Spinal Orthoses Flashcards
1
Q
Purpose of spinal orthoses
A
- Limit motion of a spinal region
- Decrease stress applied to region treated
- Prevent deformity
- Post operation
- LBP exacerbation
2
Q
What is the general role of spinal orthoses
A
- To limit the motion of a spinal region, decreasing the amount of load applied to the region treated
3
Q
Slide 4
A
4
Q
How do braces work
A
- 3 point pressure system: 3 points of applied force, one posteriorly & 2 anteriorly
- Circumferential support
5
Q
Classification of spinal orthoses
A
- Rigid (most control)
- Semirigid/combination
- Flexible (least control)
- Can be named after the creator of the brace: Knight Taylor, Jewitt Brace
6
Q
Indications for use of a rigid/semi rigid brace
A
- Status post anterior cervical fusion: very much physician guided, trend is moving towards NOT bracing
- Jefferson’s Fracture: C1
- Hangman’s fracture traumatic spondylolisthesis of C2 on C3
- Dens type I fracture of anterior diskectomy
- Cervical trauma in unconscious patients
- Cervical strain
7
Q
Describe soft collars
A
- Provide partial support of the head reducing paraspinal contraction & spasm
- True benefit is warmth, psychological reassurance & a kinesthetic reminder to limit motion
- Problem is that it gives no true structural cervical spine support
8
Q
Describe the headmaster control
A
- Limited control
- Low profile
- Used to support the head
9
Q
Why is the cervicothoracic area challenging to immobilize
A
- It is a transitional area between the very mobile & lordotic cervical spine & the kyphotic thoracic spine
10
Q
Describe cervicothoracic orthoses
A
- Provide maximal control of flexion, extension, & rotation of the cervical spine
- Can be used for conditions extending as far caudally of T5
- Increasing the length of the orthoses down the trunk enhances its capabilities
11
Q
Indications for a cervicothoracic orthoses
A
- Atlanto-axial instability such as in RA neural arch fractures of C2 due to flexion instability
12
Q
What orthoses is often used as a possible replacement to the Halo
A
- Minerva brace
13
Q
Describe the Halo Vest
A
- Best at restricting motion
- If needs to immobilize the occipitocervical spine fixation to the skull is required
- 6-8 transcranial pins provide secure proximal fixation & full contact support around the thorax & torso provide the distal fixation
- Results in maximal triplantar control
- Complications can include pressure sores, loss of reduction, & pin infection & loosening
14
Q
Rehab considerations with a Halo
A
- Rehab can be challenging due to altered center of mass
- Fixed head position alters ability to use visual cues
- May have forward head posture when ambulating, to accommodate use a cane/walker
- readjustment period following Halo removal that may require postural reeducation as part of the rehab strategy
- Poor cervical spine dissociatioon
15
Q
From most to least which cervical motions are limited due to bracing
A
- Flexion/extension
- Lateral bending
- Rotation
16
Q
Describe thoracolumbar orthoses
A
- Most common region affected by traumatic fracture & most likely to benefit from orthotic support
- Compression Fx are common & Tx varies from kyphoplasty, vertebroplasty, or conservative bracing
- Best used for Fx from T10-L2
- Goal”: prevent excessive anterior flex & development of kyphotic deformity
- Contraindicated for 3 column instability
17
Q
Contraindications for thoracolumbar orthoses
A
- Unstable 3 column vertebral fractures
- Compression fractures above T6 for there is increased motion above the pad
- Where extension is prohibited for it can cause excessive hyperextension forces on the posterior elements
18
Q
Decreasing ____________ reduces compressive forces on the fractured vertebral body 7 limited distraction oof the posterior elements
A
- Flexion
19
Q
Describe TLSO braces
A
- Used to manage Fx or post surgical pts with T6-L4 involvement
- Restrict motions in all planes
- Straps over the shoulders may provide additional stability to the brace
- Bi-valved or clamshell to allow for donning & doffing
20
Q
Describe LSO braces
A
- Difficult too effectively brace due too extensive ROM of the flexion-extension motion of the spine
- Common for post L2-4 spinal surgery for with non-op back pain
- Recent surgical advances now limit the prescription of these
- Mostly used now for comfort for those pt’s with poor bone quality
- Conflicting results when using corsets to manage acute LBP, conflicting evidence of reconditioning effect
21
Q
Describe a flexible LSO
A
- Essentially for kinesthetic awareness, pain relief, reduce excessive lumbar lordosis, vasomotor & respiratory su[port in SCI patients
22
Q
Describe a rigid LSO
A
- More stability
- Can create increased intra-abdominal pressure that will improve stability of the spine
- Concerns for reconditioning with long term use
23
Q
Describe SI support braces (SIOs)
A
- Worn around the pelvis b/w he iliac cress & the greater trochanters
- Used by patients with back pain that is attributed to SI joint hypo or hyper mobility
- Used in conjunction with manipulation or spinal stabilization exercises
- Use of a SI belt with pregnant pts may decrease SIJ mobility & reduce pain syndrome during functional actitivites
24
Q
Potential issues with spinal orthoses
A
- Poor compliance
- Body habitus
- Proper fit and function
- Dependency
- Skin breakdown
- Financial burden
- Alterations to the movement system: contracture, weakness, pain, balance strategies, ROM
25
Slide 22
26
Define structural scoliosis
- Fixed
- Not amendable by active or passive means
27
Define functional/flexible scoliosis
- Amendable by active or passive means
28
Describe scoliosis
- 3 dimensional deformity (frontal, sagittal, & transverse plane deformities)
- Lateral curvatures, kyphosis, rotation resulting in "rib hump"
29
The only type of scoliosis that is typically and frequently managed with a spinal orthosis is the
- Idiopathic curve
30
Scoliosis treatment
- Curves <20º = observation
- Curves 20-40º = bracing before skeletal maturity
- Curves 40-50º+ = surgery
- Physiotherapy Specific Scoliosis Exercises (PSSE): traditional therapies that focus on decreasing abnormal side rotation
31
Basic objectives of comprehensive conservative treatment of Scoliosis
- Stop curve progression at puberty
- Prevent/treat respiratory dysfunction
- Prevent/treat spinal pain syndromes
- Improve aesthetics via postural corrections
32
What are three primary mechanisms by which an orthosis exerts forces on a developing spine
- End point control: ability of the orthosis to constrain the spine
- Curve correction: greatest effect bc it stiffens the spine & reduces the curve & decreases the load on the spine/slows rate of deformation
- Transverse loading: at apex is primary mode of correction within modern oorthoses but loses efficacy as the curve gets larger
33
How many hours a day is meant by bracing is a full time commitment until skeletal maturity for Scoliosis
- 16-20 hours a day
34
List the braces for Scoliosis
- Milwaukee: High curve, passive/active, day/night
- Boston: Low curve (below T6), passive/active, day/night
- Wilmington: Low curve (below T6), passive, day/night
- Charleston: passive, night only
- SpineCor: dynamic, day/night
35
Describe a Wilmington brace (total contact)
- Alternative to the Boston Brace that can also be worn up to 23 hrs/day but employs different biomechanical principles for spinal correction
36
Describe a Milwaukee brace
- Original brace for Scoliosis developed in 1940's
- Used when apex of the curve is >T6 level
- Heavy, bulky, & unsightly under clothing
- Newer models do not make contact with the mandible
- Day/night wear required
37
Describe a Boston brace
- First low profile brace developed in the 1970's
- Most braces are made from custom measurements based on x-ray to provide contact points to apply 3-point counterforces for curve correction
- Most prevalent type of orthosis used
- Patient is instructed to "pull away" from the corrective pad
- Day/night wear required
38
Describe a Charleston bending/nighttime brace
- Nocturnal brace
- Addresses cosmoses & compliance issues
- Primary difference b/w daytime braces is the application of over correction in the direction oof side bend (not conductive to allowing pt to walk/do ADLs)
-Not comfortable when worn in an upright position
- Not as affective as the other braces
39
Describe a SpineCor brace
- Constructed from flexible materials
- Applies dynamic forces to maintain/improve spinal deformity while reeducating the body to return to normal posture
- Consists of a free moving configuration of belts, straps, & pads fixed at one end to a plastic pelvic base & at the other end to a fabric vest
- 4 adjustable bands work together dynamically to maintain/improve spinal deformity while allowing movement & posture reeducation
40
How do you know the brace is working
- Effect: is the brace reducing the "harmful" motions
- Fit: is the brace put on correctly; check position, straps, velcro attachments, & pad placements
- Ensure intimate contact
- Assess for compliance
