Lecture 5: Spine Orthoses Flashcards
major functions of spine orthoses
- limit motion to reduce pain, protect unstable segments, and facilitate healing
- support trunk/neck to reduce loads
- correct or limit progression of deformity
- remind user to maintain appropriate posture
soft vs rigid spine orthoses
soft
- made from fabrics, elastic, neoprene
- may have rigid elements to add support
- i.e. corsets or belts
rigid
- made from polyethylene or other plastics
- single piece or multiple pieces attached with straps
effectiveness of spine orthoses relies on
points of application
- at least 3
- direction and magnitude of forces
device fit
compliance
how is transverse plane motion controlled with spine orthoses
need 4 point pressure system
immobilization challenges with spine orthoses
extremely mobile joint complex with multiple planes
little body surface available for contact
- high incidence of skin breakdown (occiput/chin)
- pressure related pain common (clavicles, chin)
- hygiene issues limit comfort (shaving)
negative effects of spine orthoses
axial mm atrophy secondary to diseases
immobilization can promote contracture or ROM limits
excess pressure, irritation, and moisture can lead to skin breakdown
psychological dependency
normal spine motion
occiput/C1 = primarily flx/ext
C1-C2 = primarily RT
C2-C7 = flex/ext, lateral flx, and RT
T spine = greater RT than L/S
describe soft cervical orthoses
prefabricated
do not limit C/S motion
ineffective for providing protection or stabilization for acute and chronic WAD or other mechanical disorders
describe semi rigid cervical orthoses
prefabricated
used to stabilize spine post trauma (hole in neck for tracheostomy)
provide general support but not rigid immobilization
- control flexion better than extension
- least effective controlling frontal plane and transverse plane motion
when is use of cervical collars NOT supported post sx
s/p anterior or posterior discectomy and fusion
are cervical orthoses recommended post WAD
no
are COs recommended post trauma
no
CO indications for cervical fxs
semi-rigid
NecLoc CO better at controlling ROM than Philadelphia and Aspen Collars
are COs indicated for neck pain with radiating pain
yes
short term use of CO
what is grade III neck pain and does this indicate use of CO
defined as neck pain with:
- sensory S&S in arm
- limited/painful ROM
- motor disturbances such as UE weakness
CO can be used for pain reduction; should be used sparingly (only for short periods per day and only for a few weeks)
CO complications
skin breakdown (occiput, chin, mandible, ears, shoulders, Adam’s apple, sternum)
- increased risk if edema is present
limits with swallowing, coughing, breathing, and vomiting; could aspirate
general immobility
increased ICP
psychological dependence
what is a CTO
provide greater restriction of segmental and regional motion, especially at lower C/S
more effective than COs at controlling frontal and transverse plane motion
describe post type CTO
more restrictive and cooler than collar
more difficult to don/doff
2 and 4 post control flx/ext well
4 post are better at controlling frontal and transverse plane motion
describe sternal occipital mandibular immobilizer (SOMI)
3 post
no posterior thoracic plate
- more comfy for pts in supine
- pt likely not permitted to be upright without orthotic
indicated for those with instability at or above C4
most effective controlling flexion C1-C3
least effective at controlling ext
uses for Halo orthoses
to create traction (uni or bilateral)
reduce cervical dislocation
cervical fx with or without SCI
gold standard for upper C/S immobilization of frontal and transverse plane
contraindications for Halo
unstable spinal fx
traumatized skin overlying pin sites
complications for halo
6th cranial nn palsy
pin loosening/infection
CTO indications for C/S fx
cervical collars do NOT immobilize unstable vertebrae
halo orthoses control upper C/S best
minera orthosis controls lower C/S best
odontoid fx CTO indication
Halo best at resisting motions compared to minerva and Miami collar
what are rigid trunk orthoses
most often made of molded plastic
purpose = protect spine and facilitate healing
utilize 3 point counterforce system
purposes of TLSO
restrict spinal motion
limit thoracic flexiona or supporting an excessive thoracic kyphosis
prevent progression of scoliotic curves
- depending on design can alter breathing patterns; reduced total volume and increased RR
TLSO and LSO trunk control
sagittal = rigid AP panel
frontal = rigid panel in mid axillary line
transverse
- LSO = less effective at controlling RT since trunk RT mainly happens at T/S
- TLSO = more effective at controlling transverse plane trunk movement
types of rigid LSOs
chair back
- sagittal plane control
knight LSO
- sagittal and frontal plane control
clamshell body jacket
- sagittal, frontal, and transverse plane control
TSLO indications after T/S sx
controls all planes of movement
don/doff in supine since pt may not be allowed to be upright without wearing brace
TLSO indication for T/S and L/S vertebral fxs
restricts motion from T6 to L1
limit flexion, allows extension
evidence suggests no additive benefit of orthoses
TLSO indication fro osteoarthritis and rheumatoid arthritis
restricts motion from T6 to L1
limit flexion, allows ext
TLSO indication for kyphosis and osteoporosis
evidence suggests similar outcomes to postural training in adults
LSO indication for chronic LBP due to degenerative joint disease
use of custom rigid lumbar brace for 3 months may reduce pain intensity
describe soft lumbosacral corsets
minimal impact on sagittal and transverse plane movement
restricts some frontal plane movement
mixed evidence on impact on back and abdominal mm strengthening
LSO indication for weight lifting
back braces may relieve pain per self report
also important to edu on proper form
describe sacroiliac belts
used in pts with LBP due to hypo mobility
assist with stabilizing SIJ
best evidence for LBP or pelvic pain during pregnancy
PT, manipulation, acupuncture, multi modal interventions, or addition of rigid pelvic belt to exercise seemed to relieve pelvic or back pain more than usual care alone
general info to know about scoliosis
common in adolescents and females
LBP prevalence = 40%
onset at younger age and larger curve = worse prognosis
types of scoliosis
idiopathic
congenital
neuromuscular
what is neuromuscular scoliosis
due to mm imbalance and/or weakness
common in pts with CP, muscular dystrophy, SCI, or with leg length discrepancy
how is a scoliotic curve described
based on direction of CONVEXITY and location in spine
rib hump is generally on what side of the scoliotic curve
same side as convexity
sx options for scoliosis
long spinal fusion
common if curve is greater than 45 deg
goal of orthotic management with scoliosis
prevent worsening of curve until growth stops
for those with adolescent idiopathic:
- worn during times of growth
- recommended for curves between 25-45 deg that have progressed at least 5 deg since initial detection
daytime vs nighttime scoliosis braces
daytime = work minimum of 18 hours; preferable 23 hours/day
nighttime = worn 8-10 hours per day 5-7 nights/week
bracing recommendations for idiopathic scoliosis
first step to avoid or postpone sx
brace for curves 20 deg +/- 5 that are progressing
rigid bracing recommended for infants and curves between 45-60 deg to avoid sx
full time wear or no less than 18 hours/day
brace worn until end of bony growth
monitor compliance and brace for
periodic radiographs to monitor effectiveness of brace
describe Milwaukee brace
CTLSO
good for superior curves
supically used for curves with apex T6 or above
Describe Boston orthosis
custom TLSO
good for lower thoracic and lumbar curves
brace wear was considered successful (curve didn’t progress to 50 deg) in 72% pts (68% with Boston brace)
outcomes improved with brace wear time
describe Wilmington brace
custom total contact TLSO
curve progressed (>5 deg) for compliance around 62%
curve did not progress with compliance >85%
describe the Charleston custom bending brace
custom TLSO
over corrects curve
most effective for curves with apex below T7
recommended for curves 20-40 deg
describe the providence scoliosis system
custom TLSO
over corrects curve
more often used for S curves than Charleston bending brace
describe SpineCor
dynamic brace
good for early prevention
should be worn >20 hours/day
may not be as effective as rigid braces
