UPPER LIMB ORTHOSES

UPPER LIMB ORTHOSES. 1.

Upper Limb Orthoses. Orthoses of the upper limb range from shoulder including slings and rigid orthoses to wrist and elbow orthoses The orthoses which are used for a relatively short period of time are known as splints They are classified primary function as assistive, substitutive ,protective and corrective orthoses Assistive or substitutive orthoses are used for the patients with paralysis, the device augments residual motor power or substitutes mechanical joint motion and is also used for stabilization for absent anatomical function.

Upper Limb Orthoses. Protective orthoses shield the affected joint from developing contractures as in the case with burns or reduce painful motion as in the case of arthritis Corrective orthoses are used to increase joint range of motion in the case of dermal or capsular contracture.

Assistive orthoses. Of all assistive orthoses the basic opponens orthoses earlier called as the short opponens splint is the simplest It has a thumb pad attached to the palmar surfaces between the index and the middle fingers assisting the patient to use residual motor power to achieve palmar prehension.

Assistive orthoses. The forearm bar may be attached to the basic opponens orthosis to create basic opponens orthosis with wrist control also know as long opponens splint The forearm bar may be attached to the dorsal, palmar ulnar or radial aspect of wrist and forearm. It maintains the wrist in a fixed position preventing the hand from dropping into palmar flexion.

Assistive orthoses. Another addition to basic opponens orthosis is metacarpophanlangeal extension stop or the lumbrical bar Secured to the palmar bar and applies palmward force to proximal phalanges to resist metacarpophanlangeal hyperextension Protects the hand from forming claw hand deformity also aids prehension ..

Assistive orthoses. Another assistive orthosis is the wrist flexion orthosis often called as the cock-up splint It consist of a palmar hand bar and a palmar forearm bar with straps to secure the orthosis to the limb This orthosis prevents the wrist from dropping into palmar flexion seen in radial neuropathy It is also used to protect wrist from repetitive motion strain as experienced by the keyboard operators.

Substitutive Orthoses. Prehension orthoses are an e.g. of substitutive orthoses These are generally useful for patients with tetraplegia They enable the user to grasp, hold or release objects voluntarily.

Substitutive Orthoses. The wrist driven WHO has a hinged linkage between the forearm and the finger stabilizers When the patient extends the wrist the linkage causes the finger stabilizers to approach the thumb thus enabling the grasp The user must maintain active extension in order to retain the held object Release of the object occurs when the user allows the wrist extensors to relax ,allowing the wrist to flex passively.

Substitutive Orthoses. Most of the wrist driven orthoses have a mechanism that help the user to adjust the grasp according to the size of the object For lifting a paper the wearer would adjust the mechanism so that a small arc of wrist motion achieved finger closure ,for lifting a thicker object the mechanism is adjusted so that the same arc of motion achieved wider closure.

Substitutive Orthoses. Utensil Holder: It will consist of a clip or a elastic webbing along the circumference of the palm The palmar side has a slim leather pocket ,in which one may place a pen, spoon or any other object of appropriate size It is also called as a universal cuff The orthoses may have a forearm bar to prevent unwanted wrist motion and keep the wrist in a stable functional position.

Protective Orthoses. The wrist-hand stabilizer orthosis also termed a resting splint, is a sheet of semi-rigid plastic placed on palmar surface of the hand and forearm. The sheet extends from the distal tips of the fingers to the middle third of the forearm and is curved to support the palmar arch and cradle the forearm. Widely used by patients with rheumatoid arthritis and those with burns who are vulnerable to flexion contractures..

Protective Orthoses. A thumb stabilizer prevents movement of the first interphalangeal joint. The orthosis consists of a longitudinal bar along the length of the thumb with stabilizing straps or a sleeve on the thumb and a strap around the hand..

Protective Orthoses. A finger stabilizer is used for the patient with boutonniere deformity, which is persistent flexion of the proximal interphalangeal joint. Two bands that apply dorsally directed forces to the proximal and middle phalanges oppose the force..

Corrective orthosis. Corrective orthosis: apply a low, constant force with approximate counter forces to reduce contracture. The patient who has a flat hand with extension contractures of the metacarpophalangeal joints may be fitted with a finger flexion HO It has dorsally located plate over the metacarpals and another plate over the proximal phalanges linked to a palmar rod Springs or rubber bands apply tensile force to the orthosis.

Corrective orthosis. The finger extension orthosis also called reverse knuckle bender, has an opposite force system, namely a palmary located bar linked to two dorsal bars. Rubber bands or strings exert tension. Versions of these corrective orthoses are available to correct extension and flexion deformities of the interphalangeal joints. Neuromuscular electrical stimulation to forearm musculature ,combined with a corrective WHO, reduces spasticity in children with cerebral palsy..

Elbow orthoses. The elbow orthoses used for reducing soft tissue contractures must be custom made or custom fabricated with structural plastic bands and total contact plastic cuffs and straps These are used to reduce elbow extension and flexion contractures The need to reduce extension and flexion of the elbow joint can result due to trauma or disease or for immobilization after a surgery.

Shoulder elbow orthoses. Used for support of painful shoulder or traumatized brachial plexus injury For short term use a conventional arm sling is provided, for long term use a sling offers very little function A gunslinger orthosis is used in which the patients arm is strapped to a forearm trough which is mechanically coupled to a plastic hemi-girdle anchored to the patients pelvis The coupling helps to prevent external, internal rotation as well as flexion & extension of the elbow joint.

Shoulder elbow wrist orthoses. These orthoses are used to protect the soft tissues or to protect contractures of soft tissue. Sometimes they are used to correct a existing deformity which are used to promote healing or relieve pain are used custom made with selected structural and biomechanical components. the hardware is adjustable so that a few sizes will fit all This device helps in transferring the weight of the upper limb to the pelvis. The device is stabilized with the help of trunk straps.

Shoulder Abduction Orthosis. Shoulder Abduction Orthosis (Harvey Airplane Splint) Description: Frame design with thoracic and arm sections attached to adjustable shoulder joint; Also has adjustable elbow joint Function: Limit shoulder flexion/extension; Horizontal flexion/extension; Abduction; Usually set to allow free elbow range of motion Indication: Primarily for post-operative use (i.e. rotator cuff reconstruction).

Finger, Wrist-Hand and Forearm O rthosis Evaluation.

Finger, Wrist-Hand and Forearm Orthosis Evaluation (cont.).

Elbow and Shoulder O rthosis Evaluation. Forearm, elbow and shoulder have intended range of motion. Glenohumeral joint is well supported. Patient can operate the control mechanism . Mechanical joints are congruent with anatomical joint.

Guidelines for Prescription. The following are biomechanical guidelines for prescribing upper limb: For opposed position of the thumb, index and middle fingers , patient with median neuropathy a. basic opponens orthosis . b. Opponens orthosis with wrist control. c. Opponens orthosis with metacarpophanlangeal extension stop..

Guidelines for Prescription (cont.). To prevent claw deformities of the fingers and to assist finger extension, for ulnar or median-ulnar neuropathy a. Opponens orthosis with metacarpophalangeal extension stop. b. Opponens orthosis with metacarpophalangeal extension stop with wrist control..

Guidelines for Prescription (cont.). To limit wrist palmer flexion, particularly for radial neuropathy. a. wrist flexion control orthosis b. Opponens orthosis with wrist control. To enable prehension with fingers paralysis but fair plus or stronger wrist extension reatained ; C6 tetraplegia a. wrist-driven prehension orthosis . b. utensils with large handles..

Guidelines for Prescription (cont.). To assist UL function in presence of elbow weakness; a. elbow stabilizer. To reduce stress on shoulder a. single strap sling b. multi strap sling. To increase shoulder flexion and abduction or prevent contracture. a. shoulder orthosis with adjustable hinge..

Guidelines for Prescription (cont.). To assist shoulder and elbow motion. a. balanced forearm orthosis ..

Thank You. 29.