An orthosis is an externally applied device designed to influence the structural and functional characteristics of the body. Its purpose is to support, align, prevent, or correct deformities, or to improve the function of movable parts of the body. By integrating biomechanical principles, these devices can realign joints, reduce pain, and enhance overall mobility for a wide range of conditions.
It is important to distinguish an orthosis from a prosthesis. An orthosis supports or corrects an existing body part, working with the body’s existing structures to provide stability or improve alignment. In contrast, a prosthesis is a device that replaces a missing body part.
Types of Orthoses
Orthotic devices are diverse and categorized by the area of the body they support. They range from custom-fabricated models, molded for an individual, to pre-fabricated “off-the-shelf” options that can be adjusted for a fit. The materials have evolved from heavy metals and leather to lightweight thermoplastics and foams, allowing for more comfortable and functional designs.
Lower limb orthoses address issues from the foot to the hip. Ankle-Foot Orthoses (AFOs) are frequently used to control the ankle’s position and motion, compensating for weakness from conditions like drop foot. For more extensive support, Knee-Ankle-Foot Orthoses (KAFOs) encompass the knee, ankle, and foot to provide stability to the entire leg.
Upper limb orthoses target the hand, wrist, elbow, and shoulder. Wrist-Hand Orthoses (WHOs) can immobilize the wrist and hand to allow healing after a fracture or manage carpal tunnel syndrome. Elbow Orthoses (EOs) may control range of motion after surgery or stabilize a joint affected by arthritis. These devices are tailored to either restrict or assist movement.
Spinal orthoses are designed to support and correct the spine’s alignment. A common example is the Thoraco-Lumbo-Sacral Orthosis (TLSO), a brace that encases the torso to manage conditions like scoliosis. TLSOs can also be used to stabilize the spine after a fracture or surgery by restricting movement to promote healing.
Common Conditions Requiring an Orthosis
Many medical conditions can require an orthosis to improve function, manage symptoms, or provide support for both acute and chronic health issues.
Neurological conditions often affect muscle control and stability. For individuals with cerebral palsy, an AFO can help maintain proper foot and ankle alignment, improving balance and walking patterns. People who have had a stroke or a spinal cord injury may use orthoses to manage muscle tone, prevent contractures, and provide external support for safer mobility.
Orthopedic and musculoskeletal issues are another reason for orthotic treatment. A supportive brace can mitigate joint pain and instability caused by severe arthritis. Repetitive strain injuries like carpal tunnel syndrome may be treated with a wrist splint to reduce pressure on the nerve. For structural issues like scoliosis, a spinal orthosis applies corrective forces to the spine to prevent the curve from worsening.
Orthoses are frequently used for post-operative support and protection. After surgery on a joint or bone, an orthosis can immobilize the area or control its range of motion, creating an optimal environment for healing. This is common after ligament repairs in the knee or ankle, or following spinal fusion surgery, where the device acts as an external stabilizer.
The Process of Obtaining an Orthosis
Obtaining an orthosis begins with a medical evaluation by a physician. The physician assesses the patient’s condition and, if an orthosis is deemed necessary, writes a prescription detailing the type of device required.
Following the prescription, the patient is referred to a certified orthotist, a healthcare professional specializing in the design, fabrication, and fitting of orthoses. The orthotist conducts a detailed assessment, evaluating the patient’s biomechanics, range of motion, and functional goals. This evaluation helps ensure the device will meet the individual’s specific needs.
For a custom-fabricated orthosis, precise measurements are taken, often by creating a plaster cast or using digital scanning to capture the body part’s exact contours. These measurements serve as the blueprint for building the device. The fabrication process uses selected materials to construct an orthosis that matches the patient’s anatomical and functional requirements.
Once the device is fabricated, the patient returns for a fitting. The orthotist fits the orthosis, makes necessary adjustments for comfort and function, and educates the patient on its use and care. Follow-up appointments are scheduled to monitor the fit and function of the orthosis and make further adjustments as the patient’s condition changes.
Living with an Orthosis
Adapting to life with an orthosis involves an initial adjustment period. When first receiving an orthosis, a “break-in” period is common, and the orthotist will provide a specific wearing schedule. This often starts with short intervals and gradually increases in duration to allow the body and skin to acclimate to the device, which helps minimize discomfort and skin irritation.
Consistent skin care is an important part of wearing an orthosis. It is important to check the skin daily for any signs of redness, pressure sores, or irritation, particularly over bony areas. Keeping the skin clean and dry is also important for preventing breakdown, and any persistent skin issues should be reported to the orthotist so that adjustments can be made.
Proper maintenance is necessary to keep the orthosis in good working condition. This includes regular cleaning of the device according to the orthotist’s instructions, often with mild soap and water. Straps, padding, and mechanical joints should be inspected regularly for signs of wear and tear to ensure the device remains effective.
Daily activities, such as dressing, may require some modifications. Loose-fitting clothing can often be worn more easily over an orthosis. For lower limb orthoses, selecting appropriate footwear is a consideration, as shoes may need to be wider or deeper to accommodate the device. Over time, these adaptations become a normal part of the daily routine.