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P&O Exam 1 > Spine Orthoses > Flashcards

Spine Orthoses Flashcards

1
Q

What are the goals for spinal orthoses?

A
  1. limit motion to reduce pain, protect unstable segments, facilitate healing
  2. support trunk/neck to reduce loads
  3. correct or limit progression of deformity
  4. remind user to maintain appropriate posture
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2
Q

What are 2 types of spinal orthoses?

A

Soft
-made from fabrics, elastic, neoprene
-must have rigid element to add support
-coreset, belt

Rigid
-made from polyethylene or other plastics
-single piece or multiple pieces attached with straps

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3
Q

What does effectiveness rely on for spinal orthoses?

A

-points of application
-direction and magnitude of forces
-device fit
-compliance

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4
Q

What are the immobilization challanges with spinal orthoses?

A

-extremely mobile joint complex with multiple planes
-little body surface avaialbe for contact
-high incidence of skin breakdown (occiput, chin)
-pressure-related pain common (clavicles, chin)
-hygiene issues limit comfort (shaving)

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5
Q

What are the negative effects of spine orthosis?

A

-axial muscle atrophy secondary to disue
-immobilization can promote contracture
-excess pressure, irritation and moisture can lead to skin breakdown
-physiological dependency

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6
Q

What are the normal spine motions at the cervical level?

A

-C0-C1: flex/ext
-C1-C2: rotation
-C2-C7 segements involve flexion extension (C5-C7); lateral bending (C2-C3), and rotation (C2-C3)
T spine greater rotation than L spine

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7
Q

CO soft

A

-prefabricated
-do not limit cervical spine motion
-ineffective for providing protection or stabilization for acute and chronic whiplash or other mechanical disorders

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8
Q

CO Semi-rigid

A

-prefabricated
-used to stabilize the spine post trauma (hole in neck for tracheotomy)
-provide general support, but not rigid immobilization
-control flexion better than extension
-least effective controlling frontal/transverse plane motion

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9
Q

Should cervical collars be used after cervical surgery?

A

Not supported

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10
Q

Are CO’s recommended for whiplash and trauma?

A

Not recommended

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11
Q

When are CO’s indicated for?

A

-Cervical fractures
-Acute neck pain with radiating pain
-Neck pain

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12
Q

Cervical fractures

A

-NecLoc CO better at controlling ROM than Philadelphia and Aspen collars

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13
Q

Neck Pain Grade III

A

-defined as neck pain associated with sensory symptoms in the arm, limited and painful cervical ROM, motor disturbances such as UE weakness/atrophy
Recommendation: use of cervical collar for pain reduction may be considered. The advice is to use it sparingly only for a short period per day and only for a few weeks

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14
Q

What are the complications of CO?

A

-skin breakdown: occiput, chin, mandible, ears, shoulders, Adam’s apple, sternum
-increased risks associated with days in CO and presence of edema
-limitations with swallowing, coughing, breathing and vomiting. Could cause aspiration
-general immobility

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15
Q

What are the purposes of CTO?

A

-provide greater restriction of segmental and regional motion, particulary the lower cervical spine
-more effective than COs at controlling frontal and transverse plane motion

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16
Q

Post-Type CTO

A

-more restrictive and cooler than collar
-more difficult to don/doff
-two-and four post control flex/ext well
-four post better at controlling frontal/transverse plane

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17
Q

Sternal Occipital Mandibular Immobilizer

A

-3 post
-no posterior thoracic plate (more comfortable for patients lying supine. Patient unlikely to be upright without CTO)
-indicated for instability at or above C4
-most effective at controlling flexion C1-C3
-least effective at controlling extension

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18
Q

What types of CTO should be used for instability of C4 or below?

A

-four poster
-malibu collar with thoracic extension
-yale cervicothoracic orthosis

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19
Q

What orthosis is the gold standard for upper c-spine immobilization?

A

Halo orthosis

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20
Q

Halo orthosis

A

-can be used ot create traction (uni or bilateral)
-reduce cervical dislocation
-cervical fractures with or without SCI

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21
Q

What are the contraindications for Halo orthosis?

A

-unstable skull fractures
-traumatized skin overlying pin sites

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22
Q

What are the complications of using a halo orthosis?

A

-6th cranial nerve palsy
-pin loosening/infection

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23
Q

What are the indications for a CTO?

A

-instability of C4 or below
-cervical fractures
-odontoid fracture (C2)

24
Q

Cervical fractures

A

-cervical collars do not immobilize unstable vertebrae
-Halo orthosis controls upper C spine best
-Minera orthosis controls lower C spine best

25
Q

Odontoid fracture (C2)

A

Halo orthosis best at resisting motions as compared to minera and miami collar

26
Q

Rigid trunk orthoses

A

-most often made of molded plastic
-purpose: protect spine and/or facilitate healing
-utilize 3 point counterofrce system

27
Q

What are the purposes of TLSO?

A

-restrict spinal motion
-limit thoracic flexion or supporting excessive thoracic kyphosis
-preventing the progression of scoliotic curves

28
Q

TLSO and LSO trunk Control

A

-sagittal plane: rigid anterior/posterior panel
-frontal plane: rigid panel in mid-axillary line
-transverse plane
—LSO: less effective at controlling rotation
—TLSO: more effective at controlling rotation (t spine)

29
Q

Rigid LSOs

A

-chairback
-knight LSO
-clamshell body jacket

30
Q

Chairback LSOs control what plane of motion?

A

sagittal plane

31
Q

Knight LSO control what plane of motions?

A

-sagittal plane
-frontal plane

32
Q

Clamshell body jacket LSO control what plane of motions?

A

-sagittal plane
-frontal plane
-transverse plane

33
Q

TLSO indications?

A

-after thoracic spine surgery
-T-and L-spine vertebral fractures
-OA and RA
-Kyphosis

34
Q

TLSO after thoracic spine surgery

A

Clamshell body jacket TLSO
-controls all planes of movement
-don/doff in supine since patient may not be allowed upright without orthosis

35
Q

TLSO T- and L-spine vertebral fractures

A

Cruciform Anterior Spinal Hyperextension (CASH)
-restricts motion from ~T6-L1
-limit flexion, allows extension
-evdience suugests there is no additive benefit of orthoses

36
Q

TLSO OA and RA

A

Jewett Hyperextension Orthosis
-restricts motion from ~T6-L1
-limit flexion, allows extension

37
Q

TLSO kyphosis

A

Anti-kyphosis orthosis including spinomed
-evidence suggests similar outcomes to posture training in older adults

38
Q

LSO Indications?

A

-Chronic LBP due to degenerative joint disease
-LBP due to weightlifting

39
Q

Chronic LBP due to degenerative joint disease

A

-custom rigid lumbar brace for three months may reduce pain intensity

40
Q

Soft lumbosacral corsets

A

-minimal impact on sagittal and transverse plane
-restricts some frontal plane movement
-mixed evidence on impact on back and abdominal muscle strength

41
Q

LBP due to weightlifting LSO

A

-back brace may relieve pain per self report
-important on proper education on form

42
Q

Sacroiliac Belts

A

-used in patients with LBP due to hypo-or hypermobility
-assists with stabilizing the SIJ

43
Q

Scoliosis

A

-common in adolsecents and females
-LBP prevalence ~40%
-onset at younger age and larger curve –> worse prognosis

44
Q

What are 3 types of scoliosis?

A

-idiopathic
-congenital
-neuromuscular - due to muscle imbalance and/or weakness. Commonly seen in patients with CP, muscular dystrophy, and SCI as well as patients with leg length discrepancies

45
Q

How are scoliosis curves described by?

A

Based on the direction of CONVEXITY and location in spine

46
Q

How to diagnosis scoliosis?

A

-rib hump
-standing radiograph to measure cobb angle

47
Q

Scoliosis orthotic management goal

A

-prevent worsening of the curve until growth stops
-adolsecent idiopathic scoliosis
-worn during times of growth
-recommended for curves between 25-45 deg that have progressed at least 5 deg from initial detection

48
Q

Day time scoliosis braces should be worn

A

minimum of 16 hours, preferable 23 hours/day

49
Q

Night time scoliosis braces should be worn

A

8-10 hours per day on 5-7 nights per week

50
Q

What type of custom brace is a Milwaukee orthosis and what is it used for?

A

CTLSO
Day-time brace
-good for superior curves
-typically used for curves with apex T6 or above

51
Q

What type of custom brace is a Boston orthosis and what is it used for?

A

TLSO
Day-time brace
-good for lower thoracic and lumbar curves

52
Q

What type of custom brace is a Wilmington Brace and what is it used for?

A

TLSO
Day-time brace
total contact custom brace

53
Q

What type of custom brace is a Charleston Bending Brace and what is it used for?

A

Custom TLSO
Night-time brace
-overcorrects curve
-most effective for curves with apexes below T7
-recommended for curves 20-40 deg

54
Q

What type of custom brace is a Providence Scoliosis System and what is it used for?

A

Custom TLSO
Night-time brace
-overcorrects curve
-more often used for S-curves than Charleston bending brace

55
Q

What is SpineCor brace used for?

A

-dynamic brace
-daytime brace
-good for early prevention
-should be worn greater than 20 hours/day
-may not be as effective as rigid braces

56
Q

Surgical management of Scoliosis

A

-long spinal fusion
-common if curve is greater than 45 deg

P&O Exam 1 (5 decks)

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