Atlas of Orthoses and Assistive Devices E-Book

Joseph Webster, Douglas Murphy

• Publisher: Elsevier
• Year: 2017
• ISBN:
  9780323554268
• Edition: 5
• Topic: Médecine
• Subtopic: Orthopédie

Advances in the material sciences, 3D printing technology, functional electrical stimulation, smart devices and apps, FES technology, sensors and microprocessor technologies, and more have lately transformed the field of orthotics, making the prescription of these devices more complex than ever before. Atlas of Orthoses and Assistive Devices, 5th Edition, brings you completely up to date with these changes, helping physiatrists, orthopaedic surgeons, prosthetists, orthotists, and other rehabilitative specialists work together to select the appropriate orthotic device for optimal results in every patient.

Section 1

Basics

Outline

Introduction

1 Orthotic Prescription

2 Materials Science

3 Principles of Fabrication

4 Principles of Normal and Pathologic Gait

Introduction

Joseph B. Webster

The rehabilitation of persons with disabling illnesses or injuries is best accomplished through an interdisciplinary team approach and a treatment plan that includes a host of intervention modalities. The goal of this approach is to assist the person with the disabling condition to achieve their highest level of functional independence and community integration. The prescription, fabrication, and fitting of orthoses and assistive devices is often an important component of the treatment regimen. Successful prescription of an orthosis or assistive device begins with a solid understanding of underlying physiologic concepts as well as an appreciation of biomechanical and kinesiology principles. This knowledge, in combination with the technical skills that are required in the fabrication and fitting of these devices, leads to successful patient outcomes.

Section I of this text is designed to provide the reader with a solid foundation of knowledge that will be instrumental as the reader applies this information in the provision of orthoses and assistive devices for the specific conditions covered in the subsequent sections of the text. Each chapter in Section 1 provides a sufficient level of detail to stand alone as a valuable resource for the reader, but these chapters also provide solid reference lists for those who have a desire to explore these chapter topics in more detail.

The development of the prescription for an orthosis or assistive device is a crucial early task in the rehabilitation process. Chapter 1 provides comprehensive coverage of this topic and emphasizes the importance of a clear, concise, and complete prescription in order to assure that the orthosis or assistive device is able to achieve its desired goal. The chapter also covers the interdisciplinary communication required for successful prescription development and the primary responsibilities of each team member.

Chapters 2 and 3 cover the topics of material science and principles of fabrication in a detailed, yet understandable fashion. While thorough comprehension of all of the information covered in these chapters may not be required in every situation, the content will be valuable for both new practitioners and well as for those who may need to refresh their knowledge base to address a unique challenge or prior to implementation of a new process.

Chapter 4, which covers the fundamental aspects of normal and pathologic gait concludes Section 1. The key points covered in chapter 4 include the lower extremity joint interactions that are required for normal gait. The chapter also emphasizes the importance of understanding underlying biomechanical principles and applying observational gait analysis skills in the evaluation of pathologic gait patterns.

1

Orthotic Prescription

Ann Yamane

Key Points

• A prescription for an orthosis communicates the type of device recommended to meet the biomechanical needs of the patient to improve function and promote participation in life activities.

• An appropriate orthotic prescription and treatment plan is generated based on knowledge of the patient's disease process along with information from a comprehensive history, physical examination, and integration of patient-related and environmental factors.

• Optimally, the prescription for an orthosis is determined with input from members of the health care team and patient, incorporating meaningful shared rehabilitation goals that use patient-centered and interdisciplinary team approaches.

• An effective prescription for an orthosis summarizes the medical and functional issues related to the patient, details the biomechanical functions desired, and specifies key technical attributes of the desired orthosis.

The prescription for an orthosis is an essential part of the larger process of rehabilitation to improve patient function and promote participation in life activities. Each member of the interdisciplinary team offers expertise that allows the team to work collaboratively with the patient to identify goals for orthotic intervention and shared rehabilitation goals.

An effective interdisciplinary approach fosters communication by involving all team members throughout the treatment process. A collaborative clinical environment allows team members the opportunity to clarify their clinical recommendations and educate other team members on their areas of expertise. Because of current health care policy and financial demands, this interdisciplinary approach may be possible in the acute setting but is typically challenging to achieve in outpatient settings. This lack of face-to-face communication requires the use of detailed documentation notes by the physician and others to convey the assessment findings and clinical reasoning.

Formulation of the orthotic prescription begins with the physician's medical evaluation of the patient, identification of the pathology and associated functional impairments, and prognosis. The assessment of the individual consists of a history that includes problems noted by the patient, prior interventions, and patient expectations and goals. The identification of patient-related and environmental factors as outlined by the World Health Organization's conceptual framework, the International Classification of Functioning, Disability, and Health (also known as the ICF) provides insight into how an individual functions in daily life. This context is key to informing the orthotic treatment plan.⁶

Determining the appropriate orthotic prescription is grounded in the biomechanical needs of the patient as identified through a physical evaluation that includes manual muscle testing (MMT), range-of-motion (ROM) testing, and sensory testing. Through the integration of the biomechanical needs and the personal and environmental factors of the individual, the optimal orthosis design is identified. Although the actual prescription for an orthosis communicates the type of device recommended to meet the biomechanical and functional needs of the patient, the physician's clinic documentation note contains the necessary information justifying the (1) nee...