Spinal Orthotics Flashcards
3 types of cervical/cervicothoraic orthoses
Collars
Poster-type
Halo- and Minerva-types
Describe a soft collar
Made from thermoplastic foam or rubber covered by cotton stocking. Degree of support provided depends on the compressibility of the material it is made from
Describe a firm collar
Pre-fabricated or custom made. Provide greater mandible and occipital support. More rigid therefore a more effective restraint than soft collars
Examples of firm collar devices
Supra-Lite and the Philadelphia collars
How does the Yale collar design differ
It has distal anterior and posterior extensions which increase control of cervical flexion and extension
Uses of collars
Whiplash
Arthritis
Stable bone/ligamentous injuries
Benefits of collars
Act as a reminder to self-restrict motion
Keeps the neck warm
Provides psychological support
Easy to fabricate at low cost
Disadvantages of collars
Only provide limited control over cervical motion
Limited head support
What are poster-type orthoses
Cervical/Cervicothoracic collars with 2 or more uprights that extend from the thoracic component to the occipital and mandible areas
What are poster-type orthoses used for
Stable bony/ligamentous/soft tissue injuries to the mid and lower cervical spine
May be used after removal of halo-top orthosis
Give an example of a 3-poster device
Sterno-occipital mandibular immobiliser (SOMI) brace
What restrictions does the SOMI impose
Most effective at resisting head flexion
Some resistance to head extension and lateral rotational control
Which movements are a 4 poster orthoses least effective at restraining
Head rotation: head can slide on the mandible and occipital pads
Lateral head movement: because some movement between the mandible and occipital pads can occur
Benefits of poster orthoses
Unlike collars, the neck is exposed which is desirable in the presence of wound/surgical incision sites on the neck
Describe a halo-top spinal orthosis
Rigid spinal orthosis that is attached firmly to the skull by screws above eye level, connected to the thoracic/thoracolumbar component by 4 rigid uprights
How does the Minerva-type spinal orthosis differ from the Halo-type
Has a rigid one-piece posterior section which connects the halo to the thoracic component
The rigid moulded ant. section extends to the chin
What are Halo- or Minerva-type spinal orthoses used for
Unstable fractures of the cervical spine: they offer the greatest degree of constraint
List some problems of wearing Halo-/Minerva- orthoses over a prolonged period of time
Skin irritation
Muscle atrophy
Joint stiffness
Psychological disorders
What are the classifications used for orthoses other than cervical/cervicothoracic orthoses
Dynamic
Postural functional
Postural static
When are dynamic spinal orthoses used
When correction of deformity/prevention of progression are required e.g. idiopathic scoliosis and adolescent kyphosis
Aims of using dynamic spinal orthoses
Prevent progression of deformity
Minimise structural deformity
Prevent high compressive vertebral stress
Improve/maintain respiratory function
How is the neck and head kept centred above the pelvis
Positioning of the pelvic and neck ring portions of the orthosis
Give an example of a dynamic spinal orthosis
The Milwaukee CTLSO: 2 post. and 1 ant. metal uprights that connect the moulded pelvic girdle to the cervical ring around the neck. Thoracic and axillary pads attach to the uprights to correct scoliotic curves by 3-point loading
How does the Scheuermann TLSO differ from the Milwaukee
Has lateroposterior thoracic panels to correct the spinal kyphosis
Describe the Boston TLSO
Straight thermoplastic mould with corrective pads fixed to the inner surface
When are postural functional spinal orthoses used
Pathologies that require pain relief: Kyphosis from senile osteoporosis Prolapsed IV discs Lower back pain Sciatica Ank spon
Objectives of postural functional orthoses
Reduce vertebral motion/deformity
Prevent pain
Give examples of postural functional orthoses
Jewitt TLSO, Jones TLSO and Raney flexion brace
Describe a Jewitt TLSO
Anterolateral torso frame with rotating sternal pad, rigid suprapubic pad and a thoracolumbar strap and pad
Primarily controls flexion
Describe the Raney flexion brace
A rigid plastic shell which completely surrounds the trunk. An indented region creates abdo compression
What is the Raney flexion brace prescribed for
Lumbar sprain
Acute sciatica
Recurrent/post-op back pain
Disadvantages of Raney flexion brace
Uncomfortable to wear
Not suitable for patients who cant tolerate increased abdo pressure
What are postural static spinal orthoses used for
Pathologies caused by neuromuscular deficiency
Prevent further deformity rather than correcting it
E.g. spinal muscle atrophy, DMD, cerebral palsy and polio
How to postural static spinal orthoses support mass loads
Apply principle of Total Contact: maximise surface area contact to the wearers body
What are some problems with postural static spinal orthoses
Reduction in forced vital capacity
Give 2 examples of postural static orthoses
Calot TLSO
Boston Overlap Orthosis
Describe a Boston overlap orthosis
Rigid thermoplastic module with ant. positioned straps Restrains sagittal and coronal lumbar movement
