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LEARNING OBJECTIVES
Relate the major parts of the shoe to the requirements of individuals fitted with lower-limb orthoses.
Compare the characteristics, advantages, and disadvantages of plastics, metals, and other materials used in orthoses.
Describe the components of contemporary foot, ankle-foot, knee-ankle-foot, hip-knee-ankle-foot, trunk-hip-knee-ankle-foot, and trunk orthoses.
Describe common scenarios for upperlimb orthosis use.
Explain the orthotic options available for patients with paraplegia.
Identify the features of lower-limb and trunk orthoses that are considered during the examination process.
Outline the physical therapist's role in management of patients fitted with lower-limb and trunk orthoses.
Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.
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An orthosis is a device worn to restrict or assist motion or to transfer stress from one area of the body to another. Alternate terms include brace and splint. An orthotist is a health-care professional who designs, fabricates, and fits orthoses for the limbs and trunk; a pedorthist is a health-care professional who designs, fabricates, and fits shoes and foot orthoses. The term orthosis is a noun, the term orthotic is an adjective. Archaeological evidence confirms that orthoses have been used for at least four thousand years.1
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This chapter presents frequently prescribed orthoses for the lower and upper limbs and trunk, as well as new developments in the field. Essentials for teaching patients to use orthoses are considered. Focus is on orthotic designs, materials, biomechanical rationale, and criteria for evaluating orthotic fit, function, and construction. While every attempt is made to use evidence-based research to guide clinical practice, paucity of research and heterogeneity within the population of orthotic users and within orthotic designs confound this effort.2
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TERMINOLOGY AND TYPES OF ORTHOSES
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Orthoses are named by the joints they encompass, the motions they control, or the city where they were developed. Foot orthoses (FOs) are applied to the foot and placed inside or outside a shoe. Ankle-foot orthoses (AFOs) encompass the foot and terminate below the knee. The knee-ankle-foot orthosis (KAFO) extends from the shoe to the thigh, while the hip-knee-ankle-foot orthosis (HKAFO) extends beyond the hip to the pelvis. A trunk-hip-knee-ankle-foot orthosis (THKAFO) covers part of the torso and the lower limbs. Knee orthoses (KOs) and hip orthoses cover their respective joints. Cervical orthoses encircle the neck. Most trunk orthoses are named by the motions controlled, although orthoses that manage scoliosis usually are named for the city where they were designed. Upper-limb orthoses, such as a wrist orthosis, are named after the body segment(s) that they influence.
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BIOMECHANICAL INFLUENCES OF ORTHOSES
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Through the targeted application of force vectors, some orthotic devices can influence postural abnormalities like genu valgum or scoliosis. Abnormal postures are influenced by systematically applying opposing forces to the body segments ...