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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Describe and discuss the relationships among impairments of body structure and function, functional activity limitations, and participation restrictions.

  2. Recognize functional activity limitations and participation restrictions that may be improved with orthotic, ambulatory, or assistive devices.

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Physical Therapy students are expected to:

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  1. Describe the components of and perform a client preorthotic prescription examination to develop functional goals, orthotic goals, and an orthotic prescription.

  2. Evaluate preorthotic prescription examination findings to identify client impairments, functional activity limitations, and participation restrictions that may improve with the prescription of an orthosis.

  3. Describe the role of functional assessment, biomechanical analysis of function, and gait analysis in determining an orthotic prescription for a client.

  4. Select appropriate functional status or outcome instruments to measure the effectiveness of an orthotic device in improving client function.

  5. Describe the process and components of an orthotic checkout examination, evaluate the findings, and develop an appropriate plan of action.

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CASE STUDIES

Harry Green is a 67-year-old man who suffered a thrombotic cerebral vascular accident (stroke) with right hemiparesis. Mr. Green's case is described in Chapter 2.

Anne O'Callahan is a 55-year-old woman who has right knee pain that is interfering with her ability to stand, walk, and climb steps. Using the numerical rating scale to assess her pain, she rates her pain as 6/10 on standing 30 min or more. She is only able to do steps when absolutely necessary using a step-to pattern, while keeping her right knee extended. Anne is a second-grade teacher and needs to spend much time on her feet. She received a diagnosis of right knee tibiofemoral osteoarthritis (OA) about 10 years ago but does not have OA in any other joints. She attributes her right knee OA to multiple injuries to her right leg that she suffered in an automobile accident when she was 35 years old. Recent x-rays show medial compartment OA. She has had episodes of right knee pain in the past, which were related to overuse and were relieved by limiting activity and taking anti-inflammatory medication. This current episode of knee pain has lasted 2 months, and it is not improving. She visited an orthopedic surgeon who administered hyaluronic acid viscosupplementation injections, with no significant improvement, and suggested that she is not a candidate for osteochondral transplant procedures. It is now October, and Anne does not want to consider any surgical approaches until all else has failed or at least until the school year is completed. Anne's body mass index (BMI) is 22. Her right knee ROM is 5° to 100° and demonstrates a 25° varus deformity. She had walked regularly for exercise prior to this current episode of knee pain but has discontinued due to swelling and increased knee pain after walking distances longer than two blocks. In order to continue to manage her classroom of second graders, Anne must be ...

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