O & P

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AMA Citation
O & P. In: Dole RL, Chafetz R. Dole R.L., Chafetz R Eds. Robin L. Dole, and Ross Chafetz.eds. Peds Rehab Notes: Evaluation and Intervention Pocket Guide New York, NY: McGraw-Hill; . http://fadavispt.mhmedical.com/content.aspx?bookid=2599&sectionid=213632567. Accessed February 24, 2020.

MLA Citation
. "O & P." Peds Rehab Notes: Evaluation and Intervention Pocket Guide Dole RL, Chafetz R. Dole R.L., Chafetz R Eds. Robin L. Dole, and Ross Chafetz. New York, NY: McGraw-Hill, , http://fadavispt.mhmedical.com/content.aspx?bookid=2599&sectionid=213632567.

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Orthotic Devices—General Principles

Uses three-or four-point force system to prevent, assist, or control motion at one or more joints
Devices are named for the joints that are encompassed:
- CTLSO—cervicothoracolumbosacral orthosis
- HKAFO—hip-knee-ankle-foot orthosis
- EWHO—elbow-wrist-hand orthosis
Devices are typically custom-made, but "off the shelf" options are available
All orthotic devices have the potential to cause skin breakdown if not worn or fitted properly; periodic skin checks and education of child and caregiver on proper donning and doffing are required

Axial Skeleton Orthotic Examples

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Helmet/Skull Shaping

Unique attributes

Custom-molded
May need adjustments over time

Common uses

Skull reshaping in plagiocephaly

Precautions

Best results if started <1 yr old
Device worn 23 hr/day

Cervical Orthosis

Unique attributes

Can be of flexible tubular PVC or plastic and foam
May be customized

Common uses

Used either to stabilize cervical spine or to limit movement
Head positioning and movement support in torticollis

Precautions

Not tolerated well by children <4 mo
Must be able to move away from flexible collar for torticollis application

Spinal Orthoses

Unique attributes

Design depends on level of control needed
Can control motion/position in all three planes

Common uses

Scoliosis/posture
Postsurgical
Protection post-injury

Precautions

Typically worn 23 hr/day

Milwaukee brace (CTLSO)

Boston brace (TLSO)

Lower Limb Orthotic Examples

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Hip Orthosis (HpO)—SWASH
Unique attributes Prevents hip adduction and internal rotation Common uses Reduces scissoring gait Reduces hip adduction in sitting Precautions Must be worn outside of clothes	Standing-walking-and-sitting hip orthoses (SWASH)
Hip Orthoses (HpO) for Hip Dysplasia
Unique attributes Maintains legs in flexed, abducted position May be made out of straps only or employ plastic and leather components
Common uses Conservative management for hip disorders or dysplasia Prevents hip dislocation Precautions Hygiene	Scottish-Rite brace (typically used for Legg-Calvé-Perthes disease)
Hip-Knee-Ankle-Foot Orthosis (HKAFO)
Unique attributes Controls hip, knee, ankle Allows reciprocal or swing-through gait Common uses Standing and gait support after spinal cord injury and with myelodysplasias Precautions Device weight may challenge mobility	Parapodium/standing frame HKAFOs
Reciprocating Gait Orthosis (RGO)
Unique attributes Type of bilateral HKAFO—controls hip, knee, ankle Prevents double hip flexion ("jackknife") Common uses Reciprocal or swing-through gait after spinal cord injury and with myelodysplasias Precautions Device weight may limit mobility
Knee Immobilizer
Unique attributes Holds knee in extension or limits ROM Common uses Postsurgical Night splinting Precautions Adequate knee ROM needed
Knee-Ankle-Foot Orthosis (KAFO)
Unique attributes Various knee joints to allow manual or independent locking/unlocking Ankle positioned in some dorsiflexion can aid hip stability
Common uses Stability during standing or gait (knee, ankle, foot) Blocks knee flexion or recurvatum Can be used at night for splinting/stretching Correction of deformity Precautions Weight of device may limit mobility
Universal Foot Orthosis (UFO)
Unique attributes Adjustable dorsiflexion tension Common uses Provides nighttime dorsiflexion stretch Prevents plantar flexion contractures Precautions Must maintain strap tension
Rigid or Solid ...