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L5: Spinal Orthoses Flashcards

1
Q

Objectives: feel confident with these!!!

A
  • Understand nomenclature used to describe spinal orthoses
  • ID 3 primary goals of orthotic intervention for pts w/ spinal dysf.
  • Describe roles of, options for, and limitations of mgmt of:
    • vertebral fxs
    • chronic discogenic pain
    • spinal instability
  • Apply knowledge of biomechanics of the cervical spine in determining approp. cervical or cervicothoracic orthosis to manage instability
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2
Q

Orthotics for mgmt of spinal dysf and instability

Named for what?

A

Regions of spine they encompass!

NOTE: More trunk==more cumbersome==less compliance

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3
Q

All Rigid thermoplastic or Metal, or both options:

A

SIO, LSO, TLSO, CTLSO, CTO, CO

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4
Q

All soft garments and supports options

A

SI belt, LS corset, DL corset (dorsolumbar), Soft collar

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5
Q

What makes spinal orthotics different from reg. orthosis???

A

Employ force systems to CORRECT or PREVENT progression of spinal deforms and to stabilize instabilities (i.e. scoliosis)

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6
Q

Goals of spinal orthotics:

4:

A
  1. Reduce gross spinal motion
  2. Stabilize indiv. motion segments
  3. Employ force systems to correct or prevent progression of spinal deforms. and to stabilize instabilities (i.e. scoliosis)
    1. ***what makes spinal orthosis DIFFERENT!!!
  4. Protect sx procedures during healing
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7
Q

UNLIKE UE/LE orthoses, which are considered assistive devices,

Spinal orthoses are for _________ of ______ and ________

KNOW THIS!!! IMPORTANT!!!!

A

Spinal orthoses are for treatment of instability and deformity

  • educate pt on how (fit and duration) to wear
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8
Q

Trunk Orthoses

2:

A

SI belts/harnesses

Corsets (fabric)

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9
Q

Trunk orthoses

SI belts/harnesses

*LEAST RESTRICTIVE/INVASIVE

A

LEAST RESTRICTIVE/INVASIVE

  • INC SI stability
  • pregnancy, post-partum moms, gen. instability
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10
Q

Trunk orthoses

Corsets (fabric)

A
  • Fit snugly→ velcro and dec axial loading of VBs
  • DEC forces placed on spinal/abdom mm’s==> dec pain
    • hernia, rib cartilage injury, minor LBP
  • Long term use→ mm atrophy of trunk mm’s==> inc risk for re-injury
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11
Q

MOST COMMONLY Rx’d supporting orthosis for pts w/ LOW BACK PAIN

A

Lumbosacral corsets

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12
Q

What should you remember about lumbosacral corsets?

A

MOST COMMONLY RX’D ORTHOSIS FOR LOW BACK PAIN!!!

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13
Q

Lumbosacral Corsets

*think LBP!!!!

A
  • MOST COMMONLY rx’d orthosis for LBP
  • ACCOMMODATE to a deformity OR straight for posture
  • LIMITS→ gross motion of spine (to a deg.)
    • LESS CONTROL vs rigid TLSO
  • Circumferential pressure→ INCs intracavity pressure
    • 3-pt pressure system to L/S
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14
Q

Lumbosacral Corsets

Good for and Bad for

A
  • MOST effective→ acute LBP, no evidence long term use
  • MINIMAL effective→ discogenic pain, no lift to off-load disc
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15
Q

When you hear “Traditional” think….

A

Metal and Leather

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16
Q

Traditional Metal & Leather Spinal orthoses

A
  • Custom fit to anatomical landmarks
  • Pelvic and thoracic band w/ set of metal paraspinal bars
  • Corset front w/ velcro or lace attach’s

*think back in the day lady’s wore under dresses to “suck in”

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17
Q

Chairback Orthosis

Function/Indications

A
  • Controls motion in sagittal plane primarily
  • Indicated→ reduction of gross and intersegmental flexion/extension
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18
Q

Chairback Orthosis

Trunk flexion limited by:

A
  • Trunk flexion→ limited by pair of posteriorly directed forces applied by anterior corset
    • so its pushing you to maintain “upright”
    • opposed by 1 anterior directed force @ midpoint of paraspinal bars
      • remember 3-pt system***
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19
Q

Chairback Orthosis

Trunk EXT limited by:

A
  • Trunk EXT→ limtd by two anterior directed forces applied across thoracic and pelvic bands
    • Oppose a posterior directed force @ midpoint of corset panel
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20
Q

Chairback Orthosis drawbacks:

A

Limtd unloading of spine/dec intradiscal pressure→ marginal

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21
Q

Chairback Orthosis in a nutshell…

A
  • Flexion limtd by→ posteriorly directed forces so you cannot flex
  • Extension limtd by→ anteriorly directed forces so you cannot extend
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22
Q

Knight LSO

Only things to know***

A
  • Controls motion in sagittal AND coronal/frontal planes
  • Profile laterally goes higher up on trunk→ limit lateral flexion***
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23
Q

Jewett and CASH orthoses

Limit trunk ________ while encouraging trunk __________

A

LIMIT trunk FLEX

ENCOURAGE trunk HYPEREXT.

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24
Q

Jewett and CASH orthoses when you see these think…..

A

“Jews + Cash” HATE trunk FLEXION, so they LIMIT it, Jews+CASH LOVE HYPEREXTENSION so they ENCOURAGE it!!!

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25
Jewett and CASH orthoses
* Dramatically **LIMIT FLEX** and ****_E_**NCOURAGE HYPER**_E_**XT.** * **Trunk FLEX limtd→** 3pt pressure system * **Posterior forces→** sternum and pubis pads * **Anterior force→** posterior lumbar pad (so its pushing _forward)_ * **Indications:** * Compress fx of VB, OP, MVAs (burst fx)
26
compression fxs of VB, OP, MVAs
Jewett + CASH
27
Jewett
see pics
28
CASH Orthosis
see pics
29
Long term use is NO BUENO w/ this
Cervical orthosis→ soft collar
30
Cervical Orthoses ## Footnote **Soft Collar**
* Unloads **muscles** of C/S **but does _little_ to restrict C/S motion** * Kinesth. reminder w/ WAD injuries to restrict motion * **Drawbacks:** * promotes FHP * Pt dependence/mm atrophy→ long term
31
Cervical Orthoses ## Footnote **Reinforced Collars** **ex. Philadelphia collar (there are many types\*)**
* Hard plastic→ more support * Anterior shell→ chin, Posterior shell→ occiput * **NO lat or rot. prevention bc low trimlines** * Gen support, w/out rigid immob. * **some have higher lateral trim lines for more motion control**
32
MAX Control Cervical orthosis
HALO\*\*\*\*
33
Cervical Orthoses ## Footnote **Halo**
MAX control pre/post sx * **COMPLETE CONTROL** of C/S and upper T/S motion **in all 3 planes\*\*\* KNOW THIS!!!** * USED→ Pre-sx for prevention, ORIF C/S fusion, non-op mgmt non-displaced c/s fxs
34
Cervical orthoses BEST OPTION FOR _STABILITY_
HALO!!!
35
**Cervical orthoses:** **Halo: 3 components**
1. Ring and skull pins 2. Superstructure→ bars attach vest to ring 3. Vest→ Pt of stability for whole system
36
Scoliosis Info pics ## Footnote **Know how named, what is happening (rotation wise), named for, etc…**
see pics
37
Scoliosis ## Footnote **What way does VB rotate AND rib hump on which side? Named for?**
* **VB rotation→** to CONVEX side * **Rib hump→** on CONVEX side * **Named for→** curvature on CONVEX side
38
Spinal Orthoses→ **Mgmt of Scoliosis** ## Footnote **Primary vs compensatory curve, Naming**
* **Primary=\>** largest “C” Curve (usually thoracic) * **Secondary=\>** smaller “S” curve (usually lumbar) * **NAMED→** for CONVEXITY of curve * i.e. Left thoracic, Right lumbar scoliosis
39
Mgmt of Scoliosis ## Footnote **Degree of scoliotic curve most accurately measured xray/radiograph** **Angle degree where its managed _conservatively w/out orthosis_?**
\>25\* ==\> mngd conservatively (rehab) w/ out orthosis (children esp)
40
Mgmt of Scoliosis ## Footnote **Degree of scoliotic curve most accurately measured xray/radiograph** **If angle is _progressive_ may be sx/bracing after 6mos-1yr** **Degree of curve where this would happen?**
\>25\* **and/or** INC of \>5\* in 6mos
41
Spinal Orthoses→ **Idiopathic scoliosis** ## Footnote **Contributors/causes**
* Genetics, growth velocity, lig imbalances, mm imbalances, vestib/CNS dysf (cannot maint. horizon\*) * **Multifactorial→** one mech may relate to curve dev./progression
42
Idiopathic scoliosis %'s
* 89%→ ID'd in ado.→ can be fixed * **Smaller curves→** \<15-20\*→ not seen or symptomatic
43
Idiopathic Scoliosis ## Footnote **Indicated when ?**
**Skeletally immature** children w/ curves **bw 30-45\*** **\***w/ exercise→ good outcomes for prevention \***BEST outcomes when wear _full-time_!**
44
Idiopathic scoliosis ## Footnote **No efficacy w/ spinal orthotic when?**
Once curve progresses to **45\* or more**
45
Orthosis designed to: ## Footnote **Function of orthosis for scoliosis:** **4 things:**
1. Stiffen spine artificially (passive rigid) 2. Reduce curve w/ **centralized force** 3. Raise **critical load (**spine begins to bend, critical angle 25\*) 4. Reduce likelihood add. deformation
46
Spinal orthoses→ **Goals for orthotic intervention scoliosis**
* PREVENT FURTHER CURVE PROGRESSION * can be t/o entire skeletal progression until mature\* * **DOES NOT result in permanent correction of spinal align.** * get them back to pre-bracing angles\*
47
Spinal Orthoses-Scoliosis ## Footnote **Types of braces**
* Most common low profile braces→ Milwaukee, Boston, Miami * **Milwaukee=\> more aggressive correction for nighttime use** * **ALL→** use biomech. principles of **end point control, curve correction and cont. transverse support**
48
All scoliosis braces do this:
use biomech. principles of **end point control, curve correction and cont. transverse support**
49
Scoliosis correction/bracing **If we address the lateral curvature,** what happens as a result of this **as well?**
Fixes rotational component
50
3 point system for **Scoliosis bracing**
see pics ## Footnote **NOTE: R. sided thoracic, L. side lumbar scoliosis**
51
Charleston bending brace and scoliosis ## Footnote **what should you remember???**
Biggest indentation side===**side of CONVEXITY** ## Footnote **\*trying to get them bent back other way**
52
Spinal orthoses→ **Milwaukee and Boston** ## Footnote **Notes to look for**
* LOOK FOR: * **indentation in brace==\> convex side===how scoliosis named** * **pressure pad on T/S===convex side==side of scoliosis**
53
Spinal Orthoses→ **Goals for scoliotic orthotic intervention:** ## Footnote **3:**
1. **Derotation→** lateral curve reduced===spinal rotation reduced 2. **Spinal balance→** head+mass of body centered over pelvis 3. **Delay/eliminate need for sx** 1. child/ado's→ 1. **Ferraro noted→ 80% spinal growth achieved by 10yo**
54
Spinal Orthoses→ Scoliosis ## Footnote **Degree of _correction_ depends on 4 factors:** **EASY TO REMEMBER BC IT MAKES SENSE!!!**
1. **Positioning** of pad 2. **Magnitude** of corrective force applied by pad 3. **Direction** of applied force (is it going right direction based on where convex side is?) 4. **Duration** of forces applied 1. \*\*\***Need looooooong pds of time (18-24hrs)**
55
Spinal Orthoses- Scoliosis What is the **most critical aspect** to **correcting prescribing style of orthosis???**
Determining **APEX OF CURVE\*\*\*** * **T7 or above→** Milwaukee * **BELOW T7→** TLSO
56
Apex of curve **@ T7 or ABOVE**
Milwaukee
57
Apex of curve **BELOW T7**
TLSO
58
APEX OF SCOLIOTIC CURVE **Those @ risk for _curve progression_:** better mng'd w/:
CTLSO \*bc **biomech. advantage for in-brace curve correction**
59
**Crucial** for correcting scoliotic curve
WEARING TIME COMPLIANCE!!!!
60
Schroth Method→ **Non-Sx PT Approach** ## Footnote **What is it?**
Uses 3-dimensional approach to **elongate trunk and correct imbalances of spine.** **Goal→** develop **inner mm's of ribcage** in order to **change shape of upper trunk** and to **correct any spinal abnorms.** **Straighten, centralize and de-rotate spine w/ _corrective breathing exercises._**
61
Schroth Method ## Footnote **Non-sx PT approach:** **Goals:**
* Stabilize curves, mob. stiff body parts, improve postural align, teach ADLs, promote corrections, enhance NMSK control, inc mm strength/endurance, pain reduction, improve CP function

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