spinal orthoses Flashcards
orthotic goals
correction, accommodation, stabilize, reduce pain
correction goal
- for flexible deformity
- restore follower load
- reduce moment
how do we measure correction? success?
measure by doing a Cobb angle
accommodation goal
- for fixed deformity
- want to prevent deformity from progressing
stabilization goal
- limit gross vertebral sway
- decrease moment
- increase load carrying capacity
- ex: fractures
reduce pain goal condition examples
spondylylosis and spondylothesis
free desired control
motion is free
- ex: elastic binder
stop desired control
posterior component that stops ext
hold desired control
limiting motion throughout entire plane
- ex: burst fracture
hold-variable desired control
mainly used for transverse plane; allows best chance at managing rotary deformities
list of biomechanical principles of spinal orthoses
- end-point control
- total contact
- three point pressure system
- kinesthetic reminder
- increased intracavitary pressure
what is end-point control
motion control of a free body
what theory is associated with end-point control
Euler’s theory
critical load definition
upper limit of a load that the spine can withstand before it bends
end-point control application
scoliosis to increase stability
end-point control explanation for curve progression during height/weight changes
10% increase in height or weight changes leads to an automatic 20% decrease in the critical load or spinal stability
total contact purpose
applying forces to get correction
- pressure = force/area
what is the three-point pressure system
2 forces going in the same direction and the 3rd force going in an equal and opposite direction
what is the purpose of a three-point pressure system
- trying to limit motion
- encourage person to withdraw from the stimulus
- introducing a higher shear to moment ratio
three-point pressure system application
used with someone who has a compression fracture
alternative to three-point pressure system
- introduces a more bending moment and taking away the shear
- more comfortable for patient
- designed into an extended position
alternative to three-point pressure application
good for kyphosis
kinesthetic reminder purpose
- reminder to move in a manner slower than normal
- creates a stimulus to withdraw
increased intra-cavitary pressure purpose
- trying to achieve a reduction in discal pressure
which pathologies do you want to put into an extended position
burst fracture, seatbelt fracture, disc herniation, or compression fracture
which pathologies do you want to put into a flexed position
spondylolysis, spondylylothesis, central stenosis, or lateral stenosis
corset biomechanical properties
total contact, kinesthetic reminder, increased intracavitary pressure, modified three point pressure system
corset pathologies
muscle strain, post-surgical, low back pain, maternity
which spinal orthosis is the least effective at limiting gross trunk motion
corsets
total contact biomechanical principles
three point pressure system, end-point control, kinesthetic reminder, increased intracavitary pressure
how do you don/doff a total contact spinal system
in supine to reduce axial load on the spine
idiopathic adolescent scoliosis gender and curve progression
females, the bigger the curve the more likely it will progress
TLSO location
T7 and below
CTLSO location
T7 and above
idiopathic adolescent scoliosis mechanisms to manage curves
curve correction, end-point control, and transverse load
how long should you wear an orthosis per day
more than 6 hours but less than 18 hours
greatest influence on patient compliance regarding wearing of the orthosis
- difficulty paying attention in school
- emotional about having to wear orthosis
- problems with eating
- difficulty in sitting
- breathing
- look worse in clothes
neuromuscular scoliosis population
spina bifida, non-ambulatory
what is cast syndrome
loss of extension or lordosis
