Ch 6 - Prosthetic and Orthotics: Spinal Orthoses

Question 1

What does a soft cervical collar provide?

Answer 1

Kinesthetic reminder (through sensory feedback) to limit motion

Question 2

What are indications of a soft cervical collar?

Answer 2

Symptomatic treatment of soft-tissue injuries of the neck

Question 3

What is the maximum amount of time a soft cervical collar should be worn?

Answer 3

10 days

Risk of muscle atrophy and psychologic dependency if used longer

Question 4

What motions do rigid cervical collars restrict?

Answer 4

Cervical flexion, extension, rotation, and lateral bending

Question 5

Describe a Thomas collar.

Answer 5

Made of firm plastic with superior and inferior padding that wraps around the neck and is secured with Velcro

Question 6

What are indications for a Thomas collar?

Answer 6

Soft tissue injuries

Question 7

Describe a Philadelphia collar.

Answer 7

Rigid anterior and posterior plastic reinforcements, secured by Velcro and encompasses the lower jaw and the occiput and extends to the proximal thorax

Question 8

What are indications for a Philadelphia collar?

Answer 8

Soft-tissue injuries
Stable bony or ligamentous injuries
Wean from immobilization from other collars

Question 9

What are variants of the Philadelphia collar?

Answer 9

Miami–J
Newport
Malibu collars

Question 10

Describe a Sterno-Occipital Mandibular Immobilizer.

Answer 10

Cervicothoracic orthosis with chest piece connected by uprights to occipital plate

Question 11

What are indications of a Sterno-Occipital Mandibular Immobilizer?

Answer 11

Cervical arthritis
Postsurgical fusions
Stable cervical fractures

Question 12

What directions are controlled with a posterior-type CTO?

Answer 12

Provides good control of flexion/extension; lateral bending and rotation are not well controlled

Question 13

Describe a Minerva CTO.

Answer 13

Entire posterior skull, band around the forehead to control all cervical motions, and extends downward to the inferior costal margin

Question 14

What are indications of a Minerva CTO?

Answer 14

Management of unstable cervical spine in preschool age children due to ↑ comfort, ↓ weight, and because it allows early mobilization for rehab

Question 15

Describe a Halo CTO.

Answer 15

Rigid halo ring secured to the skull with four external fixation pins and four posts attached to the anterior and posterior part of the vest

Question 16

What are indications of a Halo CTO?

Answer 16

Unstable fractures of the cervical spine (especially high cervical fractures)

Question 17

Describe a TLSO position.

Answer 17

Sacrum to above the inferior angle of the scapulae

Question 18

When should TLSO be used for scolosis?

Answer 18

Prevent progression of moderate scoliosis

Question 19

What are indications for TLSO use?

Answer 19

Truncal paralysis
Post-spinal fusion
Postscoliosis surgery

Question 20

Describe a Taylor brace.

Answer 20

Flexion/extension control TLSO that consists of two posterior paraspinal bars attached inferiorly to a pelvic band, interscapular band and corset or anterior, fullfront abdominal support

Question 21

Describe a Kight-Taylor brace.

Answer 21

Consists of a Taylor style TLSO with lateral bands and a thoracic band to restrict lateral bending

Question 22

Describe a Jewett brace.

Answer 22

Flexion control TLSO consisting of a sternal pad, suprapubic pad, and anterolateral pads connected by oblique lateral uprights counteracted by a dorsolumbar pad

Question 23

What are indications of a Jewett brace?

Answer 23

1. Permit upright position while preventing flexion after thoracolumbar compression fx
2. Thoracolumbar Scheuermann’s disease
3. Thoracic osteoporotic kyphosis

Question 24

Describe a Cruciform Anterior Spinal Hyperextension (CASH) brace.

Answer 24

Anterior cross-shaped vertical and horizontal metal uprights with sternal, pubic, posterior, and anterolateral pads. The vertical upright joins the sternal and pubic pad. The horizontal uprights connect the posterior thoracolumbar pad and the anterolateral pads

Question 25

What are indications of a Cruciform Anterior Spinal Hyperextension (CASH) brace?

Answer 25

1. Permit upright position while preventing flexion after thoracolumbar compression fx
2. Thoracolumbar Scheuermann’s disease
3. Thoracic osteoporotic kyphosis

Question 26

Describe a Milwaukee brace.

Answer 26

Cervicothoracic-lumbo-sacral orthosis (CTLSO)
• Consists of a rigid plastic pelvic girdle connected to a neck ring over the upper thorax by one anterior, broad aluminum bar and two posterior paraspinal bars
• The cervical ring has mandibular and occipital bars, which rest 20 to 30 mm inferior to occiput and mandible
• Pads strapped to the bars apply a transverse load to the ribs and spine to correct scoliotic curvatures

Question 27

What are Indications of Milwaukee brace use?

Answer 27

Idiopathic or flexible congenital scoliosis with curves 25° to 40° if the curve apex is located superior to T8