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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

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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

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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

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Milwaukee brace (CTLSO)

 

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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

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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

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Common uses

  • Conservative management for hip disorders or dysplasia

  • Prevents hip dislocation

Precautions

  • Hygiene

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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

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Parapodium/standing frame

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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

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Knee Immobilizer

Unique attributes

  • Holds knee in extension or limits ROM

Common uses

  • Postsurgical

  • Night splinting

Precautions

  • Adequate knee ROM needed

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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

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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

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