Clinical Pathways. Product Selection Guide. DynaPro. OrthoPro. SoftPro. AirPro. 800/ Ongoing Care Solutions, Inc.

Transcription

1 Ongoing Care Solutions, Inc. Clinical Pathways Product Selection Guide DynaPro The next generation of NeuroFlex Technology OrthoPro SoftPro AirPro 800/

2 Introduction to Clinical Pathway Clinical Pathways Orthotic Selection Guide OCSI offers a wide selection of orthotic types and designs. The Clinical Pathways Orthotic Selection Guide is intended to facilitate brace selection based upon: 1.) the orthotic therapy provided by brace type and design, 2.) the clinical pathology of the joint(s) being treated, and 3.) the rehabilitation goal for treatment. Static Orthotics Static/Flex Neuro-Dynamic Orthotics Designed to support, protect, and correctly position the joint(s) being treated and provide maintenance therapy, preserving existing passive range of motion with routine use. Fabricated from bio-engineered flexible components that flex into the lost range of motion to provide Low Load Prolonged dynamic therapy. The flex characteristics of the devices will give or reduce tension on the stretched joint during episodes of abnormal tone uniquely appropriate for managing spasticity. Maintenance orthotic therapy is appropriate when therapeutic stretching is contraindicated due to pain or risk of injury (Rheumatoid Arthritis, RSD, severe osteoporosis, etc.). Static orthotics can also effectively provide PROGRESSIVE EXTENSION ORTHOTIC THERAPY by setting the device 5 to 8 ahead of comfortable end range stretch. DynaPro Orthotics are The Next Generation of Neuroflex Technology providing abnormal reflex arc therapy to effectively manage abnormal tone and spasticity. OCSI offers STATIC bracing with the SoftPro line of orthotics. OCSI offers STATIC/FLEX bracing with the DynaPro line of orthotics. Air Bladder Orthotics Orthotics for Specific Orthopedic Conditions Designed with strategically placed air bladders to provide gentle Low Load Prolonged (LLPS) on shortened tissue to reverse Lost Range (LROM). LLPS is effective orthotic therapy to reverse tissue shortening contractures. Air bladder inflation stretching is effective in gently reversing tissue shortening, even for severely contracted joints as the bladder(s) will conform to the angle of the joint. Designed components intended to effectively treat specific orthopedic conditions. Range and Knee Orthotics, ambulating knee braces, night splints for treating plantar fasciitis, and spinal supports are included in the product line. OCSI offers AIR BLADDER bracing with the AirPro line of orthotics. OCSI offers ORTHOPEDIC bracing with the line of orthotics. Orthotic Fitting The Palpation Method of Orthotic Fitting should be utilized when using Progressive Extension, Low Load Prolonged, or NeuroInhibiting orthotic therapy to ensure a good fit. Palpate the crease in the affected joint immediately after fitting the brace. The tissue should feel taut due to the therapeutic stretch being applied by the device. If the tissue is not taut, the device should be re-set to initiate a gentle stretch. There should never be significant discomfort or pain associated with orthotic device stretching. Immediately remove the brace and re-set the orthotic to reduce the stretch applied by the device if pain or significant discomfort occurs. Always re-palpate the treated joint several minutes after device application (10 15 minutes). An optimal fit will display significant softening in the joint crease when re-checked. If softening has occurred and the patient reports comfort, the fit is good. If there is no softening, the device should be re-set to provide a more gentle stretch.

3 CLINICAL CONDITION/PROBLEM THERAPY GOAL ORTHOTIC SELECTION/THERAPY FITTING GUIDELINES RA-pain, inflammation, deformity RSD pain w/ movement or stretch Support/Protect/Position Static Fit for support and positioning Full contact fit at comfortable end range Post injury/surgery pain w/movement Control motion of joint Limit/control motion of joint Knee & Support the joint during movement Set hinge to limit motion to tolerance 0/mild tone poor end feel poor skin integrity Maintain Range Maximize comfort and skin protection Static Fit for support and positioning Comfortable end range 0/mild tone fair end feel Conservative Therapy Progressive Extension Therapy Set device 5-8 ahead Use strapping for 3 pt. leverage* 0/to mild tone fair to good end feel Air Low Load Prolonged AirPro Orthotics Air Inflation ing Gentle Low Load Prolonged Fill air bladder(s) to provide gentle stretch; palpate joint to assess fit mild to severe tone fair to good end feel Dynamic Low Load Prolonged DynaPro Orthotics Dynamic Flex Therapy Dynamic Low Load Prolonged Set device 5-15 ahead to provide optimal Low Load Prolonged Neurological hypertonicity spasticity Neuro-contracture management Manage hypertonicity/spasticity Provide stretch on relaxed tissue DynaPro Orthotics Neuro-inhibiting Tension Negative non-linear dynamic tension Set device 5-15 ahead to inhibit joint(s) and provide LLPS Orthotic Selection Guide Orthotic Selection Guide Terms: Adaptive Tissue Shortening: connective tissue, tendons, and muscles adapt to disuse over time by shortening and becoming less elastic which limits movement of the joint (contracture). End Feel: the assessment of the relative viscoelastic quality of connective tissue, tendons, and muscle perceived by the practitioner at the very end of the available range of motion of a joint. Tone: common term for hypertonicity which is an involuntary increase in tendon reflexes including an oversensitivity and opposition to therapeutic stretching. ROM: an acronym for Range exercise of the joint. Spasticity: exaggerated deep tendon reflexes or muscle spasms usually due to an upper motor neuron (brain) lesion. Progressive Extension: a type of orthotic therapy where a brace is set to apply a gentle stretch beyond the end range of shortened tissue. The brace is progressively modified to maintain stretch and incrementally lengthen shortened tissue. Neuro-Inhibiting Tension: therapeutic muscle tension applied by a brace that is below the stretch reflex threshold which can initiate muscle inhibition and provide relaxed therapeutic stretch. Negative Non-Linear Dynamic Tension: dynamic stretch below the stretch reflex threshold which is applied by the brace to the affected joint which gives or reduces tension applied by the brace with a dynamic muscle contraction. Three Point Leverage: leverage points at the proximal and distal ends of a brace in one direction (i.e., down) with an adjustable leverage brace component at the apex of the joint in the opposite direction (up) to exert a therapeutic stretch of the joint (i.e., reverse elbow flexion). RA: Rheumatoid Arthritis RSD: Reflex Sympathetic Distrophy 1

4 Decision Tree - Upper Extremity Clinical Pathways Orthotic Decision Tree Upper Extremity Support/Position Maintain Range Conservative ing of Motion Neuro-rehab w/stretch Mild (<20 ) DynaPro DynaPro Moderate (25-55 ) Flex Flex Severe (>60 ) AirPro Graduate AirPro Graduate Mild (25% ROM loss) DynaPro / DynaPro / Moderate (30-50% ROM loss) DynaPro / DynaPro / Severe (>50% ROM loss) SoftPro Palmar SoftPro Palmar DynaPro Molded DynaPro Molded Flex Molded Flex Molded UPPER EXTREMITY Wrist Flexion w/ Fingers Mild - Moderate Wrist Flexion w/ Fingers Severe (>60 ) Fingers Severe (>60 ) Thumb Adduction Ulnar Drift Hand Fingers Wrist - Hyperextension Hyperextension / supination Flexion SoftPro Static/Gel ROM w/ Movement Hyperextension 2 SoftPro Hyper X Static Gel DynaPro SoftPro Static/Gel ROM w/ Movement DynaPro SoftPro Hyper X Static Gel Flex Flex

5 Decision Tree Tree - Lower Extremity Orthotic Decision Lower Extremity Clinical Pathways Orthotic Decision Tree Lower Extremity LOWER EXTREMITY Support/Position Maintain Range Conservative ing Neuro-rehab w/stretch KNEE Non-Ambulatory AirPro COKO ROM Knee Flexion Hyperextension DynaPro Flex Knee SoftPro Static/Gel Knee SoftPro Static/Gel Knee SoftPro Hyper X Static Gel Knee SoftPro Hyper X Static Gel Knee Flex Knee DynaPro COKO Dynamic Knee DynaPro Flex Knee Flex Knee Weight Bearing Ambulation Support Stabilization Pain Relief OA Knee Joint Stabilization POP Knee HIP Hip Adduction Mild Moderate Severe 20 Combined Hip Abduction w/knee flexion (non-weight bearing) Softpro Static Gel KO Softpro Static Gel KO w/knee flexion (weight bearing) DynaPro AFO HIP/THIGH/KNEE ANKLE/FOOT Non-Ambulatory Plantarflexion Weight Bearing/Transfer Plantarflexion/ Inversion/Eversion Assisted Ambulation Plantarflexion Ambulatory Foot Drop 10 DynaPro Elite DynaPro Elite