what-when-how
In Depth Tutorials and Information
used during therapy. Non-ambulatory patients utilize
these orthoses for standing. This allows the pediat-
ric patient to have more interaction with peers during
school and social functions. HKAFOs include full cus-
tom orthoses and parapodium-style standers.
Molding
Every patient is unique and molding the patient may
differ depending on the severity of the diagnosis. In
general, the following steps should be taken:
●
Stockinet is applied to the patient. A double layer
should be about the same thickness as a sock.
●
A custom footplate may be fabricated at this time.
Some orthotists customize the footplate during
molding and some in the modification process. As
long as the footplate provides the proper alignment
and support required it does not matter when this
process is done.
●
Next a separation or cutting strip is secured. This
will make removing the mold easier.
●
The circumferential mold is now taken. This can be
done with either fiberglass rolls or plaster bandage.
Both have their pros and cons. Fiberglass is lighter
and cleaner but it must be put on very thinly to
ensure it can be spread adequately for removal. The
plaster is heavier and messier but can be spread
much more easily even when thick. The fiberglass/
plaster is rolled around the leg without pulling.
Pulling the material can create roping which makes
the cast difficult to modify. Most orthotists develop
their own technique for molding after years of
training and experience and most are adequate.
●
The extremity or spine is now held in the most
corrected position tolerable by the patient. This
position is held until the material is semi-set. If the
material is left on too long, the mold will be very
difficult to remove without risk of fracture to the
patient.
●
The mold is now removed using a cutting tool. The
cast is spread open to prevent twisting or putting
pressure on the body.
Fracture Bracing
Probably the most common style of brace used in
OI patients. These orthoses can be above or below the
knee. Use of a joint depends on the severity of the OI
and location of the fracture. The orthosis is custom
molded in the position prescribed by the physician. The
orthosis must have an anterior shell and be well pad-
ded. The design will most likely it into the category of
AFOs and/or KAFOs.
Upper Extremity Orthotics
Upper extremity orthotics are used for fractures and
supporting the wrist and elbow. Fracture orthoses are
usually custom designed for each patient depending on
the fracture site. The style should be the same as other
orthoses. This includes total contact with an anterior
shell and good padding. Many times patients need sup-
port at the wrist and elbow when the patient depends
on the arms for weight bearing during transfers and
position changes. Depending on the severity of the OI,
the orthoses can be custom fitted for minor cases or cus-
tom fabricated for more severe cases and deformity.
FABRICATION
Molding and Measuring
After all of the information is obtained and the style
of orthosis is determined, the molding and measuring
process may begin. The ROM and manual muscle test-
ing gives the orthotist information on how much the
extremity can be moved.
Fabrication
There is a great variety of materials available for fabri-
cating orthoses. Some include polypropylene, polyethy-
lene and copolymer. Any of these materials may be used
depending on the strength and flexibility needed. These
materials are described as thermo form. This means that
the material can be adjusted after the orthosis is fabri-
cated.
2
This flexibility is important for making adjust-
ments for pressure and growth. Currently, one of the
more popular materials in orthotics is carbon fiber. It is
cosmetically appealing and light. It has, however, severe
limitations. It is called a thermo set material.
2
Once
the material is formed it cannot be changed. This does
not allow for future adjustments and therefore should
not be used. There is an even greater variety of pad-
ding choices. Padding can be open or closed cell, come
with or without a skin and come in a wide variety of
Measuring
General measurements are taken for length, width
and circumference. Measurements are extremely impor-
tant in fabrication.
EXAMPLE
An orthotist takes a mold of a leg and pulls the fiber-
glass too tight. This causes the cast circumference to
be ¼″ smaller than the anatomical circumference. The
orthotist who measured the leg prior to molding will be
able to ix the discrepancy in the modification process.
The orthotist who did not take measurements may end
up with an orthosis which is too small.
