2 Review Nomenclature Spine support orthoses Joint support orthoses Neck, ThoracoLumbarSacralJoint support orthosesTypically lower limb motor loss adaptationsMotor augmentation orthosesTypically upper limb motor presence augmentationProtection orthoses
3 Orthotic DefinitionDevice used to assist, resist, align or simulate function of a body part or system.Typically applies forces to affected extremity.Force has magnitude, direction and application point.Effectiveness depends on all 3.Movement = rotation, translation or combination of 2.Torque is strength of rotational force.
4 Orthotic Nomenclature 1971 – American Orthotic and Prosthetic Association promoted standardized nomenclature1972 – new language put into use
5 Committee on Prosthetic-Orthotic Education of the National Academy of Sciences All exoskeletal devices called orthoticsDescribed by joints they encompassAbbreviate each joint name to 1 letterCombination of symbols to indicate desired control of designated function
6 Orthotic Materials Thin metal, plastic, foam, epoxy, plaster. Short use = low durability needHigh frequency & load = high durability need
7 Spine Support Goal is stabilization in desired plane of motion Flex/ext, sidebending, rotationAbsolute vs. relative restriction
9 Cervical OrthosesPhilly: AP motion limited to 30% normal, 43% rotation, 67% side bend.SOMI: 13-27% sagittal motion, 34% rotation, 66% side bendHALO: believed most restrictive, least overall C-spine motion but individual “snaking” of vertebrae.Koch – 31% sagittal motion reduction in tetraplegia, suggested intimate fit body vest was best. 1978
20 ThoracoLumbarSacral Orthoses 3 point force application theoryNo true immobilization, just limitation of interspinous motionLimited sagittal controlFor effectiveness, must provide “inhibitory feedback signal” over bony prominences to reduce patient movement efforts.
21 LS Orthoses Commonly used for back pain syndromes Little consistent data to support idea that disk pressures reduced in lifting tasks.Nachemson A.
22 TLSO typesJewittKnight-TaylorLS corsettClamshell or turtleshell
41 Motor Augmentation Orthoses Cervical deficits can use substitution or enhancementUpper limb’s job = terminal device (hand) placement in environmentFeeding most important!Balanced forearm orthosis (BFO), tenodesis devices, hand & digit flexion or extension assist orthoses, built up grips for grip loss.General environmental control unitsOromotor adaptive equipment
53 Interface technology for high cervical injuries Eye movement trackingSip & puffVoice recognition
54 Eye Movements During Visual Scan Typical eye movement behavior while looking at a face- Note the extent to which fixations occur around the eyes- The eye movements are again voluntary and involve the saccadic system- People are generally not aware of these movements and as I have found later, verbal descriptions do not always agree with actual eye movement response.- The advantage of objective measurement techniques.
55 Eye Movement Measurement Techniques EOGPhotoelectricPupil Corneal ReflectionScleral Search Coil
56 Electrooculography (EOG) Cornea Positively ChargedRelative to Retina - A Rotating Dipole
57 Contact Lens with Embedded Induction Coil Scleral Search CoilContact Lens with Embedded Induction Coil