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Management of Special Populations > Spinal Orthoses > Flashcards

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
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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
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3
Q

Slide 4

A
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4
Q

How do braces work

A
  • 3 point pressure system: 3 points of applied force, one posteriorly & 2 anteriorly
  • Circumferential support
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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
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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
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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
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8
Q

Describe the headmaster control

A
  • Limited control
  • Low profile
  • Used to support the head
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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
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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
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11
Q

Indications for a cervicothoracic orthoses

A
  • Atlanto-axial instability such as in RA neural arch fractures of C2 due to flexion instability
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12
Q

What orthoses is often used as a possible replacement to the Halo

A
  • Minerva brace
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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
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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
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15
Q

From most to least which cervical motions are limited due to bracing

A
  • Flexion/extension
  • Lateral bending
  • Rotation
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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
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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
Q

Slide 22

A
26
Q

Define structural scoliosis

A
  • Fixed
  • Not amendable by active or passive means
27
Q

Define functional/flexible scoliosis

A
  • Amendable by active or passive means
28
Q

Describe scoliosis

A
  • 3 dimensional deformity (frontal, sagittal, & transverse plane deformities)
  • Lateral curvatures, kyphosis, rotation resulting in “rib hump”
29
Q

The only type of scoliosis that is typically and frequently managed with a spinal orthosis is the

A
  • Idiopathic curve
30
Q

Scoliosis treatment

A
  • 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
Q

Basic objectives of comprehensive conservative treatment of Scoliosis

A
  • Stop curve progression at puberty
  • Prevent/treat respiratory dysfunction
  • Prevent/treat spinal pain syndromes
  • Improve aesthetics via postural corrections
32
Q

What are three primary mechanisms by which an orthosis exerts forces on a developing spine

A
  • 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
Q

How many hours a day is meant by bracing is a full time commitment until skeletal maturity for Scoliosis

A
  • 16-20 hours a day
34
Q

List the braces for Scoliosis

A
  • 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
Q

Describe a Wilmington brace (total contact)

A
  • Alternative to the Boston Brace that can also be worn up to 23 hrs/day but employs different biomechanical principles for spinal correction
36
Q

Describe a Milwaukee brace

A
  • 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
Q

Describe a Boston brace

A
  • 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
Q

Describe a Charleston bending/nighttime brace

A
  • 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
Q

Describe a SpineCor brace

A
  • 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
Q

How do you know the brace is working

A
  • 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

Management of Special Populations (13 decks)

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