Orthotics
Encyclopedia
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- "Orthotist", "orthopaedic brace" and "ankle-foot orthotic (AFO)" redirect here, where they are dealt with in their respective sections.
Orthotics (Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
: Ορθός, ortho, "to straighten" or "align") is a specialty within the medical field concerned with the design, manufacture and application of orthoses. An orthosis (plural: orthoses) is an orthopedic device that supports or corrects the function of a limb or the torso. An orthopaedic brace, "appliance", or simply brace is an orthopaedic device used to:
- Control, guide, limit and/or immobilize an extremity, jointJointA joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...
or body segment for a particular reason - To restrict movement in a given direction
- To assist movement generally
- To reduce weight bearingWeight bearingIn orthopedics, weight-bearing is the amount of weight a patient puts on the leg on which surgery has been performed. In general, it is described as a percentage of the body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.After...
forces for a particular purpose - To aid rehabilitation from fractures after the removal of a cast
- To otherwise correct the shape and/or function of the body, to provide easier movement capability or reduce pain
It combines disciplines of study within the health and physical sciences; mathematics and materials engineering, gait analysis, anatomy and physiology, pathophysiology
Pathophysiology
Pathophysiology is the study of the changes of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting from an abnormal syndrome...
, biomechanics and psychology contribute to the work of orthotists (professionals in the field of orthotics). Patients benefiting from an orthosis have sustained a physical impairment such as a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
or a congenital abnormality like spina bifida
Spina bifida
Spina bifida is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through...
or cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
. Corrective shoe insert
Shoe insert
A shoe insert is a removable insole which accomplishes any of a number of purposes, including daily wear comfort, foot and joint pain relief from arthritis, overuse, injuries, and other causes, orthopedic correction, smell reduction, athletic performance, or even increasing the wearer's height or...
s are popularly known as orthotics. Certified pedorthic practitioners (known as pedorthists) are specialists in foot orthotics (pedorthics).
An orthosis is intended to mechanically compensate for a pathological condition. In the 1970s, an effort was put forth to classify orthoses by their function and acronyms describing the joints that are encumbered by the orthoses were proposed by a group of American professionals involved in the field of orthotics- from this effort sprung the current nomenclature : AFO- ankle foot orthosis, TLSO-thoracolumbosacral orthosis, WHO- wrist hand orthosis, etc. The nomenclature caught on, but the more tedious effort to describe the function of the orthosis; assist dorsiflexion at ankle, limit wrist flexion to 10 degrees, resist thoracolumbar rotation did not get as much mileage due perhaps to its semantic difficulty in prescription formulation.
Canada
A Certified Orthotist (or CO(c)) is an orthotist who has met the highest standards set by the Canadian Board for Certification of Prosthetists and Orthotists (CBCPO) and maintains certification through mandatory continuing educationContinuing education
Continuing education is an all-encompassing term within a broad spectrum of post-secondary learning activities and programs. The term is used mainly in the United States and Canada...
programs and adherence to the CBCPO's Code of Ethics.
A Certified Pedorthist, or C. Ped(C) (Canadian Certified Pedorthists), specializes in foot orthotics and footwear. Pedorthists are specially trained in the assessment of lower-limb anatomy and biomechanics. With specialized education and training in the design, manufacture, fit and modification of foot orthotics and footwear pedorthists help to alleviate pain, abnormalities and debilitating conditions of the lower limbs and feet that (if left untreated) could result in limited mobility.
In Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, to become certified as a pedorthist a bachelors degree in kinesiology
Kinesiology
Kinesiology, also known as human kinetics is the scientific study of human movement. Kinesiology addresses physiological, mechanical, and psychological mechanisms. Applications of kinesiology to human health include: biomechanics and orthopedics, rehabilitation, such as physical and occupational...
is generally required, followed by a postgraduate degree (a diploma in pedorthics from the University of Western Ontario
University of Western Ontario
The University of Western Ontario is a public research university located in London, Ontario, Canada. The university's main campus covers of land, with the Thames River cutting through the eastern portion of the main campus. Western administers its programs through 12 different faculties and...
). This is followed by a rigorous internship program and a two-part clinical and practical examination. The clinician's duties include gait analysis
Gait analysis
Gait analysis is the systematic study of animal locomotion, more specific as a study of human motion, using the eye and the brain of observers, augmented by instrumentation for measuring body movements, body mechanics, and the activity of the muscles. Gait analysis is used to assess, plan, and...
, casting
Casting
In metalworking, casting involves pouring liquid metal into a mold, which contains a hollow cavity of the desired shape, and then allowing it to cool and solidify. The solidified part is also known as a casting, which is ejected or broken out of the mold to complete the process...
, measuring, fabricating and fitting
Fitting
Fitting can refer to:* A dress fitting.* Any machine, component, piping or tubing part that can attach or connect two or more larger parts. For examples, see coupling, compression fitting or piping and plumbing fittings....
orthotic devices.
United Kingdom
UK orthotists design and fit orthoses for all parts of the body, and are registered with the Health Professions CouncilHealth Professions Council
The Health Professions Council is a statutory regulator of 210,000 health professionals from 15 professions in the United Kingdom. It was set up in 2003 under the National Health Service Reform and Health Care Professions Act 2002, to replace the Council for Professions Supplementary to Medicine ....
. The training is a Bsc.(Hons) in Prosthetics and Orthotics at either the University of Salford
University of Salford
The University of Salford is a campus university based in Salford, Greater Manchester, England with approximately 20,000 registered students. The main campus is about west of Manchester city centre, on the A6, opposite the former home of the physicist, James Prescott Joule and the Working Class...
or University of Strathclyde
University of Strathclyde
The University of Strathclyde , Glasgow, Scotland, is Glasgow's second university by age, founded in 1796, and receiving its Royal Charter in 1964 as the UK's first technological university...
. New graduates are therefore eligible to work as an orthotist and/or prosthetist
Prosthetist
A prosthetist, as defined by , is a person who measures, designs, fabricates, fits, or services a prosthesis as prescribed by a licensed physician, and who assists in the formulation of the prosthesis prescription for the replacement of external parts of the human body lost due to amputation or...
.
United States
A licensed orthotist is an orthotist who is recognized by the particular state in which s/he is licensed to have met basic standards of proficiency, as determined by examination and experience to adequately and safely contribute to the health of the residents of that state. An "ABC" or American Board of Certification certified orthotist has met certain standards; these include a degree in orthotics, completion of a one-year residency at an approved clinical site, and passing a rigorous three-part exam. A Certified Orthotist (CO) is an orthotist who has passed the certification standards of the American Board of Certification in Orthotics & Prosthetics.Time changes
Orthoses were traditionally made by following a tracing of the extremity with measurements to assist in creating a well fitted device. Later the advent of plastics as a material of choice for construction necessitated the idea of creating a plaster of Paris mold of the body part in question. This method extensively is still used throughout the industry. Later changes were introduced and CAD/CAMComputer-aided manufacturing
Computer-aided manufacturing is the use of computer software to control machine tools and related machinery in the manufacturing of workpieces. This is not the only definition for CAM, but it is the most common; CAM may also refer to the use of a computer to assist in all operations of a...
played its part in manufacturing.
Materials
Braces are made from various types of materials—plastic, elastic, metal, or a combination of similar materials. Some designs may be purchased at a local retailer; others are more specific and require a prescription from a physician, who will fit the brace according to the patient's requirements. Over-the-counter braces are basic and available in multiple sizes. They are generally slid on or strapped on with Velcro, and are held tightly in place. The purpose of these braces is injury protection.Upper-limb orthoses
Upper-limb (extremity) orthoses are devices applied externally to restore or improve functional and structural characteristics of the musculoskeletal and nervous systems. In general, musculoskeletal problems include those resulting from trauma, sports, and work-related injuries.- Static orthoses - As the term implies, these devices do not allow motion. They provide rigid support for fractures, inflammatory conditions of tendons and soft tissue, and nerve injuries
- Dynamic/functional orthoses - In contrast to static orthoses these devices permit motion, on which their effectiveness depends. These types of upper-extremity orthoses are used primarily to assist movement of weak muscles. Some dynamic splints have a dual or bilateral mechanism for providing tension, safely accommodating moments of spasm and thus limiting (or avoiding) soft-tissue injuries
Types of upper-limb orthoses
- Upper-arm orthoses
- Clavicular and 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)
Lower-limb orthotics
A lower-limb orthosis is an external device applied (or attached) 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.Foot orthotics
Orthotics—comprising a specially fitted insert for the insole or footbed, and providing support for the foot only—are often used, especially by athletes.Ankle-foot orthosis (AFO)
Ankle
The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus bone in the foot...
and at least part of the foot. AFOs are externally applied and intended to control position and motion of the ankle, compensate for weakness, or correct deformities. They control the ankle directly, and can be designed to control the knee joint indirectly as well. AFOs are commonly used in the treatment of disorders affecting muscle function such as stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
, muscular dystrophy
Muscular dystrophy
Muscular dystrophy is a group of muscle diseases that weaken the musculoskeletal system and hamper locomotion. Muscular dystrophies are characterized by progressive skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells and tissue.In the 1860s, descriptions of boys who...
, cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
, polio, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
and peripheral neuropathy
Peripheral neuropathy
Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of or trauma to the nerve or the side-effects of systemic illness....
. AFOs can be used to support wasted limbs, or to position a limb with contracted muscles into a more normal position. They are also used to immobilize the ankle and lower leg in the presence of arthritis or fracture, and to correct foot drop
Foot drop
Foot drop is the dropping of the forefoot due to weakness, damage to the peroneal nerve or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. It is characterized by the inability or difficulty in moving the ankle...
; an AFO is also known as a foot-drop brace.
Ankle-foot orthoses are the most commonly-used orthoses, making up about 26% of all orthoses provided in the United States. According to a review of Medicare payment data from 2001 to 2006, the base cost of an AFO was about $500 to $700. An AFO is generally constructed of lightweight polypropylene-based plastic in the shape of an "L", with the upright portion behind the calf and the lower portion running under the foot. They are attached to the calf with a strap, and are made to fit inside accommodative shoes. The unbroken "L" shape of some designs provides rigidity, while other designs (with a jointed ankle) provide different types of control.
Obtaining a good fit with an AFO involves one of two approaches:
- provision of an off-the-shelf or prefabricated AFO matched in size to the end user
- custom manufacture of an individualized AFO from a positive model, obtained from a negative cast or the use of computer-aided imaging, design, and milling. The plastic used to create a durable AFO must be heated to 400°F., making direct molding of the material on the end user impossible
The International Red Cross evidently believes there are four major types of AFOs:
| Flexible AFOs | Anti-Talus AFOs | Rigid AFOs | Tamarack Flexure Joint |
|---|---|---|---|
| may provide dorsiflexion Dorsiflexion Dorsiflexion is the movement which decreases the angle between the dorsum of the foot and the leg, so that the toes are brought closer to the shin. The movement moving in opposite directions is called plantarflexion... assistance, but give poor stabilization of the subtalar joint Subtalar joint In human anatomy, the subtalar joint, also known as thetalocalcaneal joint, is a joint of the foot. It occurs at the meeting point of the talus and the calcaneus.-Motion:... . |
block ankle motion, especially dorsiflexion; do not provide good stabilization for the subtalar joint. | block ankle movements and stabilize the subtalar joint; may also help control adduction Adduction Adduction is a movement which brings a part of the anatomy closer to the middle sagittal plane of the body. It is opposed to abduction.-Upper limb:* of arm at shoulder ** Subscapularis** Teres major** Pectoralis major** Infraspinatus... and abduction Abduction (kinesiology) Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction.-Upper limb:* of arm at shoulder ** Supraspinatus** Deltoid* of hand at wrist... of the forefoot. |
provide subtalar stabilization while allowing free ankle dorsiflexion and free or restricted plantar flexion, depending upon the design; may provide dorsiflexion assistance to correct foot drop. |
The International Committee of the Red Cross published its manufacturing guidelines for ankle-foot orthoses in 2006. Its intent is to provide standardized procedures for the manufacture of high-quality modern, durable and economical devices to people with disabilities throughout the world.
Knee-ankle-foot orthosis (KAFOs)
A knee-ankle-foot orthosis (KAFO) is an orthosis that encumbers the knee, ankle and foot. Motion at all three of these lower limb areas is affected by a KAFO and can include stopping motion, limiting motion, or assisting motion in any or all of the 3 planes of motion in a human joint: saggital, coronal, and axial. Mechanical hinges, as well as electrically controlled hinges have been used. Various materials for fabrication of a KAFO include but are not limited to metals, plastics, fabrics, and leather. Conditions that might benefit from the use of a KAFO include paralysis, joint laxity or arthritis, fracture, and others.Altho not as widely used as knee orthoses, KAFOs and HKAFOs can make a real difference in the life of a paralyzed person, helping them to walk therapeutically or, in the case of polio patients on a community level. These devices are expensive and require maintenance. Some research is being done to enhance the design, even NASA helped spearhead the development of a special knee joint for KAFOs
Knee orthosis (KO)
A knee orthosis (KO) or knee brace is a brace worn to strengthen the knee. It is worn around the knee, and works by relieving pressure from the part of the knee joint affected by diseases such as arthritisArthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
or osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...
. It also supports the knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
, and provides the stability needed to perform daily activities. Knee braces may also help to properly align the knee to help reduce osteoarthritis pain. If pain or instability is experienced, a knee brace may be appropriate. It is not meant to treat arthritis, injury or osteoarthritis on its own, but is used as a component of treatment along with drugs and physical therapy. It is beneficial in several ways; when used properly, a knee brace may help an athlete to stay in training. Knee braces may also help by improving symmetry
Symmetry
Symmetry generally conveys two primary meanings. The first is an imprecise sense of harmonious or aesthetically pleasing proportionality and balance; such that it reflects beauty or perfection...
, enhancing the position and movement of the knee while reducing pain so a person may remain active.
Individuals who cannot undergo surgery may also consider a knee brace to help them deal with acute or chronic pain. Although a knee brace is not a substitute for orthopedic surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
, it may be effective for young people. It is also effective where only one side of the knee is experiencing pain. This condition may develop if a person's alignment is incorrect, and weight is being placed on one side of the knee more than the other. A general knee-rehabilitation program (including strengthening and flexibility exercises, aerobic
Aerobics
Aerobics is a form of physical exercise that combines rhythmic aerobic exercise with stretching and strength training routines with the goal of improving all elements of fitness...
conditioning, technique refinement and proprioceptive
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
retraining) is the most important factor in improving knee function and stability.
Prophylactic, functional and rehabilitation braces
Prophylactic braces are used primarily by athletes participating in contact sports. While it is possible that this type of brace will alter the force on the knee and become problematic, when worn properly it decreases the rate of injury. The majority of these braces are made of neopreneNeoprene
Neoprene or polychloroprene is a family of synthetic rubbers that are produced by polymerization of chloroprene. Neoprene in general has good chemical stability, and maintains flexibility over a wide temperature range...
. It acts as a sleeve, providing support to the structure of the knee and reducing the knee's ability to rotate.
Functional braces are designed for use by people who have already experienced a knee injury and need support to recover from it. They are also indicated to help people who are suffering from pain associated with arthritis. They are intended to reduce the rotation of the knee and support stability. They reduce the chance of hyperextension, and increase the agility and strength of the knee. The majority of these are made of elastic. They are the least expensive of all braces and are easily found in a variety of sizes.
Rehabilitation braces are used to limit the movement of the knee in both medial and lateral directions. They are primarily used after injury or surgery to immobilize the leg. They are larger in size than other braces, due to their function.
Unloader Braces
The unloader brace was developed by a Canadian company, Generation II. Originally, the knee orthosis design that became the custom unloader brace was a functional knee brace for use by athletes. Their single upright design lent itself well to use by individuals with unicompartmental arthritic knee pain. The idea was that the brace could shift the weight bearing vector when walking off of the painful intercondylar area onto the other intercondylar area. The company enjoyed success with their design, even trademarking the term "unloader" brace. The company sold to OssurOssur
Össur is a company making non-invasive orthopaedics. It makes and sells bracing and support products, compression therapy, and prosthetics. The company’s headquarters are in Reykjavík, Iceland. The company also has extensive operations in the Americas, Europe, and Asia, with numerous distributors...
of Iceland, but the market they created is vigorous with multiple competitors.
Spinal orthoses
There are a number of spinal orthotic designs common to assist individuals with pathologies of the neck and back.The term TLSO has come to indicate a plastic body jacket to immobilize the thoracolumbar spine, although that term describes any type of orthosis that encumbers the trunk, ranging from soft corsets to metal braces to strap and pad designs that affect pathologies ranging from back pain to scoliosis to fracture.
The condition known as scoliosis, a curvature of the spine, is treated with spinal orthoses, such as the Milwaukee brace
Milwaukee brace
The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace used in the treatment of spinal curvatures in children. It is a full-torso brace that extends from the pelvis to the base of the skull...
, the Boston brace, and Charleston bending brace. Generally, this condition is found in adolescent females who have great concern about the appearance and restriction the various orthoses prescribed to address the condition present.
The halo brace (also known as a halo ring, halo vest or halo crown) is a cervical thoracic orthosis brace used to immobilize the cervical spine, usually following fracture. The halo brace allows the least cervical motion of all cervical braces currently in use, it was first developed by Dr. Vernon L. Nickel at Rancho Los Amigos National Rehabilitation Center
Rancho Los Amigos National Rehabilitation Center
Rancho Los Amigos National Rehabilitation Center is a rehabilitation hospital located in Downey, California, United States. Its name in Spanish means "Friend's Ranch". It is accredited by the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities...
in 1955.
See also
- Cognitive orthoticsCognitive orthoticsCognitive orthotics are software-based personal reminder systems for people with cognitive impairment, such as memory loss. People who can benefit include the elderly, people who have experienced traumatic brain injury, and anyone who experiences memory loss. These devices may be installed on...
- Dental braceDental braceDental braces are devices used in the orthodontic industry that help align and straighten teeth and help to position them with regard to a person’s bite, while also working to improve dental health...
- Orthotic Horseshoes
External links
- Ankle-foot orthosis definition
- Theory and Practice Combine for Custom Orthotics
- A Patient's Guide to Back and Neck Braces, from University of Maryland Spine Program
Halo Brace