Week 5 Spine orthoses Flashcards
CO
cervical orthosis
CTO
cervical-thoracic orthosis
TLSO
thoracic lumbo-sacral orthosis
LSO
lumbo-sacral orthosis
CTLSO
cervical-thoracic-lumbo-sacral orthosis
SO
sacral orthosis
Goals of spinal orthose
- 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
Soft
Made from fabrics, elastic,
neoprene
May have rigid elements to
add support
Examples: Corset, Belts
Rigid
Made from polyethylene or
other plastics
Single piece or multiple
pieces attached with
straps
Effectiveness of spinal orthoses relies on
Point of application
Direction and magnitude of forces
Device fit
Compliance
What are some immobilization challenges
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)
What are the negative effects of spine Orthosis
Axial muscle atrophy secondary to
disuse
Immobilization can promote
contracture
Excess pressure, irritation and
moisture can lead skin
breakdown
Psychological dependency
C0-C1 normal motion
primarily flexion
C1-C2 normal motion
primarily rotation
C2-C7 normal motion
involve flexion
C5-C7 normal motion
extension
C2-C3 normal motion
lateral bending
C2-C3 normal motion
rotation
T spine greater rotation ________
than L spine
Does a soft cervical orthosis limit cervical spine motion
no
Soft cervical orthosis is ineffective for providing _______
protection or
stabilization for
acute and chronic
whiplash or other
mechanical
disorders
What does semi-rigid cervical orthoses used for?
To stabilize the spine post-trauma
there is also a hole for tracheotomy
What does a semi-rigid cervical orthoses provide?
general support, but not rigid immobilization
Does a semi-rigid orthoses control flexion or extension better?
flexion
What is the semi-rigid cervical orthoses least effective in controlling
frontal plane and transverse plane motion
Use of cervical collars is not supporterd for
Post anterior cervical discectomy and fusion
and
Post posterior cervical discectomy and fusion
What does the CPG recommend regarding whiplash
The CPS does NOT recommend cervical orthoses for post whiplash
What does the CPG recommend regarding stabilization to the spine after trauma
The CPS does NOT recommend cervical orthoses for stabilization of the spine after trauma
NecLoc CO are better at controlling ROM than _______
Philadelphia and aspen collars
CO indications according to CPG
Acute neck pain with radiating pain
CPG - Neck pain grade III definition
neck pain associated with:
Sensory symptoms
in the arm
(paresthesias/numb
ness)
Limited and painful
cervical ROM
Motor disturbances
such as UE
weakness/atrophy
CPG CO recommendation
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.
CO complications
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
CTO provides greater restriction of
segmental and regional motion,
particularly of the lower cervical
spine
How is CTO more effective than a CO
CTO is more effective at controlling frontal plane and transverse plane motion
Post-Type CTO
more restrictive and cooler than collar
What is difficult post-type CTO
don/doff
two and four post CTO control
flex/ext well
Four post CTO better controlling
frontal and transverse plane motion
Three post
sternal occipital mandibular
what is a three post lacking
posterior thoracic plate
more comfortable for pt lying supine
pt lying not pretermitted to be upright w/o orthotic
When is a three post indicated
instability at or above C4
What is the three post most effective at controlling
flexion C1-C3
What is the three post least effective at controlling
extension
Uses for Halo orthosis
Can also be used to create
traction (uni- or bilateral)
Reduce cervical dislocation
Cervical fractures with or
without SCI
Halo orthosis contraindications
unstable skull fx
traumatized skin overlying pin sites
Halo orthosis complications
6th cranial nerve palsy
pin loosening/infection
Cervical collars do not immobilize _______
unstable vertebrae
Halo orthosis controls ______ best
upper C spine
Minera orthosis controls _______ best
Lower c spine
Halo orthosis are best at resisting motions compared to
minerva brace and miami collar
What are rigid trunk orthoses most often made of
molded plastic
Purpose of rigid trunk orthoses
protect spine and/or facilitate healing
it also utilizes three-point counterforce system
Purpose of TLSO
Restrict spinal motion
Limiting thoracic flexion or supporting
an excessive thoracic kyphosis
Preventing the progression of scoliotic
curves
How can TSLO design alter breathing
reduced tidal volume and increase respiration rate
Trunk control for sagittal plan
rigid anterior/posterior panel
Trunk control frontal plane
rigid panel in the mid-axillary line
LSO in transverse plane
less effective at controlling trunk rotation primarily occurs in T spine vs L spine
TSLO for transverse plane
more effective at controlling transverse plane trunk movement
Chairback rigid LSO
sagittal plane control
Knight rigid LSO
sagittal and frontal plane control
Clamshell body jacket rigid LSO
sagital, frontal, and transverse plane control
TSLO indication after thoracic spine sx
controls all planes of movement
don/doff in supine since pt may not be allowed to be upright w/o orthosis
TSLO indications:
T and L spine vertebral fractures
Restricts motion from ~T6 to
L1
Limit flexion, allows extension
Evidence suggests there is no
additive benefit of orthoses
Halo orthosis is gold standard for
Upper C spine immobilization and restriction of frontal and transverse plane
TLSO indication for OA and RA
Restricts motion from T6 to L1
limits flexion and allows extension
TLSO indication for Kyphosis
Evidence suggests
similar outcomes to
posture training in
older adults
LSO Indication: Chronic LBP due
to Degenerative Joint Disease
Use of a custom rigid
lumbar brace for three
months may reduce
pain intensity
Soft Lumbosacral corsets have minimal impact on
sagittal and transverse plane movement
Soft lumbosacral corsets restrict
some frontal plane movement
Soft Lumbosacral corset evidence
Mixed evidence on
impact on back and
abdominal muscle
strength
LSO indications for LBP due to weightlifting
back braces may relieve pain per self report
also important to education on proper form
Sacroiliac Belts
Used in patients with LBP due to hypo- or
hypermobility.
Assists with stabilizing the SIJ
LBP or pelvic pain during pregnancy
“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.
Scoliosis is common in
adolescents and females
Scoliosis LBP prevalence
40 %
Scoliosis onset at younger age and larger =
worst prognosis
Scoliosis types
Idiopathic
Congenital
Neuromuscular
Neuromuscular Scoliosis
muscle imbalance and/or weakness
Commonly seen in pt with CP, muscular dystrophy, and SCI, as well as pt with leg length discrepancies
Scoliosis diagnosis
rib hump
standing radiograph to measure cobb angle
Scoliosis Orthotic Management Goal
prevent worsening of the curve until growth stops
Daytime Braces for scoliosis
worn for minimum of 16 hr, preferable 23 hr/day
Nighttime braces for scoliosis
worn 8-10 hr per day on 5-7 nights per week
Adolescent idiopathic scoliosis management
Worn during times of growth
Recommended for curves
between 25-45 degrees that
have progressed at least 5
degrees since initial
detection
CPG bracing recommendations for scoliosis
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
Milwaukee Orthosis
Custom CTLSO
Milwaukee orthosis is good for
superior curves
Milwaukee orthosis is typically used for
curves with apex T6 or above
Boston Orthosis
Custom TSLO
Boston Orthosis is good for
lower thoracic and lumbar curves
Wilimington Brace
custom, total contact TLSO
Charleston Bending Brace
Custom TLSO
Charleston Bending Brace is most effective
for curves with apexes below T7
over-corrects curve
Charleston Bending Brace Recommended for
curves 20-40 deg
Providence Scoliosis System
Custom TLSO
Over corrects curve
Providence scoliosis system is often used for S curves than
Charleston bending brace
SpineCor
Dynamic brace
good for early prevention
should be worn > 20hrs/day
Might not be as effective as rigid braces
Surgical management of scoliosis
long spinal fusion
common if curve is greater than 45 degrees
