1. POLIOMYELITIS

Poliomyelitis is a viral infection of nerve cells in the anterior gray matter of the spinal cord, leading temporary or permanent paralysis of the muscles that they activate.

Cause:

It is caused by infection with a polio virus.

Sign & symptoms:

Fever

Permanent motor paralysis-Flaccid

Irreversible muscle atrophy

Paralysis in lower limb (gluteus medius, gluteus minimus, quadriceps, tibialis anterior, triceps surae)

Complications:

Drop foot

Genu valgum with pes cavus

Severe wasting of thigh and lower leg

External rotation of foot on leg

LLD

Trendelenburg gait adopt to counter gluteus medius weakness

Hyperlordosis to counteract gluteus maximus weakness

If not treated it may lead to:

Hip abduction contracture

Knee flexion contracture

Ilio tibial band contracture

Long C cure scoliosis

Pelvic obliquity

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

HKAFO- If hip flexor/ extensor are weak, hip adduction abduction weakness.

Ischial bearing KAFO – If femoral bone fractures, femoral head dislocation along h

Along with hip flexors, extensors weakness

KAFO- If knee extensors/extensor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weaknes

In case of AFO- If muscle grading is 3- , Solid AFO

- If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint

If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

KAFO with different joints

Free Knee: This design is provides medial-lateral stability to knee joint while allowing free motion in flexion and extension.

Posterior Offset Knee Joint: The posterior offset knee joint is used to aid in knee extension for those patients who exhibit minimal quadriceps weakness. The placement of the mechanical knee joint is just posterior to the anatomical knee joint providing for increased knee stability when walking.

Stance Control: Provide for stability during weight bearing and free flexion (bending) during the swing phase of gait or non-weight bearing. Allowing the knee to bend during the swing phase of gait provides for a more normal gait pattern, is more energy efficient. Locked Knee: Provide maximum stability to the patient. These orthoses are locked during the entire gait cycle and can be unlocked for sitting. The locking mechanism is done by a drop lock, bail or French lock, or trigger lock.

Drop Lock: This design incorporates a ring that slides down over the knee joint providing for a mechanical lock.

Bail or French Lock: This style of knee joint incorporates a loop that connects the posterior of both knee joints. Rather than locking each knee joint individually this allows both to be unlocked via a bail or loop design.

Trigger Lock: A trigger lock design is similar to the bail or French lock. This design often uses cables and a trigger switch allowing patients to unlock the knee joint via a point at the proximal edge of the orthosis. It is commonly used for patients with limited dexterity, balance and for increased safety and stability.

AFO

Posterior Leaf Spring–PLS: Allow the patient to overpower the orthosis during the push-off or plantar flexion phase and yet allowing dorsiflexion position of the foot during swing phase. It is typically used for flaccid foot drop.

Semi-rigid plastic AFO -with trim lines just behind the malleoli will allow for increase dorsiflexion of the foot and mediolateral stability of the ankle. This design is most commonly used for patients that have foot drop with some extensor tone and/or with mediolateral instability of the ankle.

Rigid or solid plastic AFO – The trim line at the malleoli or anterior to the malleoli with no motion allowed at the tibiotalar or subtalar joint. This orthosis is typically used for patients with the highest levels of spasticity, early to moderate Charcot joint, and for postoperative immobilization of the foot or ankle.

2. BURN

A burn is a type of injury that may be damaged the muscle, bone, blood vessel, nerve and epidermal tissue.

Causes:

Heat, steam, electricity, chemicals, light, radiation

Sign & symptom:

Redness

Painful on touching

Formation of blister

Loss of soft tissue

Gangrene

Complication:

Infection

Septicemia

Contracture

Functional or cosmetic damage

If not treated the complication may lead to:

Amputation

Deformity (contracture of joint, contracture of muscles)

Dupuytren's deformity

Orthotic/Prosthetic treatment:

Burn usually lead different contracture, so according to location of burn severity of deformity the orthotic treatment should be given. If the amputation done as secondary complication (septicemia), the prosthesis should be given according to the level of amputation. The main purpose of the orthotic treatment is to prevent further potential deformity and to get functional activities.

Orthosis - AFO, KO, EWHO, WHO

Prosthesis-Partial foot, TTP, TFP, TRP, THP

3. CLUB FOOT

A clubfoot, or talipes equinovarus (TEV), is a birth defect & commonly occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. This occurs in males more often than in females. The ratio is 2:1

Causes:

Genetic factors

Sign & symptoms:

High arched foot that may have a crease across the sole of the foot.

Heel is drawn up.

Toes are pointed down.

Bottom of the foot (heel) is pointed away from the body thus, the foot is twisted in the Foot and leg may be smaller in comparison to a comparatively normal child.

Foot will lack motion and be noticeably stiff.

Calf muscle may also be smaller.

Complications:

Arthritis

Affected foot may up to 1 ½ shoe size smaller than unaffected foot

May walk on the balls of the feet the outside of the feet or even the top of the feet in severe cases.

The patient may also experience corns, hard skin and in growing toenails.

If not treated, the complication may lead to:

Fixed talipes equinovarus

The main purpose of orthotic treatment

Correct the deformity early.

Correct the deformity fully

Hold the correction until growth stops.

Orthotic treatment:

Dennis Brown splint-Straight-last shoes separated by a metal bar keep the calcaneus in valgus, the forefoot in abduction and the ankle dorsiflexed - all in an attempt to straighten out the child with Club Foot. AFO

KAFO -90 degree flexion

4. CEREBRAL PALASY

Cerebral palsy is a group of disorders characterized by loss of movement or loss of

Other nerve functions.

Type:

Spastic- most common

Athetotic-5:1 ratio

Ataxic-Least common

Causes:

Idiopathic

Injuries to the brain (cerebrum) –during fetal development or near the time of birth

Premature delivery

Sign & symptoms:

Usually apparent before age 2 and in severe cases may appear as early as three months.

Delayed development of motor skills, such as reaching, sitting, rolling, crawling, walking

Mental retardation

Speech Visual hearing abnormalities

Spasticity

Limited range of motion

Muscle contractions

Difficulty sucking or feeding

Complications:

Fall injury/ Accident

Reduced mental functions

Progressive joint contracture

Limited ROM

If not treated the complication may lead to:

Upper limb- Flexion contracture of the elbow, pronation deformity of the forearm. Flexion of the wrist, and adduction of the thumb.

Lower limb- adduction of the hip, flexion of the knee, and equines of the ankle.

Orthotic treatment:

The main purposes of orthotic treatment are to prevent from potential deformities & provide mobility.

Type and design of orthosis is depend on MUSCLE GRADING, RANGE OF MOTION & JOINT STABILITY.

HKAFO

KAFO

AFO

WHO

EWHO

Compensation should provided as required in case of LLD, equinus

AFO -are provided to support, proper joint alignment to the foot and ankle, assist or substitute for muscle weakness, and protect the foot and lower limb. Different type of AFOs can used according to need these are Semi-Solid AFO, Solid Ankle Foot Orthosis, Articulated Ankle Foot Orthosis.

KAFO:

These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these are

Free Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Bail or French Lock, Trigger Lock

5.FRACTURE

Fracture is a break in a bone causing loss of continuity in its alignment

The severity of fractures increase with age. Children's bones are more flexible and less likely to break. Older adults suffer from fractures more than children because their bones are more likely to be brittle. There are many types of fractures: simple, stress, comminuted, impacted, compound, complete and incomplete.

Symptoms:

Swelling

Loss of function

Bruising

Deformity of a limb

Causes:

Fractures occur when a bone can't withstand the physical force exerted on it.

Complications:

Septicemia

Gangrene

Loss of movement

Instability

If not treated complication may lead to:

Amputation

Arthritis

Leg length discrepancy

Ortho/prosthetic treatment:

The main purpose of orthotic treatment in fracture are to stabilize the fracture site and help promote callus formation by allowing weight bearing and joint movement after initial healing of pain and edema. It helps in minimize joint stiffness and reduce complications such as nonunion. Circumferential compression of the soft tissue can be used to prevent undue bony motion at the fracture site.

Fracture Orthosis- Fracture braces according to location and severity of fracture

PTB weight bearing fracture orthosis if fracture of tibia

Ischial weight bearing fracture orthosis if fracture of femur

Prosthesis (If fracture leads to amputation) — PF, TTP, TFP, HD, TR, TH

6. MUSCULAR DYSTROPHY

It is a group of genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles which control movement. There is no specific treatment for any of the forms of muscular dystrophy.

Types of muscular dystrophy are:

Duchenne muscular dystrophy- Onset is between 3-5 years and progresses rapidly. Most boys become unable to walk at age12 and their life expectancy usually not more than 20.

Facioscapulohumeral muscular dystrophy- appears in adolescence and causes progressive weakness in facial muscles and certain muscles in the arms and legs. It progresses slowly.

Myotonic muscular dystrophy- characterized by prolonged muscle spasm in the fingers and facial muscles; a floppy-footed, high-stepping gait; cataracts; cardiac abnormalities; and endocrine disturbances.

Complications:

Joint contracture

Foot drop

If not treated the complication may lead to:

Equinus

Lordosis

LLD

Scoliosis

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

Semi-rigid plastic AFO with trim lines just behind the malleoli will allow dorsiflexion of the foot and mediolateral stability of the ankle.This design is most commonly used for patients that have foot drop with some extensor tone and/or with mediolateral instability of the ankle. During independent ambulation, interventions generally should be confined to nighttime. AFO in an attempt to slow the progression of Equinus contractures.

KAFO- These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these are

Free Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Bail or French Lock, Trigger Lock

Compensation should be adjusted if there leg length discripency.

7. SPINA BIFIDA

Spina bifida (SB) is a neural tube defect, involving incomplete development of the brain, spinal cord, and/or their protective coverings. The most common location of the malformations is the lumbar and sacral areas of the spinal cord.

Myelomeningocele is the most significant form and it leads to disability in most affected individuals. The terms spina bifida and myelomeningocele are usually used interchangeably

Causes:

Failure of the fetus's spine to close properly during the first month of pregnancy.

Sign & symptoms

Sign & symptoms are appear according to location of the affect on spine

Permanent damage of nerve leads to paralysis of lower limb.

Weakness of lower limb

Difficult to keep spine in erect position

Bowel and bladder problem

Curvature of spine

Intellectually disable

Complications:

Paralysis (partial or complete)

Bowel and bladder uncontrolled

Orthopedic problems - scoliosis, kyphosis and clubfoot

Flexion contracture

Orthotic treatment:

Patients will require lifelong assistance from wheelchairs, braces, or crutches to help them get around.

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

SPINAL ORTHOSIS

AFO

KAFO

HKAFO

HKAFO-The orthosis consists of two-molded plastic knee-ankle-foot Orthoses (KAFO) attached to a metal pelvic control band and upright thoracic supports. The posterior section of the pelvic band/thoracic component is fit with either a rocker bar system or cable system. Both function in a similar manner; the rocker system functions much like a seesaw. Shifting weight from one side of the body to the other allows one limb to be stable on the ground while advancing the contra lateral limb

KAFO: These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these are Free Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Bail or French Lock, Trigger Lock

Thoraco-Lumbo-Sacral Orthoses (TLSO): TLSOs or body jackets are fabricated effective for treating thoracic and sacral vertebrae from levels of T7/8-L3-4. They are typically fabricated from hard plastic with a soft interface.

8. MULTIPLE SCLEROSIS

Multiple Sclerosis is a disease of the central nervous system which may affect any area of the brain and spinal cord. Multiple sclerosis does not affect nerve cells but affects on transmission of electrical signals to nerve cells. Multiple sclerosis is the most common cause of chronic neurological disability in young adults.

Causes:

The exact cause is unknown

Inflammation of the nervous system

Sign & Symptoms:

In general it affect on sensory or motor function

Muscle spasm

Fatigue, numbness, tremor, loss of vision, pain, paralysis, loss of balance,

Numbness in the entire body

Complications:

Loss of mobility and spasticity

Osteoporosis

Bowel and bladder dysfunction

Cognitive disorder

Depression

Speech Problems

If not treated complication may lead to:

Joint contracture

Limited ROM

Equinus

LLD

Scoliosis

Orthotic treatment:

The type of orthosis should provided according to ROM, muscle grading and joint stability

If lower limb is affected AFO, KAFO, AFO, KO

If upper limb is affected wrist hand orthosis

If spine is affected spinal orthosis

9. DIABETIC

Diabetes is the results of defects in insulin secretion, insulin action, or both. In diabetes, glucose level increase in blood. Insulin is a hormone that allows blood glucose (blood sugar) to enter the cells of the body and be used for energy.

Sign & symptoms

Excessive thirst

Excessive urination

Extreme hunger

Unusual weight loss

Extreme fatigue

Irritability

Nausea

Vomiting

Sweet smelling breath

Complications:

Rapid bony destruction,

Recurrent ulceration and infection

Heart disease, Kidney disease

Amputation

Stroke

Diabetic retinopathy, diabetic neuropathy

Sciatica

If not treated complication may lead to:

Gangrene, Amputation, Joint contracture, Arthritis

Orthotic /prosthetic treatment:

As soon as the active stage of the disease is recognized, the patient must be immediately and aggressively protected from excess weight bearing. During orthotic or prosthetic treatment of the patient, appliance should be carefully finished and skin friendly soft in liner should be used.

FO-Silicone gel Foot orthosis

AFO-Many of these patients already have trouble in walking, so prefer not to lock the ankle against plantar flexion unless hind foot problems exists. A spring dorsiflexion assist is sometimes useful to reduce foot slap or aid toe clearance. The rocker sole is individualized since these feet are generally ulcer-free due to the weight bearing restrictions.

In case of Prosthesis – Any prosthesis must use skin friendly soft in liner e.g derma seal, silicon gel etc.

10. LEPROSY

Leprosy is an infectious disease characterized by disfiguring skin lesions, peripheral nerve damage, and progressive debilitation. Leprosy is common in many countries in the world

Causes:

Leprosy is caused by the organism Mycobacteriumleprae.

Sign & symptoms:

Decreased sensation to touch, heat, or pain

Skin lesions that do not heal after several weeks to months

Numbness or absent sensation in the hands and arms, or feet and legs

Muscle weakness

Complications

Cosmetic disfigurement

Nerve damage in the extremities

Sensory loss in the skin

Muscle weakness.

Direct injury

Ischemia

Mechanical force on open wound

If not treated complication may lead to:

May lose their hands or feet due to repeated injury resulting from lack of sensation

Amputation

Orthotic treatment:

The leprosy patient usually loss their sensory, so any appliance either orthosis or prosthesis should be made in such a way that there should not be any soft tissue damaged by appliances.

Prosthesis – according to level of limb loss.

Orthosis – according to loss of function and mobility.

11. HEMIPLEGIA

Hemiplegia is a condition in which one-half of a patient's body is paralyzed caused by a disruption in the blood flow to part of the brain.

Causes:

Cerebral palsy

Diabetic

Stroke

Brain tumor

Sign& symptoms:

Aphasia

Ataxia

Difficulty walking

Unable to perform daily task.

Visual impairments

Bladder and bowel problem

Decreased sensation

Memory loss

Depression

Complication:

Deformity of upper limb-flexion contracture of hand

Deformity of lower limb -flexion contracture of ankle, knee, hip

Leg length discrepancy

Pes Equinus

If not treated complication it may lead to:

Upper limb

Lower limb

Clenched fist attitude-Spastic contracture of Hand

Contracture of wrist

Contracture of elbow

Pes Equinus

Knee flexion contracture

Hip flexion contracture

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

For Lower limb

HKAFO- Hip flexion/extension instability,Hip adduction/abduction weakness, Hip internal rotation/external rotation instability

KAFO- If knee extensors/flexor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

HKAFO if Hip flexor or extensor weakness 3- or less.

For upper Limb

Wrist hand orthosis

Elbow wrist hand orthosis

12. PARAPLEGIA

Paraplegia is impairment in motor and/or sensory function of the lower extremities

Causes:

Trauma (acute spinal cord injury)

Tumors (chronic compression of the cord)

Multiple Sclerosis.

Spina bifida

Sign & symptoms:

Weakness of lower limb

Unable to walk

In continence of bowel and bladder

Complications

Lower body paralysis

Bladder & bowel problem

If not treated complication may lead to:

Pressure sores, thrombosis, Pneumonia

Deformities-

Pes Equinus

Knee flexion contracture

Hip flexion contracture

Scoliosis

Lumbar lordosis

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

HKAFO- If hip flexor/ extensor are weak

KAFO- If knee extensors/extensor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint

If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

For Spine:

Spinal orthosis – TLSO

13/14 TETRAPLEGIA/ QUADRIPLEGIA

Involvement of the four limbs, the trunk and the head. The great majority of these individuals will not be able to stand up or walk.

Causes:

Traumatic injury of spinal cord -accident, gunshot wound, fall, or sports injury

Disease- polio or spina bifida

Signs and symptoms

If injury above cervical region-

Motor/ sensory function of upper limbs are lost

Uncontrollable hand motions

Difficulty in Speech, swollen

If injury below cervical region-

Motor/ sensory function of lower limb are loss

Unable to maintain balance body posture

Bowel & bladder problem

Complication:

Aphasia

Ataxia

Difficulty walking

Unable to perform daily task.

Pressure sores, thrombosis, Pneumonia

If not treated complication may lead to:

Upper limb

Lower limb

Spine

Elbow flexion contracture

Wrist flexion contracture

Leg length discrepancy

Pes Equinus

Knee flexion contracture

Hip flexion contracture

Scoliosis

Kyphosis

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

For Lower limb

HKAFO- Hip flexion/extension instability

Hip adduction/abduction weakness

Hip internal rotation/external rotation instability

KAFO- If knee extensors/flexor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

- If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

HKAFO if Hip flexor or extensor weakness 3- or less.

If Leg length discrepancy or Equinus compensation should be given accordingly.

For upper Limb

To protect from potential deformity should treat with

Wrist hand orthosis

Elbow wrist hand orthosis

15. MONOPLEGIA

It is paralysis of one arm or one leg as a result of a brain injury. It is frequently associated with cerebral palsy.

Causes:

Cerebral palsy

Injury to the brain

Sign & symptoms:

Unable to walk properly-(if lower limb affected)

Unable to perform any activity-(if upper limb affected)

Complications:

Contracture-hip, knee, ankle

Spinal problem

Elbow contracture

Wrist contracture

If not treated complication may lead to:

Pes equines

Shortening

Severe contracture

Scoliosis

Loss of function

Orthotic treatment:

For Lower limb

KAFO- If knee extensors/flexor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

- If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

For upper Limb

To prevent from potential deformity should treat with

Wrist hand orthosis

Elbow wrist hand orthosis

16. ARTHRITIS

An inflammation or swelling of the joints. There are many different types of arthritis, the most common being osteoarthritis and rheumatoid arthritis.

There are many kinds of arthritis. Common, arthritis are

Osteoarthritis

Rheumatoid

Gout

Sign & Symptoms:

Joint pain

Joint swelling

Joint stiffness

Tenderness or pain when touching a joint

Problems using or moving a joint normally

Warmth and redness in a joint.

Causes:

Joint instability

Age-related changes

Altered biochemistry

Hormonal factors

Genetic predisposition

Environmental factors

Complications:

Ankle joint MT Joint pain

Knee joint pain

Hip joint pain

Lumber spine pain

Cervical spine pain

Shoulder joint pain elbow joint pain

Wrist and MCP joint pain.

If not treated complication may lead to:

Ankle valgus/varus

Knee valgus/varus

Lumber Spondylosis

Scoliosis/ Kyphosis

Cervical spondylosis

Elbow joint contracture

Hand contracture- boutonniere deformity

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

FO, AFO, KO, KAFO, SO- lumber corset

CO, TLSO, EWHO, WHO

KAFO: These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these areFree Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Trigger Lock

17.SUBLUXATION

A partial abnormal separation of the articular surfaces of a joint. In more technical terms, a subluxation is "a motion segment, in which alignment, movement integrity, and/or physiological function are altered, although contact between joint surfaces remains intact.

According to nature cause subluxation may happen to any joint

Causes:

Congenital

Trauma

Chronic osteoarthritis

Occupational hazards

Muscular weakness

Incorrect weight lifting

Lack of rest

Sign & symptoms:

Sudden pain in the joint,

Swelling of the joint

Deformity of the joint

The joint may not function or painful

Nerves and blood vessels that pass near the joint may be damaged.

Complications:

Degenerative arthritis

Cosmetic deformity

Fracture acetabulum

Fracture head of femur

Femoral head necrosis

If not treated complication may lead to:

Upper limb

Lower limb

Spine

Medial rotational contracture of shouler joint.

Vaglus deformity of elbow

Swan neck deformity finger

Shortening

Lengthening

Genu Recurvatum

Kyphosis

scoliosis

Orthotic treatment:

Orthotic treatment is depend on nature of injury, severity of injury & location of injury.

FOR HIP

Hip abduction orthoses for child: A hip abduction orthosis is designed to be used for infants from 6-8 months of age. This device provides appropriate anatomical alignment to stabilize the hip, promote tightening of loose ligament structures and promote appropriate bone growth. Application of this device is done by three Velcro straps one at the pelvis or waist and two around the thigh cuff.
Hip Abduction Orthosis for Adult: Hip abduction orthoses are designed to maintain appropriate anatomical alignment of the hip or prosthetic hip replacement. The components include a hip/pelvic girdle, thigh cuff, and hip joint. The joints are usually adjustable and set in some degree of flexion and abduction. This alignment positions the head of the femur in the acetabulum allowing for the ligaments, bone, and surrounding musculature to heal

Hip stabilization orthoses: These orthoses are designed to immobilize and stabilize the hip and surrounding soft tissues following operative management for spasticity, contractures, and hip subluxation and dislocation.They allow for hip joint range of motion to be adjusted according to the physician prescription and rehabilitation requirements.

FOR KNEE

Knee orthosis:

Functional knee orthoses help in the stability of the knee joint secondary to ligamentous injury, post-operative reconstruction, meniscus damage, and for prophylactic protection.

These orthoses is designed to provide maximum stability to the knee joint. Knee orthosis are provided according nature of need

Free Knee: This design is provides medial-lateral stability to knee joint while allowing free motion in flexion and extension.

Drop Lock: This design incorporates a ring that slides down over the knee joint providing for a mechanical lock.

Trigger Lock: A trigger lock design is similar to the bail or French lock. This design often uses cables and a trigger switch allowing patients to unlock the knee joint via a point at the proximal edge of the orthosis. It is commonly used for patients with limited dexterity, balance and for increased safety and stability.

FOR ANKLE

AFOs are provided to support, proper joint alignment to the foot and ankle, assist or substitute for muscle weakness, and protect the foot and lower limb.

Semi-Solid AFO: A semi-solid AFO fabricated from plastic is designed to fit inside of a shoe with little effort. It attaches with a Velcro strap and is stabilized by the use of a well-built shoe. Unlike the dorsi flexion assist AFO this orthosis provides more medial-lateral stability and limitation of motion.

Solid Ankle Foot Orthosis (SAFO): a Solid ankle AFO is designed to provide maximum stability of the foot and ankle. This orthosis limits plantar flexion (pointing toes down) and doors flexion (lifting toes up), medial and lateral motions

Articulated Ankle Foot Orthosis (AAFO):This style of orthosis is designed to provide maximum mediolateral stability while allowing plantar flexion (pointing toes down) and dorsi flexion (lifting toes up).

For Upper limb

Shoulder Stabilizer: It aids in prevention of excessive extension and abduction of the shoulder
Elbow orthosis: This orthosis is designed to provide for variable range of motion at the elbow joint.

Thumb Immobilizer Orthosis: This orthosis is designed to limit the motion that occurs at the wrist and thumb
Static WHFO: Static or stationary wrist hand finger Orthoses are designed to prevent contractures by maintaining proper joint alignment and finger position.
Wrist Hand Orthosis (WHO) with adjustable wrist joint: This WHO is designed with a wrist joint that allows flexion/extension of the wrist where appropriate. This orthosis may be used to position the wrist and/or hand in a desired position or help gain range of motion.

For Spine

Soft Collar: This orthosis is made from soft foam and is used to give support and stability to the cervical spine.
Rigid Collar: Some are fabricated with two pieces of Velcro on each side while others are one piece that wrap around the neck secured with one strap.Rigid collars are effective in reducing motion, providing stability and support to the cervical spine

18.DISLOCATION

It is fully luxation of joint or displaced or misaligned. The most often dislocated joint are the shoulder, patella-femoral and ankle.

Causes:
Congenital

Trauma

Chronic osteoarthritis

Occupational hazards

Muscular weakness

Incorrect weight lifting

Lack of rest

Symptoms:

Sudden pain in the joint,

Swelling of the joint

Deformity of the joint

The joint may not function or painful

Nerves and blood vessels that pass near the joint may be damaged.

Complications:

Degenerative arthritis

Cosmetic deformity

Fracture acetabulum

Fracture head of femur

Femoral head necrosis

Loss of mobility/functions

If not treated complication may lead to:

Upper limb

Lower limb

Spine

Medial rotational contracture of shoulder joint.

Valgus deformity of elbow.

Swan neck deformity finger

Shortening

Lengthening

Genu Recurvatum

Drop foot/Equinus

Kyphosis

scoliosis

Orthotic treatment is same as subluxation

19. CONTRACTURE

A contracture is a shortening of a muscle or tendon in the human body in response to stress exerted on that muscle or tendon. Contractures can occur at any joint of the body.

Causes:

Immobilization of joint

Trauma / injury / disease

Nerve injury- spinal cord damage and stroke

Damage to muscle, tendon, or ligament

Burn

Symptoms:

Significant loss of motion

Pain

Complication:

Dorsiflexion contracture

Planter flexion contracture

Knee flexion contracture

Genu recurvatum

Hip flexion contracture

Elbow flexion contracture

MCP contracture

If not treated complication may lead to:

Pes Equinus

Leg length discrepancy

Scoliosis

Dupuytren's deformity

Orthotic treatment:

Before we give orthotic treatment we must consider the severity of contracture, ROM of the joint. If there is severe contracture, better to have physiotherapy to the patient first.

The contracture patient may need serial type of orthosis according to correction of contracture

For lower limb

AFO

KAFO

HKAFO

For upper limb:

Elbow wrist hand orthosis

Wrist resting hand orthosis

20.LORDOSIS

An exaggeration of the forward curve of the lower part of the spine, sometimes called sway-back.

Causes:

The cause of lordosis is unknown.

Congenital

Poor posture/ Postural

Neuromuscular problems

Hip problem.

Lumber Spondylolysis

DDH

Symptoms:

Poor vertebral posture

The prominence of buttocks

Complications:

Lower Back Pain.

Tight Hamstrings

Bad Technique -not able to squeeze gluteus during Squats. This puts more stress on your lower back & hamstrings, increasing risk of injury.

Lower back pain is the first sign.

Kyphosis develop as secondary curve

If not treated complications may lead to:

Lumber spondylosis

Sciatica

Lower limb paralysis

Orthotic treatment:

Soft orthosis- Lumber corset

21. KYPHOISIS

Deformity in the normal posterior shape of the spine, producing a humpback appearance.

Causes:

Congenital

Postural

Metabolic problems

Neuromuscular conditions

Spina bifida

Tumor

Scheuermann's disease

Symptoms:

Poor posture with a hump appearance of the back or "hunchback,"

Difference in shoulder height

The head bends forward compared to the rest of the body

Difference in shoulder blade height or position

Tight hamstrings muscles

Complications:

Body image problems

Deformity Back pain

Breathing difficulties

Neurological problem

Lordosis develop as secondary curve

If not treated complication may lead to:

Compression fractures due to osteoporosis

Deformity become severe

Affects in function and structural of internal organs

Neurological deficit

Orthotic treatment:

In case of spinal orthosis, for proper orthotic treatment x-ray should be properly studied to know the exact Cobb’s angle for proper pressure point.

Orthosis is used for vertebral wedging greater than 5ºand curves between 45º-65º, in patients with 1 to 2 years of growth remaining.

Milwaukee brace for apex above T9

TLSO for apex below T9 and thoracic lumbar curves

Curve correction and wedging improvement of about 40% can be expected after 6 to 12 months.

The brace may have to be changed every 4-6 months until maximum correction is achieved.

Exercise stressing pelvic tilt, abdominal strengthening, spinal flexibility, and extension of the thoracic spine is an important part of the treatment plan.

22. SCOLOSIS

Scoliosis is a condition that involves complex lateral and rotational curvature and deformity of the spine.

Causes:

Idiopathic

Congenital

Neuro-muscular reason (cerebral palsy, spinal muscular atrophy)

Bio-mechanical reason

Sign & symptom:

A” hump" on one side of their back when they bend forwards (the forward bending)

The lateral curve to their spine

Uneven shoulders height

Uneven pelvic level

Uneven pants legs

Complications:

Development of secondary curve

Affects on functional & internal structural of internal organ

Low back pain

Degenerative changes in the spine.

Narrowing of the spinal canal

Weakness or numbness or pain involving the legs.

Bowel and bladder uncontrolled

Structural deformity

If not treated complication may lead to:

LLD

Paralysis of lower limb

Orthotic treatment:

In case of spinal orthosis, for proper orthotic treatment x-ray should be properly studied to know the exact Cobb’s angle for proper pressure point. Orthosis are not effective for curves greater than 45 degrees.

Milwaukee brace- This orthosis is effective in preventing further progression of spinal curves.

TLSO- This orthosis is now most commonly used because it is effective in preventing a spinal curve from getting worse, and it is easier to use because it can be worn under clothing.

To get best result from orthosis:

Orthosis should wear 23 hours a day.

Orthosis should start early, while the child is still growing.

The spinal curve is between 25 and 40 degrees. Some doctors may advise brace treatment for curves up to 45 degrees.

The orthosis should well fit.

There is family support for the child.

References:

The main references are:

Atlas of orthosis and assistive device-Mosby, 3^rd edition

Outline of orthopedic ,J C Adams,11^th edition

Knee ankle orthosis CSPO intake manual 1999

Manual of spinal orthosis- PIPOS

Manual of upper limb orthosis- PIPOS

Manual of lower limb orthosis- PIPOS

AFO guide –CSPO manual

From internet

http://www.webmd.com/back-pain/brace-orthotic-treatment-for-scoliosis http://www.scoliosisjournal.com/content/3/1/9

www.orthonurse.org/portals/0/kyphosis.pdf

www.springerlink.com/index/CP352Q3502125275.pdf www.srs.org/professionals/bracing_manuals/section12.pdf www.centri.se/dennis_browne.html - 4k

www.grundyorthotics.on.ca/.../details.html

http://www.virtueschildrennepal.org/goalsvcn.html

http://www.footankle.com/back-hip-knee.htm

http://www.cincinnatichildrens.org/health/info/orthopaedics/diagnose/limb-deformity.htm

http://www.fidelityorthopedic.com/orthodicproducts.html

www.spinal-injury.net/tetraplegia.htm - 25k

www.orthotic.com/injury.html - 47k

www.physicaltherapyjournal.com/cgi/reprint/76/2/182.pdf

www.hopehawaii.com/services.html - www.springerlink.com/index/F682166V45975N71.pdf

www.chiroweb.com/archives/24/25/03.html - 46k

www.webmd.com/back-pain/brace-orthotic-treatment-for-scoliosis - www.srs.org/professionals/bracing_manuals/section12.p www.oandp.org/jpo/library/1990_01_068