Spine Orthoses Flashcards
What are the goals for spinal orthoses?
- limit motion to reduce pain, protect unstable segments, facilitate healing
- support trunk/neck to reduce loads
- correct or limit progression of deformity
- remind user to maintain appropriate posture
What are 2 types of spinal orthoses?
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
What does effectiveness rely on for spinal orthoses?
-points of application
-direction and magnitude of forces
-device fit
-compliance
What are the immobilization challanges with spinal orthoses?
-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)
What are the negative effects of spine orthosis?
-axial muscle atrophy secondary to disue
-immobilization can promote contracture
-excess pressure, irritation and moisture can lead to skin breakdown
-physiological dependency
What are the normal spine motions at the cervical level?
-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
CO soft
-prefabricated
-do not limit cervical spine motion
-ineffective for providing protection or stabilization for acute and chronic whiplash or other mechanical disorders
CO Semi-rigid
-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
Should cervical collars be used after cervical surgery?
Not supported
Are CO’s recommended for whiplash and trauma?
Not recommended
When are CO’s indicated for?
-Cervical fractures
-Acute neck pain with radiating pain
-Neck pain
Cervical fractures
-NecLoc CO better at controlling ROM than Philadelphia and Aspen collars
Neck Pain Grade III
-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
What are the complications of CO?
-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
What are the purposes of CTO?
-provide greater restriction of segmental and regional motion, particulary the lower cervical spine
-more effective than COs at controlling frontal and transverse plane motion
Post-Type CTO
-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
Sternal Occipital Mandibular Immobilizer
-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
What types of CTO should be used for instability of C4 or below?
-four poster
-malibu collar with thoracic extension
-yale cervicothoracic orthosis
What orthosis is the gold standard for upper c-spine immobilization?
Halo orthosis
Halo orthosis
-can be used ot create traction (uni or bilateral)
-reduce cervical dislocation
-cervical fractures with or without SCI
What are the contraindications for Halo orthosis?
-unstable skull fractures
-traumatized skin overlying pin sites
What are the complications of using a halo orthosis?
-6th cranial nerve palsy
-pin loosening/infection
What are the indications for a CTO?
-instability of C4 or below
-cervical fractures
-odontoid fracture (C2)
Cervical fractures
-cervical collars do not immobilize unstable vertebrae
-Halo orthosis controls upper C spine best
-Minera orthosis controls lower C spine best
Odontoid fracture (C2)
Halo orthosis best at resisting motions as compared to minera and miami collar
Rigid trunk orthoses
-most often made of molded plastic
-purpose: protect spine and/or facilitate healing
-utilize 3 point counterofrce system
What are the purposes of TLSO?
-restrict spinal motion
-limit thoracic flexion or supporting excessive thoracic kyphosis
-preventing the progression of scoliotic curves
TLSO and LSO trunk Control
-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)
Rigid LSOs
-chairback
-knight LSO
-clamshell body jacket
Chairback LSOs control what plane of motion?
sagittal plane
Knight LSO control what plane of motions?
-sagittal plane
-frontal plane
Clamshell body jacket LSO control what plane of motions?
-sagittal plane
-frontal plane
-transverse plane
TLSO indications?
-after thoracic spine surgery
-T-and L-spine vertebral fractures
-OA and RA
-Kyphosis
TLSO after thoracic spine surgery
Clamshell body jacket TLSO
-controls all planes of movement
-don/doff in supine since patient may not be allowed upright without orthosis
TLSO T- and L-spine vertebral fractures
Cruciform Anterior Spinal Hyperextension (CASH)
-restricts motion from ~T6-L1
-limit flexion, allows extension
-evdience suugests there is no additive benefit of orthoses
TLSO OA and RA
Jewett Hyperextension Orthosis
-restricts motion from ~T6-L1
-limit flexion, allows extension
TLSO kyphosis
Anti-kyphosis orthosis including spinomed
-evidence suggests similar outcomes to posture training in older adults
LSO Indications?
-Chronic LBP due to degenerative joint disease
-LBP due to weightlifting
Chronic LBP due to degenerative joint disease
-custom rigid lumbar brace for three months may reduce pain intensity
Soft lumbosacral corsets
-minimal impact on sagittal and transverse plane
-restricts some frontal plane movement
-mixed evidence on impact on back and abdominal muscle strength
LBP due to weightlifting LSO
-back brace may relieve pain per self report
-important on proper education on form
Sacroiliac Belts
-used in patients with LBP due to hypo-or hypermobility
-assists with stabilizing the SIJ
Scoliosis
-common in adolsecents and females
-LBP prevalence ~40%
-onset at younger age and larger curve –> worse prognosis
What are 3 types of scoliosis?
-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
How are scoliosis curves described by?
Based on the direction of CONVEXITY and location in spine
How to diagnosis scoliosis?
-rib hump
-standing radiograph to measure cobb angle
Scoliosis orthotic management goal
-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
Day time scoliosis braces should be worn
minimum of 16 hours, preferable 23 hours/day
Night time scoliosis braces should be worn
8-10 hours per day on 5-7 nights per week
What type of custom brace is a Milwaukee orthosis and what is it used for?
CTLSO
Day-time brace
-good for superior curves
-typically used for curves with apex T6 or above
What type of custom brace is a Boston orthosis and what is it used for?
TLSO
Day-time brace
-good for lower thoracic and lumbar curves
What type of custom brace is a Wilmington Brace and what is it used for?
TLSO
Day-time brace
total contact custom brace
What type of custom brace is a Charleston Bending Brace and what is it used for?
Custom TLSO
Night-time brace
-overcorrects curve
-most effective for curves with apexes below T7
-recommended for curves 20-40 deg
What type of custom brace is a Providence Scoliosis System and what is it used for?
Custom TLSO
Night-time brace
-overcorrects curve
-more often used for S-curves than Charleston bending brace
What is SpineCor brace used for?
-dynamic brace
-daytime brace
-good for early prevention
-should be worn greater than 20 hours/day
-may not be as effective as rigid braces
Surgical management of Scoliosis
-long spinal fusion
-common if curve is greater than 45 deg
