Ortez ve Protez Kullanımı, Yardımcı Cihazlar ve Adaptasyonlar
Özet
Bu bölüm, ortopedik rehabilitasyonda ortez, protez ve yardımcı cihaz kullanımını klinik endikasyonlar ve güncel kanıtlar ışığında özetlemektedir. Öncelikle alt ekstremite (ayak-ayak bileği, diz, diz-ayak bileği-ayak/KAFO), üst ekstremite (omuz-dirsek, el bileği-el-başparmak) ve spinal (servikal, torakolomber) ortez grupları; tasarım özellikleri, reçetelendirme ilkeleri ve başlıca endikasyonları bakımından ele alınmaktadır. Ardından alt ve üst ekstremite protez sistemleri; soket tasarımları, süspansiyon yöntemleri, eklem ve ayak bileşenleri ile güncel bir cerrahi teknik olan osseointegrasyon tartışılmaktadır. Son bölümde baston, koltuk değneği ve yürüteç gibi yürüme yardımcıları, doğru seçim ve ayarlama ile yürüyüş eğitimi ilkeleriyle birlikte sunulmakta; giyinme, tuvalet-banyo, mutfak, transfer, çevresel düzenlemeler ve akıllı ev teknolojilerini kapsayan günlük yaşam aktivitesi adaptasyonları ile düşme önleme yaklaşımları anlatılmaktadır. Bölüm, ortopedik rehabilitasyon ekibi için pratik bir uygulama kontrol listesiyle sonlanmaktadır. Amaç, klinisyenlere biyomekanik hedefler, doku toleransı ve hasta bildirimli sonuçlar temelinde bireyselleştirilmiş cihaz reçetelendirmesi için kapsamlı, güncel bir referans sunmaktır.
This chapter provides an overview of orthoses, prostheses, and assistive devices used in orthopedic rehabilitation, framed by clinical indications and current evidence. Lower extremity (foot-ankle, knee, knee-ankle-foot/KAFO), upper extremity (shoulder-elbow, wrist-hand-thumb), and spinal (cervical, thoracolumbar) orthoses are reviewed with attention to design features, prescription principles, and key indications. Lower and upper extremity prosthetic systems are then discussed, including socket designs, suspension methods, joint and foot components, and osseointegration as an emerging surgical technique. The chapter further addresses ambulatory aids—canes, crutches, and walkers—together with proper fitting and gait-training principles, as well as adaptations that facilitate activities of daily living, including dressing, toileting, bathing, kitchen tasks, transfers, environmental modifications, and smart-home technologies, alongside fall-prevention strategies. It concludes with a practical checklist for the rehabilitation team. The overall aim is to provide clinicians with a concise, evidence-informed reference for individualized device prescription based on biomechanical goals, tissue tolerance, and patient-reported outcomes.
Referanslar
Bek N. Alt ekstremite ortezleri. In: Karaduman A (ed.). Fizyoterapi ve Rehabilitasyon. Ankara: Hipokrat Kitapevi & Pelikan Kitapevi; 2016. p. 443–444.
Neville C, et al. An ankle-foot orthosis with a lateral extension reduces forefoot abduction in subjects with stage II posterior tibial tendon dysfunction. Journal of Orthopaedic & Sports Physical Therapy. 2016;46(1):26–33. doi/10.2519/jospt.2016.5618
Holden MA, et al. Knee braces for knee osteoarthritis: A scoping review and narrative synthesis of interventions in randomised controlled trials. Osteoarthritis and Cartilage. 2024;32(11):1371–1396. http://doi.org/10.1016/j.joca.2024.08.010
NICE guideline NG226. Osteoarthritis in over 16s: diagnosis and management. 2022.
Holden MA, et al. Clinical and cost-effectiveness of bracing in symptomatic knee osteoarthritis management: protocol for a multicentre, primary care, randomised, parallel-group, superiority trial. BMJ Open. 2021;11(3):e048196. http://doi.org/10.1136/bmjopen-2020-048196
Clinical Policy: Durable Medical Equipment and Orthotics and Prosthetics Guidelines.
Rafiaei M, et al. The gait and energy efficiency of stance control knee–ankle–foot orthoses: A literature review. Prosthetics and Orthotics International. 2016;40(2):202–214. http://doi.org/10.1177/0309364615588
Davis PC, Bach TM, Pereira DM. The effect of stance control orthoses on gait characteristics and energy expenditure in knee-ankle-foot orthosis users. Prosthetics and Orthotics International. 2010;34(2):206–215. http://doi.org/10.3109/03093641003773
McDaid C, et al. Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders. BMJ Open.. doi:10.1136/bmjopen-2017-015927
Deems-Dluhy S, et al. Microprocessor controlled knee ankle foot orthosis (KAFO) vs stance control vs locked KAFO: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2021;102(2):233–244. http://doi.org/10.1016/j.apmr.2020.08.013
Lundstrom RL, et al. The C-Brace® microprocessor controlled stance and swing orthosis improves safety, mobility, and quality of life at one year: Interim results from a prospective registry. Journal of Rehabilitation and Assistive Technologies Engineering. http://doi.org/10.1177/20556683241269539
Verstuyft L, Caekebeke P, van Riet R. Postoperative rehabilitation in elbow surgery. Journal of Clinical Orthopaedics and Trauma.. http://doi.org/10.1016/j.jcot.2021.101479
Chen B, et al. Static progressive orthoses for elbow contracture: a systematic review. Journal of Healthcare Engineering. 2017. http://doi.org/10.1155/2017/7498094
Cochrane Neuromuscular Group, et al. Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews. 2023(2). http://doi.org/10.1002/14651858.CD010003
Kloppenburg M, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases. 2019;78(1):16–24. http://doi.org/10.1136/annrheumdis-2018-213826
Marotta N, et al. Comparative effectiveness of orthoses for thumb osteoarthritis: a systematic review and network meta-analysis. Archives of Physical Medicine and Rehabilitation. 2021;102(3):502–509. http://doi.org/10.1016/j.apmr.2020.06.012
Wells A, et al. The effectiveness of orthoses as a conservative treatment in treating carpometacarpal joint osteoarthritis: A systematic review. Medical Research Archives. 2024;12(4). http://doi.org/10.18103/mra.v12i4.5176
Khera BH, Chang C, Bhat W. An overview of mallet finger injuries. Acta Bio Medica. 2021;92(5):e2021246. http://doi.org/10.23750/abm.v92i5.11731
Nouri A, et al. Finger orthoses for rehabilitation—Part I: Biomedical insights and additive manufacturing innovations. Prosthesis. 2025;7(3):62. http://doi.org/10.3390/prosthesis7030062
Ktavutvat K, Reecheeva N. Thumb carpometacarpal joint immobilization orthosis. Journal of Associated Medical Sciences. 2025;58(1):150–159. http://doi.org/10.12982/JAMS.2025.016
Yates SE, et al. Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis. Journal of Hand Therapy. 2024;37(4):495–506. http://doi.org/10.1016/j.jht.2023.12.018
Holla M, et al. The ability of external immobilizers to restrict movement of the cervical spine: a systematic review. European Spine Journal. 2016;25(7):2023–2036. http://doi.org/10.1007/s00586-016-4379-6
Oyekan AA, et al. The effects of cervical orthoses on head and intervertebral range of motion. Spine. 2023;48(22):1561–1567. http://doi.org/10.1097/BRS.0000000000004755
Sandler AJ, et al. The effectiveness of various cervical orthoses: an in vivo comparison of the mechanical stability provided by several widely used models. Spine. 1996;21(14):1624–1629.
Schulz M, et al. Comparison of the immobilizing effect of soft, semi-rigid and rigid neck orthoses. European Spine Journal. 2025;34(8):3214–3221. http://doi.org/10.1007/s00586-025-08854-5
Squires M, et al. Clinical outcomes after bracing for vertebral compression fractures: a systematic review and meta-analysis of randomized trials. Journal of Spine Surgery. 2023;9(2):139. http://doi.org/10.21037/jss-22-78
Weinstein SL, et al. Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine. 2013;369(16):1512–1521. http://doi.org/10.1056/NEJMoa1307337
Hagberg K, et al. Osseointegrated prostheses for the rehabilitation of patients with transfemoral amputations: a prospective ten-year cohort study of patient-reported outcomes and complications. Journal of Orthopaedic Translation. 2023;38:56–64. https://doi.org/10.1016/j.jot.2022.09.004
Rehani M, et al. Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectiveness. Frontiers in Rehabilitation Sciences. 2024;5:1336042. https://doi.org/10.3389/fresc.2024.1336042
Thouvenin C, et al. Wearing time, quality of life, and complications of lower limb bone-anchored prostheses: A systematic review and meta-analysis. Plastic and Reconstructive Surgery Global Open. 2025;13(8):e7041. https://doi.org/10.1097/GOX.0000000000007041
Zorowitz RD, Statton MA. Energy expenditure during basic mobility and approaches to energy conservation.
Van der Esch M, Heijmans M, Dekker J. Factors contributing to possession and use of walking aids among persons with rheumatoid arthritis and osteoarthritis. Arthritis Care & Research. 2003;49(6):838–842. https://doi.org/10.1002/art.11463
Hart J, et al. Body weight support through a walking cane in inexperienced users with knee osteoarthritis. Gait & Posture. 2019;67:50–56. https://doi.org/10.1016/j.gaitpost.2018.09.021
Simic M, et al. Contralateral cane use and knee joint load in people with medial knee osteoarthritis: the effect of varying body weight support. Osteoarthritis and Cartilage. 2011;19(11):1330–1337. https://doi.org/10.1016/j.joca.2011.08.008.
Kumar R, Roe MC, Scremin OU. Methods for estimating the proper length of a cane. Archives of Physical Medicine and Rehabilitation. 1995;76(12):1173–1175. https://doi.org/10.1016/S0003-9993(95)80129-4.
Edelstein JE. Assistive devices for ambulation. Physical Medicine and Rehabilitation Clinics. 2013;24(2):291–303. https://doi.org/10.1016/j.pmr.2012.11.001.
Yap W, Hairodin Z, Kwek E. Axillary versus forearm crutches: A prospective cohort comparing which is superior for 3-point crutch gait. Malaysian Orthopaedic Journal. 2021;15(2):36. https://doi.org/10.5704/MOJ.2107.006.
Moran J, et al. The energy expenditure of non-weight bearing crutch walking on the level and ascending stairs. Gait & Posture. 2015;42(1):23–26. https://doi.org/10.1016/j.gaitpost.2014.10.024
Sehgal M, Jacobs J, Biggs WS. Mobility assistive device use in older adults. American Family Physician. 2021;103(12):737–744.
Nickerson KA, Diaz K, Muir BC. Circumstances of falls among older adult walker users in long-term care and the associated walker design deficits. Assistive Technology. 2024;36(3):248–253. https://doi.org/10.1080/10400435.2023.2267623.
Carbone LD, et al. Assistive walking device use and knee osteoarthritis: results from the Health ABC Study. Archives of Physical Medicine and Rehabilitation. 2013;94(2):332–339. https://doi.org/10.1016/j.apmr.2012.09.021.
Gray F, Gray C, McClanahan J. Assessing the accuracy of partial weight-bearing instruction. American Journal of Orthopedics. 1998;27(8):558–560.
Van Lieshout R, et al. Biofeedback in partial weight bearing: usability of two different devices from a patient’s and physical therapist’s perspective. PLoS One. 2016;11(10):e0165199.
Lewis SR, Griffin XL. Preventing falls in older people: The evidence for environmental interventions and why history matters. Cochrane Database of Systematic Reviews. 2023(3). https://doi.org/10.1002/14651858.ED000162.
Gillespie LD, et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2012(9). https://doi.org/10.1002/14651858.CD007146.
Hagsten B, Svensson O, Gardulf A. Health-related quality of life and self-reported ability concerning ADL and IADL after hip fracture: a randomized trial. Acta Orthopaedica. 2006;77(1):114–119. https://doi.org/10.1080/17453670610045786.
Smith TO, et al. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database of Systematic Reviews. 2016(7). https://doi.org/10.1002/14651858.CD010815.pub2.
Tuntland H, et al. Assistive technology for rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2009(4). https://doi.org/10.1002/14651858.CD006729.pub2.
Stark S, et al. Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. American Journal of Occupational Therapy. 2017;71(2):7102290010. https://doi.org/10.5014/ajot.2017.018887.
Lockwood KJ, et al. Predischarge home visits after hip fracture: a randomized controlled trial. Clinical Rehabilitation. 2019;33(4):681–692. https://doi.org/10.1177/0269215518823256.
Johnston K, Barras S, Grimmer-Somers K. Relationship between pre-discharge occupational therapy home assessment and prevalence of post-discharge falls. Journal of Evaluation in Clinical Practice. 2010;16(6):1333–1339. https://doi.org/10.1111/j.1365-2753.2009.01339.x.
Lektip C, et al. Home hazard modification programs for reducing falls in older adults: a systematic review and meta-analysis. PeerJ. 2023;11:e15699. https://doi.org/10.7717/peerj.15699.
Paterson M, et al. A systematic review of electronic multi-compartment medication devices with reminder systems for improving adherence to self-administered medications. International Journal of Pharmacy Practice. 2017;25(3):185–194. https://doi.org/10.1111/ijpp.12242.
Dawes A, et al. Mobile health technology for remote home monitoring after surgery: a meta-analysis. British Journal of Surgery. 2021;108(11):1304–1314. https://doi.org/10.1093/bjs/znab323
Wang Y, et al. Smart home technologies for enhancing independence of living and reducing care dependence in older adults: a systematic review. Journal of Advanced Nursing. 2025;81(6):2885–2912. https://doi.org/10.1111/jan.16569.
Tian YJ, et al. Benefits and barriers associated with the use of smart home health technologies in the care of older persons: a systematic review. BMC Geriatrics. 2024;24(1):152. https://doi.org/10.1186/s12877-024-04702-1.
Ding D, et al. Mainstream smart home technology–based intervention to enhance functional independence in individuals with complex physical disabilities: Single-group pre-post feasibility study. JMIR Rehabilitation and Assistive Technologies. 2025;12(1):e70855. https://doi.org/10.2196/70855.
