Spinal Orthotics
Spinal orthoses use biomechanical principles such as three-points of pressure, intracavitary pressure, total contact, and kinesthetic reminder to obtain positive results whether its healing, supporting, or decreasing pain in the spine. These orthoses are named for the section of spine that needs management.  Types of spinal orthoses include cervical (CO), cervicothoracic (CTO), lumbosacral (LSO), thoracolumbosacral (TLSO), and cervicothoracolumbosacral (CTLSO) orthoses. The most restrictive of all the orthoses is the CTLSO, but rarely is this device implemented or used. There are many off-the-shelf (OTS) options available used to treat pathologies that do not need the rigidity of custom orthoses; however the pathology, severity, pain, and shape of the patient will determine the use of an OTS or custom orthosis. Here are some examples of common pathologies used with spinal orthoses.

Cervical Orthoses:

• Whiplash
• Arthritis
• Muscle Strain
• Degenerative Joint Disease (DJD)

Cervicothoracic Orthoses:

• Compression Fracture
• Traumatic Spondylolisthesis
• Severe Arthritis
• Degenerative Joint Disease (DJD)
• Jefferson Fracture
• Extension Injury
• Type 1 Odontoid Fracture

Lumbosacral Orthoses:

• Spondylolysis/Spondylolisthesis
• Arthritis
• Degenerative Joint Disease (DJD)
• Degenerative Disc Disease
• Spinal Stenosis
• Herniated Disc
• Low Back Pain
• Post-operative Management

Thoracolumbosacral Orthoses:

• Arthritis
• Compression/Burst Fracture
• Neuromuscular Scoliosis
• Adolescence Idiopathic Scoliosis
• Scheuermann’s Kyphosis/Hyperkyphosis
• Osteoporosis
• Post-operative Management

Upper Extremity Orthotics
The most common orthotic service of the upper extremity is splinting, an orthotic splinting device is used to immobilize or prohibit movement in a certain direction to increase flexibility, decrease pain, or promote healing. There are several OTS options available that can meet these goals; however, more involved patients often need customized orthotic devices to obtain desired results. Many pathologies caused by trauma, congenital defects, acquired over time or by disease each have different presentations and must be evaluated and assessed for the proper device.  Some common pathologies used with upper extremity orthotics include: cerebrovascular accident (CVA), carpal tunnel, bone fractures, tenosynovitis, nerve injuries, and arthritis.

Lower Extremity Orthotics
Lower extremity orthoses are more commonly prescribed and utilized in the field of Orthotics due to the desire of maintaining independence and mobility.  There are many types of orthoses that restore functional activity levels, decrease pain, improve mobility, stabilize, and accommodate pathologies of the lower extremity. All of these orthoses use some form or combination of biomechanical principles to achieve these goals.  The severity of the pathology, malalignment, nerve involvement, gait abnormality, and clinical presentation of a deformity are all taken into consideration during the patient’s evaluation and assessment to formulate the most functional and appropriate orthotic device. Here are some examples of common pathologies used with lower extremity orthotics.

Foot Orthoses:

• Plantar Fasciitis
• Metatarsalgia
• Pes Planus (Flat Foot)
• Pes Cavus (High Arch)
• Posterior Tibialis Tendonitis
• Foot Pain
• Diabetic Feet
• Neuropathic Feet

Ankle Foot Orthoses:

• Foot Deformity
• CVA
• Spina Bifida
• Foot Drop
• Post-Polio
• Neuropathy/Nerve Injury
• Posterior Tibialis Tendon Dysfunction (PTTD)
• Foot/Ankle Fractures
• Charcot Marie Tooth (CMT)
• Charcot Foot
• Multiple Sclerosis
• Muscular Dystrophy
• Achilles Tendonitis

Knee Orthoses:

• Knee Instability
• Arthritis
• Patellar Instability
• Genu Recurvatum
• Post-operative Management

Knee Ankle Foot Orthoses:

• Severe Knee instabilit
• Genu Recurvatum
• CVA
• Bone Fracture
• Post-Polio
• Neuropathy/Nerve Injury

Hip Orthoses:

• Chronic Hip Dislocation
• Pediatric Hip Instability
• Non-surgical Hip candidate
• Post-operative Management

Orthotic Review
Many orthotic designs are available to achieve an individual’s goals, but formulating the best design for a patient comes from an experienced, educated practitioner that understands pathologies, human anatomy, biomechanics, and material science to develop the best outcome.

Martinsville – An Indiana boy with a birth defect saw his dream of riding a bike come true after a year-long effort and a new invention.

Sometimes, the measure of true friendship isn’t what you have in common, but what sets you apart.

“Many kids would have been bitter with an issue he’s had all his life,” said Ron Schoolcraft.

From birth, Bryce Duncan was different.

“When he was first born, when they measured him, they said it appeared to be one leg was shorter than the other,” said his mother, Nissa White.

By age 2, Bryce lived with a wooden leg. But to friend Ben Schoolcraft, he was just another kid who liked the same things he did.

“He’s my third brother, pretty much,” he said.

Inseparable, they did what boys do. That included things Bryce was told he couldn’t’ do.

“A specialist came in and told us our son wouldn’t play sports, wouldn’t be a runner,” said Bryce’s dad, Bruce. “I see our son now, he’s played every sport, he’s been active.”

“His old leg didn’t slow him down at all, it didn’t bother him. You couldn’t tell,” said Brian Schoolcraft.

Bryce’s determination inspired those around him.

“He’s just so bright, exuberant, the smile – he’s always got a smile on his face,” said Ron Schoolcraft.

“It’s his smile, yeah,” said Brian Schoolcraft.

But there was still something Bryce couldn’t do, something no matter how hard he tried, or how determined he was, his physical limitations were just that.

“I missed it a lot, because sometimes I was at his house and we’d ride bikes around the woods, the trails and I would have to run after them,” said Duncan.

“See him limping and whatever and wish he had something better,” said Brian Schoolcraft.

Bryce’s limitation on a bike got his friend’s brother thinking.

“Why is it a problem? What can we do to fix it?” Brian Schoolcraft said.

An engineering student at Purdue, Schoolcraft not only noticed Bryce’s problem, he studied it.

“You want to straighten both your legs at the same time and bend them,” Brian told Bryce.

He spent hours researching the problem.

“It was really getting his knee where it was supposed to be,” Schoolcraft said.

When he saw there was no other option, he invented one. As part of a senior project, Schoolcraft put together a team of students who sought a way to help Bryce by building a new, more flexible leg.

“Puts his pivots in the right spot, so he can ride a bike and his leg will behave like normal,” Schoolcraft said.

While the concept is simple, the process was something out of the space program – literally.

In less than a year, Bryce went from limping on the basketball court, to moving like a pro.

“It made me really happy and excited, because it made me walk better. When I sit down, I can actually bend my knees now,” Bryce said.

But the true test is when his feet hit the pedals and the rubber met the road. At the age of 13, Bryce did something even he never thought he could – he rode a bike for the very first time.

“Words can’t explain. It’s extraordinary,” said Bruce Duncan. “Things are a lot better for Bryce, because of what Brian did. He’s a genius.”

The story doesn’t end there. The project that allows Bryce to better keep up with his friends won first place at an engineering contest at Purdue. Schoolcraft and his team donated the $1,500 top prize to Bryce and his family.

“We’re not surprised so much that Brian would think of something like this or do this, because as parents, we’ve always tried to raise our kids to look at how we might make a difference,” said Ron Schoolcraft.

“Bryce deserves it. He’s a great little kid,” said Brian Schoolcraft.

With his new abilities, Bryce rides his bike every day.

Bryce also inspired another member of the Schoolcraft family. Ben and Brian’s younger sister, Amanda, is a freshman at Purdue, majoring in Biomedical Engineering, following in her brother’s footsteps to help Bryce.

Meanwhile, Brian Schoolcraft has set up a fund to help pay for the maintenance to Bryce’s leg as he grows.