Orthotic Considerations for the Spine Flashcards
what does SIO stand for, and what does it encompass
Sacroiliac Orthosis - encompass the sacral and iliac regions of the lower spine and pelvis
what does LSO stand for, and what does it encompass
Lumbosacral Orthosis - encompass the lumbar and sacral regions of the lower spine
what does TLSO stand for, and what does it encompass
Thoracolumbosacral Orthosis - encompass the cervical, thoracic, lumbar, and sacral regions of the spine
what does CO stand for, and what does it encompass
Cervical Orthosis - encompass the cervical spine
what does CTO stand for, and what does it encompass
Cervicothoracic Orthosis - encompass the cervical and thoracic region
what does HCTO stand for, and what does it encompass
Head-Cervical-Thoracic Orthosis - encompass the head, cervical, and thoracic region
Custom or Stock:
Ordered according to measurements taken of patient and is presized (S, M, L, XL)
stock
Custom or Stock:
This mechanism is likely to increase probability of appropriate fit and function
Custom
Custom or Stock:
Patient is casted or measured followed by orthotic fabrication to meet the exact dimensions of the cast
Custom
Custom or Stock:
More difficult to obtain proper fit due to body morphology and size of anatomic landmarks
Stock
what are the three major functions of spinal orthoses
- Immobilize gross spinal motions (limit the trunk in all degrees of freedom)
- Immobilize individual motion segments (reduce range of motion of an intervertebral segment)
- Apply external forces to correct deformity or prevent progression of a deformity
Thee indications for spinal orthoses
- Immobilize gross spinal motions (limit the trunk in all degrees of freedom)
- Immobilize individual motion segments (reduce range of motion of an intervertebral segement)
- Apply external forces to correct deformity or prevent progression of a deformity
Three indications for spinal orthoses in the category of:
Immobilize gross spinal motions (limit the trunk in all degrees of freedom)
- muscle strain, ligament sprain
- whiplash soft tissue injury
- NM based trunk weakness
Two indications for spinal orthoses in the category of:
Immobilize individual motion segments (reduce range of motion of an intervertebral segment)
- Spondyloslisthesis
2. s/p Spinal fusion
Two indications for spinal orthoses in the category of:
Apply external forces to correct deformity or prevent progression of a deformity
- Idiopathic scoliosis
2. Scheuermann’s Disease
for patients with spondyloslisthesis, what is the orthosis trying to do
keep them out of extension and bring them into flexion
Similar to the principles applied to other body regions, motion in spinal orthoses is controlled utilizing either __ or ___.
using 3 point or 4 point pressure systems
in general, where does the primary force originate when trying to correct a scoliosis
at the convex side projecting into concavity
spinal curves are named according to the…
convexity
3 point system controlling R lower thoracic curve (general)
Primary: Originating at the convexity on the R side, projecting medially
Secondary: above and below the convexity on the concave side (at the trimlines)
is the control of rotation at the spine and control of rotation at the hip the same?
no, it is significantly different
why is controlling rotation in the spine and at the hp significantly different
osteokinematics
rotation in the spine will be controlled through…
a four point pressure system
why is a four point pressure system necessary to control rotation in the spine
it is necessary to manage the counter-rotation present between upper and lower trunk utilized in a variery of functional activities
controlling R rotation, what is the general 4 point system
Trunk:
- Posterior Right
- Anterior Left
Pelvis:
- Anterior Right
- Posterior Left
Indications for Cervical Orthoses (COs)
soft tissue injuries primarily due to trauma in which c-spine stability is not affected
what is the most mobile segment of the spine due to design
the cervical spine (7 vertebrae and surrounding soft tissue)
three types of COs
- flexible
- semi-rigid
- rigid
does the soft foam collar control motion? why or why not
no - no bars and no bands
purpose of the soft foam collar
reminds the patient to limit motion of the neck
does the soft foam collar provide stability
very little control of the cervical spine
what type of general CO is a Philadelphia Collar
semi-rigid
describe the outside of Philadelphia collar’s appearance
outer plastic/semi-rigid frame
describe the inside of Philadelphia collar’s appearance
inner soft pad or closed cell foam shell
why is the Philadelphia collar considered semirigid
rigid bars, no bands
CTOs are considered ______ COs
rigid
why is there increased control in CTOs
increased control due to materials and increased stability from the orthotic because the design extends down to the thoracic spine
indications of CTOs
- ligamentous injuries of cervical spine
- stable cervical spine fractures
- s/p cervical spine fusion/stabilization
in the two post design for rigid cervical orthoses, where do the anterior and posterior sections attach
anterior: mandibular portion
posterior: occipital portion
what is a key feature of the two post design in rigid cervical orthoses
shoulder straps
what does SOMI stand for relative to CTOs
Sterno-Occiplital-Mandibular Immobilizer
what type of post design in CTO
three point design
what type of patients use CTOs
patients with poor head control
what type of orthosis is a Halo Orthosis
CTO
indications for Halo Orthosis:
injury to C-Spine resulting in instability (fractures)
Halo Orthoses are an alternative to…
traction
how long are Halo Orthoses used for
immobilization for 6-12 weeks until fracture is healed/stable
what special consideration for care must be taken into consideration for halo orthoses
clean the pin sites where the halo goes into the skull
Three indications for Thoracic, Lumbar, and Sacral Orthoses
- increase intra-abdominal pressure
- intervertebral stabilization/support (segmental immobilization)
- global limitation of motion
a corset is a _______ orthosis
semi-rigid
what is a corset typically made of
canvas or dacron material, reinforced with vertical “stays”
on the corset, vertical “stays” are similar to
bars
what can the stays of a corset be made of
plastic or metal (with varying degrees of stability)
what parts of the spine can corset encompass
- sacral
- lumbosacral
- thoracolumbar sacral
a rigid spinal orthosis will have both ____ and ____ present
bars and bands
what must a rigid spinal orthosis be composed of
solid material such as metal or rigid plastic
what is the cause of an idiopathic scoliosis
no known cause
three types of scoliosis
- idiopathic
- neuropathic
- myopathic
to find the degree of present scoliosis, what method is commonly used
the Cobb method
describe the initial setup of using the Cobb method
choose the most tilted vertebrae above and below the apex of the curve
after the most tilted vertebrae has been found, then what (Cobb angle)
the angle between intersecting lines drawn perpendicular to the top of the top vertebrae and the bottom of the bottom vertebrae is the Cobb angle
what Cobb angle indicates surgery
greater than 40 degrees
are three point pressure systems utilized to control motion in the spine
yes
what is one of the earliest and most effective designs for idiopathic scoliosis
Milwaukee Orthosis
three indications for Milwaukee Orthosis
- scoliosis curves between 25-40 degrees
- children who are not yet skeletally mature
- apex of curve is at T8 or above
what design also adresses the problem of scoliosis, but is more appropriate for curves with an apex below T8
Boston TLSO
the Boston TLSO is higher on the same/opposite side of the convexity
higher on the opposite side of convexity
what does the Charleston Orthosis do
provides overcorrection of the curve in the opposite direction
what does the Charleston Orthosis attempt to control/correct
a scoliotic curve
what shaped curve is the Charleson Orthosis most appropriate to correct
C shaped
the Charleston Orthosis is known as…
An Overcorrection Orthosis
