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P & O > Week 5 Spine orthoses > Flashcards

Week 5 Spine orthoses Flashcards

1
Q

CO

A

cervical orthosis

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2
Q

CTO

A

cervical-thoracic orthosis

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3
Q

TLSO

A

thoracic lumbo-sacral orthosis

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4
Q

LSO

A

lumbo-sacral orthosis

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5
Q

CTLSO

A

cervical-thoracic-lumbo-sacral orthosis

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6
Q

SO

A

sacral orthosis

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7
Q

Goals of spinal orthose

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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8
Q

Soft

A

Made from fabrics, elastic,
neoprene
May have rigid elements to
add support
Examples: Corset, Belts

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9
Q

Rigid

A

Made from polyethylene or
other plastics
Single piece or multiple
pieces attached with
straps

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10
Q

Effectiveness of spinal orthoses relies on

A

Point of application
Direction and magnitude of forces
Device fit
Compliance

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11
Q

What are some immobilization challenges

A

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

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12
Q

What are the negative effects of spine Orthosis

A

Axial muscle atrophy secondary to
disuse
Immobilization can promote
contracture
Excess pressure, irritation and
moisture can lead skin
breakdown
Psychological dependency

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13
Q

C0-C1 normal motion

A

primarily flexion

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14
Q

C1-C2 normal motion

A

primarily rotation

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15
Q

C2-C7 normal motion

A

involve flexion

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16
Q

C5-C7 normal motion

A

extension

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17
Q

C2-C3 normal motion

A

lateral bending

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18
Q

C2-C3 normal motion

A

rotation

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19
Q

T spine greater rotation ________

A

than L spine

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20
Q

Does a soft cervical orthosis limit cervical spine motion

A

no

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21
Q

Soft cervical orthosis is ineffective for providing _______

A

protection or
stabilization for
acute and chronic
whiplash or other
mechanical
disorders

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22
Q

What does semi-rigid cervical orthoses used for?

A

To stabilize the spine post-trauma
there is also a hole for tracheotomy

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23
Q

What does a semi-rigid cervical orthoses provide?

A

general support, but not rigid immobilization

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24
Q

Does a semi-rigid orthoses control flexion or extension better?

A

flexion

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25
Q

What is the semi-rigid cervical orthoses least effective in controlling

A

frontal plane and transverse plane motion

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26
Q

Use of cervical collars is not supporterd for

A

Post anterior cervical discectomy and fusion
and
Post posterior cervical discectomy and fusion

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27
Q

What does the CPG recommend regarding whiplash

A

The CPS does NOT recommend cervical orthoses for post whiplash

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28
Q

What does the CPG recommend regarding stabilization to the spine after trauma

A

The CPS does NOT recommend cervical orthoses for stabilization of the spine after trauma

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29
Q

NecLoc CO are better at controlling ROM than _______

A

Philadelphia and aspen collars

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30
Q

CO indications according to CPG

A

Acute neck pain with radiating pain

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31
Q

CPG - Neck pain grade III definition

A

neck pain associated with:
Sensory symptoms
in the arm
(paresthesias/numb
ness)
Limited and painful
cervical ROM
Motor disturbances
such as UE
weakness/atrophy

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32
Q

CPG CO recommendation

A

Use of a 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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33
Q

CO complications

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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34
Q

CTO provides greater restriction of

A

segmental and regional motion,
particularly of the lower cervical
spine

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35
Q

How is CTO more effective than a CO

A

CTO is more effective at controlling frontal plane and transverse plane motion

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36
Q

Post-Type CTO

A

more restrictive and cooler than collar

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37
Q

What is difficult post-type CTO

A

don/doff

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38
Q

two and four post CTO control

A

flex/ext well

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39
Q

Four post CTO better controlling

A

frontal and transverse plane motion

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40
Q

Three post

A

sternal occipital mandibular

41
Q

what is a three post lacking

A

posterior thoracic plate
more comfortable for pt lying supine
pt lying not pretermitted to be upright w/o orthotic

42
Q

When is a three post indicated

A

instability at or above C4

43
Q

What is the three post most effective at controlling

A

flexion C1-C3

44
Q

What is the three post least effective at controlling

A

extension

45
Q

Uses for Halo orthosis

A

Can also be used to create
traction (uni- or bilateral)
Reduce cervical dislocation
Cervical fractures with or
without SCI

46
Q

Halo orthosis contraindications

A

unstable skull fx
traumatized skin overlying pin sites

47
Q

Halo orthosis complications

A

6th cranial nerve palsy
pin loosening/infection

48
Q

Cervical collars do not immobilize _______

A

unstable vertebrae

49
Q

Halo orthosis controls ______ best

A

upper C spine

50
Q

Minera orthosis controls _______ best

A

Lower c spine

51
Q

Halo orthosis are best at resisting motions compared to

A

minerva brace and miami collar

52
Q

What are rigid trunk orthoses most often made of

A

molded plastic

53
Q

Purpose of rigid trunk orthoses

A

protect spine and/or facilitate healing
it also utilizes three-point counterforce system

54
Q

Purpose of TLSO

A

Restrict spinal motion
Limiting thoracic flexion or supporting
an excessive thoracic kyphosis
Preventing the progression of scoliotic
curves

55
Q

How can TSLO design alter breathing

A

reduced tidal volume and increase respiration rate

56
Q

Trunk control for sagittal plan

A

rigid anterior/posterior panel

57
Q

Trunk control frontal plane

A

rigid panel in the mid-axillary line

58
Q

LSO in transverse plane

A

less effective at controlling trunk rotation primarily occurs in T spine vs L spine

59
Q

TSLO for transverse plane

A

more effective at controlling transverse plane trunk movement

60
Q

Chairback rigid LSO

A

sagittal plane control

61
Q

Knight rigid LSO

A

sagittal and frontal plane control

62
Q

Clamshell body jacket rigid LSO

A

sagital, frontal, and transverse plane control

63
Q

TSLO indication after thoracic spine sx

A

controls all planes of movement
don/doff in supine since pt may not be allowed to be upright w/o orthosis

64
Q

TSLO indications:
T and L spine vertebral fractures

A

Restricts motion from ~T6 to
L1
Limit flexion, allows extension
Evidence suggests there is no
additive benefit of orthoses

65
Q

Halo orthosis is gold standard for

A

Upper C spine immobilization and restriction of frontal and transverse plane

66
Q

TLSO indication for OA and RA

A

Restricts motion from T6 to L1
limits flexion and allows extension

67
Q

TLSO indication for Kyphosis

A

Evidence suggests
similar outcomes to
posture training in
older adults

68
Q

LSO Indication: Chronic LBP due
to Degenerative Joint Disease

A

Use of a custom rigid
lumbar brace for three
months may reduce
pain intensity

69
Q

Soft Lumbosacral corsets have minimal impact on

A

sagittal and transverse plane movement

70
Q

Soft lumbosacral corsets restrict

A

some frontal plane movement

71
Q

Soft Lumbosacral corset evidence

A

Mixed evidence on
impact on back and
abdominal muscle
strength

72
Q

LSO indications for LBP due to weightlifting

A

back braces may relieve pain per self report
also important to education on proper form

73
Q

Sacroiliac Belts

A

Used in patients with LBP due to hypo- or
hypermobility.
Assists with stabilizing the SIJ

74
Q

LBP or pelvic pain during pregnancy

A

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

75
Q

Scoliosis is common in

A

adolescents and females

76
Q

Scoliosis LBP prevalence

A

40 %

77
Q

Scoliosis onset at younger age and larger =

A

worst prognosis

78
Q

Scoliosis types

A

Idiopathic
Congenital
Neuromuscular

79
Q

Neuromuscular Scoliosis

A

muscle imbalance and/or weakness

Commonly seen in pt with CP, muscular dystrophy, and SCI, as well as pt with leg length discrepancies

80
Q

Scoliosis diagnosis

A

rib hump
standing radiograph to measure cobb angle

81
Q

Scoliosis Orthotic Management Goal

A

prevent worsening of the curve until growth stops

82
Q

Daytime Braces for scoliosis

A

worn for minimum of 16 hr, preferable 23 hr/day

83
Q

Nighttime braces for scoliosis

A

worn 8-10 hr per day on 5-7 nights per week

84
Q

Adolescent idiopathic scoliosis management

A

Worn during times of growth
Recommended for curves
between 25-45 degrees that
have progressed at least 5
degrees since initial
detection

85
Q

CPG bracing recommendations for scoliosis

A

First step for idiopathic scoliosis to avoid or postpone
surgery
Brace for curves 20°± 5° that are progressing
Rigid bracing recommended for infants and curves
between 45-60° to avoid surgery
Full time wear or no less than 18 hours/day
Brace worn til the end of bony growth
Monitor compliance and brace fit
Periodic radiographs to monitor effectiveness of brace

86
Q

Milwaukee Orthosis

A

Custom CTLSO

87
Q

Milwaukee orthosis is good for

A

superior curves

88
Q

Milwaukee orthosis is typically used for

A

curves with apex T6 or above

89
Q

Boston Orthosis

A

Custom TSLO

90
Q

Boston Orthosis is good for

A

lower thoracic and lumbar curves

91
Q

Wilimington Brace

A

custom, total contact TLSO

92
Q

Charleston Bending Brace

A

Custom TLSO

93
Q

Charleston Bending Brace is most effective

A

for curves with apexes below T7
over-corrects curve

94
Q

Charleston Bending Brace Recommended for

A

curves 20-40 deg

95
Q

Providence Scoliosis System

A

Custom TLSO
Over corrects curve

96
Q

Providence scoliosis system is often used for S curves than

A

Charleston bending brace

97
Q

SpineCor

A

Dynamic brace
good for early prevention
should be worn > 20hrs/day
Might not be as effective as rigid braces

98
Q

Surgical management of scoliosis

A

long spinal fusion
common if curve is greater than 45 degrees

P & O (4 decks)

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