biomechanics of orthoses - intermedic.com.tof+ort... · © orfit industries drivenbycare 2015...
TRANSCRIPT
© Orfit Industries2015drivenbycare © Orfit Industries2015
BIOMECHANICS OF ORTHOSES
Jean Christophe AriasOccupational therapist, OrthotistRegular Member of GEMMSOR
© Orfit Industries2015
WHAT YOU NEED BEFORE MOULDING YOUR ORTHOSIS
- Choose the right position of the hand.
- Take into account the arches of the hand.
- Take into account the creases of the hands.
- Respect the pressure points.
- Know the biomechanical peculiarities of the hand.
© Orfit Industries2015
HAND POSITIONS
First:
- Never let the patient in supination.
- Avoid the radial slope (Rheumatoid Polyarthritis, De Quervain tendonitis, Root arthrosis, Scaphoid fracture, Hemiplegia).
© Orfit Industries2015
REST POSITION
The therapeutic objective is the analgesia
- Rheumatic pathologies: wearing protocol of the orthosis during the night
- Tendonitis: wearing protocol during the day, 3 or 4 weeks (Then, never forget the prevention).
© Orfit Industries2015
Dorsiflexion of the wrist between 0 and 20°
Curling of MCP, PIP and DIP joints, with more flexion on the
5th one than on the 2nd one.
Thumb in extension and abduction, outside the
motion path of the other (long) fingers
In polyrheumaticconditions, the MCP joints are extended
© Orfit Industries2015
FUNCTIONAL POSITIONEnhance grasp (day wearing protocol)
Dorsiflexion of the wrist between 30 et 45° max.
The long fingers are lined up at the same level.
Rotation of the thumb on its base.
Thumb in opposition or grasp position.
© Orfit Industries2015
INTRINSIC POSITION (Prevention from shortening)
- Healing : wearing protocol day and night, most of the time during 6 weeks.
- Central and peripheral paralysis: wearing protocol only the night (Day is dedicated for stimulation and rehabilitation).
© Orfit Industries2015
Position extrinsic or intrinsic minus: obtained with muscular contraction of the forearm.
The hand is stiffened, with a shortening of the muscles, capsules, ligaments and tendons.
Intrinsic or intrinsic plus position: obtained with the muscular contraction of
the hand.
This is the position we are looking for prevention from shortening and shrinkage: dorsiflexion of the
wrist between 20 et 30°, MCP joints flexion 70°, PIP and DIP straightness, thumb in opposition.
© Orfit Industries2015
CHOOSE THE FORM OF THE ORTHOSIS
- volar
- Dorsal
- Lever system
- Circular
© Orfit Industries2015
- With two contact points to obtain the flexion.
- three points, toto obtain the extension.
- More (circular immobilization).
© Orfit Industries2015
PALMAR OR VOLAR
Basically used for the resting orthoses, and additionally for the
intrinsic position.
© Orfit Industries2015
Wrist orthosis: tendonitis, arthrosis, carpal tunnel (extension 0°): night wearing protocol.
Orthosis for poly-arthritis: have a look on the rings on the Velcros which facilitate the
donning and doffing.
© Orfit Industries2015
Intrinsic orthosis for healing. Permanent wearing protocol,most of the time sixweeks (except for
scaphoid fractures, twelve weeks).
Also used in case of paralysis (night
wearing protocol).
© Orfit Industries2015
DORSALUsed most of the time for the correcting
orthoses, it’s
indeed better to pull than to push.
© Orfit Industries2015
Push: the strength is maximal in the middle and in more, we note the
friction in the extremities which
prevents from opening the joint.
© Orfit Industries2015
Pull: avoid the friction, and divides the strength by 2. It is necessary to take 2 precautions: pull perpendicularly to the
Max pressure: 50g/cm2
segment, and mould perfectly the orthosis.
© Orfit Industries2015
In case of ulnar deviation, this small functional orthosis protects the joints, and helps the patient
to make the movements of the everyday life.
© Orfit Industries2015
LEVER SYSTEM
This system offers more power to correct thedeformations, or to
stabilize the joints if we wish to make a
functional orthosis.
© Orfit Industries2015
The big part of the lever system is 3 times as long asthe little one; then, with 100 grams of
pressure in the proximal extremity, we obtain 300 grams of strength to raise
the hand.
© Orfit Industries2015
CIRCULAR
With the elastic products, the distribution of the pressures isperfect: it is the best solution to immobilize, when we look
for a healing.