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Prosthetics & Orthotics > Spine Orthoses > Flashcards

Spine Orthoses Flashcards

1
Q

what are the major functions of spinal orthoses?
– limit motion to:
– support _____
– ____ or _____ progression of deformity
– remind user to ____

A

– reduce pain, protect unstable segments, facilitate healing
– trunk/neck to reduce loads
– correct or limit
– maintain appropriate posture

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2
Q

soft spinal orthoses are made from:
– examples:

A

fabrics, elastics, neoprene
ex: corset, belts

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3
Q

rigid spinal orthoses are made from:

A

polyethylene or other plastics

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4
Q

effectiveness of spinal orthoses rely on: (3)

A
  • points of application; at least 3 points, direction and magnitude forces
  • device fit
  • compliance!!
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5
Q

in order to correct a spinal deformity, the orthosis must have at least ____ points

A

three

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6
Q

front/back pieces control _____ plane
side plates control ______ plane
to control ______ plane, you need a 4 point pressure system

A

sagittal
frontal
transverse

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7
Q

what are some challenges to completely immobilize the spine with an orthoses?

A
  • extremely mobile joint complex with multiple planes
  • little body surface available for contact
    ** skin breakdown, pressure related pain, hygiene issues
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8
Q

what are negative effects of spinal orthoses? (4)

A
  • axial muscle atrophy secondary to disuse
  • immobilization –> contracture or ROM limitations
  • skin breakdown –> excess pressure, irritation, and moisture
  • psychological dependency
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9
Q

what is the normal spine motion in:
– Occiput-C1?
– C1-C2?
– C2-C7?
– ___ spine greater rotation than ___ spine

A

– flexion/extension
– rotation
– flexion/extension (C5-C7); side bending & rotation (C2-C3)
– Thoracic > Lumbar

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10
Q

Soft cervical orthosis:
prefabricated
– does not limit ____ spine motion
– ______ for providing protection or stabilization for acute and chronic whiplash or other mechanical disorders

A

– cervical
– ineffective

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11
Q

semi-rigid cervical orthosis:
prefabricated
– post trauma used to ___
– provide _____ but not rigid immobilization
—> better at controlling ____ movement

A

– stabilize the spine
– general support
—> sagittal ; control flexion better than extension

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12
Q

after anterior cervical discectomy and fusion, are cervical collars supported?
posterior approach?

A

NO! not supported for both

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13
Q

are cervical orthoses recommended after:
- whiplash?
- trauma?

A

no to both

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14
Q

CO use after cervical fractures:
– flexibility?
– _____ better at controlling ROM than ____ and ____

A

– semi-rigid
– NecLoc ; Philadelphia and Aspen Collars

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15
Q

what is the recommendation for CO use for patients with acute neck pain with radiating pain?
– what grade?

** must have sensory symptoms in the arm, limited & painful cervical ROM, & motor disturbances**

A

use of a cervical collar for pain reduction may be considered. The advice is use it sparingly: only for a short period per day and only for a few weeks
– Grade C/III

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16
Q

Complications with CO use:

A
  • skin breakdown - increased risk associated with days in CO and edema
  • limitations in swallowing, coughing, breathing and vomiting - could cause aspiration
  • general immobility
  • increase intracranial pressure
  • psychological dependence
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17
Q

what does a CTO do?

A
  • provide greater restriction of segmental and regional motion, particularly of lower cervical spine
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18
Q

compared to COs, CTOs are more effective at _____

A

controlling frontal plane and transverse plane motion

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19
Q

Post-Type CTO:
– more _____ and cooler than collar
– more difficult to ____
– two and four-post control _____ well
– four post better at controlling ____ and ____ plane motion

A

– restrictive
– don/doff
– flex/ext
– frontal and transverse

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20
Q

Sternal Occipital Mandibular Immobilizer (SOMI):
– ___ post
– no ____ ____ plate –> more comfortable laying in supine
– indicated for those with instability at or above ____

A

– three
– posterior thoracic
– C4

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21
Q

SOMI is most effective at controlling ??
least effective ??

A
  • flexion C1-C3
  • extension
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22
Q

Four post CTO, Malibu collar with thoracic extension, and Yale CTO are collars used for ____

A

instability of C4 or below

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23
Q

Halo Orthosis uses:
– create ____
– reduce ____
– cervical fractures with or without ___

A

– traction
– cervical dislocation
– SCI

24
Q

what orthosis is the gold standard for upper C spine immobilization and restriction of frontal and transverse plane?

A

halo orthosis

25
Q

Halo orthosis contraindications?

A
  • unstable skull fractures
  • traumatized skin overlying pin sites
26
Q

Halo orthosis complications?

A
  • 6th cranial nerve palsy
  • pin loosening/infection
27
Q

____ orthosis controls upper C spine best
_____ orthosis controls lower C spine best

A

Halo
Minera

28
Q

a patient with a odontoid fracture (C2) requires an orthosis that is best at resisting motions. what kind is best?

A

Halo orthosis

29
Q

Rigid trunk orthoses:
– made of __
– purpose?
– utilizes ___ point counterforce system

A

– molded plastic
– protect spine and/or facilitate healing
– 3

30
Q

TLSO purposes:
– restrict ____
– limiting _____
– preventing ____

A

– spinal motion
– thoracic flexion or supporting an excessive thoracic kyphosis
– progression of scoliotic curves

31
Q

what is a downfall of a TLSO?

A

depending on the design, it can alter breathing patterns - reduce tidal volume and increase respiration rate

32
Q

trunk control with TLSO and LSO in the _____ plane:
– sagittal:
– frontal:
– transverse:
–> LSO , TLSO

A

– rigid ant/post panel
– rigid panel in mid-axillary line
– LSO: less effective at controlling trunk rotation since trunk rotation primarily occurs in T spine
TLSO: more effective at controlling transverse plane trunk movement

33
Q

list the rigid LSOs from least restrictive to most restrictive:

A
  1. chairback (sagittal control)
  2. knight LSO (sagittal & frontal control)
  3. Clamshell Body Jacket (sagittal, frontal, transverse control)
34
Q

TLSO indication for T and L spine vertebral fractures:
– restricts motion from _____
– limits ____, allows _____
– what does the evidence suggest?
– type?

A

– T6-L1
– flexion, extension
– no additive benefit of orthoses
– cruciform anterior spinal hyperextension (CASH)

35
Q

TLSO indication for OA & RA:
– restricts motion from ____
– limits _____, allows ____
– type?

A

– T6-L1
– flexion, extension
– Jewett Hyperextension Orthosis

36
Q

TLSO indication for Kyphosis & osteoporosis:
– what does the evidence suggest?
– types? (2)

A

– similar outcomes to posture training in older adults
– Anti-kyphosis orthosis & backpack orthosis

37
Q

use of a custom rigid lumbar brace for ______ may reduce pain intensity

A

three months

38
Q

Soft lumbosacral corsets:
– minimal impact on ___ and ____ plane movement
– restricts some _____ plane movement
– ______ evidence on impact on back and abdominal muscle strength

A

– sagittal and transverse
– frontal
– mixed

39
Q

using a LSO for LBP due to weight lighting:
– may relieve pain per self report
– important to educate on ______

A

– educate on proper form

40
Q

SI belts are used in patients with _____ and assists with ______

A

LBP due to hypomobility ; stabilizing the SIJ

41
Q

what does the evidence say to do for LBP or pelvic pain during pregnancy?

A

PT, manipulation, acupuncture, multi-modal intervention or addition of rigid pelvic belt to exercise seemed to relieve pelvic or back pain more than usual care alone

42
Q

Scoliosis:
– age?
– gender?
– worse prognosis?

A

– adolescents
– female
– onset at younger age and larger curve

43
Q

what are the 3 types of scoliosis?

A

idiopathic
congenital
neuromuscular

44
Q

a scoliosis curve is described based on _____ and ____

A

direction of convexity and location in spine
(C or S curve)

45
Q

what two things are used in diagnosis of scoliosis?

A

rip hump
standing radiograph to measure Cobb angle

46
Q

a long spinal fusion may be utilized for scoliosis if the curve is greater than ____ degrees

A

45

47
Q

what is the goal of orthotics for scoliosis?

A

prevent worsening of the curve until growth stops

48
Q

for adolescents with idiopathic scoliosis:
– when should they wear an orthotic?
– when are orthotics recommended?

A

– during times of growth
– curves between 25-45 degrees that progressed at least 5 degrees since initial detection

49
Q

how often are daytime braces worn with scoliosis?

A

minimum 18 hours, preferable 23 hours/day

50
Q

how often are nighttime braces worn with scoliosis?

A

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

51
Q

scoliosis bracing recommendations for idiopathic scoliosis:
– first step:
– brace curves ____ degrees that are progressing
– rigid bracing recommended for infants and curves between _____ to avoid surgery
– ______ wear or no less than _____ hours
– worn until ____
– periodic _____ to monitor effectiveness

A

– avoid or postpone surgery
– 20 +/- 5 degrees
– 45-60 degrees
– full time wear ; 18 hours
– end of bony growth
– radiographs

52
Q

custom CTLSO – Milwaukee Orthosis:
– good for ____
– typically used for curves with apex ______

A

– superior curves
– T6 or above

53
Q

Custom TLSO – Boston Orthosis:
– good for _____
– outcomes ____ with brace wear time

A

– lower thoracic and lumbar curves
– improved

54
Q

Custom, total contact TLSO – Wilmington Brace:
– ______ is key so the curve does not progress

A

compliance

55
Q

Custom TLSO – Charleston Bending Brace: (nighttime brace)
– ________ curve
– most effective for curves with apex _____
– recommended for curves ______ deg

A

– over corrects – to avoid wearing brace during the day
– below T7
– 20-40 deg.

56
Q

Custom TLSO – Providence Scoliosis System:
– ____ curve
– Most often used for ____ curves than Charleston Bending Brace

A

– over corrects
– S curves

57
Q

Spine Cor:
– _____ brace
– good for _____
– should be worn _____ hours/day
– may not be as effective as _____ braces

A

– dynamic (soft, custom)
– early protection
– > 20
– rigid

Prosthetics & Orthotics (15 decks)

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