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Year 3: Prosthetics and Orthotics > Lecture 5: Spine Orthoses > Flashcards

Lecture 5: Spine Orthoses Flashcards

1
Q

major functions of spine orthoses

A
  1. limit motion to reduce pain, protect unstable segments, and facilitate healing
  2. support trunk/neck to reduce loads
  3. correct or limit progression of deformity
  4. remind user to maintain appropriate posture
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2
Q

soft vs rigid spine orthoses

A

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

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3
Q

effectiveness of spine orthoses relies on

A

points of application
- at least 3
- direction and magnitude of forces

device fit

compliance

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4
Q

how is transverse plane motion controlled with spine orthoses

A

need 4 point pressure system

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5
Q

immobilization challenges with spine orthoses

A

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)

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6
Q

negative effects of spine orthoses

A

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

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7
Q

normal spine motion

A

occiput/C1 = primarily flx/ext

C1-C2 = primarily RT

C2-C7 = flex/ext, lateral flx, and RT

T spine = greater RT than L/S

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8
Q

describe soft cervical orthoses

A

prefabricated

do not limit C/S motion

ineffective for providing protection or stabilization for acute and chronic WAD or other mechanical disorders

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9
Q

describe semi rigid cervical orthoses

A

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

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10
Q

when is use of cervical collars NOT supported post sx

A

s/p anterior or posterior discectomy and fusion

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11
Q

are cervical orthoses recommended post WAD

A

no

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12
Q

are COs recommended post trauma

A

no

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13
Q

CO indications for cervical fxs

A

semi-rigid

NecLoc CO better at controlling ROM than Philadelphia and Aspen Collars

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14
Q

are COs indicated for neck pain with radiating pain

A

yes

short term use of CO

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15
Q

what is grade III neck pain and does this indicate use of CO

A

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)

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16
Q

CO complications

A

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

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17
Q

what is a CTO

A

provide greater restriction of segmental and regional motion, especially at lower C/S

more effective than COs at controlling frontal and transverse plane motion

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18
Q

describe post type CTO

A

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

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19
Q

describe sternal occipital mandibular immobilizer (SOMI)

A

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

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20
Q

uses for Halo orthoses

A

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

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21
Q

contraindications for Halo

A

unstable spinal fx

traumatized skin overlying pin sites

22
Q

complications for halo

A

6th cranial nn palsy

pin loosening/infection

23
Q

CTO indications for C/S fx

A

cervical collars do NOT immobilize unstable vertebrae

halo orthoses control upper C/S best

minera orthosis controls lower C/S best

24
Q

odontoid fx CTO indication

A

Halo best at resisting motions compared to minerva and Miami collar

25
Q

what are rigid trunk orthoses

A

most often made of molded plastic

purpose = protect spine and facilitate healing

utilize 3 point counterforce system

26
Q

purposes of TLSO

A

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
27
Q

TLSO and LSO trunk control

A

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
28
Q

types of rigid LSOs

A

chair back
- sagittal plane control

knight LSO
- sagittal and frontal plane control

clamshell body jacket
- sagittal, frontal, and transverse plane control

29
Q

TSLO indications after T/S sx

A

controls all planes of movement

don/doff in supine since pt may not be allowed to be upright without wearing brace

30
Q

TLSO indication for T/S and L/S vertebral fxs

A

restricts motion from T6 to L1

limit flexion, allows extension

evidence suggests no additive benefit of orthoses

31
Q

TLSO indication fro osteoarthritis and rheumatoid arthritis

A

restricts motion from T6 to L1

limit flexion, allows ext

32
Q

TLSO indication for kyphosis and osteoporosis

A

evidence suggests similar outcomes to postural training in adults

33
Q

LSO indication for chronic LBP due to degenerative joint disease

A

use of custom rigid lumbar brace for 3 months may reduce pain intensity

34
Q

describe soft lumbosacral corsets

A

minimal impact on sagittal and transverse plane movement

restricts some frontal plane movement

mixed evidence on impact on back and abdominal mm strengthening

35
Q

LSO indication for weight lifting

A

back braces may relieve pain per self report

also important to edu on proper form

36
Q

describe sacroiliac belts

A

used in pts with LBP due to hypo mobility

assist with stabilizing SIJ

37
Q

best evidence for LBP or pelvic pain during pregnancy

A

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

38
Q

general info to know about scoliosis

A

common in adolescents and females

LBP prevalence = 40%

onset at younger age and larger curve = worse prognosis

39
Q

types of scoliosis

A

idiopathic
congenital
neuromuscular

40
Q

what is neuromuscular scoliosis

A

due to mm imbalance and/or weakness

common in pts with CP, muscular dystrophy, SCI, or with leg length discrepancy

41
Q

how is a scoliotic curve described

A

based on direction of CONVEXITY and location in spine

42
Q

rib hump is generally on what side of the scoliotic curve

A

same side as convexity

43
Q

sx options for scoliosis

A

long spinal fusion

common if curve is greater than 45 deg

44
Q

goal of orthotic management with scoliosis

A

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

45
Q

daytime vs nighttime scoliosis braces

A

daytime = work minimum of 18 hours; preferable 23 hours/day

nighttime = worn 8-10 hours per day 5-7 nights/week

46
Q

bracing recommendations for idiopathic scoliosis

A

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

47
Q

describe Milwaukee brace

A

CTLSO

good for superior curves

supically used for curves with apex T6 or above

48
Q

Describe Boston orthosis

A

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

49
Q

describe Wilmington brace

A

custom total contact TLSO

curve progressed (>5 deg) for compliance around 62%

curve did not progress with compliance >85%

50
Q

describe the Charleston custom bending brace

A

custom TLSO

over corrects curve

most effective for curves with apex below T7

recommended for curves 20-40 deg

51
Q

describe the providence scoliosis system

A

custom TLSO

over corrects curve

more often used for S curves than Charleston bending brace

52
Q

describe SpineCor

A

dynamic brace

good for early prevention

should be worn >20 hours/day

may not be as effective as rigid braces

Year 3: Prosthetics and Orthotics (10 decks)

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