Spinal And UE Orthotics Flashcards
What is an orthotic?
something used to support, align, prevent or correct deformities, or improve function
Purposes of an orthotic
support and align immobilize, restrict, or mobilize prevent or correct deformity substitute or enhance motion reduce pain and discomfort
Indications for a spinal orthotic
correct or prevent deformity, relieve pain, support fracture healing, post-op protection, prevent further injury, support and align
Spinal orthotic principles
- ____ pressure system
- increase ______
- Provide ______
- modify_____
- 3 point
- hydrostatic pressure
- kinesthetic reminder
- support systems
Spinal support systems
- muscles
- ligaments
- discs
Muscles- -flexors: psoas, abdominals -extensors: erector spinae, paraspinals Ligaments- linkage, transfer loads, smooth motion Discs- shock absorption
- Extrinsic stability
- Intrinsic stability
- muscles
- ligaments/discs
Soft collars
- facilitate_____
- limit _____
- provide _____
- spinal alignment
- some ROM
- kinesthetic reminder
What type of collar is a Headmaster collar?
soft
Name 3 types of semi-rigid collars
Philadelphia, aspen, miami J
Two types of cervical orthoses with thoracic extension
- SOMI (sternal occipital Mandibular immobilizer)- often used for bed bound pts.
- Lerman-Minerva
Halos
- tri planar motion control of cervical spine
- maximum immobilization
- restricts 90-95% of normal motion
- poor acceptance, high complication rate
Types of LSO
- flexible LSO
- Chairback LSO
- Knight LSO
What does a chairback LSO do?
restricts sagittal plane motion, tightening abdominal support reduces lumbar lordosis
What does a Knight LSO do?
restricts sagittal and coronal plane motion, tightening abdominal support reduces lumbar lordosis
Types of TLSOs
- knight-taylor TLSO
- Jewett Hyperextension TLSO
- CASH hyperextension TLSO
- rigid TLSO (body jacket)
- CTLSO (TLSO with cervical extension
Knight-taylor TLSO
- restricts sagittal and coronal plane motion
- tightening abdominal support reduces lumbar lordosis
- tightening axillary straps facilitates thoracic extension
Jewett hyperextension TLSO
- restrictions
- indications
- restricts thoracolumbar flexion and some coronal plane movement
- compression fracture, kyphosis, arthritis
CASH hyperextension TLSO
- abbreviation
- restricts
- common in
- Cruciform Anterior Spinal Hyperextension
- thoracolumbar flexion
- geriatric pts.
Rigid TLSO (body jacket) -restricts
sagittal, coronal, and transverse plane movement
Indications for orthotic mgmt of scoliosis
- skeletal immaturity (premenarche)
- curves between 20 and 40 degrees
- documented progression
- single or double curves
Accomodative TLSO
(for scoliosis)
-addresses _____
-aligns head and trunk over pelvis, doing what?
- fixed deformity
- reducing shear forcer, facilitating UE use, enhances mobility, facilitates respiratory function
Corrective TLSO (for scoliosis) -progressive correction of \_\_\_\_\_\_\_ -stabilization of \_\_\_\_\_ -\_\_\_\_ and or \_\_\_\_\_ deformity
- idiopathic spinal curvatures
- congenital spinal curvatures
- prevent and/or correct
Types of corrective TLSOs
- Boston brace
- Milwaukee brace
- Charleston Bending Brace
Boston brace
- considered gold standard for adolescent scoliosis
- worn full time (18-23 hours/day)
Milwaukee brace
- for upper thoracic and cervical curvature
- worn full time (18-23 hours/day)
Charleston bending brace
- for smaller, flexible lumbar curvatures
- worn only at night (8 hours/day)
PT for corrective TLSOs
- skin care
- trunk mobility and strengthening
- aerobic training
- postural feedback and training
- functional training with brace
Indications for UE orthotics
- trauma (burns, MVAs, vocational)
- congenital deformity
- disease (RA, SLE, neuro impairments, esp. associated with abnormal tone)
Designs of UE orthotics
Static, serial static, static progressive, dynamic
- static progressive orthotic
- dynamic orthotic
- uses static components to apply force
- uses elastic components to apply force
Which tendon mechanism is more prone to shortening and is more difficult to compensate for?
extensor mechanism
Intrinsic plus position
anti-deformity position
MCP flexion with DIP and PIP extension.
-positioning MCP in flexion protects IP extension
Intrinsic minus position
MCP extension with PIP/DIP flexion
- results from intrinsic denervation (ulnar nerve palsy)
- unopposed extension cause MCP hyperextension and IP flexion
Pressure=
- never ____
- accommodate for_____
P=force*area
- never eliminated, only distributed
- bony prominences
prominences
olecranon, humeral epicondyles, stloid processes, base of 1st MC joint, dorsal thumb, MP and IP joints, pisiform
Nerves
radial groove of humerus, (radial) cubital tunnel (ulnar), distal forearm (ulnar), carpal tunnel (median), volar digital nerves
functional hand splint
- wrist
- thumb
- MCPs
- IPs
- 20-30 degrees extension
- palmar abduction
- 15-20 degrees flexion
- slight flexion
wrist position in intrinsic plus splint
- palmar burn
- dorsal burn
- crush injury
- 30-40 degrees extension
- neutral-slight extension
- 0-30 degrees extension
MCP position in intrinsic plus splint
- burn
- crush injury
- 70-90 degrees flexion
- 60-80 degrees flexion
IP and thumb position for intrinsic plus splint
- extension
- palmar abduction
Thumb immobilization is used for what conditions
-position
- DeQuervain’s: inflammation of APL and EPB sheaths, RA, Gamekeeper’s thumb: UCL injury
- CMC in 35-30 degrees of abduction with MP joint in neutral
