At the end of this chapter, all students are expected to:
Describe the types (categories) and functions of hip orthoses and orthoses used with individuals with paraplegia.
Identify and describe the parts of hip orthoses and orthoses prescribed for individuals with paraplegia, including the materials and componentry used.
Describe impairments that may be improved by hip orthoses (HOs) or hip–knee–ankle–foot orthoses (HKAFOs).
Discuss applications for HOs and orthoses to improve function for individuals with paraplegia.
Physical Therapy students are expected to:
Determine the need for a HO or an HKAFO based on examination findings.
Evaluate client examination findings, including preorthotic prescription examination, lower quarter biomechanical assessment, and gait and functional analyses, to diagnose impairments that may be improved with a HO or HKAFO.
Develop appropriate goals for a HO or HKAFO based on a client's impairments and functional requirements.
Describe the biomechanical methods employed in HOs and HKAFOs to achieve the orthotic goals.
Develop and execute a search strategy to locate research evidence for the effects and effectiveness of HOs or HKAFOs and to identify best practices for orthotic prescription.
Recommend an appropriate orthosis to optimize function as a part of a plan of care for individuals with paraplegia or impairments of the hip.
Recommend shoes with appropriate characteristics for use with specific HKAFOs.
Examine and evaluate HOs and HKAFOs for acceptable fit, function, comfort, and cosmesis.
Tyrone O'Neal is a 17-year-old high school football player who sustained a T8 fracture in an auto accident in which he was thrown from the car. The accident occurred 3 months ago, and he received immediate decompression and spine stabilization surgery at a trauma center. Despite prompt treatment, he has a complete spinal cord injury (ASIA level A: complete lesion with no motor or sensory function preserved in the sacral segments S4 through S5) with neural motor and sensory levels at T12 bilaterally. Initially, he required a postoperative spinal orthosis; however, he no longer needs additional external spine stabilization and does not have surgical restrictions. His upper extremity strength is 5/5, and his range of motion in both upper and lower extremities is full and pain free. Abdominal muscle strength is 3+/5. He is independent in a wheelchair and requires only minimal assistance to close supervision for transfers. He is otherwise healthy. Muscle tone in his paralyzed limbs using the modified Ashworth Scale is 2 to 2+ (marked increase in muscle tone through most of the range of motion (ROM), but affected parts are easily moved). He very much wants to walk and is highly motivated to achieve that goal.
Sasha Bogdonova is a 3-year-old child with cerebral palsy, spastic diplegic type. She is able to walk but displays scissoring gait characterized by both significant adduction and internal rotation at both hips. Using the modified Ashworth scale, her spasticity is rated 4, but she does not demonstrate fixed contractures, and passive ...
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