Lab 4: Spine Flashcards
What does CTO and CO stand for?
Cervical Thoracic Orthoses, Cervical Orthoses
Will a CTO or CO have a greater impact on restricting motion?
CTO because there is a longer level arm
What are the two types of designs for CTO and COs?
4 post and 3 post
Which is more restrictive, 3 post or 4 post?
4 post because it restricts cervical extension to a greater degree due to the additional vertical post located posteriorly
What type of device is a Halo?
Rigid
What movements are restricted with a Halo?
All movement, pressure systems are not considered
Is there axial loading with a Halo?
Moderate to full axial loading
When is a Halo indicated?
Unstable cervical fractures, post-surgery with or without SCI
What type of design does a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO have?
Rigid
What motions are controlled with a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO?
Full to moderate flexion and extension. Moderate lateral flexion and rotation
Describe the force system to control flexion with a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO
Primary: originates posteriorly from the inferior portion of the occipital pad and superior portion of the interscapular pad and is directed anteriorly
Secondary: originates anterior from the mandibular pad and is directed superior-posterior
Secondary: originates anterior from the sternal pad and is directed posteriorly
Describe the force system to control extension with a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO
Primary: originates anteriorly from the inferior aspect of the mandibular pad and superior portion of the sternal pad and is directed posterior
Secondary: originates posterior at the occipital pad and is directed anterior
Secondary: originates posterior at the interscapular pad and is directed anterior
Describe the force system to control RIGHT lateral flexion with a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO
Primary: originates from the inferior aspects of the left mandibular and occiput pads and is directed right
Secondary: originates from the right mandibular and occipital pads and is directed diagonal up and to the left
Secondary: originates from the right shoulder pad and is directed diagonally inferior and to the left
Describe the force system to control RIGHT rotation with a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO
Primary: originates from the right side of the mandibular pad and is directed left
Primary: originates from the left side of the occipital pad and is directed right
Secondary: originates anterior from the right side of the sternal pad and is directed posteriorly
Secondary: originates posterior from the left interscapular pad and is directed anteriorly
Is there axial unloading with a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO?
Moderate axial unloading
When is a 3 or 4 Poster Flexion, Extension, Lateral, Rotation Control CTO indicated?
Cervical fusion, laminectomy, discectomy
What does SOMI stand for?
Sternal Occipital Mandibular Immobilizer
What design is a SOMI?
Rigid
What movements are controlled by a SOMI?
Full flexion, minimal lateral flexion and rotation, no extension control
Describe the force system to control flexion with a SOMI
Primary: originates posterior from the occipital pad and is directed anterior
Secondary: originates anterior from the mandibular pad and is directed posterior and superior
Secondary: originates anterior from the sternal pad and is directed posterior
Is there axial loading with a SOMI?
Minimal to moderate
When is a SOMI indicated?
Cervical arthritis, stable cervical fracture, fusion, following removal of halo
What are examples of a semi-rigid CO?
Philadelphia, Aspen, Malibu, Miami J
What motions are controlled with a semi-rigid CO?
Minimal control of cervical flexion. Other motions can be self-limited from tactile cues
Does a semi-rigid CO provide any axial unloading?
No
When is a semi-rigid CO indicated?
Stable mild cervical fractures, strain or sprain, weaning off of more stable CO
What movements are controlled in a semi-rigid adjustable plastic collar?
No motion control, does limit flexion
Does a semi-rigid adjustable plastic collar provide axial unloading?
No
When is a semi-rigid adjustable plastic collar indicated?
Soft tissue injuries to cervical area
What movements are restricted with a soft foam collar?
No movement is restricted. Will check flexion, extension, and sometimes lateral flexion
What is the purpose of a soft foam collar?
Increase awareness of injured area thus providing kinesthetic reminder to self-restrict. Provide warmth to area to provide comfort
When is a soft foam collar indicated?
Soft tissue injuries
What is a soft foam collar contraindicated?
Any bony or ligamentous injury
What movements are restricted with a SI belt?
None
What is the purpose of a SI belt?
Provide external reinforcement to a hypermobile joint. Arguably not effective
When is a SI belt indicated?
Stable pelvic fracture, post natal SI instability, SI strain
Describe the optimal fit for a SI belt
Superior: iliac crest
Inferior anterior: 1/2 - 1” above pubic symphysis
Inferior posterior: apex of gluteal bulge
What type of design is an abdominal elastic binder?
Flexible
What is the optimal fit for an abdominal elastic binder?
Superior: below xiphiod
Inferior: above ASIS
Does an abdominal elastic binder restrict movement?
No
What is the purpose of an abdominal elastic binder?
Increased abdominal pressure and influence posture. Improve diaphragmatic breathing with weakness
When is an abdominal elastic binder indicated?
SCI with involvement of abdominal musculature
What movements are restricted with a semi-rigid lumbosacral orthosis?
No motions. Flexion, extension, lateral flexion may be self-limited due to tactile cues
What is the function of a semi-rigid lumbosacral orthosis?
Prevent low back injury, increase intra abdominal pressure, reduce stress of posterior muscles and decrease lumbar load, influence posture, proprioceptive input
What type of design is a lumbosacral corset?
Semi-rigid
What is the optimal positioning for a lumbosacral corset?
Anterior: superior border is 1/2” below the xiphoid process, inferior border 1/2-1” above pubic symphysis
Posterior: superior border is 1” below inferior angle of scapula, posterior border just below apex of gluteal bulge for men and gluteal fold for women
Does a lumbosacral corset control or restrict motion?
Not technically, but it attempts to control overall gross trunk movements due to increased tactile cues
When is a lumbosacral corset indicated?
Reduced low back injury, diminish load on lumbar discs, increase intra abdominal pressure to improve posture, proprioceptive input
How can you tell the difference between LSO corset and a thoracolumbosacral corset?
Thoracolumbosacral will have axillary straps
Does a thoracolumbosacral corset restrict movement?
Technically no, but is self-limited due to tactile cues
When is a thoracolumbosacral corset indicated?
Increase in intra abdominal pressure, soft tissue injury to thoracic or lumbar spine, kyphosis secondary to osteoporosis, arthritis
What is the design style of a Knight LSO?
Rigid
Where should the thoracic band be positioned with a Knight LSO?
Superior border is at the level of T9-T10 or 1” below the inferior angle of the scapula
Where should the pelvic band be positioned with a Knight LSO?
Positioned laterally between the greater trochanter and the iliac crests. Inferiorly should ended into the gluteal region without impeding sitting. Central portion is elevates over the sacrum
Where should the paraspinal bars be positioned with a Knight LSO?
Over the bulge of the paraspinal muscles avoiding contact with the spinous processes
What motions are controlled with a Knight LSO?
Flexion, extension, lateral flexion
Describe the force system to control flexion with a Knight LSO
Primary: originates posterior from the middle portion of the paraspinal bars and is directed anterior
Secondary: originates anterior at thoracic and pelvic straps or superior and inferior portions of abdominal corset and are directed posteriorly
Describe the force system to control extension with a Knight LSO
Primary: originates anteriorly from the middle portion of the abdominal corset and is directed posteriorly
Secondary: originates posteriorly from the thoracic and pelvic band and is directed anterior
Describe the force system to control RIGHT lateral flexion with a Knight LSO
Primary: originates from the medial portion of the left lateral bar and is directed right
Secondary: originates from the superior and inferior portions of the right lateral bar and is directed left
When is a Knight LSO indicated?
Originally designed for pts who had TB resulting from Potts. Spondylolysis, LBP, disc herniation
What motions are controlled with a William?
Extension and lateral flexion
Describe the force system to control extension with a Williams
Primary: originates anteriorly from the central portion of the abdominal corset and is directed posteriorly
Secondary: originate posteriorly from the thoracic and pelvic bands and is directed anteriorly
Describe the force system to control RIGHT lateral flexion with a Williams
Primary: originate from the medial portion of the left lateral bar and is directed right
Secondary: originate from the superior and inferior portions of the right lateral bar and are directed left
How does the Williams compare to the Knight?
Williams allows flexion while the Knight restricts flexion. They both restrict lateral flexion
When is a Williams indicated?
Spondylolysis, spondylolisthesis to maintain the spine in lumbar flexion to decrease shear and allow for healing
What type of design is the Jewett?
Rigid
Describe the optimal fit of the Jewett
Sternal pad: 1” below clavicle
Suprapubic pad: 1” above pubic symphysis
Lateral bars: mid axillary line
Lumbar pad: between mid thoracic and high lumbar region
What motions are controlled with the Jewett?
Flexion
Describe the force system to control flexion with the Jewett
Primary: originates posterior at the lumbar pad and is directed anteriorly
Secondary: originates anterior at the sternal and suprapubic pads and is directed posterior
Does the Jewett control lateral flexion?
No because the lateral bards are short
When is the Jewett indicated?
Traumatic compression fractures, Scheuermann’s disease. Is not effective for managing thoracic kyphosis
What design is the Taylor?
Rigid
Describe the optimal fit for the Taylor
Interscapular band across the distal 1/3 of the scapula and extends laterally to 2” from axillary fold
What motions are controlled by the Taylor?
Flexion and extension
Describe the force system to control flexion with a Taylor
Primary: originates posterior from the middle portion of the paraspinal bars and is directed anterior
Secondary: originates anterior from the axillary and pelvic straps and is directed posterior
Describe the force system to control extension with a Taylor
Primary: originates anteriorly from the abdominal corset and axillary straps and is directed posteriorly
Secondary: originates posterior from the interscapular band or superior portion of the paraspinal bars and pelvic band and is directed anteriorly
Generally describe the purpose of a body jacket
Custom molded, maintain total contact, control triplanar motion for maximal stability
Describe the optimal positioning for a BOB
Anterior: just below xiphoid to just above pubic symphysis
Posterior: just below inferior angle to just above sacralcoccygeal junction and encompass gluteal mass
What motions are controlled with a BOB?
Flexion, extension, lateral flexion
Describe the forces to control flexion with a BOB
Primary: originates posterior from the central portion of the brace and is directed anterior
Secondary: originates anterior from superior and inferior borders and is directed posterior
Describe the force system to control extension with a BOB
Primary: originates anterior from the central portion and is directed posteriorly
Secondary: originates posteriorly from the superior and inferior borders and is directed anteriorly
Describe the force system to control RIGHT lateral flexion with a BOB
Primary: originates from the left middle portion of the brace and is directed right
Secondary: originates from the right superior and inferior lateral portion of the brace and is directed left
When is a BOB indicated?
Stable non-compression fractures of lumbar vertebrae, spondylolysis, spondylolisthesis
What orthosis is shown in the picture?
TLSO Body Jacket
What motions are controlled with a TLSO body jacket?
Spinal flexion, extension, lateral flexion, rotation
Describe the force system to control flexion with a TLSO Body Jacket
Primary: originates from the medial portion of the posterior brace and is directed anterior
Secondary: originates from the superior and inferior borders of the anterior portion of the brace and is directed posteriorly
Describe the force system to control extension with a TLSO Body Jacket
Primary: originates from the medial portion of the anterior aspect of the brace and is directed posteriorly
Secondary: originates from the superior and inferior border of the posterior portion of the brace and is directed anterior
Describe the force system to control RIGHT lateral flexion with a TLSO Body Jacket
Primary: originates from the middle of the left lateral portion of the brace and is directed right
Secondary: originates from the superior and inferior right lateral portion of the brace and is directed left
What do you have to consider when analyzing force systems to control rotation with a TLSO Body Jacket?
Upper and lower trunk rotate opposite of each other
Describe the force system to control RIGHT upper trunk rotation and LEFT lower trunk rotation with a TLSO Body Jacket
Upper trunk:
Primary: originates anterior from the superior left portion of the brace and is directed posterior
Secondary: originates posterior at the superior right lateral portion of the brace and is directed anterior
Lower trunk:
Primary: originates anterior at the right inferior portion of the brace and is directed posterior
Secondary: originates posterior at the left lateral inferior portion of the brace and is directed anterior
When is a TLSO Body Jacket indicated?
Following trauma or surgically repaired fracture, spinal fusion, disc herniation or surgery, significant weakness of muscular imbalance, accommodate a rigid deformity
What conditions might a pt have that leads you to prescribe a TLSO Body Jacket?
CP, MD, spina bifida, SCI
When would a CTLSO be used instead of a TLSO Body Jacket?
When there are multiple spinal fractures or a cervical fracture combined with severe kyphosis
What type of force system is used to control an S shaped scoliosis?
4 point
What side does the primary force originate on when controlling a scoliosis curve?
Convex
What type of orthosis is shown in the image?
Milwaukee
Describe the optimal fit of the cervical ring for a Milwaukee
Holds the mandibular and occipital pads which rest 20-30 mm inferior to the occiput and mandible
Where are axillary thoracic and lumbar pads places in a Milwaukee?
At the points of convexity within the spine. Forces are applied via ribs to control alignment of the vertebrae
What is the purpose of a trochanteric extension?
To expand the force system by increasing the leverage for correction. Extension should not interfere with sitting
When is a Milwaukee CTLSO indicated?
Scoliosis curves between 25-40 degrees in children who have not reached skeletal maturity. Apex of the curve has to be at T8 or above
Describe the force system to control a RIGHT thoracic, LEFT lumbar curve with a Milwaukee CTLSO
1) originates at the right thoracic pad and is directed left
2) originates at the left axillary pad and is directed right
3) originates at the inferior left lateral border of the pelvic girdle and lumbar pad and is directed right
4) originates at the right inferior lateral border of the pelvic girdle and is directed left
How often should a Milwaukee CTLSO be worn?
23 hours per day until the child has reached skeletal maturity, which is determined by x-ray
What type of orthosis is shown in the image?
Rigid custom body jacket for scoliosis – TLSO
What is the purpose of a fenster?
Create an opening for the ribs to expand. Will always be located on the opposite side of the convexity
How high will a custom TLSO for scoliosis extend posteriorly?
T8
Will the lateral border of a custom TLSO for scoliosis extend higher on the same side or opposite side of the convexity?
Opposite side for increased leverage, lower on the side of the convexity to allow for active lateral shift to correct deformity
What is the appropriate clearance for an axillary band on a custom TLSO for scoliosis?
1-1.5” inferior to the axilla
When is a custom TLSO for scoliosis indicated?
Curves between 25-40 degrees in children who have not reached skeletal maturity and the apex of the curve is below T8
Describe the pressure system to correct a RIGHT thoracic LEFT lumbar curve with a custom TLSO for scoliosis
1) originates at the right thoracic pad and is directed left
2) originates at the left axillary band and is directed right
3) originates at the left lumbar pad and is directed right
4) originates at the right inferior border of the brace and is directed left
Describe the differences between a custom TLSO for scoliosis and a Milwaukee
Milwaukee can provide better leverage for correction and easily be modified for growth
What degree of scoliosis curve is an indication for surgery?
Greater than 40 degrees
What type of orthosis is shown in the image?
Overcorrection Orthosis for Scoliosis
When is an overcorrection orthosis indicated?
C-shaped curves between 25-40 degrees in children who have not reached skeletal maturity
If there is a trochanteric extension on an overcorrection curve, what side will it be on in relation to the convexity?
Opposite side of the convexity
What is the wear schedule for an overcorrection orthosis?
Only at night due to the limited ability to sit and stand while wearing
