An orthosis, a mechanical device that is fitted and applied to the body, is used to modify structural or functional characteristics of the neuromusculoskeletal system. To that end, orthotic treatment is often employed to relieve pain, manage deformities, and attenuate abnormal neuromuscular function. More specifically, orthotic treatment may be used to (1) prevent, reduce, or stabilize a deformity; (2) modify the range of motion of a joint; (3) add to the length or alter the shape of a segment; (4) compensate for weak muscle activity or control muscle hyperactivity; and (5) reduce or redistribute the load on tissues. Orthoses may be commonly referred to as braces or splints.
Rehabilitation physicians often work with orthotists. In conjunction with the physician, the orthotist designs and fabricates an orthosis to meet the specific needs of the patient. Proper fit and alignment of an orthosis is paramount in order for a patient to benefit from its use. An orthosis that is incorrectly fitted or uncomfortable does not confer the desired effect and may be cosmetically unacceptable to the patient. This orthosis is less likely to be worn and represents a missed opportunity to help a patient. In such cases the ill-fitting orthosis may be either modified or replaced.
It is the joint responsibility of the physician and the orthotist to ensure that an orthosis is fitted properly and that the patient is instructed in its proper use. In circumstances where a custom fit is not essential, a variety of prefabricated orthoses may be used. However, prefabricated devices are often difficult, if not impossible, to modify due to the lack of plasticity of the materials and their inherent fragility once tampered with. It is therefore still absolutely essential for the physician to ensure that the orthosis is appropriate and fits correctly.
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E: A history of splinting. To understand the present view the past. J Hand Ther 2002;15:97–132.
UPPER EXTREMITY ORTHOTICS
The function of the upper extremity, in maneuvering the hand so that it may access and manipulate objects in space, is achieved through prehension, which is the act of taking hold, seizing, or grasping an object. The shoulder, elbow, and wrist function together to place the hand in a desired locale for fine and gross motor tasks. The main goal of upper extremity orthoses, therefore, is to maintain the function of the hand, either by restoring or preserving prehension itself, or by allowing optimal positioning of the hand in space in order to manipulate objects in the environment. In this regard five common goals in upper extremity orthotics are (1) substituting for weak or absent muscles, (2) protecting damaged or diseased segments by limiting loads or motion, (3) preventing deformity, (4) correcting contracture, and (5) attaching to other assistive devices.