S3 L2: Spinal Orthosis Flashcards
2 types of spinal orthosis
Flexible & Rigid
Components are mostly cloth & bendable
material, do not have components to restrict movement
Flexible orthosis
Purpose of a flexible orthosis
For sensorium/sensory feedback, does not
restrict movement at all (not entirely); biofeedback for postural correction
How do flexible orthoses provide spinal
stability? (2)
By helping to strengthen the abdominal muscles for proper stabilization of the spine
Bracing increases intra-abdominal pressure for pneumatic support
T/F: Spinal orthoses generally limit movement, esp for traumatic cases such as fx of the spine (e.g. vertebral fracture)
True: Fx could endanger spinal cord
Feature:
Pre-fabricated belt, 5.1 cm to 10.2 cm wide
Encircles the pelvis b/w the iliac crests and
trochanters
Sacroiliac belt
Function of a sacroiliac belt
Stabilizes Sacroiliac joints
Additional:
Squeezes pelvis together
Pushes on perineum to increase intra-pelvic pressure
Special considerations for sacroiliac belt
Used in post-partum and posttraumatic sacroiliac separations
○ Pelvic inlet is traumatized
○ Used during the latter part of pregnancy
trimester, prevents low back strain
○ 4th-5th month of pregnancy referred to rehab
Where is the sacroiliac belt placed?
At the level of the sacrum
The belt is placed under the perineum for further support and pushes the pelvis up
Traditional Type
Acts as support to push/approximate pubis symphysis and SI joint together.
Sacroiliac corset
A disadvantage of a traditional type
Approximates/gumagasgas sa singit, irritating for the pt
An advantage of a traditional type
Lifts the entire perineum up which lessens pain.
Features:
○ A cloth garment with the superior border located at the iliac crest both anterior and posterior sides.
○ Inferior border is located at the pubic symphysis and gluteal bulge, respectively.
Entire pelvis + gluteus maximus muscles are
lifted up
Sacroiliac corset
Functions of a sacroiliac corset (3)
Assist in elevating intra-abdominal pressure for pts who suff er from pelvic pain
Post-partum
Post-traumatic stabilization of pelvic joints (SI and pubic symphysis)
Special considerations for a sacroiliac corset (3)
○ Posterior rigid - lessen movement of the pelvis
○ Sacral pad - prevent irritation on the sacrum
○ Has pocket to conform to pt’s sacrum
Difference between a sacroiliac belt and corset
Belt:
Only at the level of the sacrum and does not reach iliac crest
Primary function is to stabilize SI joints, push on perineum to increase intra-pelvic pressure
Corset:
Strings features placed anteriorly
Reaches iliac crest
Primary function is to approximate symphysis + SI joint
It is wrapped around lumbar spine & does not restrict movement
Lumbar binder
Feature: wrapped around the lumbar region and held in place by velcro closure
Lumbar binder
Function of a lumbar binder
Trunk support through increasing intra-abdominal pressure (which provides increased pneumatic support)
Provides sensory feedback for proper posture
Additional function of a lumbar binder
For low back pain & body shaping
○ Gives sensory feedback on when to avoid
movements that aggravates lumbar pain
○ Mild cases of lumbar sprain
Feature:
○ Most common flexible orthosis for pts c LBP
○ Encompasses the torso and hips (entire lumbar
spine)
Lumbosacral corset
Where does the anterior superior border of a lumbosacral corset end?
xiphoid process
Where does the posterior superior border of a lumbosacral corset end?
inferior angle of the scapula
Functions of a lumbosacral corset (5)
○ Decrease loading on the vertebrae and discs by
inc pneumatic support of the spine and structural
support
○ Sensory feedback to restrict motion
○ May limit FEL (flexion, extension, lateral flexion)
but not rotation (rot happens on thoracic level)
○ Unloading any pain on pelvis & lumbar spine
○ Only for minimal cases
Coverage of a lumbosacral corset
Xiphoid process up to level of sacrum
What restricts lateral movement in a lumbosacral corset
Strings at the side acts as a pillar which restrict
lateral movements
What restricts extension in a lumbosacral corset
Rigid structure at the back restricts extension
Rigid structure at the back limits flexion
Rigid strap-like structure in front limits flexion
Feature:
○ Encompasses torso and hips
○ Anterior sup border: xiphoid area
○ Posterior sup border: level of scapular spines (middle level)
○ Velcro closure
Coverage is not up to breasts
■ Esp for females - painful
■ Compromise breathing
Thoracolumbar corset
Functions of a thoracolumbar corset
○ Trunk stabilization
○ Dec loading on vertebrae and discs
○ May restrict motion: FELR (flexion, extension,
lateral rotation, rotation)
Fit of a thoracolumbar corset
Require straps that wind around shoulder and
axillary area to provide support on thoracic spine and limit rotational movement
Require snug fit on the abdomen to increase
intraabdominal pressure
Motions restricted by a thoracolumbar corset
FELR (flexion, extension, lateral rotation, rotation)
Motions restricted by a lumbosacral corset
FEL (flexion, extension, lateral flexion)
T/F: Only a thoracolumbar corset and a lumbosacral corset can limit motion among the flexible spinal orthoses
True: others are mainly for biofeedback, not for restricting / limiting motion
Primary purpose of a rigid spinal orthosis (3)
Primary Purposes
● E ffective in elevating intra-abdominal pressure
○ Issues on the lower spine may be aff ected by
gravity — this adds to pain
○ Anterior and Lateral Uprights: Abdominal
Support
● Trunk motion is restricted
○ Lessen the pain about 5 folds vs flexible orthosis
● Skeletal alignment may be modified
○ “Hindi mo talaga siya mapipigilan”
○ Correcting the posture includes orthoses and
exercises
Components of a spinal orthosis (8)
Pelvic Band
Thoracic Band
Anterior Extensions of Thoracic Band with Subclavicular Pads (Cowhorns)
Lumbosacral and Thoracolumbosacral Posterior Uprights
Lateral Uprights
Oblique Lateral Uprights
Interscapular Band
Full-front Abdominal Support
Components of a spinal orthosis:
● Level of GT, above the inferior edge of the sacrum below the PSIS (aligned in 1 plane)
● Rigid component made from metal/aluminum
● Not usually bended
Pelvic Band
Components of a spinal orthosis:
● Counterpart of pelvic band
● Sup border: T9-T10 (below the inf angle) 2.5cm
● Like the lumbosacral corset
Thoracic band
Components of a spinal orthosis:
● Rigid component; curving around pec. major, ends just below the clavicle and lat to deltopectoral groove
● 5.1 cm in diameter
● Added for those exceeding the lumbar spine
Anterior Extensions of Thoracic Band with Subclavicular Pads (Cowhorns)
Components of a spinal orthosis:
● Sup. border: scapular spine / inf. angle
● Inf. border: inferior edge of the pelvic band
○ Placed along the paraspinal muscles
○ Must avoid bony prominence
● Limit trunk extension
Lumbosacral and Thoracolumbosacral Posterior Uprights
Components of a spinal orthosis:
● Ends at the edge of the thoracic and pelvic bands
● When added, it will restrict lateral movements
● There are spinal injuries that don’t need restriction of lateral movements
Lateral Uprights
Components of a spinal orthosis:
● Obliquely placed on both thoracic and pelvic bands
● When added, it will restrict rotational movements
Oblique Lateral Uprights
Components of a spinal orthosis:
● Crosses the distal 3rd of the scapula
● Usually placed for orthosis that extends beyond the lumbar spine
● Hold posterior uprights together
○ The band maintains alignment of uprights
● Limits friction during scapular movements
● Attachment of axillary straps
Interscapular Band
Components of a spinal orthosis:
● Crosses the distal 3rd of the scapula
● Usually placed for orthosis that extends beyond the lumbar spine
● Hold posterior uprights together
○ The band maintains alignment of uprights
● Limits friction during scapular movements
● Attachment of axillary straps
Interscapular Band
Components of a spinal orthosis:
● Placed on the abdomen itself
● Compress on the abdomen to increase pneumatic support
● When it’s tight, it will restrict flexion
● Dec axial loading on vertebrae and vertebral discs
Full-front Abdominal Support
Limits flexion and extension (lumbosacral)
Chairback orthosis
Lumbosacral Flexion-Extension (L-S FE) Control
“Si FE nasa chair”
Limits flexion, extension, lateral flexion (lumbosacral)
Knight Brace
Lumbosacral Flexion-Extension-Lateral (LS FEL) Control
“Si Knight na FEL, kay FE na nasa chair”
Limits extension, lateral flexion (lumbosacral)
William’s Orthosis
Lumbosacral Extension-Lateral (LS EL) Control
“Si Knight na FEL, kay FE na nasa chair, na EL na EL
kay William”
Slightly limits flexion, extension (thoracolumbosacral)
Taylor
Thoracolumbosacral Orthosis Flexion-Extension (TLSO FE) Control
“Fe Taylor”
Not entirely limit flex-ext because most of the thoracic movement is in rotation
○ No interscapular band
Compensatory LS flexion, extension
Limits flexion, extension, lateral flexion (thoracolumbosacral)
Knight-Taylor
Thoracolumbosacral Flexion-Extension-Lateral Flexion (TLSO FEL) Control
PT’s Goal: provide a movement that will lessen the CI/compensatory movement
Has cowhorn
Limits flexion, lateral flexion, rotation (thoracolumbosacral)
Cowhorn
Thoracolumbosacral Flexion Lateral Flexion Rotation (TLSO FLR) Control
“Cowhorn on the FLR”
Won’t limit extension on thoracic level bc di na umabot yung thoracic band, ends at the scapular spine
Limits flexion (thoracolumbosacral)
Anterior Hyperextension / Jewett Brace
Thoracolumbosacral Orthosis Flexion (TLSO F) Control
“Jewett mahilig mag-flex”
Hyperextend the spine to avoid kyphosis
For those c severe osteoporosis, kyphosis (slump pos)
Limits flexion variation (thoracolumbosacral)
CASH: Cruciform Anterior Spinal Hyperextension
TLSO F Control (Variation)
“Jewett nag-flex kasi may CASH”
CASH > Jewett
○ Provides flexion restriction, but more comfortable
○ Recommended for those c much stable spine thru the referral of a doctor
○ It is easier to don and do than the Jewett and
is better tolerated.
Immobilizes entire spine
TLSO Plastic Body Jacket
Recommended with severe destabilization of the spine (MVA, spinal fx)
Cervical orthosis that limits flexion and extension
FE Control
FE control that will only provide sensorium but not totally restrict movement
Soft Collar
FE control that is used for more restrictions of movements is needed
Rigid Collar
In FE control, although there is orthosis of the neck, does it decrease the loading on the axial spine?
Nope! In order to decrease, head should be lifted up.
What is the difference of the Philadelphia and the basic collar?
Philadelphia has a chin component
This cervical collar has more restriction of motion on the mandible & occiput as it tries to reposition the head in relation to the neck so that it will prevent further injury.
Philadelphia Collar
What are the actions limited by the Philadelphia collar?
Flexion, extension, lateral flexion, and rotation
Why is there severe limitation in flexion in the Philadelphia collar?
It depends on the component tree. If there is a chin component, it will definitely restrict flexion movement.
Why does the Philadelphia collar have a hole?
Surgery on the neck or for less irritation d/t moist
Aka SOMI that restricts flexion, extension, and rotation
FER Control
What are the uprights present in the FER Control and what are their purposes?
Anterior Upright: Hold the chin and limit flexion
Lateral Upright: Hold occipital piece and limits rotation
The length of the upright determines how much limitation the orthosis can provide. The longer the upright, _____ ?
The more it will provide axial load by pushing the neck upward.
T/F: The upright should be adjustable in order to perform basic ADLs that will require movement of the mouth.
True!
This cervical control is used primarily for eating but not definitive for treatment without mandibular support to allow for functional movement of the jaw.
FER Control (Variation)
Cervical orthosis where flexion-extension is greatly limited as compared with lat rotation. Aka Post Appliance or Four Poster
FELR Control
Why is the FELR Control also called Four Poster
Presence of four appliance/uprights around the neck
What upright is seen in FELR which is not seen in FER?
Posterior Uprights
Restricts all neck motions including some thoracic motions.
Custom Molded-Cuirass Orthosis
Why are there some thoracic motions limited in the Custom Molded-Cuirass Orthosis?
There are holes that extend to the back of the head and straps that extend to the level of the chest.
Aka Cervical Thoracic Orthosis
Extends up to the mid level of the thoracic area and indicated to pts c severe injuries of the neck and will require to be in a straight position and high cervical cord injuries.
Custom Molded-Minerva Orthosis
Most restricted of the custom molded and needs drilling of the skull
Custom Molded-Halo Orthosis
TLS; Used for mid-thoracic or lower scoliosis curves of 40 deg or less and S-type scoliosis
Boston Orthosis
CTLS; Has molded plastic pelvic jacket and one anterior and two posterior uprights extended to a superior neck or chest ring. Maybe used for all KYPHOTIC and scoliotic curves of 40 deg or less
Milwaukee Orthosis
CTLS; Presence of posterior uprights and contains straps and pads inside
Wilmington Orthosis
Pediatric orthosis that puts the child into a standing position with a desk on it for those who have difficulty in standing up
Standing Frame
Pediatric orthosis that is similar to a standing frame but the child has the opportunity to swing the leg backward and forward.
Swivel Walker
Pediatric orthosis that differs from the standing frame by virtue of joints that permit the wearer to sit and is indicated by myelodysplasia.
Parapodium
