orthopaedic equipment n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Orthopaedic Equipment PowerPoint Presentation
Download Presentation
Orthopaedic Equipment

Loading in 2 Seconds...

play fullscreen
1 / 87

Orthopaedic Equipment - PowerPoint PPT Presentation


  • 195 Views
  • Uploaded on

Orthopaedic Equipment. EO 002.12. Learning Objectives. The physical therapist technician will be able to: Fit a patient with a variety of orthopaedic equipment including: Splints Braces Orthoses Tape Gait aids Adjust various orthopaedic equipment

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Orthopaedic Equipment' - gella


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
learning objectives
Learning Objectives
  • The physical therapist technician will be able to:
    • Fit a patient with a variety of orthopaedic equipment including:
      • Splints
      • Braces
      • Orthoses
      • Tape
      • Gait aids
    • Adjust various orthopaedic equipment
    • Educate patients on the proper use of various orthopaedic equipment
orthopaedic equipment1
Orthopaedic Equipment
  • A variety of structural devices designed to stabilize, protect, and/or correct orthopaedic disorders
  • Mainly used in the branch of health care known as orthopaedics
    • Medical specialty dealing with the musculoskeletal system
  • Usually limit or prevent movement, or hold a body part in a certain position to prevent further injury or deformation, and allow healthy and normal healing/development to occur
orthopaedic equipment2
Orthopaedic Equipment
  • Common forms of orthopaedic equipment include:
    • Splints
    • Braces
    • Orthoses
    • Tape
    • Gait Aids:
      • Wheelchairs
      • Canes
      • Crutches
      • Walkers
splints
Splints
  • A device used for support or immobilization of limbs or of the spine
  • Involves application of a support held in place by an elastic bandage
  • Usually used in emergency situations
  • Allows for the natural swelling that occurs during the acute inflammatory phase of an injury
  • Are easily removed for inspection of the injury site
  • Disadvantages include lack of patient compliance resulting in increased motion at the injury site
braces
Braces
  • Protect, stabilize, support and correct injuries or abnormal alignment during the process of rehabilitation and recovery
  • Meant to correct or support an injured limb or torso for an indefinite period of time
  • Usually applied to tears and sprains, but may occasionally be utilized in the rehabilitation of broken bones
  • Most often for therapeutic use and it is meant to be used for a longer time
orthoses
Orthoses
  • Orthopaedic appliances used to support, align, prevent, or correct deformities, or to improve function of movable parts of the body
  • Includes braces and splints
  • Are often custom made to the patients body
athletic tape
Athletic Tape
  • Limits the abnormal or excessive movement of a structure while also providing support
  • Often used after an injury such as a sprain or strain
  • Also used to apply compressive forces to an injury site
  • Requires detailed knowledge anatomy and biomechanics
  • Used in conjunction with the rehabilitation program whose goals are to restore ROM, strength and motor control.
tape continued
Tape Continued . . .
  • Tape is used for:
    • Prevention
    • Assessment
    • Therapy/Rehabilitation
  • Taping requires the knowledge of:
    • Origin and insertion of the target tissue
    • Direction of the target tissue
    • The role of the target tissue
taping continued
Taping Continued . . .
  • For successful taping, there are some basic skills and knowledge that are required:
    • Knowledge of anatomy and biomechanics
    • Knowledge of the mechanisms of common injuries
    • An ability to determine the appropriate technique for a given injury
    • Knowledge of basic taping techniques
  • Therefore, taping is a specialized skill that requires further education and training
gait aids
Gait Aids
  • Devices designed to assist walking or improve impaired mobility
  • Type of aid based on the patient’s weight bearing status, conditioning, functionality and needs
  • Provide gait aids for:
    • Weight bearing
    • Balance
    • Motor pattern
    • Confidence
    • Endurance
gait aid function
Gait Aid Function
  • Gait aids can:
    • Decrease pain
    • Decrease weight bearing on involved limbs
    • Allow for compensation when there are decreases in:
      • Coordination
      • Endurance
      • Balance
      • Strength
wheelchairs
Wheelchairs
  • A mobile chair used by individuals who have impairments that limit their ability to walk
  • The right wheelchair should maximize patient mobility and functional potential as well as prevent co-morbidity and restriction of remaining functional capabilities
  • Wheelchairs are used either as primary or secondary means of mobility:
    • Primary-patients are mobile mainly by a wheelchair
    • Secondary- patients use the wheelchair for longer distances or for longer endurance tasks
canes
Canes
  • A device used to help with ambulation
  • Improves balance by increasing a person’s base of support
  • Unloads the leg opposite to the hand the cane is in by up to 25%
  • Many different shapes and sizes depending on the sought purpose
    • i.e. Quad cane has increased base size for more stability
crutches
Crutches
  • Type of gait aid used to help people who have suffered an injury to one of their feet, knees, ankles, or legs
    • If both sides are injured, a wheelchair is usually prescribed
  • Can cause nerve injuries to the axilla if used improperly
  • Axillary crutches are usually used temporarily for acute conditions (6-8 weeks)
  • Forearm crutches are usually used for more chronic conditions
walkers
Walkers
  • Primarily used when a patient has difficulty balancing or is at risk of falling
  • Significantly diminishes the weight borne on the affected extremity
  • The fewer the wheels, the more the stability the walker provides
  • More commonly used in the very frail and elderly population
gait cycle
Gait Cycle
  • There are two major parts to a full gait cycle of one step:
    • The stance part (60%); and
    • The swing part (40%)
  • The full cycle of one step is subdivided into four phases (in order of occurrence):
    • Heel strike
    • Mid-stance
    • Push-off
    • Mid-swing
gait cycle continued
Gait Cycle Continued . . .
  • A complete cycle is from heel strike to heel strike
  • The period at the end of the stance phase of one leg and the beginning of the stance phase of the other leg is called the “double support” period as both extremities support the body
base of support bos
Base of Support (BOS)
  • Refers to the area beneath an object or person that includes every point of contact that the object or person makes with the supporting surface
  • These points of contact may be body parts e.g. feet or hands, or they may include things like crutches or the chair a person is sitting in
  • Important concept to understand when trying to determine a patient's ability to balance
which side should the cane go on
Which side should the cane go on?

Injured Leg

Weight Bearing

Swing Through Phase

same side
Same Side?

Small BOS

Swing Through Phase

Injured Leg

Weight Bearing

opposite side
Opposite Side?

Bigger BOS

Injured Leg

Weight Bearing

Swing Through Phase

weight bearing orders
Weight Bearing Orders:
  • Will be directed by the physician
  • Ensure weight bearing orders are provided and understood:
    • NWB- Non-weight bearing: no weight on affected leg
    • PWB- Partial-weight bearing: usually half of body weight on affected leg
    • WBAT-Weight bearing as tolerated: on affected leg with-in pain free limits
    • FWB-Full weight bearing on affected leg
gait patterns
Gait Patterns
  • 4 Point:
    • A slow gait pattern in which one crutch is advanced forward and placed on the floor, followed by advancement of the opposite leg
    • Then the remaining crutch is advanced forward followed by the opposite remaining leg
    • Requires the use of two assistive devices (crutches or canes)
    • Provides maximum stability with three points of support while one limb is moving
continued
Continued . . .
  • 3 Point:
    • Both crutches and involved leg are advanced together, then uninvolved leg is advanced forward
    • Requires use of two assistive devices (crutches or canes) or a walker
    • Indicated for use with involvement of one extremity
continued1
Continued . . .
  • 2 Point:
    • One crutch and opposite extremity move together followed by the opposite crutch and extremity
    • Requires use of two assistive devices (canes or crutches)
    • Allows for natural arm and leg motion during gait, good support and stability from two opposing points of contact
continued2
Continued . . .
  • Swing-to-Gait:
    • Both crutches are advanced forward together
    • Weight is shifted onto hands for support and both legs are then swung forward to meet the crutches
    • Requires the use of two crutches or a walker
    • Indicated for individuals with limited use of both lower extremities and trunk instability
continued3
Continued . . .
  • Swing-Through-Gait:
    • Both crutches are advanced forward together
    • Weight is shifted onto the hands for support and both legs which are swung forward beyond the point of crutch placement
    • Requires the use of two crutches
    • Not as safe as swing-to gait
common gait abnormalities
Common Gait Abnormalities
  • Abnormalities of a normal gait pattern are caused by several factors:
    • Structural factors include extremity length differences, joint or soft-tissue factors like contractures
    • Neuromuscular factors
      • Central nervous system disorders
      • Peripheral nervous system disorders
    • Pain
antalgic gait
Antalgic Gait
  • Any pattern of walking designed to relieve pain
  • Typically, the patient shortens the stance phase, avoids bearing weight, and tries to reduce the forces through the painful or affected extremity as much as possible
  • Compensatory gait patterns have one thing in common: they all require more energy to produce forward movement of the body
wheelchair fitting seat depth
Wheelchair Fitting: Seat Depth
  • Determined by measuring from the dorsal buttocks to the back of the knee and subtracting 2–3" from this measurement. If the backrest is cushioned, the thickness of the cushion must be added
  • If the seat depth is too shallow, ischial pressure is increased and stability of the chair is decreased
seat width
Seat Width
  • Patients should not sit directly on the seat. All patients should receive some type of cushion
  • Seat width is determined by measuring across the widest point of the hips (with clothing and any braces or orthoses). Once this distance is obtained, add one inch (1") to this measurement
  • Too narrow: transfers and access to the chair are difficult and pressure skin breakdown is more likely to develop
  • Too wide: trunk support is compromised, leading to scoliosis, back pain, and difficulty with propulsion
seat height
Seat Height
  • Determined by measuring from the bottom of the heel to the posterior thigh, then adding 2" to compensate for leg rest clearance
  • Consider the cushion thickness and its relative additional height. Foam cushions compress to 1/2 their normal size
backrest
Backrest
  • The backrest should be high enough to support the patient, but not inhibit movement
  • The scapula should not hang over the chair. This is measured by the distance from the bottom of the buttocks to the level of the spine of the scapula
  • Too high: may interfere with shoulder movement
  • Too low: it will not provide adequate trunk stability
backrest continued
Backrest Continued . . .
  • If the patient has good trunk control and can propel a wheelchair, 3" is subtracted from this measurement
  • If the patient has poor trunk muscles, but can still propel a wheelchair, 2" is subtracted from this measurement
  • If the patient has no upper extremity strength and poor trunk control, a full measurement is taken with the possible addition of a headrest and recliner mechanism
slide59

Back Rest

Height

Seat Depth

Seat Height

Seat Width

armrests
Armrests
  • Chair arms provide arm support, lateral support, and aid patients who must elevate their body at regular intervals to prevent pressure breakdown
  • The arm height is measured from the buttocks to the bottom of the patient's bent elbow at 90 degrees. The measurement must be done with the cushion; 1" is added to this measurement
brakes
Brakes
  • Brakes or parking locks secure the wheels of the chair to avoid rolling away on uneven surfaces and to provide stability during transfers
  • Locks should not be used to slow a chair. The abrupt stop would result in overturning. Parking locks may be toggle or lever
  • Brakes should always be applied when the patient is not in motion
cane fitting
Cane Fitting
  • Ensure cane is in proper condition (Inspect tip)
  • Hold handle of cane at crease of wrist with arm at side
  • Ensure cane is held in hand opposite to injured leg. This widens the base of support increasing balance and stability
  • Injured leg and cane move forward at same time, then good foot
  • Ensure patient has good posture with proper heel-toe gait
stairs with canes
Stairs With Canes
  • To climb stairs, grasp the handrail (if possible) and step up on the good leg first, with the cane in the hand opposite the injured leg. Then step up on the injured leg
  • To come down stairs, grasp the handrail, put the cane on the step first, then the injured leg, and finally the good leg, which carries the body weight
crutch fitting
Crutch Fitting
  • Select the proper set of crutches according to the patient’s height
  • Inspect the crutches to ensure they are in proper condition. (Hand and underarm pads)
  • Standing straight the crutch tips should be 12-20 cm to the side of and slightly in front of the feet
  • Ensure 2-3 finger widths between the armpit and the top of the crutch
crutch fitting1
Crutch Fitting
  • Standing tall, looking straight forward with arms relaxed at sides, the handgrips should be at the crease of the wrist. When holding the handgrips the elbow should be at a 15 degree angle
  • Ensure weight is supported through the hands, not the armpits. The underarm pad should be squeezed by the arms against the ribs
standing with crutches
Standing With Crutches
  • With chair steady, move forward to edge
  • Place good foot flat on floor
  • Hold both crutches in hand on affected leg side, and chair with other hand
  • Stand, putting weight through good leg
  • Place crutches in proper position
walking with crutches
Walking With Crutches
  • Put weight through hands, arms squeezing into ribs
  • Move crutches and affected leg slightly forward
  • Bring good leg through crutches, transfer weight on good foot through heel first
  • Always remind the patient to shorten stride and slow down, especially when first learning
sitting with crutches
Sitting With Crutches
  • Standing in front of chair, place back of knees against chair
  • Move crutches to one hand on affected leg side
  • Hold chair with the other hand and slowly lower (placing weight through good leg) to sitting position
using stairs with crutches
Using Stairs With Crutches
  • Use hand rails when possible
  • Place both crutches under arm furthest from the railing and hold railing with free hand
  • If no hand rails, then use crutches same as for walking
going up stairs
Going Up Stairs

“The Good Go Up”

  • Putting weight through crutches, place good leg on step
  • Bring affected leg up
  • Bring crutches onto the same step
  • Repeat
going down stairs
Going Down Stairs

“The Bad Go Down”

  • Hold affected leg in front of body, not behind.
  • Lower crutches one step.
  • Lower affected leg to same step.
  • Step down with good leg.
walker fitting
Walker Fitting
  • Elbow bend: Place hands on the grips. The elbows should bend at a comfortable angle of about 15 degrees
  • Wrist height: Stand inside the walker and relax arms at the sides. The top of the walker should line up with the crease on the inside of the wrist
  • The width of a walker must provide adequate clearance for a step. A walker that is wider than average is needed if the patient walks with their feet far apart
please ensure
Please Ensure:
  • Prescribed weight-bearing orders are understood and followed
  • Crutches, canes, walkers, or wheelchairs are provided if prescribed
  • The patient is ambulating correctly and safely before leaving the clinic or hospital
    • Practice sitting, standing, and stairs
  • Record what gait aid the patient received in their physical therapy chart
  • Ensure the patient has completed a loan card
continued4
Continued . . .
  • Always inspect the piece of equipment for any worn or missing parts
  • Ensure matching pair (i.e. crutches)
  • A range of 15 to 30 degrees of elbow flexion is optimal
  • Spring clip tips are located in all holes
    • For axillary crutches make sure the nuts and bolts are tight
comprehension check
Comprehension Check
  • What is orthopaedic equipment?
  • When is a splint used over a brace?
  • What is the function of a gait aid?
  • Which side of the body is a cane used on?
  • What are the 4 phases of a gait cycle?
  • What is a base of support?
  • Describe 2-point gait
  • What is antalgic gait?
  • What is the rule for going up and down stairs with a gait aid?
  • What landmark should be used to measure the height of a handle on a gait aid?
answers
Answers
  • Orthopaedic equipment is a variety of structural devices designed to stabilize, protect, and/or correct orthopaedic disorders
  • A splint is used over a brace in an emergency situation or for more temporary situations
answers1
Answers
  • The function of a gait aid is:
    • Decrease pain
    • Decrease weight bearing on involved limbs
    • Allow for compensation when there are decreases in:
      • Coordination
      • Endurance
      • Balance
      • Strength
answers2
Answers
  • A cane used on the opposite side of an injury
  • The 4 phases of a gait cycle are:
    • Heel strike
    • Mid-stance
    • Push-off
    • Mid-swing
  • A base of support is the area beneath an object or person that includes every point of contact that the object or person makes with the supporting surface
answers3
Answers
  • 2-Point gait is:
    • One crutch and opposite extremity move together followed by the opposite crutch and extremity
    • Requires use of two assistive devices (canes or crutches)
    • Allows for natural arm and leg motion during gait, good support and stability from two opposing points of contact
  • Antalgic gait is any pattern of walking designed to relieve pain
answers4
Answers
  • The rule for going up and down stairs with a gait aid is; “The good go up, the bad go down”
  • The landmark that should be used to measure the height of a handle on a gait aid is the ulnarstyloid on the wrist