what-when-how
In Depth Tutorials and Information
The first patient may benefit from a custom total con-
tact TLSO. This orthosis provides the pressure required
to slow the progression of the curve. Specific care must
be taken when fabricating the orthosis. These tech-
niques are discussed later in the chapter. Because of the
fragility of the second patient, a soft TLSO or garment
may be used. These orthoses are used for posture con-
trol while sitting which can help with lung function.
They are not rigid enough to provide corrective forces.
Kyphosis/Lordosis
Kyphosis and lordosis, excessive curves of the spine
in the sagittal plane, are also common in patients with
OI. Protocol for choosing a brace is similar to scoliosis.
The previous example also applies to these patients.
The acceptable degree of curves in the sagittal plane can
vary with each patient. A TLSO may be provided to a
patient who leans forward excessively and is having
trouble breathing. Before providing this orthosis, the
orthotists must determine if the patient can tolerate the
anterior pressure required to support the body.
FIGURE 50.1
Custom AFO with anterior shell for total contact.
Spinal Fractures
Fractured vertebrae can be common in patients with
OI. It can be painful and increase the severity of the pre-
vious diagnoses. It is more common to provide a soft
TLSO/LSO or garment in these situations. The orthosis
may include a rigid frame to immobilize the fracture
area. Immobilization can assist in the healing process.
Lower Extremity Orthotics
Foot Orthotics
Most common in mild forms of OI, custom foot
orthotics can provide the necessary total contact to
support the foot. This will reduce the stress on a single
bone. An impression foam box should not be used in
cases with OI. The force used to step into the box may
cause too much pressure on a single bone. Instead a
wrap mold is used to provide circumferential pres-
sure. The footplate should be custom contoured to the
patient.
FIGURE 50.2
Custom KAFO with anterior shells.
KAFOs (Knee Ankle Foot Orthosis)
Just like AFOs, KAFOs are used for stability in
ambulatory patients. The style of the KAFO is deter-
mined by the range of motion and manual muscle
tests. Both sections must be custom molded with ante-
rior shells to prevent fracture (
Figure 50.2
). KAFOs are
used in non-ambulatory patients to prevent deformity.
These orthoses may utilize a joint if adjustable range of
motion is needed. Many times the orthosis will be fabri-
cated without a joint to provide more total contact.
AFOs (Ankle Foot Orthosis)
AFOs are commonly used in patients with OI for sta-
bility and prevention of deformity. Patients with minor
cases and who can ambulate often need added support
at the ankle. An AFO can provide this support. AFOs
are also used for non-ambulatory patients to prevent
deformity at the foot and ankle. The orthosis should
be made with an anterior shell to provide total contact
(
Figure 50.1
). Straps alone will add too much pressure
across the ankle and/or calf. This extra pressure could
lead to fracture.
HKAFOs (Hip Knee Ankle Foot Orthosis)
HKAFOs follow the same protocols as AFOs and
KAFOs. These orthoses provide support from the trunk
to the foot for maximum control. They are used for
ambulatory patients to provide the control needed for
standing and taking steps. These orthoses are primarily
