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Prosthetics/Orthotics > Spinal, Hip & Special Orthoses > Flashcards

Spinal, Hip & Special Orthoses Flashcards

1
Q

Which will have a greater impact on restricting motion a CO or CTO?

A

CTO because leverage increases with length of the lever arm

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2
Q

Which design (4 Post or 3 Post) might restrict cervical extension more?

A

A 4 post design may restrict cervical extension to a greater degree than a 3 post design because of the additional vertical post posteriorly

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3
Q

What movements are controlled by a Halo Rigid Four Post Design (HCTO)?

A

All movement is fully restricted

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4
Q

Is there any axial unloading with a HCTO?

A

Moderate / full

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5
Q

What are the possible indications for HTCO?

A

This orthosis is indicated for unstable cervical fx and for post surgical reduction of cervical fx (with orwithout a spinal cord injury)

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6
Q

How is flexion controlled by a Rigid Three or Four Poster Flexion, Extension, Lateral, Rotation CO or CTO?

A

a joint anteriorly directed force originating posteriorly from the inferior portion of the occipital pad and the superior portion of the interscapular pad counterbalanced by a superior-posterior directed force originating anteriorly from the mandibular pad, and a posteriorly directed force originating anteriorly from the sternal pad

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7
Q

How is extension controlled by a Rigid Three or Four Poster Flexion, Extension, Lateral, Rotation CO or CTO?

A

joint posteriorly directed force from the inferior aspect of the mandibular pad as well as the superior portion of the sternal pad counter balanced by anteriorly directed forces originating from the occipital pad and the interscapular pad

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8
Q

How is lateral flexion to the right controlled by a Rigid Three or Four Poster Flexion, Extension, Lateral, Rotation CO or CTO?

A

joint force towards the right from the inferior aspects of the mandibular and occiput pads on the left counterbalanced by a diagonal force up and to the left from the right side of the mandibular pad and the occipital pad, a diagonal force inferior and to the left from the right shoulder pad

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9
Q

How is right rotation controlled by Rigid Three or Four Poster Flexion, Extension, Lateral, Rotation CO or CTO?

A

a left directed force from the right side of the mandibular pad with right directed force from the left side of the occipital pad combined with a posteriorly directed force from the right side of the sternal pad with an anteriorly directed force from the left side of the interscapular pad

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10
Q

Is there any unloading with a Rigid Three or Four Poster Flexion, Extension, Lateral, Rotation CO or CTO?

A

Moderate

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11
Q

What are the possible indications for a Rigid Three or Four Poster Flexion, Extension, Lateral, Rotation CO or CTO?

A

Cervical fusion, laminectomy and discectomy

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12
Q

What motions are controlled by a Rigid Sternal Occipital Mandibular Immobilizer (SOMI)?

A

Full flexion control is demonstrated

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13
Q

How is flexion controlled by a SOMI?

A

an anteriorly directed force originating posterioly from the occipital pad Counter balanced by a superior-posterior directed force originating anteriorly from mandibular pad and a posteriorly directed force originating from the sternal pad

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14
Q

Is there any axial unloading from a SOMI?

A

Minimal/moderate

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15
Q

What are the possible indications for a SOMI?

A

Cervical arthritis, stable cervical fx, fusions, following removal of a halo

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16
Q

Are there any movements restricted by semi-rigid cervical orthosis? If so how?

A
  • Extension, lateral flexion and rotation may be self-limited
  • min/mod control of cervical flexion is possible with this orthosis.
  • Flexion limited by superior-posterior directed force originating anteriorly on mandibular pad or extension, posteriorly directed force on inferior anterior border of orthosis at most distal portion of anterior plastic upright, and an anteriorly directed force from the posterior medial aspect of the posterior plastic upright.
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17
Q

Is there any axial unloading from a semi-rigid cervical orthosis?

A

No

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18
Q

What are the possible indications for a semi-rigid cervical orthosis?

A

Stable mid cervical fractures, strain or sprain or wearing from more stable CO

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19
Q

Are any movements restricted by a semi rigid adjustable plastic collar? If so how?

A
  • This orthosis is semi-rigid therefore does not fully restrict movement
  • It will minimally limit flexion with superior-posterior directed force originating anteriorly on mandibular pad, posteriorly directed force on inferior anterior border of orthosis, and an anterior directed force originating from the posterior medial aspect of the brace
  • Extension and lateral flexion may be decreased by increased tactile input and increased kinesthetic awareness.
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20
Q

Is there any axial unloading from a semi-rigid adjustable collar?

A

No

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21
Q

What are the indications for a semi-rigid adjustable collar?

A

Soft tissue injuries in cervical area

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22
Q

Are any movement restricted by a soft foam collar?

A
  • No movements are restricted as device is flexible
  • Orthotic will check flexion, extension, and possibly lateral flexion.
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23
Q

What is the function of a soft foam collar?

A
  • This orthosis is thought to increase awareness of injured area thus providing kinesthetic reminder to self restrict movement.
  • It may also provide warmth to area, contributing to patient’s comfort
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24
Q

What are the possible indications for a soft foam collar?

A

Soft tissue injuries but not for bony or ligamentous injuries

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25
Q

is a Sacroiliac Belt/ SI Corset flexible, semi-rigid, rigid?

A

Flexible

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26
Q

Are any movement restricted by a Sacroiliac Belt/ SI Corset?

A
  • The SI belt orthosis is typically not described as restricting movement in the SI joint.
  • Rather it is thought to provide external reinforcement to a hypermobile section (SI joint).
  • Its effectiveness isdebatable.
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27
Q

What are the possible indications for a SI belt orthosis?

A
  • Stable pelvic fracture
  • Pre & post natal SI instability
  • SI strain
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28
Q

What are the guidelines for fit of an SI belt?

A
  • Anteriorly and posteriorly the superior border is at the iliac crest level.
  • Anteriorly, the inferior border is 1/2 to 1” above the pubic symphysis and the posteriorly orthosis typically extends to apex of gluteal bulge
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29
Q

Is the abdominal Elastic binder flexible, semi-rigid, rigid?

A

Flexible

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30
Q

Where should the binder be positioned on a patient for optimal fit?

A

Below the diploid & above the ASIS anteriorly

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31
Q

Are any movements restricted by the abdominal elastic binder?

A

No

32
Q

What are the possible indications for an abdominal elastic binder?

A
  • This orthosis will increase intra abdominal pressure and influence posture
  • This orthosis may also improve effectiveness of diaphragmatic breathing in a patient with weak or absent abdominal musculature.
  • It is generally indicated for a patient with spinal cord injury when there is involvement of abdominal musculature
33
Q

Are any movements restricted by a semi-rigid lumbrosacral orthosis?

A
  • No movement is restricted.
  • Flexion, extension, and lateral flexion may be self limited due to increased tactile cues in this orthosis
34
Q

What are the possible indications for a semi-rigid lumbrosacral orthosis?

A
  • This orthosis may be indicated as a preventative means to reduce low back injury.
  • It is suggested that this orthosis increases intra abdominal pressure and reduce stresses on posterior musculature thus diminishing load on lumbar discs. Increase in intra abdominal pressure may positively influence posture. It may increase proprioceptive feedback for postural alignment and enhance optimal bodymechanics when bending and lifting. Increase in intra abdominal pressure may reduce excessive spinal extension and decrease stress in low back area
35
Q

Is a Lumbrosacral corset flexible, semi-rigid or rigid?

A

Semi rigid

36
Q

What is the most optimal fit of a lumbrosacral corset?

A
  • Anteriorly the superior border is 1/2” below the xiphoid process.
  • Anteriorly, the inferior border is 1/2 to 1” above the pubic symphysis.
  • Posterior superior border is 1”below the inferior angle of the scapula.
  • Posterior inferior border is just below the apex of the gluteal bulge for men and at the gluteal fold for women
37
Q

What are the indications for a lumbrosacral corset?

A
  • Due to semirigid nature of this orthosis there is an attempt to control gross spinal movements.
  • this orthosis also may be indicated as a preventative means to reduce low back injury.
  • It is suggested that this orthosis increases intra abdominal pressure and reduce stresses on posterior musculature thus diminishing load on lumbar discs.
  • Increase in intra abdominal pressure may positively influence posture.
  • Proprioceptive feedback may also be increased and improve neutral postural alignment.
  • Body mechanics may be optimized when bending and lifting.
38
Q

is a thoracolumbar sacral corset flexible, semi-rigid or rigid?

A

semi-rigid

39
Q

Are any movement restricted by thoracolumbosacral corset?

A
  • No movement is truly restricted with this orthosis.
  • spinal flexion, extension, lateral flexion and rotation may be self-limited due to increased tactile cues with this orthosis
40
Q

What are the possible indications for a thoracolumbosacral corset? Give an example

A
  • This orthosis functions similar to LS corset when an increase in intra abdominal pressure is desired.
  • For example: soft tissue injury to thoracic or lumbar spine, kyphosis secondary to osteoporosis, arthritis
41
Q

Describe the optimal fit for a rigid Lumbrosacral Flexion Extension Lateral Flexion Control Orthosis or the Knight

A
  • Thoracic band typically is positioned so that superior border is at the level of T9-T10 or approximately 1” below the inferior angle of the scapula.
  • Pelvic band is positioned laterally between the greater trochanter and the iliac crests. Inferiorly the band should extend into the gluteal region but not impede sitting. The elevated central portion of the band should be positioned over the sacrum
  • Paraspinal bars should be positioned over the bulge of the paraspinal muscles avoiding contact with the spinous process of the vertebrae
  • Abdominal corset superior border extends to 1/2” below the xiphoid process. Inferiorly the border is 1/2 to 1” above the pubic symphysis.
  • Lateral bars are positioned along the mid axillary line and connect superiorly with the thoracic band and inferiorly with the pelvic band
42
Q

How is flexion restricted by the knight?

A

posterior directed forces originating anteriorly through the thoracic and pelvic straps, or superior and inferior portions of abdominal corset and an anterior directed force originating posteriorly from the middle portion of the paraspinal bars

43
Q

How is extension restricted by the knight?

A

anterior directed forces originating posteriorly from the thoracic band and the pelvic band,and a posterior directed force originating anteriorly from the middle portion of the abdominal corset

44
Q

How is lateral flexion to the right controlled by the knight?

A

forces directed to the left originating from the superior and inferior portions of the lateral bar on the right, and a force directed to the right originating from the medial portion of the lateral bar on the left

45
Q

What are indications for the knight LSO?

A
  • This orthosis was originally designed for patients who had TB resulting in Potts disease.
  • It may also be used in patients with spondylolysis, LBP and disc herniation
46
Q

How is extension restricted by the Rigid Lumbrosacral Extension Lateral Flexion Control Orthosis (Williams)?

A

anterior directed forces originating posteriorly from the thoracic and pelvic bands, and a posterior directed force originating anteriorly from the medial portion of the abdominal corset

47
Q

How is lateral flexion to the right controlled by the Williams LSO?

A

forces directed to the left originating from the superior and inferior portions of the lateral bar on the right, and a force directed to the right originating from the medial portion of the lateral bar on the left

48
Q

How is the Williams and Knight LSO similar and different?

A
  • Williams allows flexion of trunk whereas Knight restricts it
  • Both have lateral bars restricting lateral flexion
49
Q

What are the possible indications for the Williams LSO?

A

This orthosis is generally indicated for spondylolysis and spondylolisthesis maintaining the spine in lumbar flexion decreasing shear on fracture site and allows for healing

50
Q

What is the most optimal fit for the Rigid Thoracolumbosacral Flexion Control Orthosis or Jewett?

A
  • Sternal pad should be approximately 1” below clavicles.
  • Suprapubic pad should be 1” above the pubic symphysis.
  • Lateral bars should be in line with the mid axillary line.
  • Lumbar pad should extend between the mid thoracic and high lumbar region of spin
51
Q

What movements are restricted by the Jewett?

A

Flexion

52
Q

How is flexion restricted by the Jewett?

A

posterior directed forces originating anteriorly at the sternal and suprapubic pads, and an anterior directed force originating posteriorly at the lumbar pad

53
Q

When is the Jewett indicated?

A

This orthosis may be recommended for traumatic compressive fxs and Scheuermann’s Disease

54
Q

What is the most optimal fit of Rigid Thoracolumbosacral Flexion Extension Control Orthosis or the Taylor?

A
  • Interscapular band crosses the distal 1/3 of the scapula and extends laterally to approximately 2” from the axillary fold.
  • Pelvic band is positioned laterally between the greater trochanter and the iliac crests. Inferiorly theband should extend into the gluteal region but not impede sitting.
  • The elevated central portion of the band should be positioned over the sacrum.
  • Paraspinal bars should be positioned over the bulge of the paraspinal muscles avoiding contact with the spinous process of the vertebrae.
  • Abdominal corset (superior border) extends to 1/2” below the xiphoid process.
  • Inferior border is 1/2to 1” above the pubic symphysis.
55
Q

What movements are restricted by the Taylor?

A

Flexion & Extension

56
Q

How is flexion restricted by the Taylor?

A

posterior directed forces originating anteriorly from the axillary straps and pelvic straps, and an anterior directed force originating posteriorly from the middle portion of the paraspinal bars

57
Q

How is extension controlled by the Taylor?

A

anterior directed forces originating posteriorly from the interscapular band/superior portion of the paraspinal bars and the pelvic band, and a posterior directed combined force originating anteriorly from the abdominal corset and axillary straps

58
Q

What is the most optimal fit of the Boston Overlap Brace?

A
  • Anterior sup trimline should extend to just below the xiphoid.
  • Anterior inf trimline should extend to just above the pubic symphysis.
  • Posteriorly the brace should extend from just below the inf angle of the scapula to just above the sacralcoccygeal junction and encompass the gluteal mass.
59
Q

Are any movement restricted by the Boston Overlap Brace?

A

Flexion, extension & lateral flexion of lumbar spine

60
Q

How does the Boston Overlap Brace restrict flexion?

A

posterior directed forces originating from the superior and inferior borders of the ant portion of the brace and an anterior directed force originating from the medial portion of the post aspect of the brace

61
Q

How does the Boston overlap Brace restrict extension?

A

anterior directed forces originating from the superior and inferior borders of the post portion of the brace and a posterior directed force originating from the medial portion of the ant aspect of the brace

62
Q

How does the Boston Overlap Brace restrict lateral flexion to the right?

A

forces directed to the left originating from the superior and inf lateral portion of the brace on the right and a force directed to the right from the middle of the lateral portion of the brace on the left side

63
Q

What are the possible indications for a Boston overlap brace?

A

This orthosis is indicated for stable noncompression of lumbar vertebrae fx, spondylolysis, spondylolisthesis

64
Q

What is the most optimal fit of the Rigid Custom Molded TLSO Body Jacket controlling flexion, extension, lateral flexion & rotation?

A
  • Extent of superior trimlines depends on level of stability needed and may include subclavicular extensions and thoracic flanges.
  • Inferior trimline extends to just above the sacralcoccygeal junction and encompass the gluteal mass
65
Q

How is flexion restricted by the Rigid Custom Molded TLSO Body Jacket controlling flexion, extension, lateral flexion & rotation?

A

posterior directed forces originating from the superior and inferior borders of the anterior portion of the brace and an anterior directed force originating from the medial portion of the posterior aspect of the brace

66
Q

How is extension restricted by the Rigid Custom Molded TLSO Body Jacket controlling flexion, extension, lateral flexion & rotation?

A

anterior directed forces originating from the superior and inferior borders of the posterior portion of the brace and a posterior directed force originating from the medial portion of the anterior aspect of the brace

67
Q

How is lateral flexion controlled to the right by the Rigid Custom Molded TLSO Body Jacket controlling flexion, extension, lateral flexion & rotation?

A

forces directed to the left originating from the superior and inferior lateral portion of the brace on the right and a force directed to the right from the middle of the lateral portion of the brace on the left side

68
Q

How is upper trunk rotation towards the right with lower trunk rotation to the left controlled by the Rigid Custom Molded TLSO Body Jacket controlling flexion, extension, lateral flexion & rotation?

A
  • The forces to control rotation in the upper trunk would consist of: anterior directed force originating posteriorly at the superior lateral portion of brace on the right and a posterior directed force originating anteriorly from the superior left portion of the brace.
  • Coupled with this would be an anterior directed force originating posteriorly at the lateral inferior portion of the brace on the left and a posterior directed force originating anteriorly in the inferior border of the brace on the right
69
Q

What are the possible indications for Rigid Custom Molded TLSO Body Jacket controlling flexion, extension, lateral flexion & rotation?

A

traumatic or post surgical fx, spinal fusions, disc herniation or disc surgery, significant weakness or muscular imbalance (NM disorders such as CP, MD, Spina Bifida, SCI), or to accommodate a rigid deformity

70
Q

Is a CTLSO Milwaukee Scolosis Orhtosis flexible, semi-rigid or rigid?

A

rigid

71
Q

Describe the most optimal fit of the CTLSO Milwaukee Scolosis Orthosis

A
  • Pelvic girdle posteriorly extends from just below the inferior costal margin to the gluteal fold and anteriorly from just below the xiphoid process to just above the pubic symphysis.
  • Paraspinal bars should be positioned over the bulge of the paraspinal muscles avoiding contact with spinous process of vertebrae and attach to the cervical ring.
  • The anterior upright follows along the anterior medial line of the body and also terminates at the cervical ring.
  • The cervical ring holds the mandibular and occipital pads which rest 20-30mm inferior to the occiput and mandible.
  • Axillary thoracic and lumbar pads are placed at the points of convexity within the spine.
  • Forces are appplied via ribs to control alignment of the vertebrae.
  • The trochanteric extension if present is incorporated into the force system and extends to increase leverage for correction.
  • The extension should not interfere with sitting
72
Q

What condition is the CTLSO Milwaukee Scolosis Orthosis recommended for and when is it warranted?

A

Scoliosis curves between 25-40 degrees in children who have not yet reached skeletal maturity where the apex of the curve is at T8 or above

73
Q

How is correction of right thoracic left lumbar curve deformity achieved with CTLSO Milwaukee Scolosis Orthosis ?

A

force directed to the left from the right thoracic pad is balanced by forces directed to the right from the axillary pad on the left and the inferior left lateral border of the pelvic girdle and lumbar pad. For the compensatory left lumbar curve, the primary forceis a force directed to the right from the lumbar pad on the left. This is counterbalanced by forces directed to the left from the right thoracic pad and the right inferior lateral border of the pelvic girdle

74
Q

What is the wearing time for the CTLSO Milwaukee Orthosis?

A

Worn 23 hours a day until a child has reached skeletal maturity

75
Q

What is the most optimal fit for the rigid Custom Body Jacket for Scolosis TLSO or LSO?

A
  • typically this orthosis will extend up to T8 post.
  • Superior Lateral height will depend on curve level and will extend higher laterally on side opposite of the convexity.
  • Trimlines will be lower on the side of the convexity to allow for active lateral spinal shift in that direction.
  • Inferiorly brace will extend posterior to the gluteal fold but not interfere with sitting and anteriorly to just above the pubic symphysis.
  • If axillary band is present adequate clearance within the axilla should be observed (approximately 1-1.5”).
  • The trochanteric extension if present is incorporated into the force system and extends to increase leverage for correction. The extension should not interfere with sitting
76
Q

What condition is the Rigid Custom Body Jacket for Scolosis TLSO or LSO warranted for?

A

Scoliosis curves between 25-40 degrees in children who have not yet reached skeletal maturity where the apex of the curve is below the level of T8

Prosthetics/Orthotics (12 decks)

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