what-when-how
In Depth Tutorials and Information
CHAPTER
50
Orthotics
and Osteogenesis
Imperfecta
Michelle Koehler
C.D. Denison Orthopaedic Appliance Corp., Towson, MD, USA
GENERAL CARE
●
Other: Anyone the patient, parent or other team
members deem important may provide valuable
information and should be given the same
consideration as the rest of the team.
Providing an orthosis for a patient with osteogenesis
imperfecta (OI) can be a challenging task. Utilizing a
team approach is the best way to provide an appropri-
ate orthosis with minimal fracture risk to the patient.
The team should include:
STYLES OF ORTHOSES
●
Patient/Parent: The most important person in the
team is the patient. It is very important to have good
communication with the patients and/or parents
regarding range of motion (ROM) of the limbs and
general fragility of the patient. The patient may also
have his/her own goals outside of the other team
members. The more information available will help
the orthotist provide the best orthosis.
●
Physician: Besides providing the prescription for
an orthosis, physicians will set specific goals for the
orthosis. Physician's notes will provide valuable
information on patient history. This may include
history of fractures and previous surgeries.
●
Physical/Occupational therapists: Use of available
therapy notes can provide guidance without needing
to put the patient through multiple tests. If possible,
have the patient perform active ROM of a particular
joint. This will give the feedback needed to provide
a proper orthosis. Active ROM is the patient moving
the joint without any outside assistance. Passive
ROM (assisted ROM) should only be performed if
the orthotist has been properly trained.
●
Orthotist: After all the team information is gathered,
the orthotist will design the orthosis. This includes
style and materials. The design is then reported
back to the team for final approval. The last step is
important to make sure everyone is happy with the
orthosis when complete. It cuts down on the risk of
fracture to the patient and potential remakes.
This section focuses on why specific orthoses are pre-
scribed for patients with OI. The orthotist must consider
the primary and secondary diagnoses equally. Although
the secondary diagnosis is the reason for prescribing
an orthosis, the primary diagnosis of OI will dictate the
style and material used for fabrication. Using an inap-
propriate style or material could result in a fracture. The
following is a list of orthoses that may be prescribed for
patients with OI.
TLSO/LSO (Thoraco Lumbar Sacral Orthosis/
Lumbar Sacral Orthosis)
Scoliosis
Scoliosis, a frontal plane S- or C-shaped curvature of
the spine, is very common in patients with OI.
1
The gen-
eral protocol states that scoliosis is treated with an ortho-
sis for curves between 25 and 40 degrees. The decision to
provide a brace for scoliosis must be decided on a case-
by-case basis.
EXAMPLE
Two patients may present with 30 degree curves.
The first patient has a mild form of OI, is ambulatory,
and has had minor fractures. The second patient has a
severe form of OI, is in a wheelchair, has had multiple
fractures and has trouble sitting without assistance.
