Sanjevani College Of
Physiotherapy
Topic: REHAB-ORTHOSIS-INT
Professor:Dr.Venkat Laxman
Dr.Venkat Laxman - MPT - ORTHO
ORTHOTICS
Dr.Venkat Laxman - MPT - ORTHO
DEFINITION:
An orthosis is a mechanical device fitted to
the body to maintain it in an anatomical or
functional position.
Dr.Venkat Laxman - MPT - ORTHO
GENERAL PRINCIPLES OF ORTHOSIS:
Use of forces:
Sensation:
Correcting a mobile deformity:
Fixed deformity:
Adjustability:
Maintenance and cleaning:
Application:
Limitation of movement:
Gravity:
Dr.Venkat Laxman - MPT - ORTHO
GENERAL PRINCIPLES OF ORTHOSIS:
Comfort:
Utility:
Cosmesis:
Duration:
Appropriateness:
Application:
movement: Dr.Venkat Laxman - MPT - ORTHO
•Use of forces:
Orthoses utilize forces to limit or assist movements, for example
– Rigid material spanning a joint prevents motion, e.g. posterior tube
splint.
– A spring in a joint is stressed by one motion and then recoils to assist
the opposite desired motion e.g. leaf spring orthosis.
• Sensation: An orthotic device often covers skin areas and decreases
sensory feedback. Proprioception should be preserved where possible.
• Correcting a mobile deformity: A flexible deformity may be corrected
by an orthosis, like the one given in genu recurvatum or mobile
scoliosis. The
corrective force must be balanced by proximal and distal counter forces
(three point force systems).
• Fixed deformity: If a fixed deformity is accommodated by an orthosis, it
will prevent the progression of the deformity.
Dr.Venkat Laxman - MPT - ORTHO
• Adjustability: Orthotic adjustability is indicated for children to
accommodate their growth and for patients with progressive or resolving
disorders.
• Maintenance and cleaning: The orthosis should be simple to maintain and clean
• Application: The design should be simple for easy donning and doffing. The more
complicated the gadget the less likely it is to be accepted for permanent use.
• Limitation of movement: Limiting motion to reduce pain, e.g. knee brace
• Gravity: Gravity plays an important role in upper limb orthosis, especially in those joints
where the heaviest movement masses are present. For example, a Rolyan shoulder
cuff can be used in hemiplegia to prevent subluxation of the shoulder, which is the
largest joint prone for the deleterious effects of gravity.
Dr.Venkat Laxman - MPT - ORTHO
• Comfort: The orthosis should be easy to wear and comfortable to use. This
is possible if the forces meant for correction are distributed over the
largest
area possible.
• Utility: The orthosis must be useful and serve a real purpose. If one hand
is functional and normal, an upper extremity orthosis for the affected
side may not be used as most activities of daily living can be performed
with
the good hand.
• Cosmesis: Cosmesis is important especially in the hand. A functional but
unsightly orthosis is often rejected if the patient values appearance over
function.
• Duration: Use only as indicated and for as long as necessary.
• Appropriateness: It should allow joint movement wherever appropriate.
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Principle of Jordan 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
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
CLASSIFICATION:
1. According to Function
2. Regional Classification
Dr.Venkat Laxman - MPT - ORTHO
1. According to Function
❖ Supportive: It stabilizes the joints and supports the body in its
anatomical position, e.g. calipers, gaiters.
❖ Functional: It stabilizes the joint and also makes up for a lost function,
e.g. foot drop splint in common peroneal nerve palsy or dynamic cock-
up splints in wrist drop.
❖ Corrective: To correct deformities, e.g. club foot boot in congenital
talipes equinovarus.
❖ Protective: To protect a part of the body during its healing, e.g. rigid
four postcollar for fracture cervical vertebrae.
Dr.Venkat Laxman - MPT - ORTHO
❖ 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.
❖ Strengthen certain groups of muscles: Tenodesis splint.
❖ Relief of pain: The lumbosacral corset supports the lower back,
preventing painful movement.
❖ Prevent weight bearing: A weight relieving orthosis, prescribed for
conditions like fracture calcaneum will take weight away from the
injured site to a proximal site like the patellar tendon bearing area.
Dr.Venkat Laxman - MPT - ORTHO
2.Regional Classification:
1. Upper Limb Orthosis
2. Lower Limb Orthosis
3. Spinal Orthosis
Dr.Venkat Laxman - MPT - ORTHO
Indications for recommending orthotic
devices:
1. To relief pain.
2. To limit motion (immobilization after surgery, after traumatic injury, Compression #
management & Kinesthetic reminder to avoid certain movements).
3. To correct deformity e.g. Scoliosis management
4. To relieve symptoms of a disease by supporting or assisting the MSk & neural systems.
5. To reduce axial loading, mechanical unloading
6. To improve function in a certain segment of the body.
7. Assist and improve movement and function
8. Reduce muscle tone.
9. Protect against injury.
10. Provide proprioceptive feedback.
11. Provide rest.
Dr.Venkat Laxman - MPT - ORTHO
Contraindications to Orthoses:
1. Severe deformity which cannot be accommodated in the orthosis.
2. If it limits movements at other normal joints.
3. Skin infections.
4. When the muscle power is inadequate to perform its function because of the
weight of the orthoses.
5. Where the orthosis interferes grossly with clothing or limits ones style of living.
6. Lack of motivation or other psychological problems.
7. Very young or old patients.
Dr.Venkat Laxman - MPT - ORTHO
Disadvantages of Orthosis:
1. Lack of cosmesis: an unsightly orthosis is often the reason for a patient
discontinuing its use.
2. Muscles supporting the spine can become weak.
3. Wherever segments are immobilized, we find increased movements at ends of these
segments.
4. The person becomes psychologically dependent on it.
5. Reduction in bone density.
6. Skin ulcerations or calluses at the patient orthoses interface.
Dr.Venkat Laxman - MPT - ORTHO
Duration of orthotic use:
1. It is determined by the individual situation.
2. In situations where instability is not an issue,
recommend use of an Orthosis until the patient can
tolerate discomfort without the brace.
3. When used for stabilization after surgery or acute
fractures, allow 6-12 weeks to permit ligaments and
bones to heal.
Dr.Venkat Laxman - MPT - ORTHO
Material Used:
Metals like :
1. steel
2. aluminium and alloys
3. rubber
4. leather
5. canvas.
6. plastics and synthetic fabrics.
7. Combination of Plastic and Metal:
8. Carbon – Graphite
Dr.Venkat Laxman - MPT - ORTHO
Considerations while Selecting the Material:
1. Strength
2. Durability
3. Flexibility
4. Weight
5. Should accommodate a simple and inconspicuous design
6. Comfort
7. Cosmesis
8. Distribution of forces over sufficiently large surface area
Dr.Venkat Laxman - MPT - ORTHO
Dr.Venkat Laxman - MPT - ORTHO
