Orthotics and Prosthetics Rehabilitation Engineering Centre

Upper/Limb Orthotic Guidelines - Lower/Limb Orthotic Guidelines
Spinal Orthotic Guidelines - Lower/Limb Orthotic Gait Training Guidelines

I. Primary Purpose

A. To achieve optimum independent functional use and tolerance of the orthosis consistent with the patient's physical condition and level of disability

II. Primary Goals

A. Develop confidence and acceptance to orthotic use

B. Develop knowledgeable functional use of the orthosis

C. Develop wearing tolerance to orthosis

D. Develop basic concepts of functional use and control of the orthosis

III. Primary Objectives

A. Provide positive reinforcement of the potential for independent functional use of the orthosis

B. Enhance the patient's knowledge of the normal physical aspects of their upper/limb

1. Soft tissue skin care
2. Soft tissue edema
3. Soft tissue atrophy
4. Soft tissue abrasions
5. Soft tissue hypersensitivity
6. Soft tissue scars

C. Enhance the patient's knowledge of appropriate care and use of the orthosis

1. Proper donning and doffing
2. Proper fitting assessment

D. Enhance soft tissue limb tolerance to the orthosis

1. Soft tissue friction massaging
2. Gradually increase tissue endurance and wearing time

E. Enhance the patient's knowledge of appropriate control of the components of the orthosis

1. Actuation of the wrist mechanism
2. Actuation of the elbow mechanism
3. Movement of the passive mechanical components
4. Understanding of switch control concepts

F. Optimize functional use of the orthosis

1. Develop independent use of the wrist mechanism for grasp and release of objects
2. Develop independent use of the wrist mechanism for appropriate functional positioning of the hand
3. Develop independent use of the elbow mechanism for lifting and functional positioning of the hand
4. Develop independent use of the shoulder mechanism for functional positioning of the elbow and hand

Upper/Limb Orthotic Guidelines - Lower/Limb Orthotic Guidelines
Spinal Orthotic Guidelines - Lower/Limb Orthotic Gait Training Guidelines

I. Primary Purpose

A. To achieve optimum independent functional use and tolerance of the orthosis consistent with the patient's physical condition and level of disability

II. Primary Goals

A. Develop confidence and acceptance to orthotic use

B. Develop knowledgeable functional use of the orthosis

C. Develop wearing tolerance to orthosis

D. Develop basic concepts of orthotic gait and stability

E. Develop unassisted independent ambulation skills

III. Primary Objectives

A. Provide positive reinforcement of the potential for independent functional ambulation and use of the orthosis

B. Enhance the patient's knowledge of the normal physical aspects of their lower/limb

1. Soft tissue skin care
2. Soft tissue edema
3. Soft tissue atrophy
4. Soft tissue abrasions
5. Soft tissue hypersensitivity
6. Soft tissue scars

C. Enhance the patient's knowledge of appropriate care and use of the orthosis

1. Proper donning and doffing
2. Proper fitting assessment
3. Proper use of socks

D. Enhance soft tissue limb tolerance to the orthosis

1. Soft tissue friction massaging
2. Gradually increase tissue endurance and wearing time
2. Gradually increase endurance wearing time
3. Gradually increase weight bearing time
4. Gradually increase ambulation time

E. Enhance the patient's knowledge of appropriate gait and stability with the orthosis

1. Stance phase weight bearing transfer
2. Stance phase hip and knee control
3. Swing phase hip and knee control
4. Swing phase toe clearance
5. Swing and stance phase stride length control
6. Negotiation of steps, inclined and declined surfaces

F. Optimize functional orthotic gait and stability

1. Develop independent ambulation in parallel bars
2. Develop independent ambulation with a walker
3. Develop independent ambulation with a quad cane
4. Develop independent ambulation with a single pole cane
5. Develop independent unassisted ambulation

Upper/Limb Orthotic Guidelines - Lower/Limb Orthotic Guidelines
Spinal Orthotic Guidelines - Lower/Limb Orthotic Gait Training Guidelines

I. Primary Purpose

A. To achieve optimum independent functional use and tolerance of the orthosis consistent with the patient's physical condition and level of disability

II. Primary Goals

A. Develop confidence and acceptance to orthotic use

B. Develop knowledgeable functional use of the orthosis

C. Develop wearing tolerance to orthosis

D. Develop basic concepts and functional use of orthosis

III. Primary Objectives

A. Provide positive reinforcement of the potential for independent functional use with the orthosis

B. Enhance the patient's knowledge of the normal physical aspects of their cervical and/or thoracic/lumbosacral areas

1. Soft tissue skin care
2. Soft tissue atrophy
3. Soft tissue abrasions
4. Soft tissue scars

C. Enhance the patient's knowledge of appropriate care and use of the orthosis

1. Proper donning and doffing
2. Proper fitting assessment
3. Proper use of undergarment

D. Enhance soft tissue limb tolerance to the orthosis

1. Soft tissue friction massaging
2. Gradually increase tissue endurance and wearing time

E. Enhance the patient's knowledge of appropriate sitting and ambulation with the orthosis

1. Limitation to torso and spine movements
2. Proper sitting posture
3. Proper techniques for picking up and lifting objects
4. Proper spine positioning for ambulation

Upper/Limb Orthotic Guidelines - Lower/Limb Orthotic Guidelines
Spinal Orthotic Guidelines - Lower/Limb Orthotic Gait Training Guidelines

Initial Gait Training Phase

Primary Goal: To develop the patient's initial limb tissue tolerance to the orthosis and achieve an acceptable gait for independent ambulation within parallel bars

The patient should not progress beyond this phase until they have developed an understanding of the basic concepts of normal gait and demonstrated sufficient balance and stability for independent ambulation within the parallel bars.

Secondary Gait Training Phase

Primary Goal: To further develop the patient's limb tissue tolerance to the orthosis and further develop independent ambulation, balance and stability with a walker.

The patient should not progress beyond this phase until they have demonstrated consistent control and understanding of the basic concepts of normal gait, along with independent unassisted ambulation, balance and stability with a walker.

Primary Gait Training Phase

Primary Goal: To optimize independent ambulation, balance and stability with the use of a quad or single pole cane.

The patient should not progress beyond this phase until they have demonstrated consistent control and understanding of the basic concepts of normal gait, along with independent unassisted ambulation, balance and stability with a single quad or pole cane.

Advanced Gait Training Phase

Primary Goal: To develop unassisted independent ambulation, balance and stability without the assistance of an external support.

The patient has achieved independent, unassisted ambulation and is ready to pursue all the normal ADL challenges one would expect to encounter in their environment, as well as, the resumption of their vocational and/or avocational interests.

General Information

Prosthetic Rehabilitation Care