SELAYANG PANDANG,,

SPINAL
&
UPPER LIMB
ORTHOTICS
Sumber :

• NYU (New York University)

• Jackson C. Tan
• DeLisa
• Braddom
• Sara J. Cuccurullo
• Pelatihan Ortotik Prostetik Se-Indonesia
Orthotics vs Prosthetics
Orthotics Prosthetics
• An external device • An artificial substitute
applied to body parts to for a missing body part.
support or improve the
function of that
segment.
• Alat bantu eksternal utk
membatasi atau
membantu gerakan
• Utk mengalihkan beban
pada satu area ke area
lain
3 alasan utama peresepan orthosis:
1. Support
2. Alignment
3. Protection

MEMPERBAIKI FUNGSI DAN MENCEGAH DEFORMITAS

PRINSIP BIOMEKANIK

counterforce

force

counterforce
 MATERIAL
• METAL
• Steel
• Aluminium
• Titanium alloys
• Magnesium alloys
• LEATHER  covering brace or straps, pelvic bands
• RUBBER  padding pd assistive device/body jacket/limb orthosis
• PLASTIC
Thermoplastics : • Low-temperature thermoplastic (<80° C) : Orthoplast, Plastazote
• Can be molded (110-140°C)
and remolded • High-temperature thermoplastic (150-160°C) : acrylic.
Polyethilen (PE), Polypropylene (PP), ABS, PVC, PVA
Thermosetting :
• Permanent shape
• Lebih sering menyebabkan iritasi/alergi
• Contoh: Polyesther resin, epoxies, polyurethane foam
UPPER EXTREMITY
ORTHOSES
 Primary Goal UE Orthoses:

“preservation or restoration of hand

function”

1. Substitute for weak or absent muscles  SCI cervical, BPI,

lesi saraf perifer
2. Protect damage or diseased segment by limiting load or
motion  post op, trauma, RA
3. Prevention of deformity  TBI, stroke, SCI, BPI, lesi saraf
perifer
4. Correction of contracture  post imobilisasi
5. Attachment of other assistive devices  alat makan,
sendok, garpu, alat tulis
4 Fungsi Gerakan AGA :
1. Reach (meraih)
2. Carry (membawa)
3. Prehension pattern (keterampilan tangan)
4. Release (melepaskan)
Diusahakan
Hand Prehension (gross motor grasp) : semaksimal
mungkin !
1. Hook prehension (seperti membawa tas)
2. Cylindrical grasp (seperti menggenggam gelas)
3. Spherical grasp (seperti memegang bola)
Fine motor skills :
1. Fingertip pinch
2. Lateral pinch
3. Palmar prehension/three jaw chuck (gerakan oposisi ibu
jari terhadap jari II dan III)
Klasifikasi UE Orthoses:
STATIK DINAMIK HYBRID
No moveable joints Have moveable joints • Incorporated
incorporated into the that can: features of both
design 1) “Block” static & dynamic
• Static with block 2) “Traction” orthoses into one
(allow active joint 3) “Assist” devices
motion in one • Cross multiple joints
direction, but block • Limit motion at
in another) some joints,
• Progressive static allowing motion at
others joints
Block Traction Assist
Limitation in ROM External force External force
of the joint created applied across a applied across a
by the orthosis joint for the joint to substitute
purpose of for weak muscles
stretching soft
tissue (kontraktur)
Proper prescription :
• Joints or segments involved
• Special design features controlling each of those
joints
• Materials
• Diagnosis
• Disability
• Duration of need
• Prognosis
 Prinsip anatomi:
• Wrist  slight extension,
netral pronasi/supinasi
• IP joint  ekstensi Dimobilisasi
sesegera
• MCP joint  fleksi mungkin
(70-90°)
• Thumb  palmar abduction &
extension
• Web space
• Arkus transversal proksimal &
distal
• Ujung jari 2-5 saat fleksi
scaphoid bone/arkus distal
 KLASIFIKASI STATIK DINAMIK

FINGER & Static ring orthoses Dynamic finger orthoses

THUMB Thumb carpometacarpal (CMC) Thumb (extension/flexion/abduction) -
ORTHOSES stabilizers/Thumb posts mobilization orthoses
(melewati IP
joint) Progressive static finger orthosis Finger mobilization orthoses :
Interphalangeal extension/flexion-
mobilization orthoses
HAND-FINGER MCP Ulnar-deviation restriction orthosis "Knuckle-bender orthosis"
ORTHOSES
(melewati MCP- Thumb-web space stabilizers/Thenar web
IP joint) spacers/C-bar splint
Opponens splint (short & long)
Thumb spica MCP extension mobilization orthosis
WRIST-HAND- Resting hand splint Dynamic wrist-hand-finger orthosis,
FINGER Wrist Cock-up splint with flexion/extension block, assist
ORTHOSES wrist&finger extension, tenodesis
(melewati wrist- prehension or flexor hinge orthosis
MCP-IP joint)
ELBOW Protective elbow and shoulder orthosis Dynamic elbow orthosis
ORTHOSES
SHOULDER Balance Forearm Orthosis (BFO)
ORTHOSES
Static ring orthoses
Pada rheumatoid arthritis (RA) :
• Swan neck ring splint
• Prevent PIP hyperextension

• Boutonniere ring splint

• Immobilizes PIP in extension, prevent flexion
Dynamic finger orthoses
• Tujuan : stretching flexion contracture IP joint
Progressive static finger orthosis
• Bisa dengan :
• Mengeratkan
screw
• Adjusting
thermoplastic
design
• Merubah velcro
strap
MCP Ulnar-deviation Thenar web spacers/C-
restriction orthosis bar splint
Opponens splint
 positional orthesa
 pd cedera median nerve

Thumb spica
 fix thumb in opposition
 utk inflamasi thumb pd
RA, OA, de Quervain’s
tenosynovitis
“Knuckle-bender” orthosis : MCP extension mobilization
• MCP-flexion mobilization orthosis
orthosis :
• Mis: Reverse knuckle-bender, dynamic
• Utk flexi MCP pd: claw hand, MCP splints with dorsal outrigger, radial
median/ulnar lesion, MCP collateral nerve splints
lig.contracture, extensor tendon
shortening, post-capsulotomy, post • Utk ext MCP pd: radial nerve/BPI, MCP
flexion contracture, post ORIF fraktur
ORIF fraktur metacarpal metacarpal, burns
Resting hand splint Wrist cock-up splint
• Wrist posisi 20-30° ekstensi, 5-10°
• Static wrist-hand-finger orthosis ulnar deviasi, oposisi thumb
(WHFOs)
• Imobilisasi wrist, tp MCP bebas
• Resting wrist splint utk
immobilisasi wrist pd kasus: CTS, • Bisa volar (mulai proksimal dari distal
traumatic wrist sprain, inflamasi palmar crease sampai 1/3 proximal
wrist pd RA forearm) atau dorsal (ada sensori
input wrist & palm, lebih stabil)
• Wrist positioning 0-20° ekstensi, full
freedom thumb & finger movement • Kasus: wrist drop (lesi n.radialis),
arthritis akut/kronis, post CTS
release, post trauma, dll
Dynamic wrist-hand-finger orthosis
post radial
post nerve lesion
extensor
tendon
repair

C6-level
post flexor
tetraplegia
tendon
(active wrist
repair
extension)
Protective elbow and shoulder orthosis
(semua statik kecuali C)
Dynamic elbow orthosis Balance Forearm
Orthosis (BFO):
• Elbow mobilization (or
corrective) orthoses :
• A dorsal elbow-extension- • Shoulder-elbow-wrist-hand
mobilization orthosis orthosis (SEWHO)
• A dorsal elbow-flexion • Pd kasus C5-level SCI, GBS,
mobilization orthosis Muscular distrophy, BPI
 (knuckle-bender)

(knuckle-bender)
SPINAL ORTHOSES
FUNGSI TULANG BELAKANG :
1. Mempertahankan posisi tegak
2. Menyangga BB
3. Pergerakan tubuh
4. Melindungi medulla spinalis

Dibantu oleh struktur jaringan sekitarnya:

• Diskus intervertebralis
• Ligamen
• Otot
• Kulit
• Sistem persarafan
SPINAL
Terminologi Orthoses T.B.
Sebelumnya tdk ada keseragaman :
• Nama orang : Thomas, Taylor
• Nama daerah : Milwaukee, Boston
• Sesuai bentuk : Chair Back

• Tidak mencerminkan fungsi, sering membingungkan,

salah persepsi
• Kesepakatan baru  nama sesuai fungsi
1. Segmen yang diberi orthesa
2. Kontrol gerakan/kompensasi/koreksi yg diinginkan
 TERMINOLOGI
SEGMEN YG DIBERI ORTESA KONTROL GERAKAN
/KOMPENSASI/KOREKSI
DISINGKAT DALAM 1 (SATU) DISINGKAT DALAM 1 (SATU)
HURUF : HURUF
H : Head L : Lumbal
C : Cervical S : Sacral F : Flexion L : Lateral Bending
T : Thoracal I : Iliacal E : Extension R : Rotation

Contoh : CONTOH GABUNGAN :

CO : Cervical Orthosis CO, FE CONTROL
SIO : Sacro-Iliacal Orthosis LSO, FEL CONTROL
CTLSO : Cervico-Thoraco-Lumbo- CTLSO, FELR CONTROL
Sacral Orthosis
 Tipe spinal orthoses :

1. Prefabricated atau “off-the-shelf”

2. Custom

1. Rigid Spinal Orthosis

2. Flexible Spinal Orthosis (Corsets)

RIGID FLEKSIBEL
• Merestriksi gerakan, stabilisai, • Ada vertikal stays (dari steel atau
realignment material flexibel) yg tdk berhub dgn
• Hrs bisa duduk nyaman saat horizontal bars
menggunakan orthosis • Bs menaikkan tek.intraabdomen, tp
• Tidak boleh meretriksi breathing, tdk bs mengontrol gerakan/realign
proses menelan, atau mengunyah sebesar rigid
EFEK POSITIF BIOMEKANIK
ORTHOSIS SPINAL (NYU)

1. Trunk Support
• Melalui 2 mekanisme :
1. Peningkatan tekanan intraabdomen
 Reduce functional demands on the axial musculo-skeletal structures 
concomitant reduction of spinal pain
2. Sistem 3-point pressure
 Terutama bila ada paralisis trunk (deviasi)
2. Motion Control
• Melalui 2 mekanisme:
1. Sistem 3-point pressure pd rigid orthosis (mekanikal)
2. Psychological restraint of gross trunk movement (“reminder”)
3. Spinal Realignment
• Melalui 2 mekanisme:
1. Sistem 3-point pressure
2. Stimulation of muscle action pattern in withdrawing from an
uncomfortable pressure point
EFEK NEGATIF BIOMEKANIK
ORTHOSIS SPINAL (NYU)

1. Kelemahan otot dan Atropi

• Karena functional demand menurun  imobilisasi  weakness 
bila dilepas  gejala nyeri mudah kambuh.
• Atropi  bisa menyebabkan kegagalan operasi stabilisasi spine
• Lebih baik mencegah dgn latihan isometrik sesuai toleransi, lepas
bertahap sesegera mgkn setelah kondisi klinis mengijinkan
2. Tightness & kontraktur
• Karena imobilisasi & atropi
• Utk mencegah  imobilisasi &program rehab dimulai bersamaan
3. Ketergantungan psikologis  ketergantungan fisik
• Mengganggu return to work
• Hrs segera diidentifikasi & diterminasi
4. Memperberat gejala & progresi gangguan yg tdk terdiagnosa
sebelumnya
 CERVICAL & CERVICOTHORACIC ORTHOSES
CO-FE Control CO-FER Control CO-FELR Control
Soft Cervical Hard Cervical SOMI Poster-type CTO Custom-molded
Collar Collar CTO
Fungsi = soft collar, tp Merestriksi semua
motion restriction> gerakan leher &
a)Thomas collar thorax
a) Minerva

• Bahan:
polyethylene • Bahan: firm
foam/sponge plastic, ada
rubber superior & inferior
b) Yale
• Fungsi: padding, velcro
reminder & • Bisa two, three,
retain body b) Philadelphia • Ada upright four posters
heat  collar berasal dr • Greater motion
mengurangi sternal plate limitation
spasme & anterior utk • Hold the head in
c) Halo vest
meningkatkan menyangga extension/flexio
healing soft mandibula & n by adjusting
• Mencakup rahang occiput the length of
tissue injury
bawah, occiput, • Mudah dipakai anterior &
inferio:thorax pd px supine posterior posters
proximal
KOMPONEN DASAR LSO & TLSO

1. Pelvic Band
2. Thoracic Band 2

3. Upright bar 4

4. Abdominal support +
strap 3 1
 LUMBOSACRAL ORTHOSES
LSO-FE Control LSO-FEL Control LSO-EL Control
(Chairback Orthosis) (Knight Brace) (William’s Brace)

• 2 posterior upright • Chairback brace + 2 • Sambungan upright bar

tersambung ke thoracic upright bar di lateral lateral dgn thoracic &
band & pelvic band + pelvic band dibuat spt
abdominal support dgn
sendi (bs bergerak), tp
strap
utk membatasi ekstensi
• Meningkatkan IAP,
mengurangi lumbar dibuat sambungan yg
lordosis miring
 THORACOLUMBOSACRAL ORTHOSES
TLSO-F TLSO-FE TLSO-FEL TLSO-FLR TLSO-FELR BOSTON MSO
Control Control Control Control Control TLSO
(Jewett (Taylor (Knight (Cowhorn (TLS Jacket)
brace) Brace) Taylor) Brace)

• Thoracic & • Spt • Gabungan • Modifikasi • Moulded • Simetrical •Asimetris

pelvic band di chairback tp knight + knight taylor jacket  brace 
dpn, back upright bar taylor + thoracic tercetak, axilla sejajar
support nya dipjgkan band • Utk scoliosis
• Increase s/d thoracal ditambah ke
bahannya
POP kurva
lumbar batas sup dpn & rendah
lordosis, (interscapul melengkung (plaster of
(apex dibwh
hyperextensi ar) + axillary ke atas s/d paris)/ther
on posture strap subclavicula
T9)
moplastic
• Doesn’t
increase IAP
 CTLSO
(Cervico-Thoraco-Lumbo-Sacral
Orthosis)
Milwaukee Brace
• Utk scoliosis
• Pad  utk mendorong
• Strap  utk menarik
• Indikasi :
• Cobb’s angle 20-40
• Apex kurva superior dari T8
(kurva tinggi)
• Ada progresivitas
• Masa puber belum selesai
(during skeletal growth period)
• Kekurangan : compliance kurang
 Corsets (flexible spinal orthosis)
• Korset dapat meningkatkan IAP > rigid spinal orthosis 
krn tubuh tertutup rapat tanpa celah antara korset dan
kulit
• Ada 3 :
1. TLS Corset
• Batas anterior superior: di bwh proc.xiphoid
• Batas anterior inferior : di atas simpisis pubis
• Batas posterior superior : midscapular
• Batas posterior inferior : just below the apex gluteal bulge (men),
lower down to the gluteal fold (women)
• Fungsi : reminder, mengurangi tek.intradiscal
2. LS Corset
• Sama dgn TLS Corset, kecuali batas posterior superior :
below the inferior angle of scapula
3. SI (Sacroiliac)Corset
• Batas superior: iliac crest
• Batas anterior inferior : simpisis pubis
• Batas posterior inferior : apex gluteal bulge
• Indikasi : posttraumatic stabilization sacroiliac & simfisis pubis joint,
postpartum, sacroiliac pain
 PEMILIHAN ORTHOSIS

Berdasarkan :
• Level cedera
• Tipe cedera
• Faktor mekanik : reminder/support/limit
motion/correction
• Faktor psikologis
46
Kondisi klinis Level Bidang yg tidak Orthosis yg
Segmental stabil disarankan
Fraktur C1
- Stabil Occiput-C1 Semua Yale
- Tidak Stabil Semua Halo
Dens
- Odontoid C1-2 Semua Halo
- Atlantoaxial C1-2 Fleksi SOMI
Fraktur C2
- Stabil C2-3 Fleksi SOMI
- Tidak stabil C2-3 Semua Halo
Flexion Injury C3-5 Fleksi Yale, SOMI
C5-T1 Fleksi CTO
Ekstension C3-5 Ekstensi Halo, CTO
injury C5-T1 Ekstensi Halo
Level Cedera Jenis Orthosis Gerak yg dibatasi
T1-T6 TLSO with cervical extension Semua
TLSO with Halo Semua
T7-L2 Body cast Semua
Knight Taylor Brace FEL
Taylor Brace FE
Jewett Brace/3 point F
hyperextension Brace
Cowhorn Brace FLR
L1-L5 Knight Brace FEL
William Brace EL
Chairback Brace FE
L5-S1 LSO with single thigh spica Semua
Penggunaan orthosis spinal pd kondisi-
kondisi spesifik

Masalah lumbar & thoracic

1. Mechanical-Structural LBP (sciatica, HNP,

discogenic disease, OA)
• Goal : mengurangi nyeri & mempercepat healing
• Awal : corset (lbh murah, mudah dipakai-dilepas,
kosmetik)
• Rigid orthosis  bila perbaikan stlh korset tidak cukup,
gejala klinik berat, memburuk, tidak stabil  ingat
waktu penggunaan dibatasi
 Penggunaan orthosis spinal pd kondisi-
kondisi spesifik
Masalah lumbar & thoracic

2. Operasi spine
• Preoperatif: LSO FEL  utk kontrol gejala  back-strengthening &
latihan lain lbh efektif  prognosis stabilisasi spine sukses
• Postoperatif fusi posterior LSO-FEL indikasinya : prevent excessive
stress from normal physiologic demand & to permit patient
transportation without stress to the back.
• Indikasi lain spinal support: long fusion involving 3 or more joints
• Pd Laminectomy tanpa fusi  biasanya cukup dgn korset spinal,
selama 4-6 minggu. Tergantung dari: jumlah vertebral interspace yang
terlibat & kekuatan otot preoperatif.
 Penggunaan orthosis spinal pd
kondisi-kondisi spesifik
Masalah lumbar & thoracic

3. Fraktur
• Fraktur kompresi korpus vertebra uncomplicated,
tanpa defisit neurologis  pilihan: corset (lebih utk
kontrol nyeri drpd deformitas)  axial deloading
• Bila ada cedera diskus, large & separated body
fragment  perlu rigid (TLSO-Flexion control) utk
mempertahankan trunk ekstensi
 Penggunaan orthosis spinal pd
kondisi-kondisi spesifik
Masalah lumbar & thoracic

4. Fractures with posterior segment involvement

• Stabil  cukup dgn korset, mobilisasi sesegera mungkin
• Tidak stabil  kondisi saat operasi menentukan kebutuhan
orthosis : “the more internal stabilization, the less need for
rigid external stabilization”  perlu diskusi dgn TS.orthopaedi
• TLSO-FEL/FELR mungkin digunakan untuk membantu
mobilisasi dini

5. Degenerative Spondylolisthesis
• Bila gejala hanya nyeri  korset
• Bila ada root compression, defisit neurologis  perlu dipertimbangkan
lumbosacral control orthosis utk motion control
• Regio thorax  flexion injury >>
• Regio lumbar  burst fracture >>

Denis classification 3 column

concept:
• Unstable bila ≥ 2 column disrupted
• Simple anterior wedging
fracture/sprain post.ligament 
stable
• Wedge fr. + ruptur interspinous
ligament  unstable
• Burst fr.  selalu unstable

• Criteria to predict soft-tissue injury from

bony injury :
1. Angulation > 20°
2. Translation ≥ 3,5 mm
Lig.flavum, interspinous lig.,
supraspinous lig.
TERIMA KASIH
Fungsi orthosis:
• Mengurangi nyeri/discomfort (mis: LS corset, dll)
• Mencegah/mengoreksi deformitas (mis: Milwaukee, dll)
• Support/stability (mis: TLSO, LSO, dll)
• Memperbaiki fungsi (mis: AFO, KAFO, HKAFO, orthosis AGA, dll)
• Membantu gerakan otot yang lemah (mis: knuckle-bender, dll)
• Kontrol otot spastik (mis: pd orthosis AGB)
• Membatasi gerakan (mis: resting splint, thumb splint, dll)
• Unloading sendi yang rusak (mis: PTB-patten bottom, pd kasus
RA, dll)
• Kinesthetic reminder (orthosis memberi feedback
sensoris/visual utk mengingatkan pasien thd posisi yang lebih
tepat atau lebih mengoreksi, atau menghindari
aktivitas/gerakan tertentu), mis: soft collar, dll
MINERVA YALE HALO
• Bahan: plaster of paris • Modified Philadelphia Restriksi maksimum
(gips), thermoplastic collar + thoracic Komponen:
• Meliputi seluruh extension • Halo ring
kepala bagin posterior, • Komponen: • Pins
dgn forehead band, • chin piece • Uprights
memanjang ke bawah • occipital pieces (superstructure)
sampai batas bawah extended (higher • Vest
costa on the skull)
• thoracic strap

Indikasi : untuk lesi Indikasi: stabilisasi SCI Indikasi: unstable cervical

cervical atas level C6 – T2 fracture