L5: Spinal Orthoses Flashcards
Objectives: feel confident with these!!!
- 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
Orthotics for mgmt of spinal dysf and instability
Named for what?
Regions of spine they encompass!
NOTE: More trunk==more cumbersome==less compliance
All Rigid thermoplastic or Metal, or both options:
SIO, LSO, TLSO, CTLSO, CTO, CO
All soft garments and supports options
SI belt, LS corset, DL corset (dorsolumbar), Soft collar
What makes spinal orthotics different from reg. orthosis???
Employ force systems to CORRECT or PREVENT progression of spinal deforms and to stabilize instabilities (i.e. scoliosis)
Goals of spinal orthotics:
4:
- Reduce gross spinal motion
- Stabilize indiv. motion segments
- Employ force systems to correct or prevent progression of spinal deforms. and to stabilize instabilities (i.e. scoliosis)
- ***what makes spinal orthosis DIFFERENT!!!
- Protect sx procedures during healing
UNLIKE UE/LE orthoses, which are considered assistive devices,
Spinal orthoses are for _________ of ______ and ________
KNOW THIS!!! IMPORTANT!!!!
Spinal orthoses are for treatment of instability and deformity
- educate pt on how (fit and duration) to wear
Trunk Orthoses
2:
SI belts/harnesses
Corsets (fabric)
Trunk orthoses
SI belts/harnesses
*LEAST RESTRICTIVE/INVASIVE
LEAST RESTRICTIVE/INVASIVE
- INC SI stability
- pregnancy, post-partum moms, gen. instability
Trunk orthoses
Corsets (fabric)
- 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
MOST COMMONLY Rx’d supporting orthosis for pts w/ LOW BACK PAIN
Lumbosacral corsets
What should you remember about lumbosacral corsets?
MOST COMMONLY RX’D ORTHOSIS FOR LOW BACK PAIN!!!
Lumbosacral Corsets
*think LBP!!!!
- 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
Lumbosacral Corsets
Good for and Bad for
- MOST effective→ acute LBP, no evidence long term use
- MINIMAL effective→ discogenic pain, no lift to off-load disc
When you hear “Traditional” think….
Metal and Leather
Traditional Metal & Leather Spinal orthoses
- 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”
Chairback Orthosis
Function/Indications
- Controls motion in sagittal plane primarily
- Indicated→ reduction of gross and intersegmental flexion/extension
Chairback Orthosis
Trunk flexion limited by:
-
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***
Chairback Orthosis
Trunk EXT limited by:
-
Trunk EXT→ limtd by two anterior directed forces applied across thoracic and pelvic bands
- Oppose a posterior directed force @ midpoint of corset panel
Chairback Orthosis drawbacks:
Limtd unloading of spine/dec intradiscal pressure→ marginal
Chairback Orthosis in a nutshell…
- Flexion limtd by→ posteriorly directed forces so you cannot flex
- Extension limtd by→ anteriorly directed forces so you cannot extend
Knight LSO
Only things to know***
- Controls motion in sagittal AND coronal/frontal planes
- Profile laterally goes higher up on trunk→ limit lateral flexion***
Jewett and CASH orthoses
Limit trunk ________ while encouraging trunk __________
LIMIT trunk FLEX
ENCOURAGE trunk HYPEREXT.
Jewett and CASH orthoses when you see these think…..
“Jews + Cash” HATE trunk FLEXION, so they LIMIT it, Jews+CASH LOVE HYPEREXTENSION so they ENCOURAGE it!!!
Jewett and CASH orthoses
- Dramatically LIMIT FLEX and ENCOURAGE HYPEREXT.
-
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)
compression fxs of VB, OP, MVAs
Jewett + CASH
Jewett
see pics
CASH Orthosis
see pics
Long term use is NO BUENO w/ this
Cervical orthosis→ soft collar
Cervical Orthoses
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
Cervical Orthoses
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
MAX Control Cervical orthosis
HALO****
Cervical Orthoses
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
Cervical orthoses
BEST OPTION FOR STABILITY
HALO!!!
Cervical orthoses:
Halo: 3 components
- Ring and skull pins
- Superstructure→ bars attach vest to ring
- Vest→ Pt of stability for whole system
Scoliosis Info pics
Know how named, what is happening (rotation wise), named for, etc…
see pics
Scoliosis
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
Spinal Orthoses→ Mgmt of Scoliosis
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
Mgmt of Scoliosis
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)
Mgmt of Scoliosis
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
Spinal Orthoses→ Idiopathic scoliosis
Contributors/causes
- Genetics, growth velocity, lig imbalances, mm imbalances, vestib/CNS dysf (cannot maint. horizon*)
- Multifactorial→ one mech may relate to curve dev./progression
Idiopathic scoliosis
%’s
- 89%→ ID’d in ado.→ can be fixed
- Smaller curves→ <15-20*→ not seen or symptomatic
Idiopathic Scoliosis
Indicated when ?
Skeletally immature children w/ curves bw 30-45*
*w/ exercise→ good outcomes for prevention
*BEST outcomes when wear full-time!
Idiopathic scoliosis
No efficacy w/ spinal orthotic when?
Once curve progresses to 45* or more
Orthosis designed to:
Function of orthosis for scoliosis:
4 things:
- Stiffen spine artificially (passive rigid)
- Reduce curve w/ centralized force
- Raise critical load (spine begins to bend, critical angle 25*)
- Reduce likelihood add. deformation
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*
Spinal Orthoses-Scoliosis
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
All scoliosis braces do this:
use biomech. principles of end point control, curve correction and cont. transverse support
Scoliosis correction/bracing
If we address the lateral curvature, what happens as a result of this as well?
Fixes rotational component
3 point system for Scoliosis bracing
see pics
NOTE: R. sided thoracic, L. side lumbar scoliosis
Charleston bending brace and scoliosis
what should you remember???
Biggest indentation side===side of CONVEXITY
*trying to get them bent back other way
Spinal orthoses→ Milwaukee and Boston
Notes to look for
- LOOK FOR:
- indentation in brace==> convex side===how scoliosis named
- pressure pad on T/S===convex side==side of scoliosis
Spinal Orthoses→ Goals for scoliotic orthotic intervention:
3:
- Derotation→ lateral curve reduced===spinal rotation reduced
- Spinal balance→ head+mass of body centered over pelvis
-
Delay/eliminate need for sx
- child/ado’s→
- Ferraro noted→ 80% spinal growth achieved by 10yo
- child/ado’s→
Spinal Orthoses→ Scoliosis
Degree of correction depends on 4 factors:
EASY TO REMEMBER BC IT MAKES SENSE!!!
- Positioning of pad
- Magnitude of corrective force applied by pad
- Direction of applied force (is it going right direction based on where convex side is?)
-
Duration of forces applied
- ***Need looooooong pds of time (18-24hrs)
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
Apex of curve @ T7 or ABOVE
Milwaukee
Apex of curve BELOW T7
TLSO
APEX OF SCOLIOTIC CURVE
Those @ risk for curve progression: better mng’d w/:
CTLSO
*bc biomech. advantage for in-brace curve correction
Crucial for correcting scoliotic curve
WEARING TIME COMPLIANCE!!!!
Schroth Method→ Non-Sx PT Approach
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.
Schroth Method
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
