Orfit Blog

Going Frameless: a more comfortable and non-invasive approach for stereotactic radiosurgery

1 February, 2016 | | Categorised in:

Stereotactic radiosurgery (SRS) treatments in many cases involve a metal cranial frame that is attached to the patient’s skull. A custom moulded immobilization mask has several advantages over an invasive system, for both patient comfort and the treatment itself. A frameless SRS approach is non-invasive and adds to the patient’s comfort: the patient can be treated without having a frame screwed on his or her skull. Furthermore, positioning images are no longer blocked or distorted by the metal frame and the workflow for multi-isocenter cases is improved.

Orfit offers a small vacuum bag and a wide range of hybrid thermoplastic masks reinforced with a layer of Nanor. The vacuum bag easily moulds in the Orfit head supports and around the head and neck of the patient. The hybrid mask is moulded over the face. Compared to a single layer mask, a hybrid mask provides more stability, making it extremely suitable for SRS treatments.

HybrideMaskerMetKleineVacuumZakStereotacticLeaflet

The Jessa Hospital in Hasselt, Belgium, has recently replaced its invasive stereotactic frame by hybrid masks from Orfit Industries. Research shows that the use of an Orfit Hybrid mask is just as precise as the use of an invasive frame to immobilize the head of a patient. Moreover, the use of a thermoplastic mask is painless, it is easy to reuse in case of recurrence and it increases patient throughput. Read our recent blogpost about this case here.

More information on frameless SRS treatments can be found here.

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Dynamic Orthoses and Force Application

29 January, 2016 | Tags: , | Categorised in:

Blog-Cover2

Our Orfit blog shares information and instructions in matching our thermoplastic materials to orthotic designs.
Please check back frequently to gain inspiration and ideas in orthotic fabrication for all of your 
patient’s needs.

(Based on “Krotoski JB, Breger Stanton D. The Forces of Dynamic Orthotic Positioning: Ten Questions to Ask Before Applying a Dynamic Orthosis to the Hand. In Skirven, T. M., Osterman, A. L., Fedorczyk, J., & Amadio, P. C. (2011).Rehabilitation of the hand and upper extremity, 2-volume set: expert consult. Elsevier Health Sciences.)

Orthoses for mobilization are commonly used in hand therapy interventions to substitute for weak or absent muscles or to apply force to stiff tissue and joints to regain passive joint motion. Orthoses using too much force can cause injury to body structures resulting in pain and edema. Too little force will not achieve the desired goals of the intervention.

Dr. Paul Brand identified the following 10 basic questions for therapists to consider when applying a mobilization orthosis to a specific joint:

  1. How much force?
  2. Through what surface?
  3. For how long?
  4. To what structure?
  5. By what leverage?
  6. Against what reaction?
  7. For what purpose?
  8. Measured by what scale?
  9. Avoiding what harm?
  10. Warned by what signs?

Dr. Brand’s original chapter in the classic “Rehabilitation of the Hand: Surgery and Therapy” has been updated and revised in the 6th edition “Rehabilitation of the Hand and Upper Extremity” of this two volume set. A brief summary of this enlightening chapter’s contents with regard to each of the above questions follows here, but it is highly recommended to read the entire chapter for increased comprehension and understanding of the topic.

1. How much force?

According to the authors, it has been suggested to use between 100 and 250 grams of force on an individual finger. A quick and easy method to measure force is by using a Haldex gauge. Place the patient’s finger in its finger cuff with the orthosis in place and allow the rubber band or elastic thread to hold the intended tension on the finger segment. Measure the length of the elastic thread under this tension. Then remove the finger cuff from the patient, elongate the thread to the same length and measure the tension with the Haldex gauge. Make adjustments to the tension as needed.

2. Through what surface?

Most of the time therapists apply force in the hand orthosis using finger cuffs. If the pressure is too great, the skin inside the finger cuff will show signs of redness and the patient may complain of discomfort. Make sure the area of the finger cuff is wide enough to disperse this pressure, especially if the pressure is to be applied continuously. The size of the finger cuff should be 4-cm2 with 200 grams of force. If the cuff is to be worn intermittently, then the pressure will not cause harm to the tissue. Have the patient wear the cuff for a short time and check the skin for redness.

Make sure the cuff fits well under the finger – thermoplastic cuffs that are custom made for each specific finger will distribute the pressure more evenly then soft finger cuffs.

3 Continue reading

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Immobilization Splinting for Traumatology – The Basics

19 January, 2016 | Tags: , , | Categorised in:

Basic-Splinting3

Our Orfit blog shares information and instructions in matching our thermoplastic materials to orthotic designs.
Please check back frequently to gain inspiration and ideas in orthotic fabrication for all of your 
patient’s needs.

This article is meant for novice splinters and can also serve as a refresher for more advanced therapists.

We list the basic guidelines for immobilization splinting for traumatology and talk about the thermoplastic materials that can be chosen for specific designs. We also specify some important basic principles that should be taken into account when using thermoplastic materials for splinting purposes.

Choosing the right material

There are many options in design when considering fabrication of an immobilization orthosis. The orthosis can be a volar, dorsal, dorsal- palmar or a circumferential design.

The rigidity of the splint doesn’t depend only on the thickness of the thermoplastic material, but it also depends on the form: the more circumferential in design, the more rigid the completed splint.

There are a variety of thermoplastic materials to select from, depending on the design:

  • For volar splints and/ or dorsal-palmar splints, our thermoplastic materials with minimal stretch are highly recommended due to their high resistance to stress and their high stability. Orfibrace, Orfit Eco, Orfit Eco Black NS and Orfit Classic (Stiff version) with a thickness of 3.2 mm (1/8”) are great choices for this type of design.

Volar

Continue reading

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The Current Evidence for Static Progressive Orthoses for the Upper Extremity

12 January, 2016 | | Categorised in:

The Current Evidence for Static Progressive Orthoses for the Upper Extremity

Article by Debby Schwartz published in the ASHT Times Jan 2016

Download the entire study (PDF) here >>

Static progressive orthoses is a type of mobilization orthosis that therapists use to help their clients regain passive motion in stiff joints and tissues.This type of orthosis incorporates non-elastic components to apply force to the stiff joint or tissue, holding it at end-range position to improve passive motion. The client is instructed to increase the force as the joint or tissue accommodates a new end-range position over time. In this manner, static progressive orthoses permits progressive changes in tissue position.

SPS elbow

Reaching Plastic Deformation of Tissue

According to Ulrich et al (references via the download below) connective tissue is capable of being stretched due to its viscoelastic qualities. While under tension, it can respond by reaching an either elastic or plastic deformation state. Elastic deformation means that the tissue reverts back to its original length when the force on it is removed and this is undesirable. Plastic deformation means the tissue will maintain its new length even when the force is removed, leading to a structural change in the tissue itself.

Dynamic and static progressive orthoses have been used to apply force to tight or shortened tissue to accelerate tissue remodeling. There are two types of loading conditions with the application of mobilizing orthoses, creep based and stress relaxation. In creep-based loading, the force applied is a constant force and the displacement of the limb varies. Creep-based loading is delivered via dynamic orthoses. However, there are disadvantages to creep-based loading. These orthoses may need to be worn for 6–12 hours daily, treatment may be painful and the joint may be damaged by prolonged compression.

In stress relaxation, the displacement is constant and the applied force varies. This is the principle of static progressive orthoses, in which patients are instructed to constantly adjust and readjust the tension on their stiff joints. The tissue reaches the plastic deformation state more quickly and the effects will last longer.

Static Progressive Orthoses

There are a limited number of studies on the use of static progressive orthoses with a small number of clients enrolled. This review examines the current levels of evidence supporting the use of static progressive orthoses for clients with limitations in range of motion (ROM) of the upper extremity following surgery or trauma (orthopedic pathologies). It also offers relevant information on the types of diagnoses to be treated, wearing schedules, the outcomes affected and the recommended duration of orthotic use.
Continue reading

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Expanding global access to radiotherapy has both lifesaving and economic benefits

7 January, 2016 | | Categorised in:

Over the past years, radiotherapy has become increasingly important and critical in cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is already used in more than half of all cases of cancer. However, radiotherapy is still often the last resource to be considered in planning and building treatment capacity.

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In a study published in the Lancet Oncology, the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected needs was determined. The cost and the net benefit of scaling up radiotherapy across all low-income and middle-income countries was calculated using different models. Next to positive economic benefits, investment in radiotherapy is also lifesaving. Scaling up could lead to saving of 26.9 million life-years over the lifetime of patients who receive treatment.

Source

Expanding global access to radiotherapy
Atun, Rifat et al.
The Lancet Oncology , Volume 16 , Issue 10 , 1153 – 1186
http://dx.doi.org/10.1016/S1470-2045(15)00222-3

 

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Splinting with Orficast Thermoplastic Tape: Orficast alternatives to thermoplastic splints of the hand and finger (made by Orfit distributor Otto Bock Australia)

6 January, 2016 | Tags: | Categorised in:

Splints

The information below has been created by Damien Silvester and Amanda MacKillop, hand therapy specialists at Otto Bock Australia, our distributor in Australia. They use it as a handout suggesting Orficast alternatives to thermoplastic splints of the hand and finger. 

Relative motion bar/yolk splint

  • 3 cm Orficast
  • 30-35 cm length of Orficast
  • Increase overlap of the Orficast to increase rigidity of the splint.

Relative motion bar-yolk splint
Clinical applications: Relative motion bar for extensor tendon repair, as per Wendell Merritt tendon repair protocol.

Mallet finger splint

  • 3 cm Orficast
  • Measure length required by placing the Orficast at the volar PIP joint, run it along the finger to the dorsal PIP joint. Double the length and fold in half for extra strength
  • Dry heat to attach velcro and loop.

Mallet Finger Splint
Clinical application: for bony or tendinous mallet finger injury, post operative or conservatively managed. Continue reading

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Splint in the Spotlight – Orthoses to Prevent Full Forearm Rotation: The Muenster Orthosis and the Sugar Tong Orthosis

21 December, 2015 | Tags: , , | Categorised in:

Splint-in-the-Spotlight

Our Orfit blog shares information and instructions in matching our thermoplastic materials to orthotic designs.
Please check back frequently to gain inspiration and ideas in orthotic fabrication for all of your 
patient’s needs.

Splint Design: Orthoses to Prevent Full Forearm Rotation

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Objectives of these Splints

The Muenster and Sugar Tong Orthosis are two useful orthoses indicated to prevent full forearm pronation and supination. Both help to position the forearm in a neutral position so that healing of injured structures can occur.

Pathology

After trauma and/or surgery of the radius, ulna, Distal Radial-Ulnar joint (DRUJ), proximal radial-ulnar joint and/or TFCC structures, and/or for certain elbow pathologies, it may be important to prevent full active forearm rotation so that the injured tissues and structures can heal without overstretching or shortening of tissue length. Patients with injuries such as TFCC tears, Galeazzi fracture dislocations, DRUJ fractures and dislocations, and ulnar abutment injuries are typically treated with a cast, a Sugar Tong orthosis or the Muenster orthosis to immobilize the forearm.

The Muenster and Sugar Tong orthoses allow for limited active flexion and extension of the elbow, but prevent full forearm rotation, and provide stabilization of the radial-ulnar joint and immobilization of the DRUJ.

Sugar Tong Orthosis Collage

The Sugar Tong orthosis is a long thermoplastic rectangle positioned from the dorsal metacarpal heads around the posterior elbow capturing the medial and lateral epicondyles, to the volar palm.

Muenster Orthosis Collage

The Muenster orthosis is a wrist orthosis with long proximal extensions to converge on the medial and lateral epicondyles at the distal humerus.

A study of the degree to which these orthoses actually limit forearm motion indicated that while the Sugar Tong orthosis is more effective at preventing forearm pronation than the Muenster orthosis, neither orthosis completely limits full forearm rotation (Slaughter et al, 2010). Participants in the study received sensory feedback that they were reaching limitations in forearm range of motion, but were still able to rotate through the forearm arc of motion. However, these participants had no forearm pathologies. Patients experiencing painful forearm motion would be instructed to limit full rotation of their forearm: pain, swelling and post- operative bandages would further limit motion.

Product recommendations

  • Muenster Orthosis:  An elastic based coated material is highly recommended for the Muenster Orthosis. Orfit NS, Aquafit NS (Orfit Natural NS) and Orfit Colors NS in 3.2mm (1/8”) all work very well for this design. The non-stick coating of these products allows the fabricator the ability to pinch the thermoplastic material together at the posterior elbow and on the ulnar border, allowing both hands to position the wrist in slight extension and the forearm in the a neutral posture. A more rigid material can also be used: see product recommendations for the Sugar Tong Orthosis.
  • Sugar Tong Orthosis: This orthosis is best made from a long rectangular strip of a more rigid material: OrfibraceOrfit Eco, or Orfit Eco Black NS in 3.2 mm (1/8″) are recommended. The materials that we recommend for the Muenster Orthosis would also work well for the Sugar Tong Orthosis..

The patient should be standing or seated with the elbow flexed to 90° and the forearm positioned in neutral to fabricate these orthoses. You will need full access to the posterior elbow, epicondyles and wrist for best fabrication technique.

Wearing schedule

These orthoses should be worn full time immediately after surgery of the involved structures. The patient would be instructed in gentle elbow range of motion exercises.

Questions?

If you have a question or comment, please post it in the Orfit Splinting & Rehabilitation Group on Facebook, or send an email to welcome@orfit.com.

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Splint in the Spotlight – Comfortable and lightweight orthoses with Orfilight materials

2 December, 2015 | Tags: , | Categorised in:

Splint-in-the-Spotlight

Our Orfit blog shares information and instructions in matching our thermoplastic materials to orthotic designs.
Please check back frequently to gain inspiration and ideas in orthotic fabrication for all of your 
patient’s needs.

Splint Design:  Comfortable and lightweight orthoses with Orfilight materials

PicMonkey Collage

Objectives of the Splint: Positioning for rest and support and relief of symptoms

Pathology: All pathologies that would benefit from a lightweight support

When patients are required to wear their orthoses for long duration during day and night, it is always helpful to consider the size of the patient’s extremity, the specifics of the diagnosis and the weight of the selected material for the orthosis. Orfit Industries offers an extremely lightweight material that might be appropriate for many of your patients, regardless of the specific diagnosis.

OrfilightOrfilight Black NS and Orfilight Atomic Blue NS (new color!) are designed to be highly conforming, lightweight materials with a foamy feel.

The comfort of the finished orthosis is obtained by the lightness of the splint, the contact with the material, and the absence of sweating. Continue reading

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Simulation for radiation oncology – image in UZ Magazine

25 November, 2015 | Tags: | Categorised in:

This page about radiation oncology simulations has appeared in UZ Magazine (Sept 2015) of UZ Leuven Hospital in Belgium.

UZ-Magazine---Simulatie
Simulation – More than half of all cancer patients receive radiotherapy treatment at some point. A patient undergoing radiotherapy will come to the simulator a week before the first session to prepare his or her treatment. During the simulation, radiation oncologists, nursing staff and medical imagers determine the position and the exact dose and place of the radiation. For this purpose, they draw reference lines on the patient.

Patients with head/neck-cancer receive a personalized mask that is made to fit, with lines drawn onto it. These lines will guarantee that a patient is placed in the exact same position every time. A scan will make images of the tumour, the glands and other surrounding organs during the preparatory phase. A medical physicist will be able to appoint the areas that need radiation on these images. Based on that information, the radiation physicist determines the ideal radiation schedule: the tumour receives the prescribed radiation dose, the surrounding organs the lowest possible dose.

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Sup-ER orthosis for infants with brachial plexus injuries

24 November, 2015 | Tags: | Categorised in:

Kim Durlacher (BScOT, CHT) and her colleagues at the British Columbia Children’s Hospital in Vancouver developed a special orthosis for babies born with brachial plexus injuries. The Sup- ER orthosis, described in the Journal of Hand Therapy in 2014, helps maintain the affected arm in supination (Sup-) and external rotation (ER) during nap time and sleeping.  This specific positioning helps to lengthen the tight musculature of the external rotators and forearm supinators, and maintains maximal congruity of the shoulder glenohumeral joint while awaiting for nerve recovery and active movement to return.  A recommended wearing schedule is included in the full article.

On my visit to the Miami Children’s Hospital, I met with Yvette Elias, OTR/ CHT, who also uses this Sup-ER orthosis with her brachial plexus patients.  I had the opportunity to help fabricate the total arm piece using Orfit Colors NS 1/12” (2.0 mm) on an adorable 5 month old! The original description of this orthosis calls for a volar based full arm orthosis, but I thought it might be easier for the parent to don and doff a circumferential version on their child. The thermoplastic orthosis is attached via the D-ring straps to a fabric based waistband that fits over the diaper.

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We’ll get an update from the mother soon on the ease of use of this circumferential variation!

 By: Debby Schwartz

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