Spinal Orthotics Flashcards
Kinesthetic reminder
Often a reminder not to do something
Increase intracavitary pressure
Like vasalva - turns torso into something more rigid
Effects of spinal orthosis wear - positive - trunk support
Intracavitary pressure - inc intraabdominal and intrathoracic pressure with subsequent reduction in force on the spine
3 point force systems
Effects of spinal orthosis wear - positive - motion control
Mechanical 3 point force systems - stabilize spine between end points
Psychological restraint of gross trunk movement - kinesthetic reminder
Effects of spinal orthosis wear - positive - spinal realignment
3 point pressure system - designed to shift forces from weak area to more normal segments
Stimulation of mm action patterns in withdrawing from an uncomfortable pressure point
Effects of spinal orthosis wear - negative
Weakness and atrophy following reduced demands
Tightness and/or contracture
Psychological dependence
Spondylolysis
Fracture of pars articularis
Spondylolisthesis
Anterior migration of one vertebral body on another
Metal spinal orthoses - advantages to metal
Cooler
Weight
Adjustable
Metal spinal orthoses - disadvantages
Cosmesis
Control
Areas of high pressure
Off the shelf orthoses - Function
Stable fractures Post surgery Chronic pathology Comfort Activity related They are often highly adjustable
Off the shelf orthoses - usually determined by
circumferences
Total contact spinal systems - components
Leather/Metal Kydex Polyethylene MPE (modified) Copolymer Polypropylene
Total contact spinal systems - Biomechanical principle
Multiple 3 point pressure system Modified end point control Total contact Kinesthetic reminder Inc intraabdominal pressure
Total contact spinal system - Pathology
Post surgical Kyphosis Spondylosis Spondylolisthesis Arthritis Scoliosis Burst fx
Sacral Orthoses (SO) - Function
Provide stability to SIJ
Encompasses only sacral spine
Reduce inflammation
Post pregnancy, skeletal weakness, chronic ligament laxity
Corsets - Materials
Canvas
Cotton mesh
Elastic mesh
Corsets - Closures
Snap
Hook and eye
Hook and loop pull straps
Velcro
Corsets - Biomechanical principles
Total contact
Kinesthetic reminder
Inc intracavitary pressure
Corsets - Pathology
Mm strain
Post surgical
Low back pain
Maternity
Lumbosacral orthoses (LSO)
L2/3 and inferior
Controls motion in sagittal and coronal plane
Lumbosacral orthoses (LSO) - where does it fit from
Snug around torso from xiphoid to pubis anteriorly
Post from inf angle of scapulua to sacrococcygeal junction
Lumbosacral orthoses (LSO) - L5/S1 anomaly that looks like it is displaced - what will you incorporate
For low lumbar stability may add a hip spica to control the pelvis
Metal Spinal Orthoses - Sagittal Control LSO - Chairback LSO - Biomechanical principles
3 point pressure system
Kinesthetic reminder
Inc intracavitary pressure
Metal Spinal Orthoses - Sagittal Control LSO - Chairback LSO - Pathologies
Low back pain
Discogenic pathologies
Post surgical
Metal Spinal Orthoses - Sagittal Control LSO
Chairback LSO
Metal Spinal Orthoses - Sagittal/Coronal Control LSO
Knight LSO - has the lateral stabilizer contributing to coronal control
Metal Spinal Orthoses - Sagittal/Coronal Control LSO - Knight LSO - Biomechanical principles
3 point pressure
Kinesthetic reminder
Inc intracavitary pressure
Metal Spinal Orthoses - Sagittal/Coronal Control LSO - Knight LSO - pathologies
Low back pain
Discogenic pathologies
Post surgical
Thoracolumbosacral Orthosis (TLSO)
Triplanar control of lumbar and thoracic vertebrae
TLSO - Thoracolumbosacral Orthosis - where does it go from
Sternal notch to pubis anteriorly
Spine of scapula to sacrococcygeal juntion posteriorly
Metal spinal orthoses - anterior control TLSO
Jewett and CASH
CASH = cruciform anterior spinal hyperextension
Metal spinal orthoses - anterior control TLSO - Jewett and CASH - biomechanical principles
3 point pressure
kinesthetic reminder
Metal spinal orthoses - anterior control TLSO - Jewett and CASH - pathologies
anterior compression
fracture
(creates a hyperextension moment)
Metal spine orthoses - sagittal control TLSO
Taylor TLSO
Metal spine orthoses - sagittal control TLSO - Taylor TLSO - Biomechanical principles
3 point pressure
Kinesthetic reminder
Metal spine orthoses - sagittal control TLSO - Taylor TLSO - Pathologies
Osteoporosis
Arthritis
Metal spine orthoses - sagittal control TLSO - Taylor TLSO - helps with what
Can help give the extension moment as well
Helps only with sagittal control
Metal spine orthoses - sagittal/coronal TLSO
Knight Taylor TLSO
Provides the lateral (coronal) control
Scoliosis - TLSO
What is scoliosis
Twisting (rotation) of the spine
Posterior hump formation
Quantified by Cobb angle
Scoliosis - TLSO - pathology/etiology
Can be familial
More common in F
Usually appears in late childhood/early teen
Scoliosis - TLSO - causes
Polio or muscular imbalance
MOST are idiopathic
Scoliosis - TLSO - tx
Curves less than 20 usually stable and can be monitored with xray
Bracing should start as soon as curve reaches 24 degrees or more
Even with bracing, at least half of curves progress and require surgery
Scoliosis Bracing
3 point pressure system
Concept is dynamic correction to stabilize and reduce the curve
Schroth method
Postural and breathing and over corrective postural things to help conservatively with scoliosis
Scoliosis bracing - purpose
To correct curvature of spine from idiopathc scoliosis
Apply pressure at apex of curves and reliefs to pull into
Must have necessary musculature to pull away from pressure areas
CTLSO
Cervical orthosis attached to a total contact TLSO
Custom
Cervical collar - soft collar
Soft foam
Usually OTS
Mild cervical support
Cervical collar - soft collar - mild cervical support for what
Kinesthetic reminder
Cervical disk disease
Torticollis (SCM)
Mino ligamentous or muscular injuries, neck sprains or stiff neck
Cervical collar - semi rigid
Foam with a rigid outer shell Post surgical cervical support Neck support resulting from trauma Increased AP and ML control Dec rotation Post halo cervical support
CTO
Rigid C collar attached to a thoracic vest
Inc cervical stabilization
Stable cervical fx
Gets upper thoracic and cervical
Halo
100% immobilization to upper thoracic and cervical
Provide triplanar motion control of cervical
May also be attached to a CTLSO
Unstable cervical fractures
Wear and Care
Wear orthosis over a tight cotton undershirt
Properly place orthosis on body with waist groove on proper spot
TIGHTEN straps!
Underwear and pants are worn OVER the orthosis for ease of toileting
Orthosis cleaned with warm water and mild soap
Ask physician for recommendations for wear while showering
Spinal orthosis problems
Hot Comfortable Rides up Tight Obese Bed positioning
Spinal orthosis - 3 Ps
Positioning
Pressure (tight)
Patience
