleaning, repairing,
and frequent changing of shoes.
10

11. Lower limb orthosis
11

12. Foot Orthoses (FO)
• Used to correct foot
alignment, improve function
or to relieve pain
• Are custom molded & often
designed for a specific level
of functioning
Shoes
• Accommodates deformities
or provides support to the
limb
• Minimizes pressure on
sensitive and deformed
structures
• Redistributes weight
 Two types of modifications:
A- External shoe modification
B- Internal shoe modification
12

13. A- External shoe modification
Heel correction
 Heel elevation & cushion
Medial & lateral heel wedge
Thomas heel
reverse Thomas heel
Heel flares
13

14. Outsole correction
 Medial & lateral
outsole wedge
Rocker bottom
Metatarsal bar
14

15. B- Internal shoe modification
 Cushion heel: Cushions
and absorbs forces at heel
contact
– Relieves strain on plantar
fascia in plantar fasciitis
Soft inserts: reduces areas
of high loading, restrict
forces, and protect painful
or sensitive areas of the
feet.
15

16. 16
 Metatarsal pad: takes pressure off the
metatarsal heads and onto the metatarsal
shafts; allows more push off in weak or
inflexible feet
Heel spur pads

17. Longitudinal Arch Supports
• Prevents depression of the subtalar joint
• Corrects pes planus
Eg.
UCBL insert
Scaphoid Pad
Thomas heel
17

18. Posting
Rear Foot Posting
– Alters the position of the sub-talar joint
– STJ function is not eliminated (dynamic
control)
Varus Post (medial wedge):
– Limits or controls eversion of the
calcaneus
– Limits or controls internal rotation of the
tibia after heel strike.
Valgus Post (lateral wedge):
– Controls calcaneus and sub talar joint
that are excessively inverted and
supinated at heel strike.
18

19. Forefoot posting:
– Supports the forefoot
 Medial wedge: for forefoot
varus
 Lateral wedge: for forefoot
valgus
• Contraindicated for insensitive foot
Heel Lifts:
– Either internal or external
modification
– Indication: leg length
discrepancy, ankle joint
dorsiflexion limitation
19

20. Ankle-foot orthosis(AFO)
• The most frequently prescribed orthosis
• Designed to control the rate and direction of
tibial advancement and to maintain an
adequate base of support while meeting the
specific demands for acceptable gait
• Two categories:
1. Static: prohibit motion in any plane at
ankle. Eg: SAFO, PTB
2. Dynamic: allows some degree of sagittal
plane motion at the ankle. e.g PLS(posterior
leaf spring), spiral AFOs, articulating
SAFOs
20

21. Knee-Ankle-Foot
orthoses(KAFOs)
 Considered for:
Recurvatum that jeopardizes structural integrity of
the knee joint
Excessive varus or valgus during weight bearing
Quadriceps paralysis or weakness to maintain knee
stability
 Classifications:-
21

22. CONVENTIONAL KNEE-ANKLE-FOOT
ORTHOSES
• Is composed of:
 a pair of uprights as a frame
 leather-covered posterior thigh and calf cuffs
 a pair of single axis locking orthotic knee joints,
 metal stirrups that attached between the heel and sole
of the shoe
 single axis dorsiflexion assistance with a
plantarflexion stop
• Advantages- strong, durability and adjustability
• Disadvantages- Heavier, less cosmetic, malodorous
leathery cuffs, less varus & valgus control
22

23. THERMOPLASTIC KNEE-ANKlE-FOOT
ORTHOSES
• Designed to have an intimate fit
• Advantages- Lightweight,
Interchangeability of shoes,
Greater cosmesis worn under
clothing, less discomfort due to
large surface area of contact,
more precise control in both the
frontal and transverse planes
• Disadvantages- Can be hot to
wear due to large surface area of
contact compromising
dissipation of body heat
23

24. CARBON COMPOSITE KNEE-ANKLE-FOOT
ORTHOSES (CC-KAFO)
• 30% lighter
• ~10% less energy cost of walking
• For persons for whom fatigue is a
major concern
• Advantages- improved
cosmetics, increased walking
speed, improved kinetic
characteristics of walking,
exceptional durability
• Disadvantages- Expensive
24

25. Knee orthoses(KOs)
• Based on function: prophylactic,
functional or rehabilitative
 Prophylactic brace- To protect athletes
from debilitating injuries w/o inhibiting
knee mobility
 Functional brace- Provide external
support & biomechanical stability
 Rehabilitative brace- Provide protection
& progressive ROM. Eg. Unloading &
patellofemoral braces
25

26. HIP-KNEE-ANKLE- FOOT
ORTHOSES(HKAFO)
• Consists of an AFO with metal
uprights, a mechanical knee joint,
thigh uprights, a thigh socket, a hip
joint, and waist band
• The hip joint can be adjusted in two
planes
Single-axis hip joint
Double-axis hip joint
26

27. Trunk-Hip-Knee-Ankle-Foot
orthoses(THKAFO)
• Has spinal orthosis in addition to an
HKAFO to control trunk motion and
spinal alignment.
• Indicated in patients with paraplegia.
• Are very difficult to don and doff.
27

28. Prosthesis
Definition
Prosthesis is a device that is
designed to replace, as much
possible the function or
appearance of a missing
limb or a body part.
 Prosthetist
Aim of prosthesis
 To replace a missing part
 To restore lost function
 To Comfortably ambulate
 To reduce energy
expenditure
 Minimizing the shift of the
centre of gravity during gait
28

29. Lower limb prosthesis
29

30. Parts of LL prosthesis
30

31. Types of Sockets
For transtibial amputation
• Conventional Below Knee
Socket
• Patellar Tendon Bearing
Socket
• Total surface bearing
socket
• Patellar Tendon Bearing
Supracondylar
Suprapatellar Socket
• Bent Knee Socket
• Slip Socket
For transfemoral amputation
ischial containment & sub ischial socket
31

32. Conventional Below Knee Socket
• No pressure over distal stump
• Requires external knee joint and thigh
corset
 Uses: in elderly patients with unstable
knee, quardriceps weakening
 Disadvantages
Skin irritation from friction
Stump chocking by edema
32

33. Patellar tendon bearing socket
• Loads weight in pressure tolerant areas like patellar
tendon, medial tibial flare, belly of gastric, bony
shafts
• Has a prominent indentation over patellar tendon
• Put in slight flexion (5°) and slight lateral tilt
• Posterior brim provides stability and prevents from
sliding too far to socket
33

34. Total surface bearing socket
• Weight is distributed over entire surface of
residual limb
• Molded according to type of tissue and
anticipated loading
34

35. PTB Suprapatellar Supracondylar
Socket
• A modification of PTB
• Additional brim lines:
Anterior - Suprapatellar
Medial and lateral- Supracondylar
• Forms quadriceps bar
• Gives good suspension
• Indication- short stump and genu
recurvatum
35

36. Bent Knee Socket
• Indication– Patients
having flexure
contracture of the knee
joint
• Up to 20 ° can be
accommodated
36

37. Interface Materials
• A material that separates the limb from socket
Advantages:
Provide extra layer of cushioning
 Provide shock absorption
 Mitigate shear forces
 Wicks away moisture
Types
Socks and sheaths
Soft inserts
Inner gel foams
Flexible inner socket (expandable wall sockets)
37

38. Suspension
• The method by which the prosthesis is held to the limb
• Is designed according to activity level, comfort and
safety
• More than one technique can be used simultaneously
 Types: Waist belt, joints and corset, cuff strap,
supracondylar suspension, sleeve, suction, locking
liners, semirigid locking liner
 Pistoning is a motion between socket and limb that
occurs because of a faulty or inadequate suspension
system
38

39. 39

40.  Osseous Integration
• Direct structural and
functional connection
between living bone and a
prosthetic device.
• Surgically implant a rod
in the bone that can
connect to any prosthesis
through an external
connection
• No need of a traditional
socket-type prosthesis
40

41. Shin Piece /shank/pilon/
• A leg substitute
• Restores length and shape
Types:
1. Endoskeletal
• Functional parts are
located deep
 Has pylon (shape of
skeleton)
 Exterior part formed of
foam/latex in shape of leg.
 2. Exoskeletal
• Moulded Hard plastic shell
41

42. terminal device(Ankle foot assembly)
• Types
Solid ankle cushion heel (SACH)
Single axis foot
Multi axis foot
Solid ankle flexible keel foot
Energy storing foot
42

43. Transtibial prosthesis
Immediate post operative
prosthesis
• Temporary prosthesis given on
conclusion of amputation
• Supported weight bearing for early
mobility
• C/I: excessive soft tissue damage or
delayed wound healing
Advantages:
 Reduces edema and pain
 Prevents contracture and muscle atrophy
 Reduce chance of phantom pain
 Speeds up rehabilitation
• Disadvantage- increased wound gaping,
delayed wound healing 43

44.  Rigid removable dressings
(RRDs)
– Custom-molded plaster
socket or adjustable
prefabricated plastic socket
– Applied from the distal end
to approximately two-
thirds of the thigh
– Advantages: control
postoperative edema,
protects from exterior
trauma, prevent contracture
44

45. Transfemoral prosthesis
Components
• Foot-ankle assembly
• Shank
• Knee unit
• Socket
• Means of suspension
45

46. Knee Unit
 Classified based on axis, stance phase
control, and swing phase control
mechanisms.
I. Axis
A- Single-axis knee units
• Has a transverse hinge
• Allows flexion and extension
• Light weighted, durable
• For patients with primary residual
limb who can voluntary stabilize
the knee through active hip
• Not good for pts having short stump
46

47. B- Polycentric knee joint
• Has a moving centre of rotation
Advantages:
 Has inherent stance phase
stability- For short stump and hip
extensor weakness patients
 Shortening of distal prosthesis
during swing phase, enhancing
toe clearance- for long residual
limb or knee disarticulation
patients
Disadvantage: Less durable
47

48. II- Stance Control
A- Manual locking knee units
• Single axis knee with a locking
mechanism
• Automatically locks when knee is fully
extended
• Patient walks with a stiff knee
• Slightly shorter to facilitate foot
clearance
• Indications: Pts with weak hip
extensors, weak balance, endurance,
cooperation, occupations require
prolonged standing.
48

49. B- Weight activated stance
control
• Has braking mechanism when weight is
applied
• Brake stabilized during early stance phase
• Brake disengaged during late stance and
swing phase (After complete knee
extension)
• Adjustable according to individual pattern
• Acts like single unit in swing phase
Indications: Pts with recent amputation,
short residual limbs, extensor weakness,
poor balance 49

50. III- Swing phase Control
A- Extension Aid
• A strip of elastic webbing attached to the front of the
socket and proximal shank.
• During swing phase the webbing recoils, exerting an
extension force
50

51. Swing phase Control
B- Hydraulic Knee Units
• Regulates the swing of the shank according to
the walker’s speed.
• Provides frictional resistance by the flow of
hydraulic fluid
• Variable resistance provides almost a normal
gait
• SNS system – swing and stance control
system – weight bearing stance control and
swing phase control
• Expensive, heavy, higher maintenance,
difficulty during cold time
51

52. C- Pneumatic knee prosthesis
• Functions like hydraulic but uses air
• Less weight , less maintenance & less expensive
• Less precise cadence control than hydraulic b/c air is less
dense
D- Microprocessor knee units
• Electronic sensors monitor the action of hydraulic knee
units
• Monitors swing and ground force during stance.
• Sensors measure angles, moments of force, and pressures
• Enables more natural movements
• Disadvantages: more expensive, can’t bear heavy loads,
less resistant to hazardous environments
52

53. UPPER LIMB
PROSTHESIS
53

54. Functional Prosthesis of Upper Limb
A- Passive Functional Prostheses and
Restorations
• Do not have the ability to actively
positioning
• Passive- refers to the mechanical operation of
the parts
• Are extremely functional in terms of
supporting objects or stabilizing items during
bimanual tasks and activities
• Important for social integration and
psychosocial well-being.
• Are light weighted, need less suspension,
realistic-appearing
54

55. B- Active functional Prosthesis of Upper
Limb
 Body powered prosthesis
 Electrically powered prosthesis (Myoelectric
prosthesis)
Switch control prosthesis
 Hybrid prosthesis
 Activity specific prosthesis
55

56. 1. Body-powered prosthesis
• Uses a control cable system to translate
volitional muscle force and arm movement
to operate the TD and/or prosthetic elbow
• A common type of prosthesis
• Their mechanics depend on proprioceptive
feedback through the harness system.
• Both force and excursion are necessary to
operate their components
• Advantage: Durable , easier to maintain,
often weigh less, moderate cost, Variety of
TD, Sensory feedback
• Disadvantage: limited the range of motion
due to harness, high energy expenditure, less
cosmetic
56

57. Components: Socket, Suspension, Control-cable
system, Terminal device, joints according to the
level of amputation
57

58. 2.Electrically powered prosthesis
• The control system includes the
input devices and the controller
• The controller translates the
signal from the input device to
the correct command then
transmits the commands to the
motor in the electric component
• MES is the small electrical
activity generated by the ionic
activity of the contracting
muscles and detected by surface
electrodes.
58

59. • Muscle sites for electrodes are
based on the level of amputation,
socket design, muscle action
• Hands: single degree of freedom or
multiple degree of freedom
• Advantages: cosmesis, Increased
prosthesis use, Psychosocial
adaptation, reduction of phantom
limb pain intensity, strengthening
of muscle tone, comfort, no/less
harness
• Disadvantage: Heavy, expensive,
more maintenance, more training
time, limited sensory feedback
59

60. Types of EPP
 Single Site Control: Uses 1 electrode to control both
functions of a paired activity : Flexion/Extension,
Supination/Pronation
• Used when limited muscles are available in a residual
limb.
 Dual Site contol: Separate electrodes for paired
prosthetic activity.
• It is more physiological and easier to control than SSC
 Pattern Recognition Control: Connects multiple MES to
produce muscle activation patterns
• Closer to true intuitive control and more consistency of
performance
• It eliminates the need for mode selection
60

61. 3.Switch control systems
• Utilize small switches to operate the electric motors.
• Require extremely small excursion and a force in
fractions of pounds
• A switch activated by:
– Movement of a remnant digit or
– Part of a bony prominence against the switch or
– Pull on a suspension harness
• A good option when myoelectric control sites are not
available, when the patient can not master
myoelectric control, early postoperative fittings, with
limited ROM or strength.
• Limitation: Absence of proportional control
61

62. 4.Hybrid prosthesis
• Integration of technology from both the body-
powered and externally powered systems
• Allows simultaneous control of the elbow and
terminal device and most commonly is
simplified with the use of a body-powered
elbow, electrical terminal device and wrist.
• Reduced weight of the prosthesis
• A wider selection of prosthetic components
62

63. 5.Activity specific prosthesis
• Designed for a specific activity
• Quick disconnect wrists allow for a myriad
of options in place of the existing TD
• Allow patients to resume meaningful
activities and help life ‘‘return to normal’’ in
a tangible way.
63

64. Prosthetic Complication
• Choke syndrome
• Skin problems -contact dermatitis
-Cysts and excess sweating
-scar
• Painful residual limb
• Pistoning
• Foot alignment abnormalities- inset foot,
outset foot
64

65. References
65

66. 66