Kaki Palsu

Foto Kaki Palsu | Tangan Palsu | Jari Palsu | Alat bantu Orthopedi | CV. KUSPITO Prosthetic Orthotic

2011-08-08T09:45:00.000+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

Foto Gallery produk Kuspito jg bisa dilihat di www.foto.kuspito.com agar tidak ketinggalan informasi promo, silakan daftar dengan klik disamping http://www.kuspito.com/index.php/component/user/register KUSPITO Prosthetic Orthotic berlokasi di:

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat. Penanggung jawab adalah Bp. Rachmat Winarno Direktur adalah Nur Rachmat, BPO contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

Foto Kaki Palsu bawah lutut CV. KUSPITO Prosthetic Orthotic

2011-08-08T09:43:00.000+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat. Penanggung jawab adalah Bp. Rachmat Winarno Direktur adalah Nur Rachmat, BPO contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

Foto HKAFO - Produk CV. KUSPITO Prosthetic Orthotic

2011-08-08T09:40:00.000+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat. Penanggung jawab adalah Bp. Rachmat Winarno Direktur adalah Nur Rachmat, BPO contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

KAKI PALSU SYME untuk amputasi tepat sendi ankle

2011-08-08T09:17:00.000+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat. Penanggung jawab adalah Bp. Rachmat Winarno Direktur adalah Nur Rachmat, BPO contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

Foto Syme Prosthesis - Kaki Palsu Tepat Mata Kaki

2011-08-08T09:15:00.000+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat. Penanggung jawab adalah Bp. Rachmat Winarno Direktur adalah Nur Rachmat, BPO contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

Foto Kaki Palsu | Tangan Palsu | Jari Palsu | Alat bantu Orthopedi | CV. KUSPITO Prosthetic Orthotic

2011-08-08T09:12:00.000+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat. P
Direktur adalah Nur Rachmat, BPO contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

Foto Kaki Palsu | Tangan Palsu | Jari Palsu | Alat bantu Orthopedi | CV. KUSPITO Prosthetic Orthotic

2011-08-08T09:03:00.000+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

Foto Gallery produk Kuspito jg bisa dilihat di www.foto.kuspito.com

agar tidak ketinggalan informasi promo, silakan daftar dengan klik disamping http://www.kuspito.com/index.php/component/user/register
KUSPITO Prosthetic Orthotic berlokasi di:

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat.
Penanggung jawab adalah Bp. Rachmat Winarno
Direktur adalah Nur Rachmat, BPO
contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

PROMO KAKI PALSU - Promo Produk Kaki Palsu Tangan Palsu Jari Palsu dan Alat Bantu Orthopedi untuk bulan Romadhon - Agustus 2011

2011-08-08T08:58:00.000+07:00

pada bulan Ramadhan tahun ini, Kami memberikan promo berupa diskon sampai dengan 50% untuk produk kaki palsu tangan palsu dan alat bantu orthopedi.
CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

Foto Gallery produk Kuspito jg bisa dilihat di www.foto.kuspito.com
Bulan Mei dan Juni 2011 memberikan harga promo untuk produk Kaki Palsu, Tangan Palsu dan Alat Bantu Orthopedi
daftar harga bisa didownload dalam bentuk Ms Word atau Pdf (dibuka dengan adbe reader)

agar tidak ketinggalan informasi promo, silakan daftar dengan klik disamping http://www.kuspito.com/index.php/component/user/register
KUSPITO Prosthetic Orthotic berlokasi di:

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat.
Penanggung jawab adalah Bp. Rachmat Winarno
Direktur adalah Nur Rachmat, BPO
contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

Foto Kaki Palsu | Tangan Palsu | Alat bantu Orthopedi | CV. KUSPITO Prosthetic Orthotic

2011-08-04T15:37:00.001+07:00

CV. KUSPITO Prosthetic Orthotic bergerak dibidang:

Pembuatan Kaki Palsu, Tangan Palsu (Prosthesis)
Pembuatan Alat Bantu Orthopedi, pengkoreksi kecacatan dan disabilitas (Orthosis / Splint / Brace)
Pembuatan Alat bantu Mobilitas
Penjualan Komponen Prosthesis Orthosis
Layanan Terapi Wicara
Layanan Fisioterapi
Konsultasi masalah Orthopedi

Foto Gallery produk Kuspito jg bisa dilihat di www.foto.kuspito.com

agar tidak ketinggalan informasi promo, silakan daftar dengan klik disamping http://www.kuspito.com/index.php/component/user/register
KUSPITO Prosthetic Orthotic berlokasi di:

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

KUSPITO Prosthetic Orthotic memiliki staf sebanyak 30 orang yang terbagi dalam 5 tempat.
Penanggung jawab adalah Bp. Rachmat Winarno
Direktur adalah Nur Rachmat, BPO
contact us:

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: www.kuspito.com

Pengobatan Dukun Patah Tulang VS Dokter Bedah Ortopedi

2010-10-14T23:58:00.000+07:00

Kenapa harus ke dukun patah Tulang ? kalau ternyata biaya, waktu, dan risiko infeksi dan AMPUTASI menghadapi di muka. Ada 3 alasan orang pergi ke dukun patah tulang ; ekonomi katanya lebih murah, pegaruh lingkungan , takut operasi. Mari kita bahas disini .

Masalah ekonomi, kalau dihitung total biaya yg dikeluarkan ternyata biaya ke dukun dan ke dokter tulang tidak jauh beda, contoh kasus seorang manager yg bekerja di UNILEVER pada saat itu kalau dia tidak mengikuti kakaknya yg nganjurkan ke dukun mungkin dia saat ini masih bekerja , tdk keluar biaya sepeserpun utk berobat, dan tdk cacat .Dari hasil wawancara saya di dptkan keterangan , dia di rawat inap oleh dukun selama satu setengah bulan dgn biaya pondok seratus ribu per hari, ada biaya utk minyak urut krn tiap hari di urut.

Uang utk minyak 160.000 rph /minggu. Ada lagi biaya urut utk pegal2 badan 30.000/urut, dan si dukun juga memberi obat ramuan yg hrs diminum setiap minggu seharga 200.000 rp.setelah dirawat mondok penderita dibolehkan pulang , setelah itu ada kunjungan rmh 2 x seminggu dengan biaya sekali kunjungan 100.000 rph diluar obat dan minyak urutnya.

Si manager ini tlh mengalami pengobatan oleh dukun selama 8 bulan, jadi total biaya yg dikeluarkan 4,5 jt utk mondok + 1,4 jt utk obat +960.000 rph minyak urut+ 4 jt kunjungan rmh + 4 jt obat utk selama 5 bln = 14,860.000 rph. Jadi pada kasus ini tdk benar bila dikatakan berobat ke dukun patah lebih murah dari pada ke dokter tulang, sang manager di PHK karena di beri waktu 6 bulan tetap tdk bisa bekerja, dan kondisi tulang setelah di periksa oleh dokter dan di foto rontgen tetap tdk menyambung.

Dari kasus di atas kita belajar betapa mahalnya biaya dan risiko yg harus diterima sang manager . Kasus patah tulang yg datang ke dokter tdk selalu harus di operasi kadang2 hanya perlu pakai gips atau bahkan cuma pakai bandage saja tergantung jenis patahnya, usia penderita, ada luka atau tdk ada luka. Ada rumor yg salah menyatakan kalau ke dokter pasti di operasi. Metode pengobatan patah tulang tanpa operasi juga kita lakukan , malah Prof Sarmiento telah meneliti selama 17 thn.

Memang ada beda antara yg di operasi atau dengan cara tanpa operasi. Biaya pun tdk mahal. Tips bagaimana mendapatkan pelayanan yg murah sebenarnya tdk sulit, anda pertama hrs tahu bahwa rumah sakit seperti anda memilih hotel harga hotel bintang lima akan beda dgn harga hotel bintang 3, semua berpengaruh juga terhadap jasa dr , obat dan lainnya.

Masalah terakhir adalah TAKUT dioperasi, rumor di masyarakat kalau di operasi tulang pasti di potong atau kalau di bius nanti tdk bangun lagi itu tdk benar krn saat ini obat2 bius aman, dan malah ada tehnik pembiusan yg membuat orang tetap sadar saat operasi, malah saat ini berkembang tehnik2 operasi yg sayatan operasinya kecil yg kita sebut MIS (Minimally Invasif Surgery).

Dislocation & Subluxation

2009-04-21T23:03:00.001+07:00

Definition
Dislocation is Condition where bones that usually meet at a joint, have completely lost contact with each other at the joint surface and are displaced. The most often dislocated joint are the shoulder, patella-femoral and ankle. While Subluxation, is partial dislocation of one of the bones of a joint. According to nature cause subluxation may happen to any joint. It can be shoulder Subluxation, patellar Subluxation, vertebral Subluxation, atlantoaxial Subluxation, hip Subluxation, etc.

Causes
Many causes, such as: Congenital, Trauma, Chronic osteoarthritis,Occupational hazards, Muscular weakness,Incorrect weight lifting, Lack of rest, etc

Signs & Symptoms
Sudden pain in the joint, swelling of the joint, Deformity of the joint, the joint may not function or painful, Nerves and blood vessels that pass near the joint may be damaged.

Orthotic Treatment
The treatment will be depends on the location of Dislocation or Subluxation. The main principle is to realign the joint. Hip abduction orthoses and Hip stabilization orthoses are use to provides appropriate anatomical alignment to positions the head of the femur in the acetabulum allowing for the ligaments, bone, and surrounding musculature to heal.
For knee joint dislocation or subluxation, prescribe the Knee Orthosis, either free knee or lock knee, depend on severity of Subluxation. For Ankle dislocation or subluxation, Solid Ankle Foot Orthosis is used.
Shoulder Stabilizer aids in prevention of excessive extension and abduction of the shoulder. Elbow orthosis for the elbow joint dislocation or subluxation. Thumb Immobilizer Orthosis, For Spine, Soft Orthosis or hard orthosis can be options, depending on the level and severity, such as TLSO, CTLSO, Hard Collar, and Soft Collar.
Complications

If not treated, Upper Limb Joint dislocation or subluxation may lead to: Medial rotational contracture of shouler joint, Vaglus deformity of elbow, Swan neck deformity finger. While in lower limb: Shortening, Lengthening, Genu Recurvatum. It may also affect the spine, such as Kyphosis Scoliosis.
Orthotic Treatment post complication
If the complication happens, then, the treatment is not only on the dislocation or subluxation of joint, but also to treat the contracture and deformity which arises due to untreated problems.

Orthotic Treatment Management of Contracture

2009-04-21T23:01:00.001+07:00

Definition
A contracture is a shortening of a muscle or tendon in the human body in response to stress exerted on that muscle or tendon. Contractures can occur at any joint of the body.

Causes:
Muscle imbalance, Immobilization of joint, Trauma, injury, disease, Nerve injury, stroke, damage to muscle, tendon, or ligament, burn, etc.

Sign & Symptoms:
Significant loss of motion, Pain, the joint can’t be move in its full Range of Motion.

Complication:
If not treated complication may lead to deformity, such as Pes Equinus, Dupuytren's deformity, Scoliosis, etc. Leg length discrepancy may also occur.

Orthotic treatment:
Orthotic treatment of severe contracture is usually post-operative treatment, to maintain to surgically corrected contractures. In mild to moderate contracture, sometime surgical intervention is not necessary. Orthotic treatment can be prescribed side by side with physiotherapy treatment. In some cases, serial static orthosis, static motion block or dynamic motion block orthosis can be prescribe to reduce the contracture. It is better to use long lever arm in the application of orthosis, to achieve better pressure distribution.

The objective of orthotic intervention should be follow, those are:

• to reduce or correct contracture
• to provide stability
• To stop movement in the direction of contracture, but allow the movement opposite to contracture
The contracture patient may need serial type of orthosis according to location of contracture. For lower limb: AFO, KO, KAFO, HKAFO etc. For upper limb: EWHO, EO, Wrist resting hand orthosis, etc.

Orthotic Treatment Management of Lordosis

2009-04-21T22:59:00.001+07:00

Definition
Increased posterior concavity of the lumbar and cervical curves. giving a "swayback" appearance.

Causes
The cause of lordosis is unknown. However, lordosis may be associated with poor posture, a congenital (present at birth) problem with the vertebrae, neuromuscular problems, back surgery, or a hip problem.

Signs & Symptoms
Prominence of the buttocks. pain at lumbar region. When lying on the back on a hard surface, someone with a large degree of lordosis will have a space beneath the lower back and the surface

Orthotic Treatment
Treatment of Lordosis is depending on the age of patient, cause of lordosis, apical vertebrae and the magnitude of the lordotic Cobb’s angle. Types of Orthosis for lordosis treatment: Soft orthosis, Lumber corset, Boston over lap brace, TLSO can be prescribe
The Biomechanical principle of application of forces are used in the Orthosis, those are 3 Point pressures (in sagital plane)
• One corrective force toward the apical vertebra
• Two counter forces located proximal and distal to the corrective force, to stabilize the proximal and distal segment of the curve, so that the correction can be achieved.

Complications
Lumber spondylosis
Sciatica
Lower limb paralysis
Orthotic Treatment post complication
For the Lumbar spondylosis and sciatica, realignment of spine is to be achieve with spinal orthosis. For lower limb paralysis, Lower Limb orthosis is prescribe according to the severity of paralysis.

Orthotic Treatment Management of Kyphosis

2009-04-21T22:58:00.001+07:00

Definition
Increased anterior concavity of the normal thoracic curve. Or reduction of its normal lordotic curve in the lumbar spine
Causes
• Congenital (structural)
• Postural
• Spine Muscular abnormality
• metabolic problems, nutritional deficiencies
• secondary to osteogenesis imperfecta, spina bifida, Scheuermann's disease
Signs & Symptoms
• Difference in shoulder height
• The head bends forward compared to the rest of the body
• Difference in shoulder blade height or position
• When bending forward, the height of the upper back appears higher than normal
• Tight hamstrings (back thigh) muscles
Orthotic Treatment
Treatment of kyphosis is depending on the age of patient, cause of lordosis, apical vertebrae and the magnitude of the kyphosis Cobb’s angle. Types of Orthosis for kyphosis treatment:

• Milwaukee brace for apex above T9
• TLSO for apex below T9 and thoracic lumbar curves,
Orthosis is used for vertebral wedging greater than 5ºand curves between 45º-65º
The Biomechanical principle of application of forces are used in the Orthosis, those are 3 Point pressures (in sagital plane)
• One corrective force toward the apical vertebra
• Two counter forces located proximal and distal to the corrective force, to stabilize the proximal and distal segment of the curve, so that the correction can be achieved.
Complications
• Compression fractures due to osteoporosis
• Deformity become severe
• Affects in function and structural of internal organs
• Neurological deficit
Orthotic Treatment post complication
Orthotic treatment for untreated kyphosis is depending on the complication. The treatment should be in preference of correction of kyphosis, and then followed the treatment of complication.

Orthotic Treatment Management of Scoliosis

2009-04-21T22:55:00.001+07:00

Definition
an abnormal lateral curve to the vertebral column

Causes
Idiopathic
Secondary to shortening, cerebral palsy, spina bifida, etc

Signs & Symptoms
• Uneven musculature on one side of the spine
• A rib "hump" and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
• Uneven hip, rib cage, and shoulder levels
• Asymmetric size or location of breast in females
• Unequal distance between arms and body
• Slow nerve action (in some cases)

Complications
• Leg length Discrepancy
• Problem with respiration
• Kyphoscoliosis

Orthotic Treatment
Treatment of scoliosis is depending on the age of patient, type of the scoliosis, level of apical vertebrae and the magnitude of the Cobb’s angle. For the apical vertebrae below T8, TLSO can be used, but above that, high profile CTLSO is required for the correction.
Types of TLSO for Scoliosis treatment:
• Boston
• New York Orthopedic Hospital Orthosis
• Wilmington
• Miami
• Charleston, etc

Most common CTLSO, which proved success, is Milwaukee Orthosis.
The Biomechanical principle of application of forces are used in the Orthosis, those are 3 Point pressures:

One corrective force toward the apical vertebra
Two counter forces located proximal and distal to the corrective force, to stabilize the proximal and distal segment of the curve, so that the correction can be achieved.
For the scoliosis double curve (S shape), six point pressures are needed, but the force can be combine in the form of four point pressures.

Orthotic Treatment post complication
When Leg length Discrepancy is occur due to untreated scoliosis, treatment of scoliosis should be considered first, with the successful treatment of Scoliosis, the shortening will be diminished.
In fixed deformity equinus or knee Flexion contracture, the Orthotic treatment to reduce / correct the deformity should be considered.
If the KyphoScoliosis occurred, the application of pressures will be both in Sagital plane and frontal plane, each curve required 3 point pressures application.

Orthotic Treatment Management of Arthritis

2009-04-21T22:53:00.001+07:00

It is an inflammation or swelling of the joints. Osteoarthritis, Gouty and rheumatoid arthritis are most common arthritis.

Sign & Symptoms:
• Joint pain
• Joint swelling
• Joint stiffness
• Tenderness or pain when touching a joint
• Problems using or moving a joint normally
• Warmth and redness in a joint.

Causes:
• Joint instability
• Age-related changes
• Altered biochemistry
• Hormonal factors
• Genetic predisposition
• Environmental factors

Orthotic treatment:
The main objective of orthosis is to rest the inflamed joint, so that the inflammation reduced. The joint needs to be immobilized in proper position, so that the alignment of joint will not be disturbed due to arthritis. Variety of orthosis is prescribed according to location and severity of arthritis. For example: FO, AFO, KO, KAFO, SO- lumber corset, CO, TLSO, EWHO, WHO

Complications:

• Ankle valgus/varus
• Knee valgus/varus
• Lumber Spondylosis
• Scoliosis/ Kyphosis
• Cervical spondylosis
• Elbow joint contracture
• Hand contracture- boutonniere deformity
Orthotic Treatment post complication
In this step, main objective is to correct or reduce the contracture or deformity. The complication should be treating accordingly.

Orthotic Treatment Management of Monoplegia

2009-04-21T22:52:00.001+07:00

Definition
Paresis or paralysis affecting one limb only.

Causes:
• Cerebral palsy
• Injury to the brain

Sign & symptoms:
• Unable to walk properly-(if lower limb affected)
• Unable to perform any activity-(if upper limb affected)
Complications
• Pes equines
• Shortening
• Severe contracture
• Scoliosis
• Loss of function

Orthotic Treatment

For Lower limb
KAFO- If knee extensors/flexor affected
AFO-If quadricep weakness with genu recurvatum
Rigid AFO- If tibialis anterior and tricep surae weakness
In case of AFO- If muscle grading is 3- , Solid AFO
- If muscle grading is 3+, AFO with Ankle joint
In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock
For upper Limb
Wrist hand orthosis
Elbow wrist hand orthosis

Orthotic Treatment Management of Tetraplegia / Quadriplegia

2009-04-21T22:49:00.001+07:00

Definition
Quadriplegia, also known as tetraplegia, is a symptom in which a human experiences paralysis affecting all four limbs, although not necessarily total paralysis or loss of function.

Causes
It is caused by damage to the brain or the spinal cord at a high level - in particular spinal cord injuries secondary to an injury to the cervical spine. Typical causes of this damage are trauma (such as car crash, gunshot wound, fall, or sports injury) or disease (such as transverse myelitis, polio, or spina bifida). Fractured or dislocated cervical vertebrae, ruptured disc or bony spur on the vertebra protrudes pressing the spinal cord

Signs & Symptoms
• Motor/ sensory function of limbs are lost
• Uncontrollable hand motions
• Difficulty in Speech, swollen
• Unable to maintain balance body posture
• Bowel & bladder problem

Complications

Elbow flexion contracture, Wrist flexion contracture, Leg length discrepancy, Pes Equinus, Knee flexion contracture, Hip flexion contracture, Scoliosis, Kyphosis
Orthotic Treatment
Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.
For Lower limb
HKAFO- Hip flexion/extension instability
Hip adduction/abduction weakness
Hip internal rotation/external rotation instability
KAFO- If knee extensors/flexor affected
AFO-If quadricep weakness with genu recurvatum
Rigid AFO- If tibialis anterior and tricep surae weakness
In case of AFO- If muscle grading is 3- , Solid AFO
- If muscle grading is 3+, AFO with Ankle joint
In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock
HKAFO if Hip flexor or extensor weakness 3- or less.
For upper Limb
Wrist hand orthosis
Elbow wrist hand orthosis

Orthotic Treatment Management of Paraplegia

2009-04-21T22:47:00.000+07:00

Definition
Paraplegia is impairment in motor and/or sensory function of the lower extremities

Causes
The causes range from trauma (acute spinal cord injury: transaction or compression of the cord, usually by bone fragments from vertebral fractures) to tumors (chronic compression of the cord), myelitis transversa and multiple sclerosis.

Signs & Symptoms
• Difficulty walking (may trip and stumble frequently)
• Difficulty with balance
• Urinary frequency and urgency
• Muscle spasms

Complications
• Pressure sores, thrombosis, Pneumonia
• Deformities-
• Pes Equinus
• Knee flexion contracture
• Hip flexion contracture
• Scoliosis
• Lumbar lordosis

Orthotic Treatment

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.
• HKAFO- If hip flexor/ extensor are weak
• KAFO- If knee extensors/extensor affected
• AFO-If quadricep weakness with genu recurvatum
• Rigid AFO- If tibialis anterior and tricep surae weakness
• In case of AFO- If muscle grading is 3- , Solid AFO
• If muscle grading is 3+, AFO with Ankle joint
• In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint
• If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock
• For Spine: Spinal orthosis – TLSO

Orthotic Management of Hemiplegia

2009-04-21T22:17:00.001+07:00

Definition
Hemiplegia is a condition in which one-half of a patient's body is paralyzed

Causes
Stroke (Cerebro Vascular Accident)
Diabetes
Cerebral Palsy

Signs & Symptoms
Aphasia, ataxia, difficulty using arms to dress, visual impairments, the inability to control urination, decreased sensation, numbness, or tingling on affected side of the body, Slow, labored and uncoordinated limb movements. Residual muscle weakness, abnormal movement synergies, and spasticity result in altered gait patterns and contribute to poor balance, greater risk of falling and increased energy expenditure during walking, or single-limb balance and difficulty controlling forward progression.

Objectives of Orthotic Intervention
a. To correct and/or prevent deformity
b. To provide a base of support
c. To facilitate training in skills
d. To improve the efficiency of gait

Orthotic Treatment
When hemiplegia are present, ankle-foot function is disrupted and an Ankle Foot Orthoses (AFO) may be worn in an attempt to restore function. AFOs are used to improve toe clearance during swing and ankle position at initial contact. Leaf Spring AFO which are mainly Dorsi Flexion assist is often used. Plantar flexion-stop dynamic ankle-foot orthoses (DAFOs) can also be the option. in upper limb, spasticity is usually present, orthotic treatment mainly is to reduce the tone, and prevent contracture & deformity, Elbow Orthosis, Resting Hand Orthosis are the options

Complications

Equinus varus deformity, knee flexion contracture, Hip Flexion contracture, clenched hand position, elbow & wrist flexion contractures, Scoliosis

Orthotic Treatment post complication
When the deformity present, orthotic treatment is to reduce or correct the deformity. In equinus varus deformity, Solid AFO which maintains the correction of manipulation or surgery can be used. Knee Orthosis is used for Knee Flexion contracture, Elbow orthosis for Elbow Flexion contracture. For the Scoliosis has to be treating not with spinal orthosis, but by correction of the underlying cause in lower limb.

Orthotic Treatment Management of Poliomyelitis

2009-04-21T22:14:00.002+07:00

Definition
Acute infection by the polio virus, especially of the motor neurons in the spinal cord and brainstem, leading to muscle weakness, paralysis and sometimes deformity.

Causes
polio virus

Signs & Symptoms
Sub clinical Infection: General discomfort or uneasiness (malaise), Headache, Red throat, Slight fever, Sore throat, Vomiting
No paralytic Poliomyelitis: Back pain or backache, fatigue, Headache, Irritability, Muscle stiffness, Muscle tenderness and spasm in any area of the body, Neck pain and stiffness, etc
Paralytic Poliomyelitis: Irritability or poor temper control, Muscle contractions or muscle spasms in the calf, neck, or back, Muscle pain, Muscle weakness, asymmetrical (only on one side or worse on one side), Location depends on where the spinal cord is affected, Progresses to paralysis, Rapid onset, Sensitivity to touch; mild touch may be painful

Orthotic Treatment
The orthotic goal to halt increasing debility may be to stop the motion at a joint to compensate for failing compensatory motion in order to increase safety and stability, improve walking ability and perceived walking safety with less overall pain.

Objectives of orthotic intervention
1. correcting or accommodating and preventing deformity;
2. supporting the limb for stability;
3. decreasing the stresses placed on the joints;
4. decreasing the energy expenditure that is causing the muscles to become fatigued;
5. To normalize the gait pattern, since normal gait is the most energy-efficient and least stressful way to walk.

The orthotic management of polio patients may consist of the return to functional orthoses, often after many years of nonuse. Designs incorporating increased function and stability with decreased weight are desirable

Management of Ankle Foot Complex

The plantar surface of the foot should be carefully examined for weight bearing, the presence of metatarsalgia or hypercalosity indicate the needs for improvement of weight bearing. If the hip and knee are stable, painless and free from gross deformity, an AFO can be applied. When useful talocrural motion is present, the articulating AFO can be applied.
If there is weakness of pretibial muscles, posterior leaf spring AFO can be used. If the knee is relatively free from transverse plane deformity and recurvatum, but weakness of Calf muscle present, an Anterior Floor Reaction AFO design may suffice.

Management of Knee
Genu recurvatum is common, secondary to weak quadriceps, when there is present of other weakness or deformity at ankle, KAFO with knee Lock often used.

Management of Hip
When the weakness also present on Hip muscle, Ischial Weight Bearing KAFO often used, with Quadrilateral style Brim.

Complications
Contracture, and deformity may develop, such as, cavus, forefoot adductus, halus Valgus, equinus, pes Valgus, pes varus, genu recuravatum, genu valgum, genu varum, Lordosis, scoliosis, etc.

Orthotic Treatment post complication
With the present of contracture and deformity, the orthotic treatment is to reduce / correct the deformity, along with proving stability as well as enhance mobility, so that patient can perform the Activity daily living.

Prosthetic Orthotic Treatment Management of Leprocy

2009-04-21T22:12:00.000+07:00

Definition
A chronic granulomatous infection caused by Mycobacterium Leprae. Lesions are manifested in the skin, the mucous membranes, and the peripheral nerves

Causes
Mycobacterium Leprae

Signs & Symptoms
• one or more hypopigmented (lighter than normal skin color) skin lesions that have decreased sensation to touch, heat, or pain
• skin lesions that do not heal after several weeks to months
• numbness or absent sensation in the hands and arms, or feet and legs
• muscle weakness resulting in signs such as foot drop

Orthotic Treatment
The leprosy patient usually loss their sensory, so any appliance either orthosis or prosthesis should be made in such a way that there should not be any soft tissue damaged by appliances. Orthosis is prescribed according to loss of function and mobility. If the patient having drop foot, dorsi flexion assists AFO (Leaf spring AFO) can be prescribed. If patient having wrist drop, the Cock up Splint can be prescribed and any other assistive devices according to patient needs.

Complications

If untreated, there can be progressive and permanent damage to the skin, nerves, limbs and eyes. Patient May lose their hands or feet (Amputation) due to repeated injury resulting from lack of sensation
Treatment post complication
When patient lost their feet or finger, Prosthesis is prescribed according to level of limb loss. One should consider the absent of sensation in leprosy patient. Socket should not harm the stump, patient will not feel the pain and injury may happens

Prosthetic Orthotic Treatment management of Diabetic

2009-04-21T22:10:00.001+07:00

Definition
A disease in which the body cannot produce insulin or cannot use insulin to its full potential. It is characterized by high blood glucose levels.

Causes
• Heredity
• Autoimmune disease
• Drugs such as steroids, Dilantin, and others may elevate the blood sugar through a variety of mechanisms
• Certain syndromes (for example, Prader-Willi, Down's, Progeria, and Turner's) may result in a hyperglycemic state; if this state is prolonged, the result can be permanent diabetes.

Signs & Symptoms
• Flu-like symptoms
• Weight gain or loss
• Blurred vision
• Slow-healing sores or frequent infections
• Nerve damage (neuropathy)
• Red, swollen, tender gums

Orthotic Treatment
As soon as the active stage of the disease is recognized, the patient must be immediately and aggressively protected from excess weight bearing. More agile diabetics with unilateral involvement have done well with crutch-walking on the contralateral foot. As a general rule, forefoot lesions receive less body weight and hence require less protection, a rocker-soled shoe can be used.
Because many of patients already have trouble walking, we prefer not to lock the ankle against plantarflexion unless hindfoot problems exist. A spring dorsiflexion assist is sometimes useful to reduce footslap or aid toe clearance. The rocker sole is individualized since these feet are generally ulcer-free due to the weight bearing restrictions rocker is reduces forefoot pressures.

Complications
• Infections
• Gangrene
• Amputation

Treatment post complication
Due to untreated diabetes amputation usually happens. Depends on the level of amputation, Prosthesis has to be prescribed to patient. Extra care should be taken while giving socket. Material such as Derma seal, silicone can be an option for soft in-liner. Avoid any pressure on the bony sensitive area. Prevent any pain or wound, because healing is very slow in diabetes patient.

Orthotic Management of Multiple sclerosis

2009-04-21T22:08:00.001+07:00

Definition
It is an autoimmune condition in which the immune system attacks the central nervous system, leading to demyelination

Causes
Unknown, but likely occurs as a result of some combination of both environmental and genetic factors.

Signs & Symptoms
• Visual Symptoms: Blurred vision, eye pain, loss of colour vision, blindness, etc
• Motor Symptoms: Spasticity, Muscle weakness, wasting of muscles, Footdrop, etc
• Sensory Symptoms: Paraesthesia, Anaesthesia, etc
• Coordination and Balance Symptoms: Ataxia, Intention tremor, etc

Complications
• Contractures: knee flexion contractures, elbow flexion contractures, etc
• Deformity: equinus, etc

Orthotic Treatment
It depends in the location and severity of conditions. If Upper limb effected, Upper Limb Orthoses can be prescribed, for example when the wrist extensor weakness is present, Cock up splint can be used. If Lower limb effected, Lower Limb Orthosis can be prescribed. for example, dorsi flexion assist AFO (Leaf Spring AFO) can be prescribe when patient having Foot drop. But when it becomes equinus, Rigid AFO can be prescribed. So many orthoses can be prescribed according to the severity of condition, but main objectives of orthotic treatment should be followed.

Objective Orthotic Intervention
a. To provide stability for the limb
b. To providing safety and stability & comfort
c. To prevent or Reduces contractures
d. To prevent or correct deformity
e. Control of undesirable motions while permitting motion which occurs normally.

f. Protection of weak muscle.
g. Control of deviations associated with tonus abnormality.
h. Enhancement of experience for those patients who can experience upright posture with the support of biomechanical support devices.

Orthotic management of Spina bifida

2009-04-21T22:03:00.001+07:00

Definition
Spina bifida is a congenital neural tube defect affecting fetal development of the central nervous system. The three types of spina bifida include spina bifida occulta, meningocele, and myelomeningocele.

Causes
The cause of spina bifida is unknown, but it's thought to result from a combination of genetic and environmental factors.

Signs & Symptoms
• In spina bifida occulta, spinal cord does not protrude through the skin, although a patch of hair, a birthmark, or a dimple may be present on the skin over the lower spine.
• In meningocele, a fluid-filled sac visible on the back. The sac is often covered by a thin layer of skin and can be as small as a grape or as large as a grapefruit.
• In myelomeningocele also have a sac-like mass that bulges from the back, but a layer of skin may not always cover it. In some cases, the nerves of the spinal cord may be exposed.

Complications
• In myeomeningocele, usually present paralysis of hip and knee flexor, inversion and inversion, and plantar flexion weakness.
• If left untreated, usually deformity occurred, such as: equino valgus, calcaneo valgus, equinovarus, Club foot etc

Orthotic Options
It depends in the location and severity of conditions. Most orthoses prescribed are custom-made ankle-foot orthoses (AFOs), either floor-reaction or posterior solid in design AFOs. Floor-reaction AFOs are particularly beneficial in providing a knee-extension force at the knee, due to the plastic being formed anteriorly at the proximal tibia region and the toe lever footplate, restricting dorsiflexion. Knee-ankle-foot orthoses (KAFOs) and hip-knee-ankle-foot orthoses (HKAFOs) are also can be prescribed.

Orthotic Management of Muscular dystrophy

2009-04-21T22:00:00.001+07:00

Definition
Muscular dystrophy is comprised of a group of genetically determined disorders of muscle presenting with diffuse weakness of many muscle groups. The degeneration of muscle cells and replacement by fat and fibrous tissue creates distorted and dysfunctional muscles that disrupt static and dynamic balance capabilities.

Causes
a defect in the gene which makes up the muscle
Signs & Symptoms
• Progressive Muscular Wasting (weakness)
• Poor Balance
• Frequent Falls
• Walking Difficulty
• Waddling Gait
• Calf Pain
• Limited Range of Movement
• Muscle Contractures
• Respiratory Difficulty
• Drooping Eyelids (ptosis)
• Gonadal atrophy
• Scoliosis (curvature of the spine)
• Inability to walk

Complications
• Contractures: knee flexion contractures, elbow flexion contractures, etc
• Deformity: Scoliosis, Kyphosis, equinus, lordosis, etc
Objective Orthotic Intervention
a. To provide stability for the limb
b. To providing safety and stability & comfort
c. To prevent or Reduces contractures
d. To prevent or correct deformity

Orthotic Option

It depends in the location and severity of conditions.Orthotic intervention is often confined to nighttime splints to slow the development of contracture. For lower Limb Muscular dystrophy, usually knee-ankle-foot orthoses (KAFOs) with locking knee joints is prescribed. It can be prescribe postoperative, positional ankle-foot orthoses to prevent recurrence of equinus deformities

Characteristic walking features include a wide-based, waddling gait, toe-walking, increased lumbar lordosis, significant pelvic instability with bilateral Trendelenburg signs and noticeable knee instability with a tendency for anterior collapse. Static and dynamic balance is severely challenged, and many children rely on bilateral knee-ankle-foot orthoses (KAFOs

pemberian kaki palsu bawah lutut - test dan latihan jalan - Transtibial prosthesis

2009-04-06T01:50:00.005+07:00

patient coming.MPG

patient stump movie.MPG

coordination test By Nur Rachmat P&O

Upper Limb Assessment 1 By Nur Rachmat P&O

Upper Limb Assessment 2 - By Nur Rachmat P&O.mpg

Upper Limb Assessment - grip strength 2 - By Nur Rachmat P&O.mpg

Upper Limb Assessment - grip strength - By Nur Rachmat P&O.mpg

Lower Limb Clearance Test - FABER Test - By Nur Rachmat P&O.mpg

Hip joint Assessment - Thomas test.mpg

Hip joint Assessment - OBER test.mpg

Hip joint muscle assessment - Flexion - By Nur Rachmat P&O.mpg

Hip joint muscle assessment - Extnsion - By Nur Rachmat P&O.mpg

uccess Hip joint muscle assessment - Abduction and adduction - By Nur Rachmat

Knee joint Assessment - muscle grade - knee Extension and flexoion.mpg

Knee joint Assessment - muscle ROM - knee Extension and flexoion.mpg

Knee Joint ROM Assessment Extension and Flexion ROM By Nur Rachmat P&O

Knee joint stability test - Anterior prosterior Knee Draw Test - and Sensation test By Nur Rachmat P&O.mpg

Patient able to donning or fitting the prosthesis by him self By Nur Rachmat P&O

Gait Analysis Sagital View - By Nur Rachmat P&O.mpg

Gait Analysis Frontal View - By Nur Rachmat P&O.mpg

Gait Analysis Sagital View - with walking Aids - By Nur Rachmat P&O.mpg

Gait Analysis Frontal view - climbing the stairs By Nur Rachmat P&O.mpg

Seputar Ortotik Prosthetik - pengenalan profesi - info kaki palsu dan alat bantu untuk kecacatan

2009-03-17T22:55:00.005+07:00

Ortotik Prostetik, atau dalam bahasa Inggrisnya Orthotic and Prosthetic mungkin suatu ilmu yang kurang dikenal di Indonesia. tetapi didunia Internasional, ilmu ini sudah berkembang pesat. Ilmu yang mempelajari anatomy tubuh manusia, dan patologi yang menyebabkan kecacatan pada manusia, dan dikombinasikan dengan ilmu Biomekanik, yaitu tentang force atau tekanan dan ilmu mekanik tubuh manusia, untuk selanjutnya diberikan alat bantu maupun alat ganti yang sesuai dengan kebutuhan dan kekurangan tubuh manusia.

sebagai contoh, jika ada orang yang kehilangan kaki, maka seorang prostetis ortotist mampu untuk memberikan alat bantu bagi orang buntung tersebut, yang sesuai dengan kebutuhan manusia, yaitu untuk berjalan. sudah tentu kaki palsu yang dibuat tidak sempurna seperti kaki pemberian tuhan, tetapi dengan majunya teknologi dan medik, kaki palsu bisa memberikan fungsi yang dibutuhkan manusia dengan kakinya. berikut ini akan kami ulas mengeni istilah- istilah dan segala sesuatu yang menyangkut mengenai ilmu ini.

Ortotik : ilmu teknik dalam bidang medis yang mempelajari tentang pembuatan alat bantu penyangga(penguat) anggota gerak tubuh/ tubuh yang mengalami layuh, lemas, lumpuh, atau cacat karena suatu sebab, mulai dari anamnese, assessment, penegakan diagnosa, fabrikasi (pembuatan), fitting (pemasangan), hingga finishing (penyelesaian), untuk kemudian diberikan kepada pasien yang membutuhkannya.

Ortose/ Ortesa / Orthosis : alat bantu penyangga tubuh/ anggota gerak tubuh yang layuh, lumpuh, atau cacat.

Orthosis dibagi dalam 3 jenis, berdasar atas bagian dari tubuh manusia.

1. Orthosis Anggota Gerak Atas

orthosis ini diberikan kepada orang yang mengalami kecacatan atau kelumpuhan pada anggota gerak atas, yaitu lengan dan tangan.

contoh orthosis anggota gerak atas:

STATIC COCK UP SPLINT

ortose yang di gunakan pada tangan yang mengalami drop hand yang memungkinkan jari-jari tangan tidak bisa bergerak

COCK UP SLINT DYNAMIC

ortose yang di gunakan pada tangan yang mengalami drop hand yang memungkinkan jari-jari tangan bisa bergerak

Elbow Brace

Kegunaan :

Ortose digunakan untuk penguat sendi siku, ortose pada AGA

ARM CORSET

stabilitasi lengan bawah karena fraktur

NIGHT SPLINT

untuk tangan yang mengalami drop hand tetapi digunakan pada malam hari

dan masih banyak lagi jenis2 orthosis yang lain. bisa lihat disini atau disini

2.Orthosis Anggota Gerak Bawah

orthosis ini diberikan kepada orang yang mengalami kecacatan atau kelumpuhan pada anggota gerak bawah, yaitu paha, betis dan kaki.

contoh orthosis anggota gerak Bawah:

HKAFO

(Hip Knee Ankle Foot Orthosis)

Kegunaan :

Ortose yang digunakan pada anggota gerak bawah yang seluruhnya mengalami Kelayuan

KAFO

(Knee Ankle Foot Ortosis)

Kegunaan : pd pasien dengan kelainan panjang tungkai, folio

AFO

(Ankle Foot Orthosis)

Kegunaan :

Ortose yang digunakan untuk koreksi kecacatan pada daerah ankle&foot yang mengalami droop foot

FO (Foot orthosis)

Kegunaan :

Ortose yang digunakan untuk koreksi kecacatan padatelapak kaki

Orthopaedic Shoes / sepatu Ortopedi

Kegunaan : Mengoreksi kelainan kaki yang cacat, seperti flat foot,menetralisir dari kaki yg valgus/varus

berikut ini saya utarakan tentang sepatu ortopedi

Komponen Sepatu

Sole

Bagian bawah dari sepatu,terdiri dari:

-Outer sole

-Inner sole

Heel

Ditempelkan pada outer sole dibawah tumit

Upper

Merupakan bagian atas sepatu yg tdd:

- VampàBag. depan dari upper yg menutupi jari, tdd:

1. tounge

2. throat

3. lace stay

4. toe box

- quarteràBag. Belakang sepatu

-Closureàpenutup sepatu,tdd:

1. Adjustable

2. Non adjustable

Tipe Sepatu

Berdasarkan tinggi quarter,tdpt 3 mcm:

Low quarter shoes = oxford shoes,tinggi 1 inci dibawah maleolus

High quarter shoes = chukka shoes,quarter menutupi maleolus

Boots = * quarter 2 inci/lebih dari maleolus

* memberikan kestabilan mediolateral sendi kaki dan ankle

Berdasarkan tipe throat, tdpt 3 mcm:

Blucher Type = lace stayàtidak dilekatkan pada vamp

Bal Type (balmoral) = lace stayàditempelkan pada vamp

Surgical shoes = lace to toe shoesàseluruh kaki sampai jari terlihat

Modifikasi Sepatu

Fungsi Sepatu:

• Melindungi kaki dari permukaan kasar, cuaca dan lingkungan

• Menopang kaki selama berdiri dan berjalan

• Memperbaiki fungsi dan kenyamanan

Tujuan Koreksi:

Mengurangi rasa nyeri

Support profilaksis,unt prefensi thd deformitas yg progressif

Substitusi mekanik pd hilangnya gerakan

Metode modifikasi

Internal

àLebih efektif,dapat dipindahkan tetapi kurang dt ditoleransi

1. Arch support,

Bfx u/ : -menopang arkus longitudinal yg lemah

-mbtx kesegarisan yg baik, dengan mengelevasi medial/lateral aspek

a) Steel shanks, adl besi pengisi shanks yg digunakan untuk menopang arkus longitudinal yg lemah

b) Cookie

c) Scapoid pad

d) Medial longitudinal arch support

e) Lateral longitudinal arch support

2. Metatarsal pad

àdiberikan utk mengurangi tekanan pada metatarsal head II-III-IV

3. Sesamoid/dancer’s pad

àutk menopang metatarsal head I pada kasus metatarsalgia

4. Heel elevation

Bila lebih dari ¼ inci, mk elevasi ditempatkan diluar

5. Cushion inner heel

6. Levy insole/inlay

àdiberikan pada kasus hallux valgus dan dipasang pd insole

Eksternal

1. Wedge,

dibuat dr kulit yg diletakkan dibawah sole/tumit pada sisi medial / lateral

a) Thomas heel wedge,

-adl perluasan heel ke antero medial, dg bag.lateral tepat dibwh maleolus lateralis

-bfx u/ :* menopang arkus longitudinal medial yg lemah

* menetralisir posisi pronasi/valgus

* memindahkan berat badan kesisi lateral

b) Reverse Thomas Heel,

-perluasan heel sepatu ke antero lateral

-Bfx u/ : * menopang arkus longitudinal lateral yg lemah

* menetralisir varus/suprinasi

* memindahkan berat badan kesisi medial

2. Shank Filler

àdiperlukan utk menopang arkus longitudinal lateral/medial, dg mengisi kekosongan antara lantai dg arkus longitudinal sepatu

3. Flanges/flare out,

-adl memperluas sisi lateral/medial dari sole/tumit

-tujuan utk memperbaiki stabilitas sendi

4. Elevasi pada sole dan tumit,

-digunakan utk: * penyesuaian tinggi kaki sehingga pelvis rata

* mengurangi tekanan pada hind foot, dg memindahkan berat ke metatarsal

5. Metatarsal bar,

-ditempelkan secara transversal pada outer sole metatarsal head

-berguna utk mengurangi tekanan dan nyeri pd daerah tsb

6. Rocker bar,

-dari metatarsal head meluas ke bagian depan jari

-utk mengurangi tekanan pd metatarsal head dan MTP yg nyeri pd waktu push off

7. Denver bar,

-utk menopang metatarsal

-ditempelkan pd metatarsal head dan meluas sampai ke sendi tarsometatarsal

8. Cushion,

-berguna utk mengurangi nyeri pd tumit/calcaneus

-terbuat dari soft rubber/bahan yg kompresibel

-terdapat 2 tipe: * inner cushion

* SACH (Solid Ankle Cushion Heel) : sering digunakan bersama rocker bar, utk meminimalkan gerakan sendi ankle pada rigid foot

dan masih banyak lagi jenis2 orthosis yang lain. bisa lihat disini atau disini

3.Orthosis Spinal

Boston Brace

Kegunaan :

Ortose yang digunakan sebagai penguat vertebra yang mengalami scoliosis

Cervical collar

Kegunaan :

Ortose yang digunakan untuk penguat pada leher

Jewett Hyperextension Brace

Kegunaan :

Ortose yang digunakan pada vertebra yang mengalami kifosis

Millwaukee Brace

Kegunaan :

Ortose yang digunakan untuk koreksi scoliosis agar mencapai posisi anatomi

dan masih banyak lagi jenis2 orthosis yang lain. bisa lihat disini atau disini

Prostetik : ilmu teknik dalam bidang medis yang mempelajari tentang pembuatan alat bantu pengganti anggota gerak tubuh yang hilang akibat amputasi, atau cacat bawaan mulai dari anamnese, assesment, penegakan diagnosa, fabrikasi, fitting, hingga finishing, untuk kemudian diberikan kepada pasien yang membutuhkan.

Protese/ protesa / Prosthesis : alat bantu pengganti anggota gerak tubuh yang hilang sebab amputasi atau cacat bawaan. sering disebut kaki palsu, atau tangan palsu

Prosthesis dibagi dalam 2 jenis, berdasar atas bagian dari tubuh manusia.

1. Prothese Anggota Gerak Atas

yaitu alat ganti anggota tubuh bagian atas, lengan atau tangan. sering disebut tangan palsu.

contohnya:

Shoulder disarticulation prosthesis

INDIKASI : Aputasi pada anggota gerak atas tepat pada bahu/shoulder

ABOVE ELBOW PROSTESIS

INDIKASI : Amputasi anggota gerak atas tubuh, pada posisi di atas siku,stump bisa berukuran panjang,medium,pendek

BELOW ELBOW PROSTESIS

INDIKASI: Amputasi anggota gerak atas tubuh, pada posisi di Bawah siku,stump bisa berukuran panjang,medium,pendek

Hand Prostesis

Indikasi : amputasi pada tangan, biasanya buat kosmetik

FINGER PROSTESIS

INDIKASI : Amputasi pada jari-jari tangan

2. Protese Anggota gerak bawah

yaitu alat ganti anggota gerak tubuh bagian bawah. paha, betis atau telapak kaki. sering disebut kaki palsu.

contohnya:

1. Protese Atas Lutut

2. Protese Bawah lutut

3. Protese Telapak kaki

Sebuah prostesis yang digunakan untuk amputasi yang mungkin disebabkan oleh penyakit(DM)sehinnga di amputasi ,tumor,conginetal,dll

beberapa contoh protese Anggota gerak bawah (kaki palsu):

PTB Convesional dengan Tight corset dan Knee joint

Indikasi: Untuk Knee Joint yang tidak stabilitas,ada gerakan hiperekstensi yang berlebihan,penderita yang sudah terbiasa dengan prostese knee joint(kebiasaan)

kontra indikasi:

Bila knee joint bagus jangan dipakai,bila stup terjadi udema(pada penderita DM)

Kelebihan: Memberikan pencegahan rectufartum, memberikan tumpuan berat badan pada paha, menyestabilkan knee joint,faktor kepuasan.

Kelemahan:Dapat memperparah udema, cenderung atropi otot-otot paha,kebersihan harus dijaga dengan baik karena kulit mudah berbau, kosmetik kurang bagus, mechanical axis tidak bisa singkron dengan anatomi axis, pembuatan membutuhkan waktu yang lama.

PTB Strap

Indikasi: Amputasi bawah lutut transtibia cocok untuk PTB kecuali Ada Unstabilitas

Kontraindikasi: Sendi lutut tidak stabil, hanya sedikit area menumpu berat badan/stup pendek

Kelebihan : mempunyai Biomekanik yang baik

Kelemahan: Menyebabkan Atropi

PTB SC (supra condyler)

Indikasi: Pasien Butuh Banyak berlutut, pasien yang tidak tahan dengan memakai fermur corset

Kontraindikasi:Bila kita tidak membutuhkan control genu rectufartum, unstabilitas medio lateral yg tidak dapat dicontrol oleh socet

Kelebihan:mudah berlutut,mudah dilepas,kosmetik baik

Kelemahan: Tidak dapat mengontrol rektufartum,penyangga yang sedikit

PTB SP(Supra Patela)

Indikasi: Untuk stump yang pendek,Pasien yang tidak tahan dengan manset supra condyler cuff, untuk memberikan koreksi pada ekstensi sendi lutut, bila pasien memilih prostesis ini.

Kontraindikasi: Pasien yang gemuk, sendi lutut tidak stabilitas

kelebihan: Tanpa strep, Bisa mengontrol knee joint, tidak mengambat ateri poplitea

Kelemahan : Sulit memberikan modifikasi yang tepat, Kosmetik tidak bagus

SYME PROSTHESIS

Kegunaan :

Protese yang digunakan untuk amputasi pada pergelangan kaki / tepat pada maleolus

dan masih banyak lagi jenis2 prootese yang lain. bisa lihat disini atau disini

Ortotis Prostetis / Orthotist Prosthetist: seseorang yang berprofesi atau ahli dalam bidang ortotik prostetik. sering disingkat sebagai OP atau P&O

seorang OP atau P&O, berkeahlian untuk membuat orthose dan prostese tersebut. P&O telah dibekali ilmu formal perkuliahan, yaitu anatomy patologi, biomekanik, ortopedik klinik, maupun protetic ortotik. dengan bekal tersebut seorang OP mampu membuat protese maupun ortose sesuai dengan kebutuhan pasien, sehingga pasien mampu untuk beraktifitas kembali.

saya sebagai seorang OP, bersedia untuk membantu saudara saudara kita yang cacat sehingga mampu untuk pulih dan beraktifitas kembali. dan berusaha membantu penangganan kasus-kasus orthopedi yang terjadi di masyarakat. Seperti masalah muskulo skeletal (otot-tulang), cedera musculo skeletal, amputasi, kelainan-kelainan bawaan lahir, kelainan tumbuh kembang, dan juga kasus-kasus kecelakaan fisik seperti kecelakaan lalulintas, kecelakaan kerja, yang menyebabkan seseorang tersebut kehilangan kemampuan fungsionalnya, mengalami kelayuhan, kelumpuhan anggota geraknya, atau bahkan harus kehilangan anggota geraknya karena proses amputasi. Sehingga diperlukan penangganan yang bersifat rehabilitatif guna mengembalikan kemampuan fungsional seseorang tersebut semaksimal mungkin.

seorang OP bekerja sama dengan anggota tim rehabilitasi yang lain :

1. SpBo (Spesialis Bedah Orthopedi) & SpRm (Spesialis Rehabilitasi Medis)

2. Perawat Orthopedi

3. Psikolog

4. Psikiater

5. Fisioterapis

6. Okupasi Terapis

Regards

Nur Rachmat, BPO
Prosthetist Orthotist
Direktur CV. Kuspito Prosthetic Orthotic

IM3 085642045678
SIMPATI 082137774443
FLEXY 02717997888
FAX 0271821843
PIN BB 268AA9A0
Skype: infobiru
YM: op_nurrachmat@yahoo.co.id
Email: info@kuspito.com
Website: http://www.kuspito.com
blog: http://blog.kuspito.com

KUSPITO 1 – Main Office, Klinik OP, TW, Pemasaran – Jl.Raya Solo-KRA KM.10 Jaten KRA Solo
KUSPITO 2 – Workshop Custom P&O – Ngiri 04/07 Sapen Mojolaban Sukoharjo
KUSPITO 3 - Prefabricated Orthosis Factory – Cengklik 05/03 Jetis Karangpung Kalijambe Sragen
KUSPITO 4 - Klinik OP, FT – Jl.Pinang 2 03/15 no.13 Limo Cinere Depok
KUSPITO 5 – Pemasaran – Jl. Kav Madukismo no 10 Seturan Condong catur Sleman Yogyakarta

SPONDYLOLISTHESIS (Lumbar spondylolisthesis)

2009-03-13T01:39:00.002+07:00

spondylolisthesis is the term applied to spontaneous displacement of a lumbar vertebral body upon the segment next below it. Displacement is usually forwards, but may be backwards.

Cause. There are three predisposing factors: 1) congenital malformation the articular processes (rare); 2) spondylolysis (a defect in the pars interarticularis of the neural arch) and 3) osteoarthritis of the posterior (facet) joints.

Pathology. In the normal spine forward displacement of a vertebral joint is prevented by engagement of its articular processes with those of the segment next below it. In spondylolisthesis there is a failure of this check mechanism, and the attachments of the intervertebral disc alone are not strong enough to hold the vertebral bodies in alignment.

In the first type, the least common, there is a congenital basis for the displacement. The posterior intervertebral joints are unstable because the articular processes are congenitally malformed or even rudimentary, thus they form no bar to forward displacement of the spinal column . This defect occurs most often at the lumbo-sacral joint. Displacement may be severe and, since the whole vertebra is displaced complete with its neural arch, the cauda equina may be trapped, with consequent severe neurological disturbance . In the second type, which is the best recognised, a defect in the neural arch of a vertebra alloy's separation of its two halves (see spondylolysis). The body, with the pedicles and superior articular processes (and the whole of the spinal column above it), slips forwards, leaving behind the laminae and inferior articular processes . The fifth lumbar is the vertebra usually affected, the fourth occasionally. Displacement may gradually increase, especially during adolescence, and it sometimes reaches a severe degree. There may be minor irritation of one of the issuing nerves, with consequent sciatica: but despite severe bony displacement serious interference with the nerves of the cauda cquina is exceptional in this type of spondylolisthesis.

In the third type of spondylolisthesis, seen fairly commonly, the posterior intervertebral (facet) joints become unstable on account of osteoarthritis, with degeneration of the articular cartilage that is essential lo a snug fit of the joint surfaces. It may occur at any level in the lumbar spine most commonly between the fourth and fifth lumbar vertebrae. In this type the vertebral displacement is occasionally backwards rather than forwards but in either case displacement is never severe, neurological disturbance is the intervertebral disc at the site of vertebral slipping is inevitably Damaged and disc prolapse may occur

Clinical features. The clinical features of spondylolisthesis are inconsistent they depend to some extent upon the nature of the causative lesion and upon the degree of displacement. Thus in spondylolisthesis from under-development the articular processes and in that from a defect of the pars interarticularis the patient is usually an adolescent or a young adult. whereas displacement from degeneration of te facet joints in osteoarthritisis seen characteristically in patients beyond middle age. In some cases the deformity is entirely symptomless. When symptom occur they take the form of chronic backache, with or without sciatica. The back pain is worse on standing.

On examination there is often a visible or palpable 'step' above the sacral crest, due to the forward displacement of the spinal column; but this is obvious only when the displacement is severe. Spinal movements restricted only slightly, if at all. Abdomen: When displacement is severe spinal column is projected forwards and the lumbar vertebral bodies may palpable through the abdominal wall. Lower limbs Minor irritation of a sciatic root is often evidenced by impairment of straight leg raising, but severe neurological disturbance is seldom observed except in the rare cases in which congenital malformation of the articular process allows dislocation of the whole vertebra complete with its neural arch. Radiographic features. Radiographs show the displacement. The lateral and oblique views will demonstrate whether or not there is a defect of the neural arch.

Diagnosis. Spondylolisthesis is distinguished from other causes of back pain and sciatica by the radiographs.

SPONDYLOLYSIS

2009-03-13T01:32:00.002+07:00

In spondylolysis there is a defect in the neural arch of the fifth (rarely the fourth) lumbar vertebra. There is loss of bony continuity between the superior and the inferior articular processes, the deficiency being bridged by fibrous tissue. If this stretches or gives way, the consequent vertebral displacement constitutes one variety of spondylosthesis

through the detect was formerly regarded as congenital it is now widely believed that it may be caused by injury; or, more often, it may be the result of a stress fracture in childhood or adolescence. Clinically, spondylolysis (the defect without displacement) is often symptomless, but it if sometimes a cause of deep lumbar back pain. radiographically the defect is usually best shown in oblique projections

Treatment. This is often unnecessary. Aching may be relieved by a surgical corset, If pain is unusually troublesome an attempt may be made to to close the defect in the pars interarticularis on each aide by transfixing it with a screw and laying in slender bone grafts (Buck, 1970); or alternatively, local fusion of the spine may be undertaken.

Lumbago - Acute lower back pain

2009-03-13T01:23:00.002+07:00

Lumbago is a symptom rather than a disease. In a typical attack of acute lumbago the patient is suddenly seized with agonizing pain in the lumbar region of the spine, usually while stooping, lifting, turning, or coughing. The pain is often so severe that any movement is difficult and the patient is 'stuck.' With rest, the pain gradually subsides, but in some cases the acute back pain is succeeded by sciatica, suggesting irritation of a lumbar or sacral nerve.

The pathogenesis of acute lumbago is not entirely clear. Indeed there may be more than one cause. Probably in many cases the underlying lesion is a prolapsed disc that has not yet been retropulsed far enough to interfere with a nerve root. It is in these cases that sciatica may develop later, as the size of the prolapse increases. But other examples of acute lumbago are more convincingly described to some other mechanical disorder, such as sudden nipping of synovial membrane in one of the facet joints, or momentary subluxation with consequent ligamentous strain, especially at an intervertebral joint that is unstable on account of disc degeneration or osteoarthritis. In such a case acute attacks of pain may recur at interval of months or years.

Treatment should usually be to provide rest for the spine, either by recumbency or by a plaster jacket or surgical corset, as for a prolapsed intcrvertebral disc. Full recovery is often observed within one or two weeks. Because of the frightening severity of the pain confident reassurance may be needed.

PROLAPSED LUMBAR INTERVERTBRAL DISC

2009-03-13T00:54:00.002+07:00

Herniation of pan of a lumbar intervertebral disc is a common cause of combined back. pain and sciatica.

Cause. Prolapse of a disc is often precipitated by injury. Spontaneous age-degeneration of the disc is probably an important predisposing factor.

Pathology. The discs between L.5 and S.I and between L.4 and L.5 are those most often affected. Part of the gelatinous nucleus pulposus protrudes through a rent in the annulus fibrosus in its weakest part, which is postero-lateral or sometimes the torn annulus itself protrudes back ward If it is small, the protrusion bulges the pain-sensitive posterior longitudinal ligament, causing pain in the back. If it is large, the protrusion herniated through the posterior ligament and may impinge upon an issuing cause sciatic pain. The nerve affected is that which leaves the spinal canal at the interspace next below the site of the disc lesion. Thus the first spinal nerve is impinged upon by a prolapse between L.5 and S.I, the fifth lumbar nerve by a prolapse between L.4 and L.5, and so on. Natural healing is by shrinkage and fibrosis of the extruded disc material; not by its reposition within the disc

Secondary effect. Progressive degeneration of the disc leads, after months or years, to osteoarthritis with ultimate involvement of the posterior intervertebral (facet) joints as well as the central (body-to-body) joints.

Clinical features. In a typical case of disc prolapse at the L.4-5 or L.5- S.l level tile clinical picture is clearly defined. The patient is aged between 18 and 60. A few hours or days after jarring or straining the back he is seized, while twisting, stooping or coughing, with agonising pain in the lumbar region. He is unable to move. The acute pain gradually lessens in severity, but after a few days a radiating pain is felt in one or other buttock and down the back or side of the thigh to the calf and foot. Tingling or numbness is felt in the calf or foot. The pain is aggravated by coughing or sneezing.

On examination ion the patient with a fully developed acute attack stands either with a lumbar scoliosis (sciatic scoliosis) or with the normal anterior lumbar curve obliterated, Forward flexion is greatly restricted, as also may be extension. Lateral flexion, on the other hand, is usually free and painless—certainly to one side if not to both. Straight leg raising is restricted on the affected side. Careful tests may reveal slight muscle wasting or weakness in the distribution of the affected nerve, and the corresponding tendon jerk (knee jerk in L.3-L.4 lesions; ankle Jerk in L.5-S.I lesions) is impaired or absent.

Variations. Atypical cases are common. Thus a definite history of injury or strain is often lacking. The pain may begin gradually rather than suddenly. The symptoms may be confined to the back and never radiate to the lower limb (acute lumbago). On the other hand, the pain is sometimes felt predominantly in the limb and is scarcely perceptible in the back. The the severity of the pain varies greatly from cage to case, and its exact distributiondepends upon the level of the disc prolapse, for instance, in the relatively common cases of high lumbar or mid-lumbar prolapse the pain radiates towards the groin and the front of the thigh rather than to the back of the thigh and leg. In severe case in which the prolapse is almost central there may be Pressure upon the cauda equina, with consequent loss of bladder sensibility and retention of urine.

Imaging
Radiographic features. In a case of acute prolapsed disc plain radiographs do not show any abnormality, and the purpose of radiography is mainly exclude other causes of back pain and sciatica. It is only when a disc has been deranged for many months or years that appreciable narrowing of the disc space and spurring of the foint margins (denoting secondary osteoarthritis are observed. Myelography or preferably, radiography may outline the disc protusion, thus indicating its level. This investigation, however, it superseded eventually by magnetic resonance imaging, which can show the intervcrtebral disc substance and the nerve roots. Discography and ascending spinal venography have an occasional place.

Investigations, Lumbar puncture reveals either normal cerebro-spinal fluid or, commonly, a slight increase of protein content. Correlation of pathology with clinical features. The initial injury or strain marks the time when the annulus fibrosus is torn or damaged. The nucleus pulposus is very gelatinous and an interval elapses before it becomes extruded. Bulging of the extruded material beneath the posterior longitudinal ligament corresponds to the stage of acute back pain. Herniation through the ligament with impingement against the adjacent nerve is responsible for the radiating limb pain.

Diagnosis. Prolapsed intervertebral disc must be differentiated from other causes of pain in the back or leg. The conditions with which it is most likely to be confused are: tuberculosis of the spine or sacro-iliac joints; intraspinal tumour; tumour of the spine or pelvis: spondylolisthesis; ankylosing spondylitis; osteoarthritis of the spine; arthritis of the hip; and occlusion of the aorta or of the iliac or femoral artery, with consequent
ischaemic pain in the proximal limb muscles on exercise. A dramatically sudden onset is always suggestive of a mechanical derangement and especially of a prolapsed disc, whereas pain that increases relentlessly without intermission suggests a progressive lesion, inflammatory or neoplastic. Although the clinical features are often highly suggestive,definitive diagnosis rests upon radiculography or magnetic resonance imaging.

Assessment for TF Amputee.

2009-03-10T01:28:00.001+07:00

Introduction

Clinical assessment is performed to examine the assessment process and consider important information that should be collected during initial patient consultation. And also examine the difference between subjective and objective assessment.

Definition:
Assessment is the process of gathering information to make decisions for diagnosis and prescription.
Our diagnosis and prescription should be in light of information that we get during assessment. It is done before casting and procedure during which the careful and detailed examination of both the normal and amputated side as well as sound side is done. And use for purpose to do right diagnosis. When done for amputation above knee then it is called assessment of trans femoral amputee.
CLINICAL ASSESSMENT CONTEXT.

CLINICAL ASSESSMENT CONSIST OF TWO PARTS.
1) Subjective assessment.
2) Objective assessment.

Subjective Assessment
• Personal information.
General information about patient, e.g Name, father name, gander, age etc.
• Social condition.
Finical condition, assistance available, living arrangements of patient etc.
• Medical history.
List of present condition, symptom, medication and health risk factors
• Past medical history.
List of previous illness
. Previous treatment.
Pre prosthetic treatment, crutches, old prosthesis.

Objective Assessment
• Observation.
a) Posture.
Shoulder height, pelvic level, spine condition etc.
b) Amputation.
Trans femoral amputation, Level of amputation weather it is at proximal 1/3, middle 1/3, distal 1/3.
c) Causes of Amputation.
Congenital, Traumatic, Vascular, Infection, Neoplasm, Diabetes Mellitus etc
d) Swelling.
Edema. e) Muscle bulk or wasting.

Bulky stump or atrophic stump.

. Palpation.
a) Stump condition.
Stump is good for prosthetic fitting or not, Scar is moveable or fixed, Myoplasty or Myodesis.
b) Stump complication.
Flexion contracture, Abduction contracture, fixed scar, cut

aneous horn, Neuroma , cutaneous Horn etc.

• U/L manual dexterity.

Amputation in upper limb, power of U/L (Donning & Doffing).

• Joint condition.
a) Hip joint (Sound side & effected side).
b) Knee joint (Sound side).
c) Ankle joint (Sound side).

• Spinal condition.
Deformity in spine (Lardosis, Kyphosis, scoliosis).

Muscle Grading.

We start to check muscles strength from grade 3 if muscle is weak we move to grade 2, 1, 0. If a muscle is strong we move towards grade 4 and 5.

0 no movement
1 flickering movement
2 complete range of movement without gravity
3 complete range of movement against gravity
4 complete range of movement against gravity and with slight resistance
5 complete range of movement Against gravity with full resistance Tests

Tests

1) Hip Abduction test.
• ROM: 45 deg – 50 deg.
Muscles:
a) Gluteus Medius.
b) Gluteus minimus.
c) Tensor Fascia lata.

POSITION OF PATIENT DURING TEST.

Patient will lie down on examination table in spine position if patient muscle is below grade 3 or side vise when its grade is above 3.
Place your hand on the lateral aspect of stump and ask patient to push against your hand .The force with which patient pushes will give good impression of muscle strength's. Ask the patient to do the same movement alone .observe if range of movement is normal.
NOTE: while doing this test patient should keep pelvis in level otherwise movement will occurring at trunk as will as the hip.

2) Hip Adduction Test.
• ROM: 20 deg – 30 deg.
• Muscles:
a) Adductor Longus.
b) Adductor Brevis.
c) Adductor Magnus.
d) Gracilus.
e) Pectineus.

POSITION OF PATIENT DURING TEST.

Patient will lie down on examination table in spine position if patient muscle is below grade 3 or side vise towards amputated side when its grade is above 3.
Place your hand on the medial aspect of stump and ask patient to push against your hand .The force with which patient pushes will give good impression of muscle strength's. Ask the patient to do the same movement alone .observe if range of movement is normal.
NOTE: while doing this test patient should keep pelvis in level otherwise movement will occurring at trunk as will as the hip.

3) Hip Flexion Test.
• ROM: 130 deg.
• Muscles:
a) Psoas Major.
b) Iliacus.

POSITION OF PATIENT DURING TEST.

Patient will lie down on examination table in spine position if patient muscle is above grade 3 or side vise when its grade is below 3.Place your hand on the anterior aspect of stump and ask patient to push against your hand .The force with which patient pushes will give good impression of muscle strength's. Ask the patient to do the same movement alone .observe if range of movement is normal.

4) Hip Extension Test.
• ROM: 20 deg - 30 deg
• Muscles:
a) Gluteus Maximus.
b) Hamstring.

POSITION OF PATIENT DURING TEST.

Patient will lie down on examination table in prone position if patient muscle is above grade 3 or side vise when its grade is below 3.Place your hand on the posterior aspect of stump and ask patient to push against your hand .The force with which patient pushes will give good impression of muscle strength's. Ask the patient to do the same movement alone .observe if range of movement is normal.
Note: If the patient compensates for lack of hip movement by moving the pelvis. it is strong indication of flexion contracture.

5) Thomas Test.

POSITION OF PATIENT DURING TEST.

The patient lies flat on the examination table. the sound leg is flexed and held in position by either the patient or posthetist.if the patient can keep the back and the stump in contact with the table, there is no flexion contracture in the stump. if patient is unable to bring stump down on table in this position. There is flexion contracture of the muscles of stump and degree of flexion contracture is measured by measuring the angle between the mid line of body and the mid line of the stump.
1 2 3
Note: Patient with flexion contracture must be fitted with TFP where the Socket is flexed to accommodate contracture. Other wise patient will walk with anterior pelvic tilt and excessive Lumbar Lordosis.

6) Measuring The Lateral Wall Adduction Angle.

 The amputee will have to stand between bars or other supports with pelvis in level position.
 The amputee will have to extend the stump as for as possible without anterior rotation of pelvis.
 Then move the amputee s pelvis slightly towards amputated side, so that the mid sagittal line will be about one inch medial to the heel of sound foot.
 Normally the mid sagittal line is at the same distance from both the heels, there for to get normal alignment the stump should be adducted so that if the amputated leg were back in place, the heel would be about 2.5cm from mid sagittal line.
 If the patient has an abduction contracture, it will not be possible to adduct the stump to the position just prescribed above in such case help the patient to adduct the stump as much as possible, keeping the pelvis level, and then measure the angle.

Conclusion

After performing subjective, objective assessment, muscle grading and Tests, we will get the Diagnosis. According to the diagnosis we prescribed appropriate Prosthesis for the Patient.

References

• Nizar Akhtar. Transfemoral Prosthetic Module. PIPOS. 2004.
• Aziz Ahmad. Patient Evaluation and Assessment. PIPOS. 2008
• http://en.wikipedia.org/wiki/Assessments
• www.biologyonline.org/dictionary / Subjective assessment
C. Leslie Mitchell and S. William Levy
National research council Washington 25, D.C

Upper Limb Orthotics

2009-03-07T02:46:00.000+07:00

Upper limb orthoses are distinct from other orthoses because of the complexity of the human hand. There are many simultaneous joint movements that have to be considered for mobilization or immobilization (e.g. nine IP, five MCP, wrist, forearm, elbow, shoulder) short digital levers (Which translate to high forces, high pressures, and skin intolerance) and little soft tissues padding for bands and other components. Orthotic design for the upper limb must give equal focus to mechanical efficiency and precision of fit because comfort is critical for acceptance.

Upper limb orthoses are most likely to be accepted by patients if there is a well defined therapeutic purpose or if the orthoses provide a desired function that cannot be accomplished by any other means, such as substitute. Because even the best upper limb orthoses lacks mechanical versatility to grasp objects that vary in size, shape and weight with equal ease.
Upper limb orthotic design tends to be optimized for a specific purpose. Combine this mechanical shortcoming with impaired sensation, reduced skin friction, and poor subcutaneous contouring; an individual has to produce greater force than the normal hand just to accomplish routine activities. In addition, an upper limb orthoses is conspicuous and advertise the disability. Despite these limitations, upper limb orthoses can offer appealing advantages for the limb left
impaired by paralysis, deformity and pain.

Upper limb orthoses can be categorized in several ways, such as by pathology (e.g. spinal injury, arthritis, trauma, head injury) arthrosegmentally according to joint encompassed (e.g. shoulder, elbow, wrist hand fingers) or treatment objective(e.g. promote healing, direct growth, prevent deformity, correct deformity, enhance function) Specific orthoses are selected according to the patient physical need. It is helpful to organize upper limb orthoses into groups that reflect need. Therefore, the orthoses reviewed for orthotic management of the patient with upper limb paresis or traumas are grouped into therapeutic and functional categories.

Outcome of Different Orthotic Techniques For The Management of Plantar Fasciitis

2009-03-07T02:15:00.002+07:00

INTRODUCTION
Excessive load and tension at the point of insertion of plantar fascia lead to inflammatory condition known as plantar fasciitis (PF). Plantar fasciitis is a major cause of the pain at the plantar aspect of the heel; the common site of pain is the medial tubercle of calcaneus (Roxas 2005; David & Lori 2004; Quaschnick 1996; Chandler & Kibler1993). Treatment remedies include both surgical and non-surgical interventions. Non surgical or conservative treatment comprises Non Steroidal Anti Inflammatory Drugs (NSAIDs), stretching, icing, physical therapy and orthotic management including foot orthosis and night splints (AFO), shoe modifications, low dye taping and walking casts (Kavros, 2005; Roxas, 2005; Young, Rutherford & Niedfeldt 2001). The aim of orthotic management is relief pain; reduce stresses on plantar fascia and increase in shock absorption. Also to maintain normal alignment of the foot to allow the fascia to heal. The aim of this paper is to discuss the outcomes of different orthotic devices and techniques for the management of PF in terms of pain relief, resolution of the symptoms and improvement in the anatomical and biomechanical condition.

Signs and Symptoms
Pain is classical symptom of PF, patient feels sever pain when he takes first few steps after sleep or long period of rest. It is sharp, knife like and piercing pain at the medial aspect of the heel and lessens or resolve as patient worm up. Prolong standing will also cause pain along with stiffness. There is localized tenderness of the tissue at the site of the pain. Tenderness can be felt when toes are hyper extended and ankle is dorsiflexed. A calcaneal spur is visible in the X-ray of affected foot (Cole, Craig & Gazewood, 2005; Young, Rutherford & Niedfeldt, 2001).

Etiology And Risk Factor
Etiology of plantar fasciitis is multifactoral, including anatomical, biomechanical and environmental factors. Anatomical factors include flat foot, cavus foot, obesity, and leg length discrepancy and fat pad atrophy.Biomechanical factor are equinus, weak plantar flexors, weak intrinsic muscle and excessive pronation at subtalar joint, whereas trauma, walking bare foot, walking on rough surface for a long time are included in environmental factors (Martin, Hosch, Goforth, Murff, Lynch & Odom, 2001; Gross, Davlin & Evanski 1991).

PATHOLOGY OF PLANTAR FASCIITIS (PF)
Plantar fascia is attached to the medial tubercle of calcaneus proximally and metatarsal head distally. With weight bearing it stretched and micro tears of fascia occur as well as tearing of periosteum at point of attachment of fascia. During rest these micro tears undergo healing and remodeling results in the formation of big bony mass or scar, the heel spur (Young, Rutherford & Niedfeldt, 2001; Quaschnick, 1996; Ryan, 1995; Corrigan & Maitland, 1994). There are inflammatory responses in plantar fascia from disorder of collagen fiber as result of repetition of excessive stress leads to chronic degenerative changes (Stadler, Johnson & Stephens, 2003).

In PF, Plantar flexors strength is decreased and gastro-soleus complex is tightened. Excessive pronation causes instability of hind foot, which leads to more strain on the origin of plantar fascia. Entrapment of medial calcaneal branch of posterior tibial nerve also causes pain. (Roxas 2005; Young, Rutherford & Niedfeldt, 2001; Quaschnick, 1996).

TREATMENT MODALITIES
Both surgical procedures and conservative managements are used to treat plantar fasciitis. Application of ice, use of NSAIDs, stretching and strengthening exercises for gaestrosoleus tightness and plantar flexors strength are non-surgical intervention as well as the orthotic management. Orthotic management is accomplished with use of different types of foot orthoses, heel pads, night splints, low dye taping and walking casts (Kavros, 2005; Sobel, Levitz & Caselli,
1999; Lynch, Goforth, Martin, Odom, Preece & Kotter, 1998).

AIM OF ORTHOTIC MANAGEMENT OF PLANTAR FASCIITIS
PF is self-limiting condition, but it takes a long period usually 6-18 months for complete resolution of symptoms, it is frustrating for both patient and physician. Aim of orthotic management is to address the pain, excessive stresses and inflammatory condition; provide shock absorption and to deal with biomechanical adaptation like slight varus position
of the heel and excessive pronation of fore foot during heel strike that lead to pain in foot and other part of body (Roxas, 2005; Young, Rutherford & Niedfeldt, 2001). Another important goal of the treatment is to keep the plantar fascia in its proper length, during weight bearing and non-weight bearing and restore the strength and flexibility of involved tissues (Barry, Anna & Yinpu. 2002). Injuries to the foot are usually the result of varying degree and size of the kinetic and kinametic changes in the foot, the use of correct orthosis that addresses these changes will result in the relief of the symptoms (Kavros, 2005).

FOOT ORTHOSES
Foot orthoses are effective in reducing pain in heel and arch area and provide comfort by altering the intrinsic factor and realigning the foot by keeping the sub tarsal joint in neutral position and preventing forefoot pronation, thus improve activity level (Karas &, David, 2002; Sobel, Levitz & Caselli, 1999; Gill & Kiebzak 1996). This goal is also achieved by support the medial longitudinal arch with rigid foundation to reduce the tensile forces within fascia (Gross, Byers, Krafft, Lackey & Melton 2002; Joan & Mark, 2001; Sobel, Levitz & Caselli, 1999; Turlik, Donatalli & Veremis 1999; Lynch et al, 1998).
Prefabricated semi rigid orthoses are effective in pain relief either by realigning the foot or by soft cushioning effect Success rate for foot orthoses is 83-100 % and there is high level of compliance (Kavros, 2005; Landorf, Keenan & Herbert, 2004; Martin et al, 2001; Pfeffer et al, 1999; Gross, Davlin & Evanski, 1991).

Viscoelastic Heel Pads
Viscoelastic heel pads and cushions are used to replace the atrophied fat pads of the heel and act as shock absorber during heel strike to dissipate the ground reaction forces hence reducing the impact force on leg and spine. Silicon heel pads provide relief at the site of tenderness and heel spur by distributing the weight around the point. Rear foot varus post or lateral wedge reduces pronation of forefoot and reduce the stretch to fascia result in the resolution of symptoms specially the pain (Landorf, Keenan & Herbert, 2004; Seligman & Dawson, 2003; Caselli, 1999; Pfeffer et al 1999).

Night Splints
During sleeping irrespective of whether supine or prone position, foot is postured in plantar flexion due to normal tone of gastrosoleus complex, this non functional plantar flexion will result in tightness of Achilles tendon and plantar fascia. Patient will experience a sharp pain at heel when foot touches the ground during first step in the morning due to stretching of tight plantar fascia. Tension night splint in chronic PF keeps foot in dorsi flexion preventing the contraction of the plantar fascia and Achilles tendon, which relaxed in stretched position due to stress relaxation, thus proper length of fascia is maintained (Barry, Anna & Yinpu. 2002; Probe, Baca, Adams & Preece, 1999; Powell, Post, Keener & Wearden, 1998; Chandler & Kibler1993).
The results are supplemented if night splint is used in conjunct with other conservative treatment such as FO, low dye taping and NSAIDs. 100% of success is achieved by use of night splint in chronic cases although these devices have no significant effect during acute phase. Unfortunately few patients feel unpleasant to use AFO during sleep or they feel
discomfort numbness or non compliance (Ryan, 1995; Wapner & Sharkey, 1991).
The night splint made of polypropylene aligned in 5 dorsiflexion and 30 dorsiflexion at metatarsophalangeal joint by placing a wedge under forefoot could be prescribed in chronic cases.

Low- Dye Taping
Taping is less expensive but more effective way of treatment of the plantar fasciitis, Though it is not considered as proper orthotic technique but still used in initial managements of planter fasciitis. Taping maintain the arch, stabilizes the metatarsal head and pronation of the foot (Cole, Craig & Gazewood, 2005; Quaschnick, 1996; Young, Rutherford & Niedfeldt 2001).
The injuries where there are very little traces of inflammation are present, tissue healing is allowed by protected or very limited ROM through taping during acute phase. Taping is also used as indicator of the Plantar fasciitis if symptoms still persist after few weeks of taping, the patient will reassessed for plantar fasciitis. If it is successful then permanent orthosis is prescribed (Brian, 2006; Landorf, Radford, Keenan, & Remond, 2005; Osbome & Allison, 2006; Chandler & Kibler, 1993).

Supportive Foot Wear
Proper shoes with proper fit and well supported arch and mid sole should be used in case of PF for proper distribution of forces. Shoes must be changed frequently and new shoes can be readjusted according to need, thus improving the symptoms. Shoe with well defined medial arch will reduce the strain in fascia. (Young, Rutherford & Niedfeldt 2001; Quaschnick, 1996; David, 1991).Older shoe will exacerbate the condition in the PF. Plantar fascia will under go tension from heel rise to toe off during gait and will cause the irritation of already inflamed ligament, which can be reduced or even diminished by modifying the commercially available shoes. Such modification include placement medial wedge to elevate arch and placement of silicon pads etc. shoe with proper fit will prevent the recurrence of disorder. (Joan & Mark, 2001; Sobel, Levitz & Caselli, 1999; Mizel, Marymont, & Trepman, 1996).

Walking Casts
In some cases casting is considered to be an effective way of treatment. This process is accomplished by wrapping ankle in neutral position or slightly dorsiflexion with fiberglass walking cast. Walking cast provides rest for heel and reduces the pressure at heel strike. These are also used to provide arch support and avoid the tightness of the Achilles tendon. (Roxas,
2005; Sobel, Levitz & Caselli, 1999; Gill & Kiebzak, 1996).

CONCLUSION
To sum up, PF is one of the common disorders of the foot that causes localized pain in the heel as well as change the functional biomechanics of the patient which in turn affect the activity level of the sufferer. The aim for orthotic management of plantar fasciitis is to deal with pain relief, correction of the posture (excessive pronation and varus heel) and hence the restoring the activities of the patient. Orthotic technique includes the foot orthosis, shoe inserts heel pads,
taping and casting of the foot. No single treatment is thought to be effective. Foot orthosis and heel pads produce relief in the pain by direct cushioning effect or by elevated arch support and controls the pronation of the foot during walking and running thus reduces the tensile forces on the foot, consequently improving the functional restorations. Heel pads also act as shock absorber at heel strike and reduce the overall impact on the leg and low back. In chronic cases the use of night splint aligned in 5 dorsi flexion cause considerable reduction in pain. Night
splints are also effective in the improving the symptoms in recalcitrant PF and reduce the formation of the micro tears. Arch taping and walking casts used to minimize the ROM at ankle during acute phase. Finally, there is no single treatment modality that is effective in the management of the PF; it is combination of the treatments that result in the resolution of the symptoms pain, inflammation and biomechanical factors.

SUGGESTED REFFERENCES:

Barry, L.D., Anna, N. and Yinpu, C. ( 2002) A retrospective study of standing gastrocnemius-soleus stretching versus night splinting in the treatment of plantar fasciitis. Journal of Foot & Ankle Surgery. 41(4):221-7,

Brian, F (2006) Plantar Fasciitis: how to maximize outcomes with conservative treatment Podiatry Today, 19 (5), 48 - 56

Chandler, T . and Kibler, W B. (1993) A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. Sports Medicine, 15(5):344-52,

Cole, C.S., Craig, G.J. (2005) plantar fasciitis: evidence-based review of diagnosis and therapy. [Review] American Family Physician, 72(11):2237-42,

David O. D. (1991) A Comparison of Shoe Inserts to Taping for Painful Arches, Journal of Prosthetics and Orthotics 3(2); 84-. Gill, L H. and Kiebzak, G. M. (1996) Outcome of no surgical treatment for plantar fasciitis Foot & Ankle International. 17(9):527-32,

Gross, M.T., Byers, J.M., Kraft ,J.L. , Lackey, E.L and Melton K.M. (2002) The impact of custom semi rigid foot orthotics on pain and disability for individuals with plantar fasciitis: Journal of Orthopeadic And sports physical therapy 32(4):149-57

Joan, M. B. and Mark, W.N. (2001) Over the counter foot remedies Journal of American Family Physician 64(5) 791-6

Karas, M .A. and David, J.H., (2002) Compensatory Midfoot Dorsiflexion in the Individual with Heel cord Tightness: Implications for Orthotic Device Designs, Journal of Prosthetics and Orthotics 14(2); 82-93.

www.ankle-foot.com accessed on 15 -10-2008

Http://www.icbmedical.com/conditions/heelspurs/low_dye_strapping accessed on 15 -10-2008

HIP-KNEE-ANKLE-FOOT ORTHOTICS

2009-03-07T02:10:00.002+07:00

HKAFO consists of a hip joint and pelvic band in addition to a KAFO. The orthotic hip joint is positioned with the patient sitting upright at 90°, while the orthotic knee joint is centered over the medial femoral condyle. Pelvic bands complicate dressing after toileting unless the orthosis is worn under all clothing. Pelvic bands increase the energy demands for ambulation.

Pelvic bands
1. Bilateral pelvic band: This band is used more commonly with its posterior metal ends located anterior to the lateral midline of the pelvis and is interconnected by a flexible belt.
2. Unilateral pelvic band: This band rarely is used because most conditions requiring a HKAFO have bilateral involvement.
3. Pelvic girdle: The pelvic girdle is made of molded thermoplastic materials, providing a maximum degree of control in patients with bilateral involvement.
4. Silesian belt: This belt has no metal or rigid band and offers mild resistance to abduction and rotation of the hip. The Silesian belt attaches to the lateral upright and encircles the pelvis.

Hip joints and locks: The hip joint can prevent abduction and adduction as well as hip rotation.
1. Single axis hip joint with lock: This joint is the most common hip joint with flexion and extension. The single axis hip joint with lock may include an adjustable stop to control hyperextension.
2. Two-position lock hip joint: This hip joint can be locked at full extension and 90° of flexion and is used for hip spasticity control in a patient who has difficulty maintaining a seated position.
3. Double axis hip joint: This hip joint has a flexion-extension axis and abduction-adduction axis to control these motions.

KNEE ORTHOTICS (KO)

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A knee orthosis (KO) only provides support or control of the knee but not of the foot and ankle. The knee joint is centered over the medial femoral condyle. If the patient does not have adequate gastrocnemius delineation so that there is a shelf for the distal end of the orthosis to rest on, the brace may slide down the leg with wear. In that case, the brace needs to extend to the sole of the foot.

Knee orthoses for patellofemoral disorder: These orthoses are used to supply mediolateral knee stability and to control tracking of the patella during knee flexion and extension. This type of orthosis includes an infrapatellar strap KO and Palumbo KO.
Knee orthoses for knee control in the sagittal plane: These orthoses are used to control genu recurvatum with minimal mediolateral stability. This type of KO includes a Swedish knee cage and a 3-way knee stabilizer.
Knee orthoses for knee control in the frontal plane: These orthoses consist of thigh and calf cuffs joined by sidebars with mechanical knee joints. The knee joint usually is polycentric and closely mimics the anatomic joint motion. This type of KO includes traditional metal-leather KO, Miami KO, Canadian Arthritis and Rheumatism Society- University of British Columbia KO, and supracondylar KO.

Knee orthoses for axial rotation control: These orthoses can provide angular control of flexion-extension and mediolateral planes, in addition to controlling axial rotation. This orthosis is used mostly in management of sports injuries of the knee. This type of KO includes Lenox-Hill derotation orthosis and Lerman multiligamentous knee control orthosis.

KNEE-ANKLE-FOOT ORTHOTICS (KAFO)

2009-03-07T01:48:00.001+07:00

KAFOs consist of an AFO with metal uprights, a mechanical knee joint, and 2 thigh bands. KAFO can be used in quadriceps paralysis or weakness to maintain knee stability and control flexible genu valgum or varum. KAFO also is used to limit the weight bearing of the thigh, leg, and foot with quadrilateral or ischial containment brim. A KAFO is more difficult to don and doff than an AFO, so it is not recommended for patients who have moderate-to-severe cognitive dysfunction.
! KAFO: This orthosis can be made of metal-leather and metal-plastic or plastic and plastic-metal. The metal design includes double upright metal KAFO (most common), single upright metal KAFO (lateral upright only), and Scott-Craig metal KAFO. The plastic designs are indicated for closer fit and maximum control of the foot, including supracondylar plastic KAFO, supracondylar plastic-metal KAFO, and plastic shells with metal uprights KAFO.

A double upright metal KAFO: This is an AFO with 2 metal uprights extending proximally to the thigh to control knee motion and alignment. This orthosis consists of a mechanical knee joint and 2 thigh bands between 2 uprights.
A Scott-Craig orthosis consists of a cushioned heel with a T-shaped foot plate for mediolateral stability, ankle joint with anterior and posterior adjustable stops, double uprights, a pretibial band, a posterior thigh band, and knee joint with pawl locks and bail control. Hyperextension of the hip allows the center of gravity falling behind the hip joint and in front of the locked knee and ankle joint. With 10° of ankle dorsiflexion alignment, it allows a swing-to or swing-through gait with crutches. This orthosis is used for standing and ambulation in patients with paraplegia dueto spinal cord injury (SCI).
The supracondylar plastic orthosis uses immobilized ankle in slight plantar flexion to produce a knee extension moment in stance to help eliminate the need for a mechanical knee lock. This orthosis also resists genu recurvatum and provides mediolateral knee stability.
A plastic shell and metal upright orthosis consists of a posterior leaf spring AFO with double metal uprights extending up to a plastic shell in the thigh with an intervening knee joint.

Knee joints: The mechanical knee joint can be polycentric or single axis. Polycentric is used for significant knee motion, and a single axis is more common and is used for knee stabilization. Single axis knee joints include the following:

Free motion knee joint: This joint has unrestricted knee flexion and extension with a stop to prevent hyperextension. The free motion knee joint is used for patients with recurvatum but good strength of the quadriceps to control knee motion.
Offset knee joint: The hinge is located posterior to the knee joint and ground reaction force; thus, it extends the knee and provides great stability during early stance phase of the gait cycle. This joint flexes the knee freely during swing phase and is contraindicated with knee or hip flexion contracture and ankle plantar flexion stop.
Drop ring lock knee joint: The drop ring lock is the most commonly used knee lock to control knee flexion. The rings drop to unlock over the knee joint while the knee is in extension by gravity or manual assistance. This type of joint is stable, but gait is stiff without knee motion. A ball bearing on a spring can be added just above the drop lock to keep it from slipping up as the patient ambulates. Patients over 120 pounds usually feel more secure with both medial and lateral drop locks.
Pawl lock with bail release knee joint: The semicircular bail attaches to the knee joint posteriorly, and it can unlock both joints easily by pulling up the bail or backing up to sit down in a chair. A major drawback is the accidental unlocking while the patient is pulling his or her pants up or bumping into a chair. Adjustable knee lock joint (dial lock): The serrated adjustable knee joint allows knee locking at different degrees of flexion. This type of knee joint is used in patients with knee flexion contractures that are improving gradually with stretching.
Ischial weight bearing: Most individuals in a KAFO sit partially on the upper thigh band unless the cuff is brought up above the ischium.

Knee cap and strap: The knee cap can be placed in front of the knee in the orthosis to prevent flexion of the knee. A medial strap is used for genu valgum and a lateral strap is used for genu varum. These buckles wrap around the upright in the same way as ankle straps.

Plastic shell and metal uprights moldedknee-ankle-foot orthosis with drop lock joints.

Offset knee joint knee-ankle-foot orthosis.

SHOES, FOOT ORTHOTICS, ANKLE FOOT ORTHOTICS

2009-03-07T01:09:00.002+07:00

Shoes
Shoes are the important foundation of the lower limb orthosis. Shoes are used to protect and warm the feet, transfer body weight while walking, and reduce pressure or pain through redistributing weight. Shoes should be comfortable and properly fitted.
They should be at least 1 cm longer than the longest toe and correspond to the shape of the feet.
The shoe can be divided into lower and upper parts. The lower parts consist of the sole, shank, ball, toe spring, and heel. The upper parts include the quarter, heel counter, vamp, toe box, tongue, and throat.

Rocker Shoe

Blucher style orthopedic shoe

Diabetic shoe

Foot orthosis
The foot orthosis extends from the posterior border of the foot to a point just posterior to the metatarsal heads. This device is used to accommodate the abnormal foot to help restore more normalized lower limb biomechanics.

Custom Foot Orthotic Shoe insert: This insert is made of rigid plastic fabricated over a cast of the foot held in maximal manual correction. It encompasses the heel and midfoot, and it has rigid medial, lateral, and posterior walls.
Heel cup: The heel cup is a rigid plastic insert that covers the plantar surface of the heel and extends posteriorly, medially,and laterally up the side of the heel. The heel cup is used to prevent lateral calcaneal shift in the flexible flat foot.
Sesamoid insert: This addition to an orthosis is an insert amounting to three quarters of an inch with an extension under the hallux to transfer pressure off the short first metatarsal head and onto its shaft.

ANKLE-FOOT ORTHOTICS (AFO)
An AFO is commonly prescribed for weakness or paralysis of ankle dorsiflexors, plantar flexors, invertors, and evertors. AFOs are used to prevent or correct deformities and reduce weight bearing. The position of the ankle indirectly affects the stability of the knee with ankle plantar flexion providing a knee extension force and ankle dorsiflexion providing a knee flexion force. An AFO has been shown to reduce the energy cost of ambulation in a wide variety of conditions, such as spastic diplegia due to cerebral palsy, lower motor neuron weakness of poliomyelitis, and spastic hemiplegia in cerebral infarction.

Thermoplastic AFOs: These devices are plastic molded AFOs, consisting of the following 3 parts: (1) a shoe insert, (2) a calf shell, and (3) a calf strap attached proximally. The rigidity depends on the thickness and composition of the plastic, aswell as the trim line and shape. Thermoplastic AFOs are contraindicated in cases of fluctuating edema and insensation.

Posterior leaf spring (PLS): The PLS is the most common form of AFO with a narrow calf shell and a narrow ankle trimline behind the malleoli. The PLS is used for compensating for weak ankle dorsiflexors by resisting ankle plantar flexion at heel strike and during swing phase with no mediolateral control.
Spiral AFO: This AFO consists of a shoe insert, a spiral that starts medially, passes around the leg posteriorly, then passes anteriorly to terminate at the medial tibial flare where a calf band is attached. The spiral AFO allows for rotation in the transverse plane while controlling ankle dorsiflexion and plantar flexion, as well as eversion and inversion.
Hemispiral AFO: This AFO consists of a shoe insert with a spiral starting on the lateral side of the shoe insert, passing up the posterior leg, and terminating at the medial tibial flare where the calf band is attached. This design is used for achieving better control of equinovarus than the spiral AFO can.
Solid AFO: The solid AFO has a wider calf shell with trim line anterior to the malleoli. This AFO prevents ankle dorsiflexion and plantar flexion, as well as varus and valgus deviation.
AFO with flange: This AFO has an extension (flange) that projects from the calf shell medially for maximum valgus control and laterally for maximum varus control.
Hinged AFO: The adjustable ankle hinges can be set to the desired range of ankle dorsiflexion or plantar flexion.
Tone-reducing AFO (TRAFO): The broad footplate is used to provide support around most of the foot, extendingdistally under the toes and up over the foot medially and laterally to maintain the subtalar joint in normal alignment.

The TRAFO is indicated for patients with spastic hemiplegia.

Modular ankle-foot orthosis with ankle foot double adjustable hinged joint

Double uprightmetal AFO

Carbon plastic orthosis with footplate.

REFERENCES

Braddom RL, Dumitru D, Johnson EW, et al, eds. Lower limb orthoses. In: Physical Medicine and Rehabilitation. 1st ed. WB Saunders Co;1995:333-358.
Merritt JL. Knee-ankle-foot orthotics: long leg braces and their practical applications. In: Physical Medicine and Rehabilitation: State of the Art Reviews. Vol 1. 1987:67-82.
Molnar GE, Alexander MA. Orthotics and assistive devices. In: Pediatric Rehabilitation, Rehabilitation Medicine Library. Lippincott Williams & Wilkins;1985:157-177.
Tan JC. Orthoses. In: Practical Manual of Physical Medicine and Rehabilitation. 1st ed. Mosby-Year Book;1998:178-228.
Rubin G, Bonarrigo D, Danisi M. The shoe as a component of the orthosis. Prosthet Orthot Int.1976;30(2):13-25

Lower Limb Orthotics

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A lower limb orthosis is an external device applied or attached to a lower body segment to improve function by controlling motion, providing support through stabilizing gait, reducing pain through transferring load to another area, correcting flexible deformities, and preventing progression of fixed deformities.

Orthosis is the medical term for what most people would refer to as a brace or splint. Orthoses generally are named by the body regions that they involve, as demonstrated by the following abbreviations:

AFO is an ankle-foot orthosis.
KAFO is a knee-ankle-foot orthosis.
HKAFO is a hip-knee-ankle-foot orthosis.
THKAFO is a trunk-hip-knee-ankle-foot orthosis.

Regarding human gait, the purpose of using an orthosis is to enhance normal movement and to decrease abnormal posture and tone. Lower extremity orthoses can be used to correct abnormal gait patterns and to increase the efficiency of walking.

Classes of Lower extremity Orthoses
An orthosis may be classified as a static or dynamic device. A static orthosis is rigid and is used to support the weakened or paralyzed body parts in a particular position. A dynamic orthosis is used to facilitate body motion to allow optimal function. In all orthotic devices, 3 points of pressure are needed for proper control of a joint.

Principles of Orthotics
A lower limb orthosis should be used only for specific management of a selected disorder. The orthotic joints should be aligned at the approximate anatomic joints. Most orthoses use a 3-point system to ensure proper positioning of the lower limb inside the orthosis.
The orthosis selected should be simple, lightweight, strong, durable, and cosmetically acceptable. Considerations for orthotic prescription should include the 3-point pressure control system, static or dynamic stabilization, flexible material, and tissue tolerance to compression and shear force.

REFERENCES

Braddom RL, Dumitru D, Johnson EW, et al, eds. Lower limb orthoses. In: Physical Medicine and Rehabilitation. 1st ed. WB Saunders Co;1995:333-358.
Merritt JL. Knee-ankle-foot orthotics: long leg braces and their practical applications. In: Physical Medicine and Rehabilitation: State of the Art Reviews. Vol 1. 1987:67-82.
Molnar GE, Alexander MA. Orthotics and assistive devices. In: Pediatric Rehabilitation, Rehabilitation Medicine Library. Lippincott Williams & Wilkins;1985:157-177.
Tan JC. Orthoses. In: Practical Manual of Physical Medicine and Rehabilitation. 1st ed. Mosby-Year Book;1998:178-228.
Rubin G, Bonarrigo D, Danisi M. The shoe as a component of the orthosis. Prosthet Orthot Int.1976;30(2):13-25

Muscles of the hip

2009-03-06T16:52:00.001+07:00

In human anatomy, the muscles of the hip joint are those muscles that cause movement in the hip. Most modern anatomists define 17 of these muscles, although some additional muscles may sometimes be considered. Muscles of hip joint are divided in to 6 groups on the basis of its function. Those are: Hip Flexor, Hip Extensor, Hip Abductor, Hip Adductor, Hip internal Rotator, Hip External Rotator

Hip joint is most stable and multi-axial joint in the body .Muscular factor is one of them which give more stability to the hip joint.According to different movements of hip, different muscles are listed below, which act on hip join.

1. EXTENSOR MUSCLES
Prime movers
1. Gluteus Maximus
2. Semitendinous
3. Semimembraneous
4.Biceps Femoris( Long Head)
5.Adductor magnus
( Hamstring part)

2. FLEXOR MUSCLES
Prime movers
1.Psoas Major
2.Iiacus
3.Rectus Femoris
4.Sartorious
Accessory muscles
• Tensor fasciae latae
• Sartorious
• Rectus femoris
• Pectineus

3. ABDUCTOR MUSCLES
Prime movers
1.Gluteus medius
2.Gluteus minimus
3.Tensor fasciae latae

Accessory muscles
• Gluteus maximus
• Piriformis
• Sartorious

4. ADDUCTOR MUSCLES
Prime movers
1.Adductor magnus
2.Adductor longus
3.Adductor brevis
4.Gracilus

Accessory muscles
• Gracilis
• Pectineus
• Obturator internus
• Gemelli 2
• Obturator externus
• Quadricep femoris

5. Medial Rotator Muscles
1.Gluteus medius
2.Gluteus minimus
3.Tensor fasciae lata
6. Lateral Rotator Muscles
(Prime movers)
1.Obturator externus
2.Obturator internus
3.Periformis
3.2 Gemelli
4.Quadricep femoris
5.Quadratus femoris
Accessory muscles
• Iliopsoas
• Gluteus maximus

1. Hip Flexors.
The iliacus and psoas major comprise the iliopsoas group. The iliopsoas is a large muscle that runs from the transverse processes of the T-12 to L-5 vertebrae, joins with the iliacus via its tendon, and connects to the lesser trochanter of the femur. The iliacus originates on the iliac fossa of the ilium. Together these muscles are commonly referred to as the "iliopsoas".Because of their common action and nerve supply.Function: flexion at hip joint.

Prime Movers.

Psoas major .

Origin: Transverse process of all lumber vertebra, Intervertebral discs b/w the lumbar vertebrae,Lateral sideof the bodies of lumbar vertebrae.
Insertion: Tip of the lesser trochenter of femur
Nerve: Lumber plexus
Iliacus.
Origin: Iliac fossa, inner lip of iliac crest, base of sacrum.
Insertion: Base of lesser trochenter
Nerve: Lumber plexus

Hip Flexor Accessory
Rectus femoris:
Origin: Straight head from AIIS ( Anterior inferior iliac spine ) and reflected head from above acetabulum.
Insertion: upper border of patella
Nerve: Femoral nerve.
Function: Flexor of hip and extensor of knee joint.
Sartorius:
Origin: ASIS ( Anterior superior iliac spine )
Insertion:Upper part of medial shaft of tibia
Nerve: Femoral nerve.
Function: 1) Weak flexor, abductor and lateral rotator of hip.
2) weak flexor and medial rotator of knee.

2. Hip Extensors.
Gluteus maximus and Hamstring muscles are the main extensors of hip joint. Gluteus maximus is one of the largest and thickest muscle in the body, it placed entirely behind the hip joint and is shaped like a parallelogram.
1) Gluteus Maximus:
Functions.
1. It is an extensor of hip joint but it is used only when the joint has to extend with power e.g aginst gravity. It is mainly used in rising from sitting position, climbing a hill, or going upstairs. It is used in running but not in walking on level surface.
2. The anterior fibers of gluteus maximus help in abduction at hip joint.
3. It is a lateral rotator of extended thing and loses this power when thing is flexed.
2) Hamstring muscles:
Functions.
1. They extend the hip and flex the knee.
2. Bicep is the lateral rotator of flexed knee.
3. Semimembranosus, semitendeninosus, Gracillis, Sartorius and Popliteus are the medial rotator of flexed knee.

1) Gluteusmaximus:
Origin: Behind Posterior gluteal line of ilium, Sacrum, Sacrotuberosus Ligament,Deep fascia,Thoraco Lumbar verterea.
Insertion: 3/4 Iliotibial band of fascia lata over GT ( femur), 1/4 Gluteal tubersity.
Nerve : Inferior gluteal.

2) Hamstring muscles:
Semitendinosus:
Origin: Medial surface of upper part of Ischial tubersity above the transverse ridge.
Insertion: Upper medial surface of shaft of tibia
Nerve: Sciatic nerve
Semimembranosus:
Origin: Lateral surface of upper part of Ischial tubersity above the transverse ridge.
Insertion: Medial condyl of tibia.
Nerve: Sciatic nerve
Bicep femoris:
Origin: Long head from ischial tubersity & short head from lower end of linera aspera.
Insertion: Head of the fibula.
Nerve: Sciatic nerve.
Adductor magnus (hamstring part):
Origin: Lower part of ischial tubersity below the transverse ridge.
Insertion: Medial femoral condyl (adductor tubercle) .
Nerve: Sciatic nerve.

3. Abductor Muscles (prime movers):
Gluteusmedius:
Origin: Gluteal surface b/w middle and posterior gluteal line.
Insertion: Lateral surface of GT of femur.
Nerve :Superior gluteal nerve (L4,5,S1).
Gluteus minimus
Origin: Outer surface of ilium b/w anterior and inferior gluteal line.
Insertion: Anterior surface of GTof femur.
Nerve: Superior gluteal nerve (L4,5,S1).
Tensor fascia lata:
Origin: Anterior part of outer lip of iliac crest.
Insertion: Lateral condyl of tibia.
Nerve:Superior gluteal nerve (L4,5, S1).

Abductor Accessory.
Gluleus maximus:
Piriformis:
Origin: S2,S3,S4 segment of sacrum(anterior).
Insertion: Apex of GT of femur.
Nerve: Sacral Plexus (S1,S2).

Gluteus medius and minimus:-
Functions:
Gluteus medius and minimus both act in combination as abductor of hip joint. During walking the two limbs alternately support body weight when stand on right lower limb the pelvis on left side tilt downward due to action of gravity. The right gluteus medius and minimus become active in this situation pull upon pelvis prevent the tilt as unsupported limb and vice versa.
When glutei of one side get paralyzed than during walking pelvis tilt to opposite side in order to prevent this tilting the patient learn to sway his trunk toward paralyzed side in order to lift the pelvis, to reduce the forces and to get some comfort this kind of gait are called “Trendelenberg gait”.

4. Adductor Muscles (prime movers):
The adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis make up the adductor group. The adductors all originate on the pubis and insert on the medial, posterior surface of the femur, with the exception of the gracilis which inserts just below the medial condyle of the tibia.
Aductor magnus:
Origin:Outer margin of inferior surface of Ischial tubersity, Inferior ramus of ischium.
Insertion: Whole length of linea aspera & up to medial supra condyal of femur.
Nerve: Obturator nerve ( L3,4).
Adductor longus:
Origin: Anterior surface of pubic at angle b/w Pubic crest and superior ramus.
Insertion: Middle portion of medial lip of linea aspera.
Nerve: Obturator nerve (L3,4).
Adductor brevis:
Origin: Outer surface of inferior ramus of pubis.
Insertion: Upper part of linea aspera.
Nerve: Obturator nerve (L3,4).
Gracilus:
Origin: Anterior surface of inferior ramus of pubis.
Insertion: Medial surface of shaft of tibia.
Nerve: Obturator nerve.
Function:-
Adduction of thigh at hip joint.

5. Hip External Rotators.
Obturator externus:
Origin: Medial side of bony margin of obturator foramen.
Insertion: Trochenteric fossa of femur.
Nerve: Obturator nerve (L3,4).
Obturator internus:
Origin: Internal surface of obturator formen.
Insertion: Medial border of GT of femur.
Nerve: Obturator nerve (L5 S1,2).
Periformis:
Origin: S2,S3,S4 segment of sacrum(anterior).
Insertion: Apex of GT of femur
Nerve: Sacral Plexus (S1,S2)
Gemellus superior:
Origin: Outer surface of Ischial spine.
Insertion: Medial border of GT of femur.
Nerve: Obturator nerve (L5,S1,S).
Gemellus Inferior:
Origin: Posterior surface of body of ischium just above ischial tubersity.
Insertion: Medial border of GT of femur.
Nerve: Quadratus femoris (L4,L5 ,S1).
Quadratus femoris:
Origin: Lateral surface of body of ischium.
Insertion: Quadrate tubercle of inter trochenteric crest.
Nerve: Quadratus femoris.
Function:
All six are lateral rotator of the hip

6. Hip Internal Rotators.
Gluteus medius.
Gluteus minimus.
Tensor fasciae lata.

Flexion of the hip occurs when the angle between the torso and thigh is decreased. When this angle is increased beyond normal standing posture, the movement is called hip extension. Hip rotation occurs when the femur moves along its longitudinal axis. When the anterior surface of the femur turns outward, this is lateral rotation of the hip. The movement of the anterior surface of the femur inward is medial rotation of the hip. Medial rotation of the hip is carried out by gluteus medius and gluteus minimus. Hip abduction occurs when the femur moves outward to the side, as in taking the thighs apart. Hip adduction occurs when the femur moves back to the midline.
Many of the hip muscles are responsible for more than one type of movement in the hip, as different areas of the muscle act on tendons in different ways.
The psoas is the primary hip flexor, assisted by the iliacus. The pectineus, the adductors longus, brevis, and magnus, as well as the tensor fasciae latae are also involved in flexion.
The gluteus maximus is the main hip extensor, but the inferior portion of the adductor magnus also plays a role.
The adductor group is responsible for hip adduction. Abduction primarily occurs via the gluteus medius as well as the gluteus minimus.
Medial rotation is performed by the glutaei medius and minimus, as well as the tensor fasciae latae and assisted by the adductors brevis and longus and the superior portion of the adductor magnus.
Each muscle of the lateral rotator group causes lateral rotation of the thigh. These muscles are aided by the gluteus maximus and the inferior portion of the adductor magnus.

communication

2009-03-04T00:06:00.000+07:00

communication is also important part of the skill we need to be develop as an Orthotist Prosthetist, or other profession. in fact the communication skills are very important in our life, with the good communication skill, we will have good relationship with other. I am going to discuss the Basic Communication Theory.

Communication:
it is a two way process of sending and receiving messages.
in communication, there is a Sender, and Receivers. Sender is the person who sent the messages to receiver. while Receivers are the people who receive the messages from the receivers.
communication is a process, means the senders sent some thing to receiver, the receiver receive something from the sender.
the function of communication are to built and enhance the relationship among people. Gaining Information (which often requires disclosing information; self-disclosure, Building a Context of Understanding, etc.

generally, communication are differentiate in to two,

those are verbal communication and non verbal communication. verbal communication is the Oral communication; speech; The process of sending and receiving messages with words, including writing and sign language. Verbal communication is one way for people to communicate face-to-face. Some of the key components of verbal communication are sound, words, speaking, and language. while Non verbal communication is Ways of conveying or altering the meaning of an intended message other than oral speech (eg gestures, eye contact, facial expression, posture, body language, sound, etc.)

Good communication in Organization is also important. there are two type, those are, Internal communication and external communication. Internal communications includes all communication within an organization. internal communication can be further divided into three type, down ward communication ( eq, from Boss to employ), upward communication (eq, from from employ to Boss), and Horizontal communication, that is the communication amongst the employ. the downward and upward communication there fore also called as Vertical communication. therefore the understanding of the member of organization which further improve the system and management is the result of good internal communication.

External communication covers how a provider interacts with those outside their own organization. This may be with the public, employers, community organizations, local authorities, job centers, careers offices, funding bodies, specialist agencies and other training providers. external communication is dependent on internal communication, means without good internal communication, the external communication will be bad. for example, to make an advertisement for an organization, there is a need of good communication amongst the organization members.

Component of communication:
basically, there are some components are necessary to make the communication happen.
1. context, it is an environmental scanning. a discourse that surrounds a language unit and helps to determine its interpretation . it refers to the situational variables of any spoken, written or mathematical text and the relationship between them. These will include the subject matter, the participants, the purposes (both implicit and explicit), and the social environment in which the text or activity occurs. the communication between friends, is different with communication between student with teacher. with friends frankly style of speaking is good, while with teacher, we have to talk with respectful manner. the context is influenced by internal stimulus and external stimulus.The external stimuli are the plural of stimulus, which means prompt. What prompts a sender to transmit his message is its stimulus. The external stimuli may be a letter, memo, note, electronic mail, fax, telex, telephone call, a meeting or even a casual conversation. Response to this stimulus or prompt may be oral or written depending on the situation.
The internal stimuli have a very complex influence on how a person, sender or receiver, translates ideas into a message. When a person encodes, his own view of the world affects the choices he makes in language. His way of communication in influenced by his attitudes, opinions, emotions past experiences, likes and dislikes, job status, education and confidence in communication skills. The most important is his ability to analyze his receiver's culture, needs, skills, viewpoints, experiences, expectations and mental ability. In order to make communication effective, all these aspects of context must be considered.

2. sender (encoder)
it is someone who transmits a message.
3. messages.
The message is the idea or feeling which the sender wants to transmit to the receiver in order to achieve understanding. It makes a connection between sender and receiver of the message. No message can achieve its purpose unless it has unity of thought, consistency in expression and emphasis on the main point. The message may be verbal or written. First of all, the sender must be very clear about his message and all the important contents in it. The message should be very clear so that the receiver may understand it. The sender must also design his message in view of the receiver. He must plan the message carefully so that some irrelevant details may not creep into the message.
messages should be complete, con size ( with fewest possible words) , considerate (according to the receivers), concrete (to the point), clears, correct, courtesy, and empathy.

4. medium / channel
are the storage and transmission tools used to store and deliver information or data. It is often referred to as synonymous with mass media or news media, but may refer to a single medium used to communicate any data for any purpose.
medium of communication is the way through which we communicated. and it should be use correctly with common sense.
6. receivers
it is the person who receive the message from from the sender. it is the receiving end of a communication channel. It receives decoded messages/information from the sender, who first encoded them. receiver should have proper understanding, interpretation capacity, experiences, and perception.
6. feed back.
it is the responds toward the sender. it is The flow of information back into the communication system so that actual messages can be compared with planned messages.

there fore, Communication is a process whereby information is encoded and imparted by a sender to a receiver via a channel/medium.The receiver then decodes the message and gives the sender a feedback.

Communication barriers:
It refers to the any interference in the environment of communication that hinders the smooth sending and receiving of information. There are multiples of communication barriers that exist in an organization. However following three are explained only:
1) General faults in communication:
It may take different forms such as:
• Distortion or omission of information by the sender.
• Misunderstanding due to lack of clarity or technical jargon.
• Non-verbal signals such as gesture posture and facial expressions.
• Overload of information.
• Differences in social, racial or educational background.
• People hearing what they want to hear.
2) Particular difficulties in work situation:
It also varies situation to situation. The few are described below:
• A general tendency to distrust a message in its retelling from one person to another.
• A subordinate mistrusting his superior and looking for hidden meanings in the message.
• People from different job or specialist backgrounds having difficulty in talking on a non-specialist's wavelength.
3) Difference in Social, racial and educational background:
Different social and/or educational backgrounds may cause some people to feel superior to other people. A young person might be resented by an older person of the same grade or status in the organization.

factors causing the barriers.
there are basically 4 factors.
1. Physiological, that is the people state of mind
2. individual linguistic, that is word, language, etc
3. Physiological, the physical state of person
4. attitudinal, the manner and behavior of person

the are ways of responding which create a barrier in communication
1. advising, that is giving to other person a solution which is not necessary, it make him hesitate.
2. diagnosing, that is analyzing the person and commenting upon person
3. diverting, when the person divert the topic of discussion
4. close ended question, when the question is only can be answer by yes or no
5. logical argument, the argument make the communication boring
6. criticizing, more criticize makes the person feel depress
7. name calling, do not call directly the person name, but call them with respect, eg, MR. Nur Rachmat
8. ordering, asking the person to do something according to our will, person will not comfortable, let them decide by them self
9. praising evaluates, when excessive praising toward other people
10. reassuring, when we assure something which we can't do it
11. threatening, makes the person afraid to communicate

to have a good communication we to be..
"patient and understanding even with unjustly and insulting person"

Orthotic Management of Cerebral Palsy

2009-03-02T01:00:00.001+07:00

Definition
Cerebral palsy or CP is a group of disorders associated with developmental brain injuries that occur during fetal development, birth, or shortly after birth. It is damage to the immature brain resulting in problems with balance, coordination, and movement

Causes
Since cerebral palsy refers to a group of disorders, there is no exact known cause. Some major causes are asphyxia or hypoxia of brain, birth trauma or premature birth, genetic susceptibility, certain infections in the mother during and before birth, central nervous system infections, trauma, and consecutive hematomas. After birth, the condition may be caused by toxins, physical brain injury, incidents involving hypoxia to the brain (such as drowning), and encephalitis or meningitis.

Signs & Symptoms
a. In Ataxia type, having problems with balance, especially while walking.
b. In Athetoid or dyskinetic type, Persons have involuntary body movements.
c. In Spastic type, Persons having Upper Limb Flexion synergy, and Lower Limb Extension synergy.

Complications
a. Contractures: Knee Flexion Contracture, Elbow, wrist, finger Flexion Contracture
b. Deformities: Equinus, Scoliosis
c. Hip Subluxation

Objective of orthotic intervention:
a. To correct and/or prevent deformity
b. To provide a base of support
c. To facilitate training in skills
d. To improve the efficiency of gait

Orthotic Prescription
a. Prestanding
• For Scoliosis, give spinal orthoses (TLSO)
• For Hip Subluxation, give Hip abduction spinal orthoses (HASO)
• Postoperative Hip Orthoses
• For Lower Limb Deformities: rigid ankle foot orthosis (AFO)
• For Upper Limb Management: Elbow orthosis, WHO, etc

b. Standing
• Hip knee ankle foot orthosis (HKAFO) will be required to maintain an upright posture
• Spastic equinus and any secondary hind- or mid-foot valgus or varus can either be corrected or accommodated in rigid AFOs
• Heel wedges can be used to alter the inclination of the lower leg relative to the floor to accommodate fixed flexion of the hips and knees or fixed equinus.

c. Walking
• posterior leaf spring or hinged AFO with a plantar flexion stop may improve foot ground clearance
• when equinus persists in stance and swing phase and the knee is hyper-extended during stance, a rigid AFO is recommended

The International Society for Prosthetics and Orthotics (ISPO)

2009-02-28T20:09:00.000+07:00

The International Society for Prosthetics and Orthotics (ISPO), is a multi-disciplinary organization comprised of persons who have a professional interest in the clinical, educational and research aspects of prosthetics, orthotics, rehabilitation engineering and related areas.

ISPO was founded in Copenhagen, Denmark in 1970 by a group of surgeons, prosthetist-orthotists, physiotherapists, occupational therapists and engineers to promote improvements in the care of all persons with neuromuscular and skeletal impairments.

ISPO is a Non-Governmental Organisation (NGO) in Special Consultative Status with the Economic and Social Council of the United Nations, and is in Official Relations with the World Health Organisation.

ISPO has 3003 members worldwide in 85 countries. Where there are more than five members in any country, or region, they may band together to form a National Member Society. National Member Societies have been established in 40 countries. It is beneficial to form National Member Societies due to the representation and voice gained within the governing structure of the Society.

The Nippon Foundation Sponsoring APOS Asia

2009-02-28T19:52:00.000+07:00

The Nippon Foundation was established in 1962 as a private, non-profit grant making organization. In 2008, our budget for expenses is approximately 300 million US dollars, of which about 16% is directed to countries outside of Japan.

We provide global financial assistance to various humanitarian projects with the aim of promoting the development of human resources and international understanding, and assisting people to better meet their basic human needs. We offer grant funding to programs in areas such as education, health care, agricultural and community development, cultural and intellectual exchanges, as well as support for disabled persons and others who are socially vulnerable.

In order to make the best use of limited capital, we believe that it is important to support activities that confront a variety of difficulties in our society. Our goals differ from those of government measures, which focus on promoting social equality. Coupled with foresight and the ascertainment of what is needed most, The Nippon Foundation focuses on providing support for the development of programs that meet specific needs. We are neither a government nor an enterprise, and we are convinced that through activities in the social sector a new energy and drive is working to help bring forth social change.

The Vietnamese Training Centre for Orthopaedic Technologists (Vietnam) - Member of Apos - Asia

2009-02-28T19:50:00.000+07:00

With its 83 million inhabitants and a history of resent wars, Vietnam faces an immense problem in rehabilitating its disabled population Vietnam has endured in recent decades. Referring to data and calculation procedures of the world health Organization( WHO) one may estimate 0.5% of the population or 415,000 individuals are in need of technical health care.

A former project by German Technical Cooperation (GTZ) in partnership with MOLISA and ULSA from 1994- 2006 laid the foundation for VIETCOT’s ongoing work. After three year of construction, a school well equipments with tool and machinery meeting international O&P standards opened in October 1997.

3 Year training course Vietcot offers a training content based on the standards of the International Society for Prosthetics and Orthotics (ISPO) and the WHO, with the goal of preparing students to qualify as ISPO Category II “Orthopaedic Technologists”. Classroom teaching comprises biomechanics, technical drawing and drafting, anatomy, physical science, lab technology, material technology, mathematics and CAD-CAM introduction includes lower extremity orthotics and lower limb prosthetics at all levels of amputation in the second year, while the third year is exclusively geared toward gaining clinical experience (1607 hours). In addition, the students fulfill an intensive six– months clinical placement, providing supervised orthotic and prosthetic patient care in an outside rehabilitation center (880 hours).

18 - month Course in Lower-Upper Limb-Spinal Orthotic-Prosthetic Technology Several recent surveys and professional studies examining the availability and quality of services for people with disabilities in Vietnam highlighted deficiencies in both professional clinical care and equipment. To address this issues, VIETCOT is complementing its three-year programme by running specialist courses for practising professionals. A similar approach has already been successful in the training institutions TATCOT in Tanzania and PIPOS in Pakistan

Sirindhorn School of Prosthetics and Orthotics (SSPO) - Member of APOS - Asia

2009-02-28T19:48:00.000+07:00

The Sirindhorn School of Prosthetics and Orthotics (SSPO) offers a 4 year Bachelor Degree of Prosthetic and Orthotic Program with the total of 153 credits.
The school is within the Department of Rehabilitation Medicine Faculty of Medicine Siriraj Hospital, Mahidol University. It was established since 2002 by the collaboration between Sirindhorn National Medical Rehabilitation Centre and Faculty of Medicine Siriraj Hospital, Mahidol University with the support from The Nippon Foundation.

Goal : To meet international education level and establish professional ethic to meet
requirement by ISPO and WHO

The SSPO can accept, on average, 15 undergraduate students per year.

The curriculum consist of three main categories which are
- General Academic Subjects such as Engineering, Biology, Statistics, Physic

- Medical Subjects such as Anatomy, Pathology, Biomechanics, Physiology

- P&O Subjects such as Lower Limb Prosthetics, Lower Limb Orthotics, Clinical Practice, Clinical Placement

Currently, the school has the total of 55 current students. Twenty two graduates are all
hired by university hospitals, government hospitals, and private companies and some
have chances to continue higher study.

Sri Lanka School of Prosthetics and Orthotics (SLSPO)

2009-02-28T19:46:00.000+07:00

The Sri Lanka School of Prosthetics and Orthotics (SLSPO) is the collaboration between the Ministry of Health, the Nippon Foundation and the Cambodia Trust. It was first started in 2004. The primary objective of SLSPO is the education of Prosthetist / Orthotists, trained to International standards, to meet the needs of mobility impaired people in Sri Lanka.

The SLSPO will be the national training centre for the education of Prosthetist – Orthotists in Sri Lanka. Students are taught how to prescribe, manufacture and fit prostheses (artificial limbs) and orthoses (braces), to International standards. The course consists of two years practical and academic training plus one year supervised clinical placement. Not only the education, SLSPO will also become a service provider, delivering prosthetic, orthotic and other rehabilitation services to people with mobility disability. The project is based at the Rehabilitation Hospital at Ragama, 20 kms north of Colombo. Those successfully qualifying from the programme will be recognised and certified as Prosthetist-Orthotists by the Ministry of Health through the Medical College Council. The School will seek international accreditation by The International Society for Prosthetics and Orthotics (ISPO) at category II level.

PIPOS (Pakistan Institute of Prosthetic and Orthotic Sciences) - Member of APOS Asia

2009-02-28T19:44:00.000+07:00

Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS) previously known as PETCOT, is the only unique institute of its kind in the field of prosthetics and orthotics in Pakistan. PIPOS was established in 1981 under bi-lateral assistance cooperation program between Pakistan and Germany and has transitioned into a centre of excellence awarding B.Sc (Hons) degree in prosthetics and orthotics from the University of Peshawar. PIPOS has been awarded as Category-II accreditation for training and education in the field of Prosthetics and Orthotics by ISPO (International Society for Prosthetics and Orthotics) based in Copenhagen, Denmark. Each year 12 students including both locals and foreigners are trained in the field of Prosthetics and Orthotics.

The students after graduation undergo an exam here in Pakistan conducted by a delegation of ISPO. After passing the exam; students are awarded a Category II certificate of orthopaedic technologist. Along with the provision of B.Sc (Hons) degree, PIPOS is also providing all types of Prosthesis (Artificial limbs) and Orthosis (Braces) for almost every kind of physical disability. For this purpose institute maintains a model production centre providing assessment, rehabilitation services to thousands of people annually. Each year more than 6000 orthopaedically disabled patients including amputees are fitted with the artificial limbs and supports in PIPOS rehabilitation centre located at Hayatabad, Peshawar.

Education at Pipos

PIPOS offers Bsc (Hons) degree in the field of prosthetics and orthotics, from the University of Peshawar. PIPOS has been accredited as Category-II school for training and education in the
field of prosthetics and orthotics by ISPO (International Society for Prosthetics and Orthotics) based in Copenhagen, Denmark. PIPOS is energized with a vision for future and is committed to
academic excellence. Keeping this in view PIPOS is going to start Category-I training; accredited by ISPO. Cat-I is provided by developed countries like UK, Australia etc. soon PIPOS will also be counted among them and the only institute to provide Cat-I in South Asia; accredited by ISPO. PIPOS provides an environment where intellect, character and resilience are nurtured. Our students are able to reason critically in the world of prosthetic and orthotics. This is because our teachers are highly devoted and faithful to their job with a plus point of being certified Cat-1 graduates from Australia.

About the course:

The course is 04 years (08 semesters) in duration. The last year (semester 7 and 8 ) are clinical based. The course is set up and runs on ISPO (International Society for Prosthetics and Orthotics) and WHO (World Health Organizations) guidelines. Adjustments have been made to suit Pakistan's education and UOP (university of Peshawar) requirements.

Course contains the following subjects:
1) Anatomy
2) Physiology
3) Biomechanics of human body
4) Pathology
5) Clinical orthopaedics
6) Prosthetics and Orthotics
7) Mechanics
8) Material Technology
9) Workshop Technology
10) Mathematics
11) Pro-Engineering (3-D Drawing)
12) Psychology
13) Communications
14) Islamiyat
15) Pak-studies
16) Electro-Technology
17) Patient Work

Rehabilitation at PIPOS
According to the estimation based on WHO guide lines, the existing need for the provision of rehabilitation services (physiotherapy and prosthetics/orthotics) in Pakistan are more than 820,000. It is estimated that the earthquake and present crises in FATA has increased this figure to 850,000 (including amputees, spinal cord injured people and other type of trauma patients) whom are in need of these services. Today there are only few places all over Pakistan to provide these services. PIPOS being the pioneer in this field, always struggle to provide maximum treatment to as many patients as possible. In this regard PIPOS holds meetings, workshops and faculty exchange programs throughout Pakistan. One major step that PIPOS has taken for the betterment of NWFP is the establishment of PIPOS REHABILITATION SERVICES PROJECT (PRSP). PIPOS maintains a model rehabilitation centre where patients are provided with every kind of prosthetics/orthotics facility. Patients from all over Pakistan are treated with equal services and respect. To get an idea about the rehab services at PIPOS; only six months record (from March-Aug, 2008) is presented here

March-Aug, 2008 Record

The aim of this rehabilitation section is to provide maximum information about the prosthetic/orthotic treatment that is being provided at PIPOS. For this purpose; classification of prosthetic and orthotic appliances has been done along with pictures. This is an overview off the treatment provided.

Hong Kong Polytechnic University - APOS Asia

2009-02-28T19:40:00.000+07:00

The Hong Kong Polytechnic University is the largest UGC-funded tertiary institution in terms of number of students. A wide range of courses which directly meets industrial, commercial and community needs is offered. In addition to meet Hong Kong's manpower requirements, PolyU also makes significant contributions towards the territory's success by providing the public and private sectors with its expanding range of consultancy, professional training and applied research services. Through these activities, the University maintains a strong partnership with the business and industrial sectors. It is a prime aim of the University to equip students not only with professional competency but also the ability of independent thinking, good communication skills and a global outlook.

The Department of Health Technology and Informatics (HTI) is an academic department of the Faculty of Health & Social Science. HTI is the home of the disciplines of Biomedical Engineering (subsuming Prosthetics and Orthotics), Medical Laboratory Science, and Radiography.

The B.Sc. (Hons.) in Biomedical Engineering is the unique education programme for the academic requirement of professional Prosthetist- Orthotists in Hong Kong. The Programme has been accredited by the Hong Kong Institution of Engineers and the Hong Kong Society of Certified Prosthetist-Orthotists locally, as well as the International Society for Prosthetics and orthotics as Categoty I P&O education programme. All graduates of the programme will be recognized as graduate Biomedical Engineers. Graduates who complete all the P&O professional curriculum of the programme will also be recognized as graduate Prosthetist-Orthotists. An one-year post degree Graduate P&O training is required for the status of CPO(HK).

Cambodian School of Prosthetics and Orthotics (CSPO) - member of APOS Asia

2009-02-28T19:37:00.000+07:00

Childhood disability, road traffic accidents, unexploded ordnance (UXO) and land mines are major problems for Cambodia. Cambodian Red Cross statistics show the incident of one amputee in every 266 head of population. In addition the report from the National Census of theVictims and Survivors of Landmines and Unexploded Ordnance in Cambodia reported the total casualties recorded from 1979 to 2006 as 62,653. The actual incidence may be higher due to the lack of communication and recording system at community and higher level.

The Cambodian School of Prosthetics and Orthotics (CSPO) was established in 1994 in Phnom Penh, Cambodia. The school was initially planned to provide prosthetics and orthotics training for Cambodians.

CSPO was accredited by the International Society for Prosthetics and Orthotics in 1999. Since then CSPO has offered training to students from the region and other low income countries. As part of the Cambodia Trust Rehabilitation Program, CSPO is certified with ISO 9001:2000. The implementation of ISO Quality Management System requires CSPO to focus on Continual Improvement and Customer Satisfaction.
CSPO is the only prosthetics and orthotics school in the world with ISO certification.

Currently CSPO has students from 15 nations; Cambodia, East Timor, Georgia, Indonesia, Iraq, Japan, Kiribati, Lao PDR, Malaysia, Myanmar, Nepal, Papua New Guinea, PDRK (N. Korea), the Philippines and Sri Lanka.

40% of students are women, 15% are people with disabilities.

English is used as the language for education. Foreign students undertake the local language classes in order to be able to communicate with disabled people.

Each academic year runs from October to September. A maximum of 14 places are offered for each intake. The course is 3-year full time studies. Students learn clinical and technical procedures in prosthetics and orthotics. A training clinic is attached to CSPO, which provides a structured learning environment for students.

Each class is supervised by a lecturing team (an expatriate lecturer and Cambodian Assistant Lecturer) in both clinical and technical practice.

CSPO in collaboration with La Trobe University developed an upgrading course to Bachelor degree level. These students will undertake modules from La Trobe in Cambodia with 3 months clinical placement in Australia. The course is 30 months full time studies. These graduates will become leaders and educators in the region.

Through 11 years of prosthetics and orthotics training delivery, CSPO is aiming to be the center of excellent in Prosthetics and Orthotics for South East Asia. CSPO assists to meet the need of prosthetics and orthotics education for low income countries, where prosthetics and orthotics schools do not exist.

The National Centre for Prosthetics and Orthotics (NCPO) - La Trobe University

2009-02-28T19:33:00.000+07:00

La Trobe University was officially opened on 8 March 1967 by the Premier of Victoria. It began teaching during the first term of that year.

La Trobe was the third university established in Victoria. It has grown to accommodate more than 15,000 students at its Bundoora campus and over 7,000 at campuses in Albury-Wodonga, Beechworth, Bendigo, Mildura, Melbourne City and Shepparton.

The National Centre for Prosthetics and Orthotics (NCPO) is a Centre within the Division of Allied Health in the Faculty of Health Sciences at La Trobe University in Melbourne, Australia. La Trobe qualifications in all health disciplines are recognised nationally and internationally. La Trobe is generally considered to be ranked amongst the top ten universities in Australia and in 2005 was ranked in the top 100 universities in the world. The NCPO offers a 3.5 year Bachelor Degree or a 4 year Honours Degree. Postgraduate training including Masters and PhDs by research is offered.
The NCPO is highly regarded for its undergraduate research program and for its innovative use of learning technologies.

SAPOS [Strategic Alliance of Prosthetic Orthotic Schools]

2009-02-28T19:18:00.000+07:00

SAPOS [Strategic Alliance of Prosthetic Orthotic Schools] is another development milestone resulted from the collaboration of prosthetic and orthotic schools which first initiated among the schools with funding provided by The Nippon Foundation. For a number of years CSPO has facilitated this collaborative programme. The programme includes annual meetings of the schools' management and staff exchanges. This develops the capacity of the human resources within the institutes involved as well as building international and regional networks and improving the quality of rehabilitation and education services.

The objectives of the regional schools collaboration are to:

1. Share knowledge, skills and teaching materials to enhance P/O education in the

region amongst existing (and soon to be founded) P/O schools;

2. Establish a focus group of educators from the P/O schools in Cambodia, Thailand,

Pakistan and Sri Lanka to avoid duplication of work;

3. Facilitate the inclusion of other P/O schools into this regional activities;

4. Initiate regular meetings between representatives from the P/O schools;

5. Co-ordinate and facilitate national staff exchanges between partner P/O schools;

6. Build regional capacity;

7. Facilitate the exchange of teaching materials;

8. Institute technology transfer;

9. Encourage cross-cultural understanding.

The objectives of the regional collaboration on P/O education are being achieved through the following activities: For more information : http://www.opoedh.org/

Annual Meetings of P/O Schools:

These meetings were initiated in 2003 by CSPO. The meeting greatly enlarges the working group and involved representatives from the Nippon Foundation, ISPO, Japan, Australia, Cambodia, Hong Kong, Indonesia, Malaysia, Pakistan, Thailand and Sri Lanka. A number of the participants were self-funded, showing the interest that exists to develop regional co-operation.

The meeting encouraged participants to set goals for their activities both nationally and regionally, and to monitor their achievements on a regular basis.

Documentation from the P/O school meetings and staff exchange programmes are forwarded to the Nippon Foundation.

These meetings:

Allow discussion on various issues related to P/O education and the sharing of experience, knowledge, skills and teaching materials, Facilitate the development of regional professional links in P/O education, Provide an opportunity for individuals to observe how education is provided in a range of cultural settings.

Each school was required to prepare and deliver presentations on their activities for the meetings. During the final session, a brief report on the outcomes of the meeting was agreed by the participants.

Prosthetics and Orthotics Education Atmosphere Site Development:

The development of the SAPOS Collaboration Site [Strategic Alliance of Prosthetic Orthotic Schools] (SAPOS) website was another step forward to provide a range of possibilities for those individuals with interest in learning more about the

collaboration and activities among the schools.

The ability to post the discussion and register as SAPOS user is a good tool to move forward with the use of the benefits of information technology in prosthetic and orthotic field. The main objective of the development of SAPOS website is to allow

effective information sharing and collaboration in the development of strategic plans for the role of Prosthetics and Orthotics education in the region. The concept of the site was originated by Mr. Ronald Altman, a Lecturer at CSPO, it was developed by James Altman, Academic Technology Training Specialist at Northwestern University’s Academic Technologies Services.

The SAPOS site was conceived as a tool for the administrators, faculty, and staff of the member institutions to use collaboratively to further the development of all the various educational programs.

Staff Exchange Programmes.

It is proposed to facilitate 4 staff exchanges per year amongst the staff of the regional P/O schools.Participants from the Vietnamese P/O school are invited to the P/O school meetings and staff exchanges, on a self-funded basis. For each staff exchange a set of learning objectives is agreed by the school sending the individual, the school receiving the individual and the individual concerned. Following each staff exchange, a report is submitted by the individual on the activities of the exchange programme.

The staff exchange programme provides an opportunity for individuals to observe how education is provided in a range of cultural settings.

visit APOS Asia website

BHS/MCPO from Latrobe University Australia

2009-02-26T22:38:00.000+07:00

Mostly the people from our field deviate and they do MBA or anything else but I must say if you love your profession you must not leave your profession and try your best to study further in a good university.

That will be a better decision for your profession and your country as well.
This article is for the people who have done B.Sc. honors in Prosthetics and orthotics Sciences or they are doing and searching for a good future and want to study further.

Latrobe University which is present in Australia offering new degree for ISPO cat-2 students. It is a four year course which I am going to introduce and known as BHS/MCPO Bachelor in Health in Health Sciences and Master in Clinical Prosthetics and Orthotics.

I think it is a very good university for the students who want to study further.

Now this is a link for NCPO National Centre for Prosthetics and Orthotics present in UK.

http://www.strath.ac.uk/prosthetics

Now this is actually a link for the students who want to study in Latrobe from all over the world.

http://www.latrobe.edu.au/international

This is the home page of Latrobe

www.ncpo@latrobe.edu.au

Link for course information offered in NCPO Latrobe Australia.

www.latrobe.edu.au/ncpo/docs/courseinfo

As I told about the course which is BHS/MCPO so we must know about health sciences.

www.latrobe.edu.au/health/

Now this link is actually related to this course from here you can get all the information you want about the course…………

Must check it……………………….

http://www.latrobe.edu.au/coursefinder/international/2009/Bachelor-of-Health-Sciences-and-Master-of-Clinical-Prosthetics-and-Orthotics.4166.html

Apply for admission to Latrobe University courses with assistance from worldwide network of overseas representatives.

http://luis.latrobe.edu.au/ipo2/searchReps.asp

How the international students can apply in undergraduate and Post graduate research programs

http://www.latrobe.edu.au/international/apply/how-to/ug-pg

Link: How the international students can apply in Postgraduate research programs.
http://www.latrobe.edu.au/international/apply/how-to/research
E-mail addresses of the info providers and heads of deps. Of Latrobe………. You can get any type of info from them………. I am sure they will help you…….

v.blackmore@latrobe.edu.au

international@latrobe.edu.au

studentcentre@latrobe.edu.au

At the Southern California Orthopedic Institute, we are dedicated to providing the best possible care available for people of all ages and all walks of life

http://www.scoi.com/index.html

The prosthetist /orthotist is an integral member of the health care team who

has a clinical, technical, advisory and educational role.

Function, Types & mechanism of prosthetic knee joint

2009-02-16T04:31:00.002+07:00

Function of knee joint
Main function:
Support during stance.
Shorten the leg during swing to allow clearance.
Others:
Allowing sitting.
Adaptation to variable cadence.
Impact absorption during weight acceptance.
Stop the extension during swing.

Classification
On the basis of biomechanical performance prosthetic knees are grouped into :

Constant friction
Stance Control
Polycentric knees
Manual Locking
Hydraulic & pneumatic
Hybrids

Constant Friction Joints ("single axis" knees)

Simple axis connecting the thigh and shank segments.
needs strong hip extensors to prevent the knee from buckling.
ground reaction kept in front of the knee from initial contact through midstance to maintain extended knee.
ground reaction behind the knee at terminal stance to allow knee flexion.
relatively inexpensive, simple to manufacture.
friction prevents shank from swinging forward too fast.
best for level ground walking at constant speed.

Stance Control (weight-activated)

force of the body weight engages a brake that keeps the knee from buckling (friction lock)
spring loaded brake bushing binds when loaded during stance but released during swing
amount of friction is adjustable
cannot support full body weight in extreme flexion
device must also be fully unloaded before sitting down
very popular for elderly patient with poor hip control
bilateral amputee virtually impossible

Polycentric Knees

4 bar linkage, instantaneous center of rotation.
posterior (and proximal) when extended (for stability at heel strike)
anterior (and more distal) as soon as knee starts to flex (to facilitate unlocking)
Posterior (and distal) as knee flexes more (to shorten leg and improve clearance)
excellent stance phase stability, especially at heel strike
allows load bearing during flexion
also used for knee disarticulation (because of lack of space)

Manual Locking prostheses

ultimate stability but seldom required
produces uncosmetic and energy-consuming gait pattern
useful for the manual labourer who needs stability
remote release cable requires a free hand to release it prior to sitting

Hydraulic & pneumatic Knees

fluid (silicone oil) or gas filled piston allows amputee to vary speed & cadence voluntarily
swing and stance control types
piston is attached to a pivot in the thigh section of the prosthesis behind the knee bolt
cylinder is attached to pivot in shank
amount of resistance required provided automatically for a given walking speed
mimics loading response stance flexion for impact absorptiondoes not interfere with normal flexion and extensionfluid filled devices stronger
produce the most normal looking gait
relatively heavy and expensive
most popular with vary amputees

Hybrid Devices

combine some of the properties of the above groups
e.g. titanium polycentric device with mini hydraulic unit for swing phase control (Otto Bock)
"bouncy" knees which control knee flexion during stance (Blatchford)
"intelligent " knees with microprocessors
Allow going down the stairs and climbing down a slope.

HIP Joint

2009-02-16T03:54:00.002+07:00

Formed by:

Acetabulum of Hip Bone
& Head Of The Femur

Hip Bone
formed by:

Ileum
Ischium
Pubis

Ileum

superior (upper) part of the Hip bone.
Fan shaped bone
<2/5th>

Ischium

inferior posterior part of the hip bone
Occupy 2/5th part of the acetabulum
Supports all weight of the body during sitting position.

Pubis

inferior anterior part of the hip bone.
It occupy 1/5th part of the acetabulum.

Accetabulum

Articular surface (Horse shoe)
Act as socket of Hip joint Outer aspect of coxae
Hollow hemisphere 5cm dia Downward, Forward, Laterally

Glenoidal Labrum

fibro cartilaginous rim attached to the margin of the acetabulum
it deepens cavity protects the edge of the bone fills up the inequalities of its surface.
It bridges over the notch

Femur

long bone
two ends
shaft.
25% of the body length.

Femoral head

Three quarter of sphere
Mounted on short neck (125-140 degree)
Transverse rotations >> angular movement of shafts

Characteristic of Hip joint

Synovial joint / diarthrosis
Articular surfaces
Glenoidal Labrum
Synovial capsule
Synovial membrane
Bursa
Articular ligament

Articular surfaces

Ball
Socket

Fibrous capsule

Strong & extensive

Attached:

Beyond acetabular circumference
Intertrochanteric line
Close neck & head of femur

Synovial membrane

extensive

Covered:

neck & head of femur
ligamentum teres,
both surfaces of glenoidal labrum.
Cell >> Synovial fluid

Ligaments of the hip joint

Illiofemoral ligament
Pubo femoral ligament
Ischio femoral ligament.
Ligamentum teres.
Transverse ligament.

Illiofemoral ligament

strongest ligament of the body
Inverted V
Above: AIIS
Below: intertrochanteric line

Pubo femoral ligament

Above: obturator crest & superior ramus of the pubis
Below: blends with the capsule & deep surface of the vertical band of the oliofemoral ligament.

Ischio femoral ligament

triangular band of strong fibers
spring from the ischium below and behind the acetabulum, and blend with the circular fibers of the capsule.

Ligamentum teres

triangular, extends from fovea capitis femoris to the acetabular notch, and between these bony attachments it blends with the transverse ligament.

transverse ligament

portion of the glenoidal labrum (no cartilage cells among its fibers)
strong, flattened fibers
cross the acetabular notch, and convert it into a foramen through which the nutrient vessels enter the joint

Stabilizing factors of hip joint

Ligamentum factor
Bony shape
Muscular factor

Movements of the hip joint
1) Flexion
2) Extension
3) Adduction
4) Abduction
5) Rotation (medial and lateral)

Arteries

Obturator
Medial femoral circumflex
Superior and inferior gluteals.

Nerves

femoral nerve
sciatic nerve
obturatur nerve

PRE PROSTHETIC TREATMENT FOR FRESH TRANSFEMORAL AMPUTEE

2009-02-16T03:06:00.002+07:00

Pre Prosthetic treatment

Is the care done before the use of any prosthetic or other assistive device

Goal of Pre Prosthetic Treatment

to maintain a good shape and good position of stump for fitting an artificial limb

steps to be taken

    * Ensure uncomplicated wound healing
    * Control edema
    * Maintaining good range of motion
    * Prevent or reduce joint contractures
    * Maintain muscle strength
    * Desensitization
    * Skin Mobility

Methods

    * Desensitization
    * Skin mobility
    * Soft Dressing
    * Rigid Dressing
    * Bandaging
    * Elastic Stump Socks
    * Shrinker Socks
    * Elevation
    * Exercises
    * Education to patient

Desensitization

It is Decreasing or lessening sensitivity

Tell patient to gently touch their stump with firm pressure just after amputation

brushing with soft cloth

gentle tapping

Be careful not to interfere with the healing in the acute (early) phase before stitches are removed and the incision is completely healed. Begin after this phase.

Skin Mobility

skin should not stuck to the underlying bone by scar tissue

Other wise, abnormal pressure and rubbing of this skin and bone against the inside of the socket of the prosthesis might happen.

How?

skin over the bones of the stump

press down gently & firmly, move in small circle

skin around and over the incision

move side to side & move in small circle

Soft Dressing
It is a dressing coated with soft materials as an adhesive or a wound contact layer
The properties soft materials are such that these dressings may be removed without causing trauma to the wound or to the surrounding skin.

Soft Dressing materials

absorbent paste
pieces of soft gauze
gauze roll (for wrap over)
elastic bandage (secure the soft gauze and control edema)

Advantages Soft Dressing

It is Easy to apply
Low cost
It is easy accessibility to the wound.
It supports the amputated site under the compressive pressure.

Disadvantages of Soft Dressing

it requires frequent changing and close monitoring to maintain the correct amount of pressure.
It is easy to loosen and fall off.

Rigid Dressing
It is a mildly total contact wrapping applied to the stump using rigid materials.

Material:

Plaster of Paris
DynaCast
Thermoplastic materials

Purpose
to provides rapid residual limb shrinkage, prevents edema, provides soft tissue immobilization, decreases wound pain and prevents trauma to the residual limb

Dry wound surface should be maintain
The dressing should be properly suspended to maintain distal pressure.
Placing a compressible material such as foam or distal pads at the site of surgery helps maintain distal pressure.

Disadvantages Of Rigid Dressing

It prohibits frequent inspection
Any complications will require cast (dressing) removal

Elastic Stump Socks

Made up of elastic materials.
available in different sizes
Their fitting is exact due to elastic materials.
They are less likely to wrinkle and cause a tourniquet effect.

Advantages of Elastic Stump Socks

It can be put on and take off easily.
Clinical control and cleaning of the stump can be done without complications.

Disadvantages of Elastic Stump Socks

not available in all sizes
weak upper limb dexterity always have difficulties
It should not be used over the bandage

Shrinker Socks:
It is a type of elastic stump sock
used for healed stump having edema.

Elevation
keeping the stump in a position higher in level than the rest of the body.
the stump is raised above the heart level to facilitate the back flow of blood.
Amputation results in cutting of the muscles that helps back flow of the blood.

Proper position avoid any contracture deformity.
keeping feet of the bed higher than head level.
keeping a pillow under patient’s stump
prone position extension avoid hip flexion contracture

Exercises

keep the muscles active
regain the lost strength
prevent deformities due to muscle weakness
Active contraction of antagonist muscles helps in venous blood return.

Hip flexion & extension
Hip adduction & abduction
Weight bearing exercises.
Fresh stump cannot bear load, so one must press it to exercise it for weight bearing.
regular intervals.

Any amputee having strong and well coordinated muscles
give bright prosthetic future life.
able for sustaining a self suspended socket
indicate for free knee joint mechanism.

Education to the patient

Postural Position
During Standing
Sitting Position
Lying Position

Orthotic Management of Club Foot

2009-02-02T03:02:00.002+07:00

Club foot

Definition

Clubfoot is a congenital condition that affects newborn infants, that giving gross deformity of the foot stunted lumpy appearance, which is foot turned under and towards the other foot (equinus and varus)

Causes

Muscles imbalance, some muscles are stronger then the other which makes the foot in improper position

Primarily by Congenital (Genetic & Environmental factors)

secondary to Spina bifida, Cerebral palsy, Poliomyelitis, Arthrogryposis Multiplex congenital, etc

Signs & Symptoms

Foot is turned under and towards the other foot (equinus and varus)

Short Achilles tendon

High and small heel

No creases behind Heel

Abnormal crease in middle of the foot

Foot is smaller in unilateral affection

Callosities at abnormal pressure areas

Internal torsion of the leg

Calf muscles wasting

Treatment

Treatment for clubfoot usually starts at birth. The goal of treatment for clubfoot is to obtain a plantigrade foot that is functional, painless, and stable over time, as well as cosmetically pleasing appearance. Correction of the deformity is to strengthen the weak muscles and weakened the strong muscles.

There are three types of treatment to correct the deformity, those are:

Manipulation

Exercise

Surgery

To maintain the correction, following method can be use

Plaster Cast

Orthosis / Splint

Bandaging

Orthosis

Orthosis is used to maintain the correction, the foot is first to be manipulated into maximal correction can be tolerated, and then the corrective position of the manipulation is maintained by the splint. Orthosis also can be prescribed post surgery, to maintain the correction done by surgery.

Orthotic options:

a. Dennis Brown splint

The splint is set at 60 to 70deg of external rotation, and 50 Dorsiflexion

b. Ankle Foot Orthosis

It can be used if the deformity is already reduced, and the child needs to walk.

c. Knee Ankle foot Orthosis set in 90deg knee Flexion

Maintain the foot abducted and externally rotated. 90deg knee flexion position to reduce the tension of gastrocnemius, which make easy to correct the equinus.

Complications

Fix deformity of Talipes Equino Varus

Patient walk with lateral border of foot touching the ground

Orthotic Treatment post complication

Fixed deformity cannot be corrected when it is neglected, the orthotic objectives are to accommodate the deformity and enhance mobility. Ankle Foot Orthosis which provide accommodation to the deformed foot can be prescribe to the patient

Orthotic Management of Burns

2009-02-02T02:30:00.002+07:00

Burns

Definition

Is a type of injury that damage to the skin or other body parts, caused by exposure to un tolerable heat, cold, electricity, chemicals, light, radiation, or friction.

Classification, Signs & Symptoms

First degree burn is superficial and causes local inflammation of the skin, characterized by pain, redness, and a mild amount of swelling. The skin may be very tender to touch.
Second degree burns are deeper and in addition to the pain, redness and inflammation, there is also blistering of the skin.
Third degree burns are deeper still, involving all layers of the skin, in effect killing that area of skin. Because the nerves and blood vessels are damaged, it appears white and leathery and tends to be relatively painless.
Fourth-degree burns damage muscle, tendon, and ligament tissue, thus result in charring and catastrophic damage of the hypodermis

Objective of orthotic intervention:

Reduce pain & inflammation
Prevent contracture & deformity
Prevent infection

Orthotic Options

It depends on the location and severity of condition. If the Burn is located in upper limb, Upper limb orthosis can be prescribed, such as: Elbow Orthosis, Wrist Hand Orthosis, etc. if the Burn is located in Lower limb, the Lower Limb Orthosis can be prescribed.

Complications

Infection
Scar tissue
Contracture
Deformity

Objective of Orthotic Treatment

Reduce pain
Reduce & correct the Contracture & deformity
Enhance hand function

Orthotic Options

It also depends on the location and severity of condition. For example, when contractures happen in fingers, Web Spacer can be prescribed. When elbow joint contracture, the serial static Flexion Contracture reducing Elbow Orthosis can be prescribed.

Orthotic Management of Fracture

2009-01-03T01:00:00.001+07:00

Definition
Fracture is a break of continuity of bone or cartilage or both, as a result of excessive application of force to the bone

Causes
a. direct violence
• Application of stress beyond the limits of strength of a bone. In this type of injury the skin may be broken by the external force of the object onto the skin, not the fracture breaking the skin from within.
• Another mechanism for direct fractures where the body strikes an object
b. Indirect violence
• a twisting or bending force may be applied to a bone, which result in a fracture

Signs & Symptoms
• Pain and swelling at the fracture site
• Tenderness close to the fracture
• function of an extremity may not be able to be performed
• tingling, numbness or paralysis in areas below the fracture if nerves injured
• the extremity may appear pale and without a pulse if an artery has been damaged

Complications
a. Fibrous union
b. Non-union
c. Delayed union.

Fracture management
a. Reduction of the fracture: by alignment
b. Immobilization of reduced fracture until healing is complete
Principles of Fracture cast bracing
a. Immobilize the fracture site while allowing movement at adjacent joints.
b. Control the fracture site by incorporating soft tissue containment
c. Reduce rehabilitation time by maintaining joint ROM and muscle strength
d. Accommodate volume change (reduce swelling or increase muscle bulk) while maintaining control over the fracture
e. Allow access to the skin when required by providing a removable fracture orthosis

Type of Fracture orthoses

a. Non Removable
Once applied, can be removed by only qualified person with appropriate equipment. It needs to be reviewed on a regular basis, as they are not adjustable for volume fluctuations. They are also prone to breakdown and should be appropriately protected from damage. Example: POP Bandages cast boot

b. Removable
The orthosis is applied with a mechanism for removal and adjustment. The orthosis therefore adjustable and may be removed for reasons of hygiene, wound viewing, etc. Its enable volume adjustment as inflammation and swelling subside.
Example: Tibial Fracture brace, Humerus Fracture Brace, Scaphoid Fracture.
It is depend on the location and severity of the fractures.

World Disability Day in Pakistan - Nur Rachmat PIPOS

2008-12-04T02:58:00.001+07:00

World disability day was celebrated all over the world on 3 Dec. In Peshawar, Pakistan this day was celebrated at Special Education Complex, located at Hayatabad, Peshawar. The program was organized by an NGO named Special Life Foundation (SLF). The program was divided in two sessions. First session included some skits by the children and the second session comprised speeches and presentations. Prof. Dr. Daud Khan, the Vice Chancellor of KMU delivered a speech and Prof. Dr. Bakht Sarwar, Consultant to PIPOS, gave a presentation on the Rehabilitation Services in Pakistan and also delivered a small speech.After the second session a musical show took place. Stalls were also setup by different organizations in this program. PIPOS also set a stall over there; with an objective to provide maximum information to the audience about PIPOS and the services it provides. The PIPOS Stall was organized by a Group of 6 members.From left-right: Mr. Nur Rachmat (Student), Ms Kausar Parveen (P&O),Ms Neelam Abdullah (P&O), Mr. Riazuddin (Student),Mr. Hussain Zaidi (Student), Mr. Naveed Ahmed (P&O). Different prosthetic and orthotic appliances were displayed at the stall.