Chapter thirteen: Principles and components of Upper limb Orthoses Flashcards Preview

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Flashcards in Chapter thirteen: Principles and components of Upper limb Orthoses Deck (50)
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1
Q

What is the clinical application of the static WHO?

A

supports the wrist joint, maintains the functional architecture of the hands, and prevents wrist hand deformities.

2
Q

What patient population benefits from static WHOs?

A

Patients with severe weakness or paralysis of the wrist and hand musculature.
Without it, patients are susceptible to developing the “clawhand” deformity.
Indicated as a positional orthosis for C1-5 quadriplegics with zero wrist extensors and an intrinsic minus hand.

3
Q

What are the most common attachments used with the static WHO?

A

MCP extension stop and Ip extension assist.

4
Q

What does the MCp extension stop and IP extension assist help prevent?

A

The clawhand deformity

5
Q

What is the clinical application of the static Hand Orthosis (HdO)

A

It maintains the functional position of the hand and prevents development of deformities.

6
Q

Which attachments can be used with the static HdO?

A

All the attachments that could be used with the static WHO

7
Q

Which patient population benefits from a static HdO

A

Patient’s with weakness or paralysis of the hand intrinsic musculature and strong wrist extensors.
Without the orthosis, these patients are at risk for developing a flat hand with the thumb carpometacarpal joint in extension.
The C7 neurosegmental level quadriplegic exhibits this weakness.

8
Q

What is the clinical application of static elbow orthoses?

A

They reduce soft tissue contractures.

9
Q

With elbow contractures, the arm and forearm must be restricted to what?

A

Pure rotation with minimum translation to avoid joint subluxation or dislocation.

10
Q

What patient population benefits from static EO?

A

Patient’s with elbow contractures.
Patient’s with spinal cord injury that require full ROM of the elbow for alleviating ischial sitting pressure, propelling a manual wheelchair, or bringing the hand to the face.
Patient who were immobilized after trauma.

11
Q

What is the clinical application of the shoulder-elbow orthosis?

A

Support of a painful shoulder or traumatized brachial plexus injured limb with an orthosis.

12
Q

What is the most common SEO?

A

A sling

13
Q

What is another type of SEO?

A

Abduction orthosis, anchored on the hip

Ex: gunslinger

14
Q

What patient population benefits from SEOs?

A

The brachial plexus-injured patient

15
Q

What is the clinical application of the shoulder-elbow-wrist orthosis?

A

They are used to protect soft tissues or to prevent contracture of soft tissues. Occasionally they are used to correct an existing deformity.

16
Q

What is an example of a SEWO?

A

The airplane orthosis also known as the shoulder stabilizer.

17
Q

What does the airplane orthosis or shoulder stabilizer do?

A

it externally rotates the glenohumeral joint, this puts the internal rotators on stretch, and the tension on the deltoid and rotator cuff is relieved, which are desired after surgery.

18
Q

What patient population benefits from SEWO?

A

Airplane orthosis is and excellent orthosis after rotator cuff repairs, anterioposterior capsular repairs, and postmanipulation.
It is prescribed for axillary burns to prevent contracture and reduce contracture.

19
Q

What is the clinical application of functional WHO and HdO?

A

The attachment of utensils and other items in order to make ADLs easier.

20
Q

When are functional WHO and HdO indicated?

A

When patients have rigid deformities in the hand and finger joints and prehension is not feasible.

21
Q

What does WAWHO stand for?

A

Wrist-action wrist-hand orthosis

22
Q

What is the clincial application of the WAWHO?

A

A positional and therapeutic orthosis. It maintains the functional position of the hand and prevents wrist and hand deformities.
It functions to protect and assist weak wrist extensors with mechanical wrist motion stops.

23
Q

What patient population are WAWHOs indicated for?

A

Patients with weak (2 or 3) wrist extensors and paralyzed hand muscles.
Patients who have potential for wrist extensor musculature return.

24
Q

What are the clinical applications of dynamic EO?

A

Use immediately after trauma or surgery. They usually consist of joints that have adjustable ROM.

25
Q

What patient population benefits from dynamic EO?

A

After cast removal for stable fractures.
Postoperatively as an adjunct to internal fixation
Elbow disloaction mangement
Strains
Sprains
Muscle trauma

26
Q

What is the clinical application of the ratchet WHO?

A

It is the functional prehension orthosis.
It allows patients to grasp and relase objects by using external power.
It is manually controlled and substitutes for finger flexor and extensor muscles that are less than grade 3.
Patient’s with C5 quadriplegia may benefit.

27
Q

What is an alternative to the ratchet WHO?

A

The electric-powered prehension unit (EPPU). It uses a rechargeable battery pack that closes the hand

28
Q

What patient population benefits from a ratchet WHO and EPPU?

A

C5 quadriplegia

Patients with paralysis or severe weakness of the hand and wrist musculature.

29
Q

What musculature must be present to operate a ratchet WHO?

A

3+ strength in shoulder flexion, abduction, external rotation , and internal rotation.

30
Q

What other factors must be checked for a patient to use a ratchet WHO?

A
Endurance
ROM
Spasticity
Sensation
Patient motivation and social support
31
Q

What does WDWHO stand for?

A

Wrist-driven WHO

32
Q

What is another name for WDWHO?

A

Flexor hinge WHO

33
Q

What is the clinical application of WDWHO?

A

A dynamic prehension orthosis for transferring power from the wrist extensors to the fingers. Active wrist extension provides grasp, and gravity-assisted wrist flexion enables the patient to open the hand.

34
Q

What patient population benefits from WDWHO?

A

Individuals with paralysis or severe weakness of the hand. Wrist extensor strength must be at least grade 3+ and proximal strength must be functional.
Patients with C6 or C7 quadriplegia benefit.

35
Q

What is the clinical application of the mobile arm support (MAS)?

A

It supports the weight of the arm and provides assistance to the shoulder and elbow motions through a linkage of bearing joints. Joint ROM can be maintained with a MAS

36
Q

What are the basic components of the MAS?

A

Wheelchair mounting bracket,
Proximal arm
Distal arm
The forearm trough

37
Q

What patient population benefits from MAS?

A

Patients who have severe arm paralysis such as due to Muscular dystrophy, poliomyelitis, cervical spinal cord lesion, Guillain-Barre syndrome, and amyotrophic lateral sclerosis

38
Q

What are the arm muscle criteria for the use of MAS?

A

Absent or weak elbow flexion
Absent or weak shoulder flexion and abduction
Absent or weak external rotation
limited endurance for sustained upper limb activity.

39
Q

What is usually added to a functional EO?

A

An elastic device with a locking mechanism to assist elbow flexion with multiple angular lock points.

40
Q

What patient population benefits from functional EO?

A

Individuals with selective loss of elbow flexion secondary to a brachial plexus injury or congenital deficit.

41
Q

What is the clinical application of the resting WHO?

A

It maintains the arches of the hand, keeps the thumb abducted and flexed, maintains the wrist in a functional position.

42
Q

What patient population benefits from a resting WHO?

A

Patient swith paralyzed musculature, and to reduce hypertonicity by abducting the fingers.
Can add in scar formation in a burn patient.

43
Q

What is the clinical application of the HO with thumb adduction stop?

A

It positions the thumb in opposition and maintains the thumb web space.

44
Q

What patient population benefits from the HO with thunmb adduction stop?

A

Acute intervention in a painful hand or in cases where a thumb contracture is threatening.
A burn victim with palmar hand trauma or the arthritic patient with tender joints

45
Q

What is the clinical application of the HO with MCP extension stop?

A

To prevent MCP hyperextension due to intrinsic weakness of the hand which often rests in a posture that encourages MCP hyperextension.

46
Q

What patient population benefits from HO with MCp extension stop?

A

Patients with median and radial nerve injury cuases weakening of the transverse arch.

47
Q

What is the clinical application of the dynamic dorsal WHO?

A

It provides a quickk clincial means for positioning the hand and assisting wrist and MCP extension.

48
Q

what are the components of the dynamic dorsal WHO?

A

The dorsal forearm piece
The palmar piece
The MCP extension assist.

49
Q

What patient population benefits from the dynamic dorsal WHO?

A

Patients with radial nerve injury resulting in weakness of wrist and MCp extension.

50
Q

A patient presents after 1 month of use his WDWHO. The patient was able to use the brace for ADL activities, but was unable to begin self-catheterization. What should be done to change the brace?

A

Compromise finger opening for a tighter pinch by having the orthotist shorten the tenodesis bar and have the therapist provide additional training.

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