S3 L2: Spinal Orthosis Flashcards by Naomi Nakazato

2 types of spinal orthosis

Flexible & Rigid

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Components are mostly cloth & bendable
material, do not have components to restrict movement

Flexible orthosis

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Purpose of a flexible orthosis

For sensorium/sensory feedback, does not
restrict movement at all (not entirely); biofeedback for postural correction

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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

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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

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Feature:
Pre-fabricated belt, 5.1 cm to 10.2 cm wide
Encircles the pelvis b/w the iliac crests and
trochanters

Sacroiliac belt

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Function of a sacroiliac belt

Stabilizes Sacroiliac joints

Additional:
Squeezes pelvis together
Pushes on perineum to increase intra-pelvic pressure

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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

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Where is the sacroiliac belt placed?

At the level of the sacrum

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The belt is placed under the perineum for further support and pushes the pelvis up

Traditional Type

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Acts as support to push/approximate pubis symphysis and SI joint together.

Sacroiliac corset

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A disadvantage of a traditional type

Approximates/gumagasgas sa singit, irritating for the pt

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An advantage of a traditional type

Lifts the entire perineum up which lessens pain.

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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

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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)

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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

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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

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It is wrapped around lumbar spine & does not restrict movement

Lumbar binder

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Feature: wrapped around the lumbar region and held in place by velcro closure

Lumbar binder

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Function of a lumbar binder

Trunk support through increasing intra-abdominal pressure (which provides increased pneumatic support)

Provides sensory feedback for proper posture

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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

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Feature:
○ Most common flexible orthosis for pts c LBP
○ Encompasses the torso and hips (entire lumbar
spine)

Lumbosacral corset

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Where does the anterior superior border of a lumbosacral corset end?

xiphoid process

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Where does the posterior superior border of a lumbosacral corset end?

inferior angle of the scapula

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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 ● Effective in elevating intra-abdominal pressure ○ Issues on the lower spine may be affected 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: ● 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