Spine Orthoses Flashcards
what are the major functions of spinal orthoses?
– limit motion to:
– support _____
– ____ or _____ progression of deformity
– remind user to ____
– reduce pain, protect unstable segments, facilitate healing
– trunk/neck to reduce loads
– correct or limit
– maintain appropriate posture
soft spinal orthoses are made from:
– examples:
fabrics, elastics, neoprene
ex: corset, belts
rigid spinal orthoses are made from:
polyethylene or other plastics
effectiveness of spinal orthoses rely on: (3)
- points of application; at least 3 points, direction and magnitude forces
- device fit
- compliance!!
in order to correct a spinal deformity, the orthosis must have at least ____ points
three
front/back pieces control _____ plane
side plates control ______ plane
to control ______ plane, you need a 4 point pressure system
sagittal
frontal
transverse
what are some challenges to completely immobilize the spine with an orthoses?
- extremely mobile joint complex with multiple planes
- little body surface available for contact
** skin breakdown, pressure related pain, hygiene issues
what are negative effects of spinal orthoses? (4)
- axial muscle atrophy secondary to disuse
- immobilization –> contracture or ROM limitations
- skin breakdown –> excess pressure, irritation, and moisture
- psychological dependency
what is the normal spine motion in:
– Occiput-C1?
– C1-C2?
– C2-C7?
– ___ spine greater rotation than ___ spine
– flexion/extension
– rotation
– flexion/extension (C5-C7); side bending & rotation (C2-C3)
– Thoracic > Lumbar
Soft cervical orthosis:
prefabricated
– does not limit ____ spine motion
– ______ for providing protection or stabilization for acute and chronic whiplash or other mechanical disorders
– cervical
– ineffective
semi-rigid cervical orthosis:
prefabricated
– post trauma used to ___
– provide _____ but not rigid immobilization
—> better at controlling ____ movement
– stabilize the spine
– general support
—> sagittal ; control flexion better than extension
after anterior cervical discectomy and fusion, are cervical collars supported?
posterior approach?
NO! not supported for both
are cervical orthoses recommended after:
- whiplash?
- trauma?
no to both
CO use after cervical fractures:
– flexibility?
– _____ better at controlling ROM than ____ and ____
– semi-rigid
– NecLoc ; Philadelphia and Aspen Collars
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**
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
Complications with CO use:
- 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
what does a CTO do?
- provide greater restriction of segmental and regional motion, particularly of lower cervical spine
compared to COs, CTOs are more effective at _____
controlling frontal plane and transverse plane motion
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
– restrictive
– don/doff
– flex/ext
– frontal and transverse
Sternal Occipital Mandibular Immobilizer (SOMI):
– ___ post
– no ____ ____ plate –> more comfortable laying in supine
– indicated for those with instability at or above ____
– three
– posterior thoracic
– C4
SOMI is most effective at controlling ??
least effective ??
- flexion C1-C3
- extension
Four post CTO, Malibu collar with thoracic extension, and Yale CTO are collars used for ____
instability of C4 or below
Halo Orthosis uses:
– create ____
– reduce ____
– cervical fractures with or without ___
– traction
– cervical dislocation
– SCI
what orthosis is the gold standard for upper C spine immobilization and restriction of frontal and transverse plane?
halo orthosis
Halo orthosis contraindications?
- unstable skull fractures
- traumatized skin overlying pin sites
Halo orthosis complications?
- 6th cranial nerve palsy
- pin loosening/infection
____ orthosis controls upper C spine best
_____ orthosis controls lower C spine best
Halo
Minera
a patient with a odontoid fracture (C2) requires an orthosis that is best at resisting motions. what kind is best?
Halo orthosis
Rigid trunk orthoses:
– made of __
– purpose?
– utilizes ___ point counterforce system
– molded plastic
– protect spine and/or facilitate healing
– 3
TLSO purposes:
– restrict ____
– limiting _____
– preventing ____
– spinal motion
– thoracic flexion or supporting an excessive thoracic kyphosis
– progression of scoliotic curves
what is a downfall of a TLSO?
depending on the design, it can alter breathing patterns - reduce tidal volume and increase respiration rate
trunk control with TLSO and LSO in the _____ plane:
– sagittal:
– frontal:
– transverse:
–> LSO , TLSO
– 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
list the rigid LSOs from least restrictive to most restrictive:
- chairback (sagittal control)
- knight LSO (sagittal & frontal control)
- Clamshell Body Jacket (sagittal, frontal, transverse control)
TLSO indication for T and L spine vertebral fractures:
– restricts motion from _____
– limits ____, allows _____
– what does the evidence suggest?
– type?
– T6-L1
– flexion, extension
– no additive benefit of orthoses
– cruciform anterior spinal hyperextension (CASH)
TLSO indication for OA & RA:
– restricts motion from ____
– limits _____, allows ____
– type?
– T6-L1
– flexion, extension
– Jewett Hyperextension Orthosis
TLSO indication for Kyphosis & osteoporosis:
– what does the evidence suggest?
– types? (2)
– similar outcomes to posture training in older adults
– Anti-kyphosis orthosis & backpack orthosis
use of a custom rigid lumbar brace for ______ may reduce pain intensity
three months
Soft lumbosacral corsets:
– minimal impact on ___ and ____ plane movement
– restricts some _____ plane movement
– ______ evidence on impact on back and abdominal muscle strength
– sagittal and transverse
– frontal
– mixed
using a LSO for LBP due to weight lighting:
– may relieve pain per self report
– important to educate on ______
– educate on proper form
SI belts are used in patients with _____ and assists with ______
LBP due to hypomobility ; stabilizing the SIJ
what does the evidence say to do for LBP or pelvic pain during pregnancy?
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
Scoliosis:
– age?
– gender?
– worse prognosis?
– adolescents
– female
– onset at younger age and larger curve
what are the 3 types of scoliosis?
idiopathic
congenital
neuromuscular
a scoliosis curve is described based on _____ and ____
direction of convexity and location in spine
(C or S curve)
what two things are used in diagnosis of scoliosis?
rip hump
standing radiograph to measure Cobb angle
a long spinal fusion may be utilized for scoliosis if the curve is greater than ____ degrees
45
what is the goal of orthotics for scoliosis?
prevent worsening of the curve until growth stops
for adolescents with idiopathic scoliosis:
– when should they wear an orthotic?
– when are orthotics recommended?
– during times of growth
– curves between 25-45 degrees that progressed at least 5 degrees since initial detection
how often are daytime braces worn with scoliosis?
minimum 18 hours, preferable 23 hours/day
how often are nighttime braces worn with scoliosis?
8-10 hours per day on 5-7 nights per week
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
– avoid or postpone surgery
– 20 +/- 5 degrees
– 45-60 degrees
– full time wear ; 18 hours
– end of bony growth
– radiographs
custom CTLSO – Milwaukee Orthosis:
– good for ____
– typically used for curves with apex ______
– superior curves
– T6 or above
Custom TLSO – Boston Orthosis:
– good for _____
– outcomes ____ with brace wear time
– lower thoracic and lumbar curves
– improved
Custom, total contact TLSO – Wilmington Brace:
– ______ is key so the curve does not progress
compliance
Custom TLSO – Charleston Bending Brace: (nighttime brace)
– ________ curve
– most effective for curves with apex _____
– recommended for curves ______ deg
– over corrects – to avoid wearing brace during the day
– below T7
– 20-40 deg.
Custom TLSO – Providence Scoliosis System:
– ____ curve
– Most often used for ____ curves than Charleston Bending Brace
– over corrects
– S curves
Spine Cor:
– _____ brace
– good for _____
– should be worn _____ hours/day
– may not be as effective as _____ braces
– dynamic (soft, custom)
– early protection
– > 20
– rigid
