ORTHOTIC DESIGNS

In the past,orthoses were categorized as static or dynamic. This classification

system has its problems and controversies.in some clinics,ASHT orthotic
terminology is not often used .Therefore ,therapists must be familiar with the
ASHT classification system and other commonly used nomenclature.Static
orthose have no movable parts. In addition static orthoses have no movable
parts.In addition,static orthoses place tissues in astress-free position to enhance
healing and tominimize friction.dynamic orthoses have one or more movable
parts and are synonymous with orthoses that employ elastics, springs,and were,
as well as with multipart orthoses.
The purpose of an orthosis as a therapeutic intervention assists the therapist in
determining its design. Orthotic design classifications include:Static, serial
static,dropout ,dynamic,static-progressive.

Torque transmission orthoses may create motionof primary joints situated

longitudinally(A)or transversely(B) according to secondary joints(From Fess EE,
gettle KS. Pluilips CAet al: hand and upper extremity splinting principles and
methods ed..St.louis 2005.Elsevier Mosby)

A static or immobilization orthosis can maintain a position to hold anatomical

structures at the end of avabile range ofmotion,thus exerting amobilizing effect
on a joint.For example ,a terapist fabricates an orthosis to position the wirst in

maximum tolerated extension to increase extension of a stiff wrist.Because the

orthosis positions the shortened wrist flexors at maximum length and holds them
there,the tissue remodels in a lengt hened form.

Static immobilization orthosis. This static orthosis immobilizes the thumb, fingers
and wirst
Serial static orthoses require the remolding of a static orthosis.The serial static
orthosis holds the joint or series of joints at the limit of tolerable range thus
promoting tissue remodeling.As the tissue remodels,the joint gains range and
The practitioner remolds the orthosis to once again place the joint at end range
confortably.

Serialstatic orthoses ( A and B).The therapist intermittently remolds the orthosis

as the client gains wrist extension motion
A dropout orthosis (fig1-5) allows motion in one direction while blocking motions
in another.This type of orthosis may help a person regain lost range of motion
while preventing poor posture.For example an orthosis may be designed to
enhance wirst estension while blocking wirst flexion.
Elastic tension dynamic(mobilization) orthoses (fig 1-6) have self-adjusting or
elastic components, which may include wire,rubber bands , or springs.An
orthosis that applies an elastic tension force to straighten an index finger PIP

flexion ,contracture exemplifies an elastic tension/traction dynamic (mobilization)

orthosis.
Orteza tenso-elasto dinamica (de mobilizare) area autoajustare sau componente
elastice,care includ fire,benzi de guma sau arcuri. O orteza care aplica o forta de
tensiune elastica pentru a indrepta un deget aratator ,
Static progressive orthoses (fig 1-7) are types of dynamic (mobilization)
orthoses.They incorporate the use of inelastic components, such as hook-andloop tapes, outrigger line, progressive hinges,turnnbuckles, and screws. The
orthotic design incorporates the use of inelastic components to allow the client
to adjust the amount of tension so as to prevent overstressing of tissue.Chapter
12 more thoroughly addresses mobilization and torque transmission (dynamic)
orthoses.
Many possibilities exist for orthotic design and fabrication. A therapist creativity
and skills are neccessary for determining the best orthotic design. Therapists
must stay updated on orthtic techniques and materials,which change rapidly.
Reading professional literature and manufactures tehnical information helps
therapist maintain knowledge about materialsand thechniques. A personal
collection of reference books is also beneficial,and continuing-education courses
and professional conferences provide ongoing updates on the latest theories and
tehniques.
Evidence-Based practice and orthotic provision
Calls for evidence-based practice have stemmed frommedicine but have affected
all health care delivery, including orthoses. Sackett and colleagues defined
evidence-based practice as the consientious, explicit, and judicious use of
current best evidence in making decisions about the care of individual clients.the
practice of evidence- based medicine means integrating individual clinical
expertise with the best available external clinical evidence from systematic
research.
The aim of applying evidence-based practice ist o ensur that the interventions
used are the most effective and the safest options.Additionally the American
health care systemincreasingly emphasize effectiveness and cost- efficiency and
less credibility of provider preferences. Essentially,therapists apply the research
process during practice.This process includes formulating a clear questions
based on