Dynamic Contracture Correction Components

Transcription

1 E Your partner in Neuro-Orthotics Dynamic Contracture Correction Components by Dirame Ortho ORTHOPEDIE P R O T H E S E Your partner in Neuro-Orthotics

2 Neuro-Orthotics The term Neuro-Orthotics refers to our therapeutic bracing concept of effective care for patients with a neurological disorder. It applies to cases where appropriate orthopaedic care is indicated and can be chosen jointly by the multi-disciplinary team consisting of the doctor, the therapist, the orthotist and other caregivers. Our task is to support all the participants in this multidisciplinary approach so that they together can make a successful therapeutic contribution and improve the patients condition. Besides innovative orthopaedic bracing, we also supply supportive information such as product documentation, manuals, studies, presentations, certification training courses etc. Ultraflex forms part of our Neuro-Orthotic program. What is Ultraflex is a new concept in the field of orthopaedic technology with an application-orientated range of orthotic components including linear, adjustable dynamic Power Units. In the treatment of correctable (dynamic) contractures, Ultraflex applies on the limb a constant corrective power, in both extension and/or flexion directions, with adjustable range of motion control (LLPS* Principle - P. Brand, K. Light et al., see bibliographical references on the last page). products Ultraflex offers a complete modular system for the design and custom to cast fabrication of dynamic stress orthoses by the orthotist. Depending on the joint(s) to be treated, there is a choice of adapted components available for the wrist, elbow, knee and ankle (or combinations of these) always adjusted to the individual needs of paediatric, adolescent or adult patients. properties Ultraflex is a patented system consisting of both, a Platform and a Power Unit with adjustable isotonic spring. In the paediatric hinges the two parts are integrated into one single module. By means of the precise, uniformly exercised force of the spring, both the contractures of muscles and connective tissue can be repaired, and the active function can be supported and even improved. The uniform force of the linear spring provides optimal stretching, and supports the therapeutic or functional movements, regardless of the constraint of the joint. It is better not to use the word stretch for what should be long-term growth. If we wish to restore the length of tissue which has shortened with disuse, we need to apply the stimulus of activity, or better, hold the tissue at the moderately lengthened position for a significant time. Then it will grow. (Brand, P.) * LLPS (Low Load Prolonged Stress) = a low, persistent and progressive, slowly increasing force distributed over a long period of time.

3 Components Hand (WHO) Elbow (EO) Knee (KO) Ankle (AFO) Supronator Lively subtalar stirrup Adult version Paediatric version Lateral side Medial side Medial side Lateral side Platform - Platform or - Basic R.O.M. * hinge Basic R.O.M. * hinge Paediatric module Power Unit Dynamic Concept ** * ROM (Range of Motion) hinges, cannot be used in orthoses that need to support the weight of the body, e.g. with ambulatory patients ** The Ultraflex dynamic concept implies the orthotist s and orthotic technician s participation in a certification seminar. It is also necessary to inform the therapeutic team, both for the benefit of the patient and for the achievement of an optimal therapeutic result with the orthosis. Get in contact with Ultraflex Europe for training/certification seminar. Ultraflex dynamic components available in a variety of versions for WHO, EO, KO, AFO and combinations.

4 indications The positioning, rotation, flexion and/or extension of spastic musculature have been used for decades to prevent and/or correct deformations. Orthopaedic appliances fitted with dynamic Ultraflex tension hinges can be constructed in such a way that they stretch in a physiologically correct manner the soft tissue and muscles which keep the joint constrained. Thus the limb is brought to rest in a better position and the patient becomes more functional. The torque exercised is always adjusted individually below the spastic tonus and/or below the level of pain. In doing so, a low, persistant, progressive force is used, that slowly increases and is spread over a long period in order to increase the Total End Range Time (LLPS Principle P. Brand, K. Light et al., see bibliographical references on the last page). If Ultraflex is used in traumas, then caution is advised insofar as the trauma is not stable. Ultraflex then provides a correct, safe and efficient action which greatly assists the rehabilitation process. Neurological disorders: Cerebral Palsy (CP) Cerebral Vascular Accident Spinal Cord Injury Multiple Sclerosis Spina Bifida Traumatic Brain Injury Muscular Dystrophy Indications Orthopaedic disorders: Total Knee prosthesis Burns Below Knee amputation (knee flexion contracture) Operations after ruptures (ACL, PCL, biceps tendon injury) Fractures Arthrogryposis

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6 Hand (WHO) Ultraflex Power Unit for the Platform This modular Power Unit is mounted on the Platform and is available with the force applied to assist extension, flexion or a combination of the two (bi-directional). The Power Unit is supplied with a low, medium or high maximum torque which, however, can be adjusted to any point in the range. The Power Unit should always be mounted on the lateral side of the platform. A Power Unit with the force assisting extension is normally mounted on a Platform with a flexion stop, and a Power Unit with the force assisting flexion is mounted on a Platform with an extension stop. Power Unit assisting either extension or flexion Housing: aluminium with polycarbonate 75 x 55 mm (L x W) Height: 5.1 Nm = 35 mm, 6.8 Nm= 37 mm, 10.2 Nm= 40 mm (total height of Power Unit mounted on Platform) Range: minus 75 to plus 75 (extension and flexion) minus 75 to plus 75 (bi-directional) High: 0 to 10.2 Nm Medium: 0 to 6.8 Nm Low: 0 to 5.1 Nm Ultraflex Platform for the wrist joint This component forms the basis of the Ultraflex system and at the same time serves as a platform for the Power Unit. The hinge made dynamic by its coupling with the Power Unit should be mounted on the ulnar side. Furthermore the Platform is available in a version with a flexion stop or extension stop or in a bi-directional version, so that the adapted bi-directional Power Unit can be easily removed and adjusted to direct its power either to flexion or to extension. The Platform is supplied with removable side bars. A Platform with an adjustable flexion stop is normally coupled with a Power Unit assisting extension, while a Platform with an extension stop is coupled with a Power Unit assisting flexion. extension stops. The bi-directional Platform is not shown Hinge: Bars: aluminium with black polymer coating 89 x 38 mm (L x W) aluminium with epoxy coating 300 x 16 x 3 mm (L x W x H) Range: minus 75 to plus 75 (extension and flexion) minus 75 to plus 75 (bi-directional) Lockingunlocking: in each position in 7.5º increments Load limit M L strength: 45 A P strength: 95 Ultraflex Basic ROM* hinge for the wrist joint This component is used as a basic ROM hinge. It does not have the same features as the Platform, but is easy to fix at the desired flexion or extension limit with screws. This hinge used for the hand is suitable for both adults and children. Hinge: Screws: Bolts: aluminium with epoxy coating stainless steel stainless steel Range: minus 75 to plus 75 Length: 160 mm (total length) Ultraflex Dynamic Paediatric Module for the wrist joint This hinge is intended primarily for children although it also may be used for adults. The Power Unit is already integrated with the hinge. This wrist joint hinge is available in two versions: with the force applied in the direction offlexion or extension. Both designs have a maximum torque of 3.4 Nm. The hinge is intended for mounting on the ulnar side. Housing: polycarbonate 66 x 32 x 22 mm (L x W x H) Bars: aluminium with epoxy coating 280 mm (total length) Range: minus 55 to plus 55 Adjustable: 0 to 3.4 Nm * R.O.M. (Range of Motion) = limits the range of movement

7 Hand (WHO) Ultraflex Digital Finger Pan 2 for dynamic extension support or flexion resist of MCP joints This Digital Finger Pan (DFP2) utilizes a volar centre leaf spring for easier donning and biomechanical alignment with MCP s. This fingerpan is lined with a memory foam for better contouring to the patients fingers. For Adults and flexion assist use Paediatric Module WHO PC1 or 2. Leaf spring: springsteel Range: MCP extension assist MCP flexion resist Ultraflex Supronator for adult wrist joint This component intended for adults has a pronation or supination correcting function. The polyurethane spring can be adjusted by means of a rack to the needs of the individual patient and is intended for mounting on a wrist and upper arm shell. For supination the supronator is mounted laterally at the elbow and dorsally at the wrist. For pronation, it is mounted medially at elbow and volarly at wrist. Spring: polyurethane Rack: stainless steel Housing: aluminium with epoxy coating Supination correction and/or pronation correction Adjustable Ultraflex Supronator for paediatric wrist joint This component intended for children has a pronation or supination correcting function. The spring is made of aluminium. Adjustment is made by means of a rack and it is intended for mounting on a wrist and upper arm shell. For supination the supronator is mounted laterally at the elbow and dorsally at the wrist. For pronation, it is mounted medially at elbow and volarly at wrist Spring: aluminium Rack: stainless steel Housing: aluminium with epoxy coating Supination correction and/or pronation correction Adjustable

8 Hand (WHO) Ultraflex Power Unit for Platform Side of Suggested for patient weight Ultraflex Platform for the wrist joint extension (1) flexion (3) Adjustable force direction (bi-directional) Side of Flexion stop (adjustable) (4) Extension stop (adjustable) (6) Adjustable force direction (bi-directional) UF-WHO-AA1-L left UF-WHO-AA1-R right UF-WHO-AA2-L left UF-WHO-AA2-R right UF-WHO-AA3-L left UF-WHO-AA3-R right Maximum torque (Nm) UF-WHO-P1-L left ,2 UF-WHO-P1-R right ,2 UF-WHO-P2-L left ,2 UF-WHO-P2-R right ,2 UF-WHO-P3-L left ,8 UF-WHO-P3-R right ,8 UF-WHO-P4-L left ,8 UF-WHO-P4-R right ,8 UF-WHO-P5-L left ,1 UF-WHO-P5-R right ,1 UF-WHO-P6-L left ,1 UF-WHO-P6-R right ,1 UF-WHO-P7-L left ,2 UF-WHO-P7-R right ,2 UF-WHO-P8-L left ,8 UF-WHO-P8-R right ,8 UF-WHO-P9-L left ,1 UF-WHO-P9-R right ,1 Ultraflex ROM basic hinge for the wrist joint Adults Children UF-WHO-ROM Ultraflex Paediatric module for the wrist joint Side of Suggested for patient weight extension flexion Maximum torque (Nm) UF-WHO-PC1-L left ,4 UF-WHO-PC1-R right ,4 UF-WHO-PC2-L left ,4 UF-WHO-PC2-R right ,4 Ultraflex Dynamic extension or flexion support for MCP Assistance with extension or flexion Adults Children UF-DFP2 Ultraflex Supronator for the wrist joint Adults Children UF-WHO-P10 UF-WHO-P11 (1) Normally coupled with a Platform with a flexion stop (4) (3) Normally coupled with a Platform with an extension stop (6) (4) Normally coupled with a Power Unit with force assisting extension (1) (6) Normally coupled with a Power Unit with force assisting flexion (3)

9 Elbow (EO) Ultraflex Power Unit for Platform This modular Power Unit is mounted on the Platform and is available with force assisting extension, hyperextension, flexion or a combination of the two (bi-directional). The Power Unit is available with low, medium or high maximum torque, the torque being adjustable to any point from zero to maximum. The Power Unit should always be mounted on the Platform on the lateral side. A Power Unit assisting extension is normally mounted on a Platform with a flexion stop, and a Power Unit assisting flexion is mounted on a Platform with an extension stop. Power Unit assisting either (hyper)extension or flexion Housing: aluminium with polycarbonate 75 x 55 mm (L x W) Height: 5.1 Nm = 35 mm, 6.8 Nm = 37 mm, 10.2 Nm = 40 mm (total height of Power Unit mounted on Platform) Range: 0 to plus 135 (extension and flexion) minus 15 to plus 135 (hyperextension and bi-directional) High: 0 to 10.2 Nm Medium: 0 to 6.8 Nm Low: 0 to 5.1 Nm Ultraflex Platform for the elbow joint This component forms the basis of the Ultraflex system and also serves as a platform for the Power Unit. The hinge made dynamic by the Power Unit should be mounted laterally, but can also be used as a ROM hinge (limiting movement) on the medial side (normally without Power Unit, but if needed with a Power Unit). Furthermore the Platform is available in a version with a flexion stop, an extension stop, the possibility of a hyperextension design with a flexion stop or else as a bi-directional version, which allows the adapted bi-directional Power Unit to be easily removed and adjusted for its power to assist hyperextension Bi-directional platform extension or flexion. The Platform is supplied with removable side bars. A Platform with an adjustable flexion stop is normally coupled with a Power Unit assisting extension, while a Platform with an extension stop is coupled with a Power Unit assisting flexion. Hinge: stainless steel with black polymer coating 89 x 38 mm (L x W) Bars: aluminium, with epoxy coating 300 x 16 x 3 mm (L x W x H) Range: 0 to plus 135 (extension and flexion) minus 15 to plus 135 (hyperextension and bi-directional) flexion and extension stop adjustable in 7.5 increments Lockingunlocking: any position, adjustable in 7.5 increments Load limit M L strength:82 A P strength: 113 Ultraflex basic ROM hinge for the elbow joint As well as using the standard Ultraflex platform as a ROM hinge, there is, depending on the case, also the option of using this basic ROM hinge. It is true that it does not have the same features as the Platform, but it is easily fixed with screws at the desired flexion or extension limit. Hinge: aluminium with epoxy coating Screws: stainless steel Bolts: stainless steel Range: 0 to plus 160 Ultraflex Dynamic Paediatric Module for the elbow joint This hinge is primarily intended for children. For this reason the Power Unit is already integrated in the hinge. This elbow hinge is available in two versions: with the force assisting extension, and with the force assisting flexion. Both versions have a maximum torque of 3.4 Nm. The hinge is intended for mounting on the lateral side, but another module can be mounted medially if needed. Housing: polycarbonate 66 x 32 x 22 mm (L x W x H) Bars: aluminium with epoxy coating 280 mm (total length) Range: 0 to plus 115 Adjustable: 0 to 3.4 Nm Ultraflex ROM basic paediatric hinge for the elbow joint This basic ROM hinge is intended for use on the medial side in combination with the Ultraflex elbow hinge paediatric systems. The hinge can easily be fixed by means of screws at the desired extension or flexion limit and has the advantage that it can be curved close to the shell. Hinge: aluminium with epoxy coating Screws: stainless steel Bolts: stainless steel Range: 0 to plus 115 Length: 276 mm (total length)

10 Elbow (EO) Ultraflex Power Unit for platform Ultraflex Platform for the elbow joint Side of Side of Suggested for patient weight Flexion stop (adjustable) (4) Force assisting extension (1) extension with hyperextension (2) Flexion stop (adjustable) with possibility of hyperextension (5) Force assisting flexion (3) Extension stop (adjustable) (6) Adjustable force direction (bi-directional) Adjustable force direction (bi-directional) left UF-EO-SS1-R right UF-EO-SS1H-L left UF-EO-SS1H-R right UF-EO-SS2-L left UF-EO-SS2-R right UF-EO-SS3-L left UF-EO-SS3-R right Maximum torque (Nm) UF-EO-P1-L left ,2 UF-EO-P1-R right ,2 UF-EO-P1H-L left ,2 UF-EO-P1H-R right ,2 UF-EO-P2-L left ,2 UF-EO-P2-R right ,2 UF-EO-P3-L left ,8 UF-EO-P3-R right ,8 UF-EO-P3H-L left ,8 UF-EO-P3H-R right ,8 UF-EO-P4-L left ,8 UF-EO-P4-R right ,8 UF-EO-P5-L left ,1 UF-EO-P5-R right ,1 UF-EO-P5H-L left ,1 UF-EO-P5H-R right ,1 UF-EO-P6-L left ,1 UF-EO-P6-R right ,1 UF-EO-P7-L left ,2 UF-EO-P7-R right ,2 UF-EO-P8-L left ,8 UF-EO-P8-R right ,8 UF-EO-P9-L left ,1 UF-EO-P9-R right ,1 Ultraflex ROM basic hinge for the elbow joint Adults Children UF-E/KO-ROM Ultraflex Paediatric module for the elbow joint Side of Suggested for patient weight extension flexion Maximum torque (Nm) UF-EO-PC1-L left ,4 UF-EO-PC1-R right ,4 UF-EO-PC2-L left ,4 UF-EO-PC2-R right ,4 Ultraflex ROM basic paediatric hinge for the elbow joint Adults Children UF-E/KO-PROM (1) Normally coupled with a Platform with a flexion stop (4) (2) Normally coupled with a Platform in hyperextension and with a flexion stop (5) (3) Normally coupled with a Platform with an extension stop (6) (4) Normally coupled with a Power Unit with force assisting extension (1) (5) Normally coupled with a Power Unit with force assisting hyperextension (2) (6) Normally coupled with a Power Unit with force assisting flexion (3)

11 Knee (KO) Ultraflex Power Unit for Platform This modular Power Unit is mounted on the platform and is available with the force assisting extension, hyperextension, or flexion, or a combination of extension and flexion (bi-directional). The Power Unit is supplied with a low, medium or high maximum torque which, however, can be adjusted to any point from zero to maximum. The Power Unit should always be mounted on the lateral side of the Platform, if necessary, a second Power Unit can be fitted on the medial side. A Power Unit with the force assisting extension is normally mounted on a Platform with a flexion stop, and a Power Unit with the force assisting flexion is mounted on a Platform with an extension stop. Housing: aluminium with polycarbonate 75 x 55 mm (L x W) Height: 5.1 Nm: 35 mm, 6.8 Nm: 37 mm, 10.2 Nm: 40 mm (total height of Power Unit mounted on Platform) Power Unit assisting (hyper)extension or flexion Range: 0 to plus 135 (extension and flexion) minus 15 to plus 135 (hyperextension and bi-directional) High: 0 to 10.2 Nm Medium: 0 to 6.8 Nm Low: 0 to 5.1 Nm Ultraflex Platform for the knee joint This component forms the basis of the Ultraflex system and also serves as a platform for the Power Unit. In combination with a Power Unit the hinge made dynamic, should be mounted laterally, but it may also be used as a ROM hinge (movement limitation) on the medial side (normally without Power Unit, but also with a Power Unit if necessary). Furthermore the Platform is available in a version with a flexion stop, an extension stop, the possibility of a hyperextension design with an extension stop or a bi-directional design, p p yp Bi-directional Platform whereby the adapted Power Unit can easily be removed and adjusted for the force to assist flexion or extension. The Platform is supplied with removable bars. A Platform with an adjustable flexion stop is normally coupled with a Power unit with the force assisting extension, and a Platform with an extension stop is coupled with a Power Unit with the force assisting flexion. Hinge: stainless steel with black polymer coating 89 x 38 mm (L x W) Bars: aluminium, with epoxy coating 300 x 16 x 3 mm (L x W x H) Range: Load limit 0 to plus 135 (extension and flexion) M L Strength: 82 minus 15 to plus 135 (hyperextension and bi-directional) A P Strength: 113 flexion and extension stops adjustable in 7.5 increments Lockingunlocking: any position, adjustable in increments of 7.5 Ultraflex basic ROM hinge for the knee joint As well as using the standard Ultraflex Platform as a ROM hinge, there is, depending on the case, also the option of using this basic ROM hinge. It is true that it does not have the same features as the Platform, but it is easily fixed with a screw at the desired flexion or extension limit. This hinge cannot be used in orthoses that t need to support the weight of the body, e.g. with ambulatory patients. ts Hinge: aluminium with epoxy coating Screws: stainless steel Bolts: stainless steel Range: 0 to plus 160 Ultraflex Dynamic Paediatric Module for the knee joint This hinge is intended primarily for children. The Power Unit is already integrated with the hinge. This knee joint hinge is available in two versions: with the force assisting extension or flexion. Both designs have a maximum torque of 3.4 Nm. The hinge is intended for mounting on the lateral side, but another module can be mounted medially if needed. Housing: polycarbonate 66 x 32 x 22 mm (L x W x H) Bars: aluminium with epoxy coating 280 mm (total length) Range: 0 to plus 115 Adjustable: 0 to 3.4 Nm Ultraflex ROM basic paediatric hinge for the knee joint This basic ROM hinge is intended for use on the medial side in combination with the Ultraflex paediatric knee module. The component can easily be fixed by means of screws at the desired extension or flexion limit and has the advantage that it can be curved close to the orthotic shell. This hinge cannot be used in orthoses that t need to support the weight of the body, e.g. with ambulantory patients. ts Hinge: aluminium with epoxy coating Screws: stainless steel Bolts: stainless steel Range: 0 to plus 115 Length: 276 mm (total length)

12 Knee (KO) Ultraflex Power Unit for platform Ultraflex Platform for the knee joint Side of Side of Suggested for patient weight With flexion stop (adjustable) (4) Force assisting extension (1) extension with hyperextension (2) With flexion stop (adjustable) with possibility of hyperextension (5) Force assisting flexion (3) With extension stop (adjustable) (6) Adjustable force direction (bi-directional) Adjustable force direction (bi-directional) UF-KO-SS1-L left UF-KO-SS1-R right UF-KO-SS1H-L left UF-KO-SS1H-R right UF-KO-SS2-L left UF-KO-SS2-R right UF-KO-SS3-L left UF-KO-SS3-R right Maximum torque (Nm) UF-KO-P1-L left ,2 UF-KO-P1-R right ,2 UF-KO-P1H-L left ,2 UF-KO-P1H-R right ,2 UF-KO-P2-L left ,2 UF-KO-P2-R right ,2 UF-KO-P3-L left ,8 UF-KO-P3-R right ,8 UF-KO-P3H-L left ,8 UF-KO-P3H-R right ,8 UF-KO-P4-L left ,8 UF-KO-P4-R right ,8 UF-KO-P5-L left ,1 UF-KO-P5-R right ,1 UF-KO-P5H-L left ,1 UF-KO-P5H-R right ,1 UF-KO-P6-L left ,1 UF-KO-P6-R right ,1 UF-KO-P7-L left ,2 UF-KO-P7-R right ,2 UF-KO-P8-L left ,8 UF-KO-P8-R right ,8 UF-KO-P9-L left ,1 UF-KO-P9-R right ,1 Ultraflex ROM hinge for the knee joint Adults Children UF-E/KO-ROM Ultraflex Paediatric module for the knee joint Side of Suggested for patient weight extension flexion Maximum torque (Nm) UF-KO-PC1-L left ,4 UF-KO-PC1-R right ,4 UF-KO-PC2-L left ,4 UF-KO-PC2-R right ,4 Ultraflex ROM paediatric hinge for the knee joint Adults Children UF-E/KO-PROM (1) Normally coupled with a Platform with a flexion stop (4) (2) Normally coupled with a Platform in hyperextension and with a flexion stop (5) (3) Normally coupled with a Platform with an extension stop (6 (4) Normally coupled with a Power Unit with force assisting extension (1) (5) Normally coupled with a Power Unit with force assisting hyperextension (2) (6) Normally coupled with a Power Unit with force assisting flexion (3)

13 Ankle (AFO) Ultraflex Power Unit for T and Lively Platforms The modular Power Unit is mounted on the Platform and is available with the force assisting dorsal flexion or plantar flexion. The Power Unit for the Lively and T Platforms is available with low, medium or high torque, the torque being adjustable to any point from zero to maximum. The Power Unit should always be mounted on the lateral side of the Platform and, if necessary, a second power unit, can be fitted on the medial side. A Power Unit with force assisting dorsal flexion is normally mounted on a Platform with a plantar flexion stop, and a Power Unit with force assisting plantar flexion is mounted on a Platform with adorsal flexion stop. Power Unit with force assisting plantar flexion or dorsal flexion Housing: aluminium with polycarbonate 75 x 55 mm (L x W) Height: 5.1 Nm = 35 mm, 6.8 Nm = 37 mm, 10.2 Nm = 40 mm (total height, mounted on hinge) Range: minus 75 to plus 75 ( T Power Unit) 0 to plus 135 ( Lively Power Unit) High: 0 to 10.2 Nm Average: 0 to 6.8 Nm Low: 0 to 5.1 Nm Ultraflex T Platform for the ankle joint This component forms the basis of the Ultraflex system and also serves as a platform for the Power Unit. The hinge made dynamic by its coupling with the Power Unit should be mounted laterally, but it can also be used as a ROM hinge (movement limitation) on the medial side (normally without a Power Unit). Furthermore, this Platform is available in versions with a plantar flexion stop and a dorsal flexion stop. The hinge is supplied with a removable proximal bar and a T-shapeddistal bar (removable). The T hinge system is also suitable for the mobile patient. A platform with a plantar flexion stop is normally coupled with a Power Unit assisting dorsal flexion, and a Platform with a dorsal flexion stop is coupled with a Power Unit assisting plantar flexion. T -Platform with plantar flexion stop or dorsal flexion stop Hinge: stainless steel with black polymer coating 89 x 38 mm (L x W) Bar: aluminium, with epoxy coating 300 x 16 x 3 mm (L x W x H) Range: minus 75 to plus 75 Plantar flexion and dorsal extension stops Adjustable in 7.5 increments Lockingunlocking: any position, adjustable in 7.5 increments Load limit M L strength:160 A P strength: 225 Ultraflex Lively Platform for the ankle joint This component forms the basis of the Ultraflex system and at the same time serves as a platform for the Power Unit. The hinge made dynamic by its coupling with the Power Unit should be mounted laterally, but it can also be used as a ROM hinge (movement limitation) on the medial side (normally without a Power Unit). Furthermore the hinge is available in versions with a plantar flexion stop or a dorsal flexion stop. The Platform is supplied including a removable proximal bar. The Lively system is not suitable for walking and should always be ordered in combination with the Ultraflex subtalar stirrup. A platform with a plantar flexion stop is normally coupled with a Power Unit assisting dorsal flexion, and a Platform with a dorsal flexion stop is coupled with a Power Unit assisting plantar flexion. Lively Platform with plantar flexion stop or dorsal flexion stop Hinge: stainless steel with black polymer coating 89 x 38 mm (L x W) Bar: aluminium, with epoxy coating 300 x 16 x 3 mm (L x W x H) Range: 0 to plus 135 Plantar flexion and dorsal flexion stops adjustable in 7.5 increments Lockingunlocking: any position, adjustable in 7.5 increments Load limit M L strength:160 A P strength: 225 Ultraflex basic ROM hinge for the ankle joint As well as using the standard Ultraflex Platform as a ROM hinge, there is, depending on the case, also the option of using this basic ROM component. It is true that it does not have the same features as the Platform, but it is easily fixed with screws at the desired limit ofplantar or dorsal flexion. This hinge cannot be used in orthoses that t need to support the weight of the body, e.g. with ambulantory patients. ts Hinge: Screws: Bolts: aluminium with epoxy coating stainless steel stainless steel Range: 0 to plus 160

14 Ankle (AFO) Ultraflex LSK subtalar stirrup for Lively ankle joint hinge The subtalar stirrup should always be ordered in combination with a Lively hinge for the ankle joint. This component is available in adult and paediatric versions. The stirrup kit consists of: either aluminium stirrup for adults (300 mm) or aluminium stirrup for children (216 mm) heel cup subtalar mount (dummy) stainless steel washers (2x) stainless steel screws (2x) flange head bolt Ultraflex Dynamic Paediatric Module with Lively ankle joint hinge This hinge is primarily intended for children. The Power Unit is already integrated with the hinge. This ankle support hinge is supplied in two versions, with the force assisting dorsal flexion or plantar flexion. Both versions have a maximum torque of 3.4 Nm. This hinge should be mounted laterally, and another module can be mounted medially if needed. Housing: polycarbonate 66 x 32 x 22 mm (L x W x H) Bars: aluminium with epoxy coating 280 mm (total length) Range: minus 55 to plus 55 Adjustable: 0 to 3.4 Nm Ultraflex Dynamic Paediatric Module with T ankle joint hinge This hinge is primarily intended for children. The Power Unit is already integrated with the hinge. This ankle support hinge is supplied in two versions, with the force assisting dorsal flexion or plantar flexion. Both versions have a maximum torque of 3.4 Nm. This hinge should be mounted laterally, another module can be mounted medially if needed. Housing: polycarbonate 66 x 32 x 22 mm (L x W x H) Bars: aluminium with epoxy coating 178 mm (total length) Range: 0 to plus 110 Adjustable: 0 to 3.4 Nm Ultraflex ROM basic paediatric hinge for the ankle joint This ROM hinge is intended for use on the medial side in combination with the Ultraflex ankle hinge paediatric systems. The hinge can easily be fixed by means of screws at the desired extension or flexion limit and has the advantage that it can be curved close to the shell. Hinge: aluminium with epoxy coating Screws: stainless steel Bolts: stainless steel Range: minus 55 to plus mm x 140 mm (L x W)

15 Ankle (AFO) Ultraflex Power Unit for T and Lively Platforms Power Unit item number for T stirrup Power Unit item number for Lively stirrup Side of Suggested for patient weight Ultraflex Lively Platform for ankle joint dorsal flexion (1) plantar flexion (3) Side of Plantar flexion stop (adjustable) (4) Dorsal flexion stop (adjustable) (6) UF-AFO-SS1-L Left UF-AFO-SS1-R Right UF-AFO-SS2-L Left UF-AFO-SS2-R Right Maximum torque (Nm) UF-AFO-P1T-L UF-AFO-P1-L Left ,2 UF-AFO-P1T-R UF-AFO-P1-R Right ,2 UF-AFO-P2T-L UF-AFO-P2-L Left ,2 UF-AFO-P2T-R UF-AFO-P2-R Right ,2 UF-AFO-P3T-L UF-AFO-P3-L Left ,8 UF-AFO-P3T-R UF-AFO-P3-R Right ,8 UF-AFO-P4T-L UF-AFO-P4-L Left ,8 UF-AFO-P4T-R UF-AFO-P4-R Right ,8 UF-AFO-P5T-L UF-AFO-P5-L Left ,1 UF-AFO-P5T-R UF-AFO-P5-R Right ,1 UF-AFO-P6T-L UF-AFO-P6-L Left ,1 UF-AFO-P6T-R UF-AFO-P6-R Right ,1 Ultraflex T Platform for ankle joint Side of Plantar flexion stop (adjustable) (4) Dorsal flexion stop (adjustable) (6) UF-AFO-SS1T-L Left UF-AFO-SS1T-R Right UF-AFO-SS2T-L Left UF-AFO-SS2T-R Right Ultraflex ROM basic hinge for the ankle joint ( Lively stirrup) Adults Children UF-E/KO-ROM Ultraflex LSK subtalar stirrup for Lively ankle joint hinge Adults Children UF-LSK UF-P-LSK Ultraflex paediatric module for Lively ankle joint hinge Side of Suggested for patient weight dorsal flexion plantar flexion Maximum torque (Nm) UF-AFO-PC1-L Left ,4 UF-AFO-PC1-R Right ,4 UF-AFO-PC2-L Left ,4 UF-AFO-PC2-R Right ,4 Ultraflex paediatric module for T ankle joint hinge Side of Suggested for patient weight dorsal flexion plantar flexion Maximum torque (Nm) UF-AFO-PC1T-L Left ,4 UF-AFO-PC1T-R Right ,4 UF-AFO-PC2T-L Left ,4 UF-AFO-PC2T-R Right ,4 Ultraflex ROM basic paediatric hinge for the ankle joint ( T and Lively hinges) T item number Lively item number Adults Children UF-AFO-P-ROM-T UF-E/KO-P-ROM (1) Normally coupled with a Platform with a plantar flexion stop (4) (3) Normally coupled with a Platform with a dorsal flexion stop (6) (4) Normally coupled with a Power Unit with force assisting dorsal flexion (1) (6) Normally coupled with a Power Unit with force assisting plantar flexion (3)

16 ORTHOPEDIE Bibliographical References References about LLPS Principle 1. McClure PW, Blackburn LG, Dusold C. The use of splints in the treatment of joint stiffness: Biologic rationale and an Algorithm for making clinical decisions. Physical Therapy 74, , Barbara A. Nuismer, Ann M. Ekes, Margo B. Holm. The Use of Low-Load Prolonged Stretch Devices in Rehabilitation Programs in the Pacific Northwest. American Journal of Occupational Therapy, July/August 1997, Volume51, Number 7, page Flowers KR, Michlovitz SL. Assessment and management of loss of motion in orthopaedic dysfunction. Postgraduate Advances in Physical Therapy, 1988 series 4. Sapega A, Quedenfeld TC, Moyer RA, Butler RA. Biophysical factors in Range of Motion Exercise. 5. Brand P. Clinical Mechanics of the Hand. St. Louis, C.V. Mosby Co, 1985, pp Light K, Nuzik S, Personius W, Barstrom A. Low-load prolonged stretch vs high-load brief stretch in treating knee contractures. Physical Therapy 64: , 1984 General References 7. Farmer SE, Woollam PJ, Patrick JH, Roberts AP, Bromwich W, Dynamic orthoses in the management of joint contracture. The Journal of Bone & Joint Surgery (Br) Volume 87-B, No 3, p291-5, March Yasukawa A, Bryan S., Gaebler-Spira D. Efficacy for maintenance of elbow range of motion of two types of orthotic devices: a case series. Journal of Prosthetics and Orthotics 15: 72-76, Anderson JP, Snow D, Dorey FJ, Kabo JM. Efficacity of soft splints in reducing severe knee flexion contractures. Developmental Medecine and Child Neurology 30 (4), , Radtka S, Skinner S, Dixon D, Johanson E. A comparison of gait with solid, dynamic and no ankle foot orthoses in children with spastic cerebral palsy. Physical Therapy 77, 39-54, Richard R, Shanesy C, Miller S. Dynamic versus statis splints: a prospective case for sustained stress. Journal of Burn Care Rehabilitation 16, , Regis D, Montanari M, Mgnan B, Spagnol S, Bragantini A. Dynamic orthopaedic brace in the treatment of ankle sprains. Foot Ankle International 16 (7), , Flowers K, Lastayo P. Effect of Total End Range Time on improving passive range of motion. Journal of Hand Therapy, , Richard R, Staley M. Dynamic Splinting Basic Science + Modern Technology. Physical Therapy Forum, April 1993 by Dirame Ortho P R O T H E S E Your partner in Neuro-Orthotics CLINICAL SUPPORT, EDUCATION & CERTIFICATION HEADQUARTERS EUROPE, MIDDLE EAST AND AFRICA DIRAME ORTHO SA/NV ASSESTEENWEG 27/29, B-1740 TERNAT (BRUSSELS) - BELGIUM (EU) PHONE. +32 (0) , FAX +32 (0) ultraflex@dirame.be - dirame.ortho@skynet.be irame.com EUR O PE MIDDLE EAST AFRIC A UF 16General E