ORTHOSIS FOR PARAPLEGIA AND HIP

DISORDERS
Submitted by: Muhammad Shahmeer
10324
PARAPLEGIA
 Paraplegia is a type of spinal injury that causes impairment of the motor and sensory nerve
functions leading to loss of feeling or movement of the lower extremities.
 An injury or trauma to the vertebral column affects the brain and spinal cord’s ability to send and
receive messages from the brain to the different parts of the body that are controlled by the sensory,
motor and autonomic nerve functions.
 It is usually caused by involvement of cerebral cortex, spinal cord, the nerves supplying the
muscles of lower limbs or due to involvement of the muscles directly.
 The gait orthoses used by SCI patients is also known as a paraplegic orthoses, and is designed to
assist standing and walking; the basic functions include stabilization and support, locomotion
assistance, correction, and protection.
STANDING FRAME
 A standing frame is also known as a standing aid is specifically designed for wheelchair users.
 The standing frame consist of a broad base, posterior non-articulated uprights extending from a
base, to a mid-torso chest band with a transverse thoraco-lumbar band.
 The frame has a chest strap and a knee strap.
 Standers are used by people with mild to severe disabilities such as Spinal Cord Injury, TBI, CP,
Spina bifida and Muscular Dystrophy.
STANDING FRAMES
L” STANDING FRAME
The simplest standing frame resembles a capital “L”when viewed from
the side.
It consist of a broad wooden board approximately as long as the child
is tall. A footboard is attached to the lower end of the main board. Chest
and knee straps complete the frame.
 The “L” frame can be made easily.
A” STANDING FRAME
It resembles a capital “A” when viewed from the back.
The posterior support consists of two angled metal uprights
with a transverse dorsolumbar band.
 The frame has a chest and a knee strap.
SPECIFIC DEVICES FOR PARAPLEGIA
SWIVEL WALKER
Another version of a standing frame was developed at the orthotic research and locomotion
assessment unit(ORLAU), England. The posterior section is a curved aluminum or plastic trough,
which facilitates donning.
Its upper surface has straps designed to secure the wearer's shoes. The lower surface has two
swiveling plates, which facilitate ambulation.
 The swivel walker, unlike the other standing frames, is manufactured in both child and adult sizes.
Patients can ambulate with it only on flat, smooth surface.
PARAPODIUM
◦ The parapodium is an articulated version of a standing
frame originated at the ontario crippled children's center.
◦ The aluminum orthoses has lateral uprights that
terminate superiorly in a dorsolumbar band and
inferiorly in a footplate with springs to secure the child’s
shoes. The orthoses has hip and knee joints that the child
can operate by means of levers on each lateral upright.
◦ Chest and knee straps provide posteriorly directed force
to keep the wearer uprights.
 ORTHOSES DESIGNED FOR
AMBULATION
ANKLE FOOT ORTHOSES:
 A different orthotic approach for patients with paraplegia involves cutom-made orthoses. The
least encumbering orthoses are AFOs known as vannini-Rizzoli stabilizing AFOs or boots.
 Vannini-Rizzoli stabilizing boots designed for spinal cord injury patients, these boots extend
to four centimeters below the knee to immobilize the ankles and feets approximately 10-15
degrees of plantar flexion.
 The patient controls balance by holding the head high with shoulders back and hips forward,
effectively locking the knees.
 Patients learn to walk by shifting the upper body left or right, causing the center of gravity to
shift, then moving the unweighted foot in a pendulum motion.
KNEE-ANKLE FOOT ORTHOSES
CRAIG-SCOTT ORTHOSES:
 One of the most common orthotic designs for adults with paraplegia is
known as the Craig-Scott KAFO.
 This design allows a person to stand with a posterior lean of the trunk.
 Craig-Scott KAFOs are somewhat more expensive than other versions of
KAFOs.
 SPREADER BAR

Some patients have such severe adductor spasticity that their balance is precarious. They may find a
steel spreader bar attached to both medial upright near the ankle to be a useful device.
 The bar prevent any hip adduction or rotation.
MEDIALLY LINKED KAFOs
The medical linkage orthoses, also known as walkabout orthosis, has a hinge-like joint positioned
between the legs. The joint limits hip flexion and extention but does not mechanically assist either.
Instead, gravity flexes the hip and moves the unweighted leg forward.
Hip extention is achieved by leaning the trunk backwards and extending the lumbar spine,
consequently, even slight loss of passive hip extention can be a problem, increasing patient’s reliance
or their upper limbs to hold the trunk upright.
The medially-linkage orthoses is aesthetically more appealing than other types of hip-knee ankle foot
orthoses but it provides a slower and more energy-consuming gait.
 As is the case with stabilizing boots, KAFOs are not suited to patient whi have hip or knee flexion
contracture, marked spasticity, or obesity.
HIP-KNEE ANKLE FOOT ORTHOSIS:

 Hip-Knee Ankle-Foot orthoses are sometimes prescribes for patients with paraplegia, particularly
children born with spina bifida.
 The pelvic band with hip joints blocks hip abduction, adduction, and rotation
TRUNK-HIP-KNEE-ANKLE-FOOT
ORTHOSES
RIGID THKAFO:
 The most conservative apparoach for adults and children with paraplegia is a custom-made trunk-
hip-knee-ankle-foot orthoses (THKAFO).
 The device usually consists of a pair of plastic solid ankle orthoses and thigh shells with lateral
uprights, which incorporate locking knee joints and hip joints attached to a trunk orthoses.
 Gait requires the use of parallel bar or crutches.
 RECIPROCATING GAIT ORTHOSES
 The reciprocating/responding gait orthoses joins two
knee-ankle foot orthoses to a trunk corset with laterally
placed joints. A key feature of the reciprocating gait
orthoses is coupling together of the hip joints, preventing
bilateral hip flexion in stance.
 The hip mechanism was designed so hip extension on
one leg could assist flexion on the other leg when
stepping. However, the effectiveness of this mechanism
may be overstated. The hip joint can be unlocked to flex
simultaneously, this is important for sitting.
PARAWALKER
 The parawalker is the version fitted to adults with paraplegia. Rather than having a cable joining
the hips, the parawalker has exceptionally strudy hip joints that have an adjustable feature.
 The orthoses has shoe plates with limited ankle motion joint, it is considerable heavier and more
rigid than the RGO.
 As with other orthoses for paraplegia, the wearer needs an assistive device for ambulation.
FUNCTIONAL ELECTRICAL
STIMULATION
 Some patients are interested in maintaining muscle tone so that the joint mobility is preserved,
these people may benefit from functional electrical stimulation, which involves application of a
low-volt current to neutral trigger points.
 An electrical current causes muscular contractions, which prevent muscle fiber atrophy.
 Stationary bicycles and other exercise equipment have been adapted for use by patients with
paraplegia who use functional electrical stimulation to achieve leg movement.
HIP ORTHOSES

HIP DISLOCATION:
Infants with congenital hip dislocation are often placed in an orthosis that maintains the femoral head in
the acetabulum.
The most popular of these devices is the pavlik harness, in the harness the hips are kept abducted, flexed
and externally rotated.
 The harness does not restrict the baby from kicking and moving about. It is washable.
 LEGG-CALVE-PERTHES
DISEASE
 The disease is most commonly found in children between the ages of 4 to 8 but it can occur in children
between the ages of 2 to 15. The main long-term problem with this condition is that it can produce a
permanent deformity of the femoral head which increases the risk of developing osteoarthritis in adults.
It is also commonly known as Perthes Disease, Legg–PerthesDisease, or Legg–Calve–Perthes Disease
(LCPD).
ATLANTA HIP ORTHOSES

The more common approach is to permit weight bearing through the affected limb while
preventing the hip. Two orthoses fulfill this purpose, namely the Atlanta (sometimes called
Scottish Rite) and the Toronto orthoses.
The Atlanta hip orthoses (HO) consists of a pelvic band and thigh cuffs. The cuffs are attached to
the band by means of heavy metal hip joints, which restrict abduction, adduction, and rotation.
 The orthoses can be worn under clothing.
HIP CONTROL ORTHOSES
Children who have deficient hip control because of cerebral palsy or
septic arthritis may benefit from a HO that restricts motion in one or
more planes.
The simplest such HO has a pelvic band to which two leg cuffs are
joined by single-axis hinges.
 The HO permits hip flexion and extension but restricts motion in the
frontal and transverse planes.
For the non-ambulatory child with a hip dislocation, a hip abduction
KAFO can hold the joint in place while healing occurs. A newer design
is the standing-walking-and-sitting-hip (SWASH) ORTHOSIS. Its
hinges permit sagittal motion and abduction.
POST OPERATIVE ORTHOSES
Most orthotic manufacturers offer a range of Hos that limit the excursion
of the hip joint in one or more planes.
 The orthoses typically include a pelvic band and a thigh cuff. The hip
joint has an adjustable mechanism, enabling the clinician to select the
appropriate range of motion and to alter the excursion as necessary.
These Hos are usually intended for adults who have arthroplasty or
similar surgery.
GUIDELINES FOR
PRESCRIPTION
The following are biomechanical guidelines for prescribing orthoses for patients who have paraplegia:
1. To control hip flexion
a. HKAFO with hip locks

2. To control hip rotation