Chapter Seven: Principles and components of spinal orthoses Flashcards
1
Q
Spinal orthoses are recommended for what three reasons?
A
Abdominal support
Pain mangagement
Motion/positional control
2
Q
When is trunk support indicated?
A
when patients have weakend spinal or abdominal musculature.
3
Q
When should a spinal orthosis be indicated for back pain?
A
When pain impedes functional capabilities.
4
Q
When should motion be controlled with a spinal orthosis?
A
When motion aggravates a fracture or other pathology.
5
Q
Corsets are made of what?
A
Inelastic construction consisting of soft canvas or dacron and fortification with both rigid and flexible stays.
6
Q
Corsets can provide degree of immobilization?
A
Some degree of immobilization of the spine, but not to the same degree as rigid TLSOS.
7
Q
What can be used to accommodate a deformity or to encourage postural correction in a corset?
A
spring steel posterior stays.
8
Q
What should be done to manage lumbosacral muscle strain in a corset?
A
reduce lordosis
9
Q
Wearing a corset can result in what?
A
Increased intracavitary pressure, which contributes to abdominal support and reduced axial load on the vertebral bodies.
10
Q
Corsets can be effective in managing what?
A
Pain caused by muscle strain because they reduce the activity of the spinal and abdominal musculature.
11
Q
What can happen if corsets are worn long term?
A
Musculature can atrophy and increase the chance of reinjury.
12
Q
Sacroiliac corsets are meant to provide what?
A
Assistance to the pelvis only.
13
Q
What is a sacroiliac corset?
A
An orthosis that encompasses the pelvis with endpoints inferior to the waist and superior to the pubis.
14
Q
What are sacroiliac corsets used for?
A
Minimal support to the spine and typically are used to effect a slight increase in abdominal circumferential pressure for mild conditions.
15
Q
What are lumbosacral corsets?
A
A corset that encompasses the pelvis and abdomen. It exerts circumferential pressure, increase intracavitary pressure in the abdomen and transmit a semirigid three-point pressure system on the lumbar spine.
The trimlines are inferior to the xiphoid process and superior to the pubic symphysis anteriorly and extends between the inferior angle of the scapula and the sacrococcygeal junction posteriorly.
In females, the posterior trimlines extends to the gluteal fold to reduce migration in patients with significant hip development.
16
Q
What are the trimlines of the TLSO corset?
A
Same as the lso corset except posteriorly the superior edge terminates inferior to the scapular spine. Shoulder straps are also added to provide a posteriorly directed force meant to extend the thoracic spine.
17
Q
TLSO corsets mostly serve to do what?
A
as a kinesthetic reminder to control motion in the thoracic spine. They do not provide sufficient rigidity to prevent such motion.
18
Q
What are the componenets of most common metal spinal orthoses?
A
Aluminum alloys that are radiolucent and malleable
19
Q
Where is the thoracic band located?
A
The superior edge rests 24MM inferior to the inferior angle of the scapulae
20
Q
How does the thoracic band sit?
A
It may be horizontal across the back or convex superiorly to provide the greatest height in the midline while allowing for relief of the scapulae.
Lateral to the scapula, the component dips inferiorly to relieve for the axilla.
It ends just anterior to the lateral midline of the body or the midaxillary trochanteric line. (a line defined by a bisection of the body at the axilla and trochanter).
21
Q
Where does the pelvic band rest?
A
At the midline, the inferior edge of the pelvic band rests at the sacrococcygeal junction. Lateral to the midline, the component usually dips inferiorly to contain the gluteal musculature. This curve will provide the greatest leverage.
It ends anterior to the midaxillary trochanteric line.
22
Q
How are the paraspinal bars contoured?
A
To follow the paraspinal musculature.
23
Q
On LSOs, the parapinal bars look how and are where?
A
They appear vertical and pass from the pelvic band to the thoracic band.
24
Q
Where do the paraspinal bars end in TLSOs?
A
Inferior to the spine of the scapula.
25
Where do the lateral bars lie?
Following the midaxillary trochanteric line from the superior edge of the thoracic band to the inferior edge of the pelvic band.
26
Where is the interscapular band?
Within the lateral borders of the scapulae, with its inferior edge superior to the inferior border of the scapulae.
27
All metal orthoses can be worn with what?
A corset or an anterior panel of corset material.
28
What is another name for LSO: Sagittal control?
LSO: Chairback Style.
29
What components are included in an LSO: sagittal control?
A thoracic band,
Pelvic band
Two paraspinal bars
30
When is an LSO: sagittal control indicated?
Reduction of gross motion in the sagittal plane, including both flexion and extension.
31
Where are the three point pressure systems in an LSO: sagittal control?
Flexion control is achieved via two posteriorly directed forces (at the xipohid level and the pubic level on the corset panel) and one anteriorly directed force at the midpoint of the paraspinal bars.
Extenion control is achieved via two anteriorly directed forces )arising from the thoracic and pelvic band) and one posteriorly directed force from the midpoint of the corset panel.
32
What is added in an LSO: sagittal-coronal control?
Lateral bars control coronal movement.
33
What is another name for LSO: Sagittal-coronal control:
Knight style.
34
What components are included in an LSO: sagittal-coronal control:
Thoracic band
Pelvic band
Paraspinal bars
Lateral bars.
35
What three point pressure systems are in an LSO: sagittal-coronal control?
Same as LSO: sagittal control but with the addition of three point pressure system in the coronal plane to limit lateral flexion.
36
What are the components of LSO: Extension-coronal control?
Thoracic band,
Pelvic band
lateral Bars
Oblique bars
37
What is another name for LSO: extension-coronal control?
Williams flexion
38
What do the oblique bars provide to an LSO: extension-coronal control?
Structural integrity
39
In an LSO: extension-coronal control, the attachments at the thoracic band and lateral bars are what?
Mobile
40
In an LSO: extension-coronal control, in what plane is motion allowed?
Sagittal plane
41
As an LSO: extension-coronal control devvice is worn, what is tightened, and what does this allow to occur? What is stopped
The inelastic plevic strap is tightened so that free flexion can occur, but extension is stopped.
42
What treatment is a LSO: extension-coronal control used for?
Spondylolisthesis
43
What is one style of TLSO: Flexion control (hyperextension orthosis)
Jewett style
| It is made with an aluminum frame with pads at the pubis, sternum, and lateral midline of the trunk.
44
What is another style of TLSO: flexion control (hyperextension orthosis)?
Control is achieved through a single three-point pressure system. Two posteriorly directed forces are applied, one at the sternal pad, one at the pubic pad, and an equal anteriorly directed force is applied from the lumbar pad.
45
Jewett and CASH orthoses prevent what movement?
Flexion of the spine.
46
What is another name for TLSO: Sagittal control?
Taylor Style
47
What are the components of the TLSO: sagittal control?
Pelvic band
Paraspinal bars
Interscapular band
Axillary straps
48
What kind of three point pressure systems are applied in a TLSO: sagittal control?
2 three point pressure systems in flexion and extension for the thoracic and lumbar spine.
The interscapular band provides one of the anteriorly directed forces to limit extension and the axillary straps provide one of the posteriorly directed forces to reduce the range of flexion.
49
What is another name for TLSO: sagittal-coronal control?
Knight-Taylor style
50
What are the components of the TLSO: sagittal-coronal control?
```
Thoracic band
Pelvic band
Paraspinal bars
Lateral bars
Interscpular band
Axillary straps
```
51
What motions are limited in the TLSO: sagittal-coronal control?
Flexion
Extension
lateral flexion of the thoracic and lumbar spine
52
What are the components of the TLSO: triplanar control?
Thoracic band with subclavicular extensions,
Pelvic band
Paraspinal bars
Lateral bars.
53
What is another name for subclavicular extensions?
Cowhorn projections
54
What do the subclavicular extensions do? How?
Add transverse plane control.
As a person attempts right or left rotation of the thoracic spine, counterforces from the thoracic band and extensions limit the motion .
55
Which orthosis is indicated for maimum control?
TLSO: triplanar control, custom fabricated
| Also called a Custom fabricated TLSO body jacket.
56
What does a TLSO: triplanar control custom fabricated body jacket provide?
Increased intracavitary pressure
57
When is a bivalve design of a TLSO: triplanar control custom fabricated body jacket indicated? Why?
In patients with variable volume. The anterior and posterior shells can spread apart or compress together while maintaining their Mediolateral dimensions. This will prevent the loss of coronal plane stability.
58
An anterior opening of a TLSO: triplanar control custom fabricated body jacket has what advantage?
It is easier to don
59
The height of the TLSO: triplanar control custom fabricated body jacket is dependent on what?
The spinal level requiring stabilization.
60
For a xiphoid-level body jacket, where should the trimlines terminate?
1 in superior to the xiphoid
| For women it should terminate under the breats to prevent impingement of the soft tissues.
61
If stabilization is required higher than the xipohid level with a custom body jacket, where should the trimlines end?
For females, the brace will encase the breats and terminate 1 inch distal to the sternal notce anteriorly.
A variation may be a xiphoid level jacket and a padded metal sternal extension.
62
What is the TLSO: Triplanar control, soft body jacket?
Rigid frame surrounded by soft closed-cell foam. The foam extendes to teh customary trimlines.
63
What are the trimlines for the TLSO: triplanar control, soft body jacket?
The frame terminates 1-1.5in. inside the foam edges. There is typically and anterior opening.
64
Who are TLSO: triplanar control, soft body jackets helpful for? Why?
The elderly because it is lighter and more comfortable.
65
What are cervical orthoses indicated for?
Pain management
| Motion control of the cervical spine.
66
What are the three types of cervical orthoses?
Soft, semirigid, Hard
67
What is a soft cervical collar indicated for?
A kinesthetic reminder for the individual to reduce excessive motion.
68
What is another name for a soft cervical collar?
Foam collar
69
What motion do semirigid and hard cervical collar limit?
Motion in the sagittal plane
| A little control of lateral flexion and rotation
70
What are some of the components of a semirigid or hard cervical collar?
Occipital pad
Mandibular pad
Sternal pads
Thoracic pads
71
What is a commonly used Cervicothoracic orthosis?
Sternal occipital mandibular immobilization (SOMI)
72
What are the components of a SOMI?
Sternal plate with shoulder components
Mandibular pad and bar,
occiputal pad and bars
73
What motion control does a SOMI provide?
Flexion, especially in the lower cervical segments, it allows some extension
74
What is another ccervicothoracic orthosis?
The halo
75
What motion does the halo control?
Triplanar control of the cervical spine
76
What are the components of a halo?
A halo ring fixed to the skull with pins, a chest jacket, and a superstructure that connects the ring and jacket.
77
What phenomenon may occur with a halo?
Intersegmental snaking
78
What other orthoses can be used to prevent intersegmental snaking?
A total contract cervicothoracic orthosis such as a minerva or miami JTO.
79
What are the primary clinical goals of orthoses indicated for spinal deformity?
Preventing the progression of aberrant curvature.
80
What are the basic principles of stabilization for orthoses for spinal deformities?
Endpoint control
Transverse load
Curve correction
A Combined effect
81
What is endpoint control?
The mechanical constraints on the spine provided by an orthosis.
82
What is the purpose of a pelvic interface in orthoses for spinal deformity?
To fix the orthosis rigidly to the base of the spine.
83
Endpoint control increases what?
The critical load of a spinal curve.
84
All scoliosis orthoses provide some form of what to the spine?
Transversely directed load to the curvature of the spine.
85
With scoliosis curves of 45 degrees or more, what may occur?
Further progression of the curve, even with a brace.
86
What degrees of a scoliosis curve, is it usually possible to correct and by how much?
20-30 degrees
| You can correct the curve from 50% of normal to 80% of normal usually.
87
No matter the degree of curve, reducing it will improve what?
The load carrying capactity of the spine.
88
With curves of 40 degrees or more, what percent of the curve must be corrected for satisfactory results?
50%
89
What is the milwaukee brace?
A device that was fabricated from steel and leather and extended from the pelvis to the mandible and occiput.
It provides longitudinal distraction along with a lateral pad against the most displaced ribs on the convex side of the deformity.
90
What was the purpose of the milwaukee brace?
Control scoliosis in an effort to prevent or delay surgery.
91
What amount of stability is achieved with the milwaukee brace?
Eightfold increase in stability when a flexible linear column is fixed at the base and constrained near the top.
92
What are thoracic and lumbar pads used for in scoliosis braces?
Curve reduction via transverse loading of the deformed spine.
93
How does the thoracic pad in a milwaukee brace look?
It is fashioned in an L shape and often is fabricated from low-density polyethylene, with a foam padding on the patient's side. It is shaped in an arc from posterior to anterior, contouring to the torso.
94
Where is the thoracic pad fitted in a milwaukee brace?
On the convex side of the curve and is placed over the rib that articulates with the apical vertebra and the next rib inferior. The transverse span of the pad covers the medial aspect of the convex-side paraspinal musculature to the midcoronoal line. It spans the entire posterolateral side of the trunk.
The posterior vertical aspect of the L pad is fitted under the convex-side paraspinal bar of the superstructure so that this bar can be contoured inward to assist in the anterior derotational force.
95
What is added because of the thoracic pad mounted on a flexible dacron strap on the milwaukee brace?
A transverse outrigger made of aluminum is used on the anterior bar to bridge the strap away from the patient in the area anterior to the midcoronal line. If there is any anterior contact, it will dimenish the load on the thoracic pad and prevent correction.
96
How does the placement of the thoracic pad change in a milwaukee brace with a patient with hypokyphosis?
It is palced directly lateral so that the anterior derotational force is eliminated. This is achieved by moving the pad anteriorly on the strap to a direct lateral position and either shortening or eliminating the anterior outrigger.
97
How should the neck ring be positioned in a milwaukee brace for a patient with hypokyphosis?
Centered anteriorly to midline to induce a kyphotic force.
98
What is the lumbar pad of a milwaukee brace?
It is a triangular pad that is placed inferior to the costal ribs and superior to the iliac crest. It is fashioned from a high-density foam and is contoured to the waist.
99
Where should the placement of the lumbar pad of a milwaukee brace be?
Directly over the curve apex on the convex-side posteriolateral quadrant. The transverse span is similar to the thoracic pad
100
For patients with more than one curve, what should occur?
The curve of greatest mechanical stiffness or primary curve should be loaded and shifted first.
Once that curve is shifted, the the other curve can be loaded
101
What should you do with patient that have two primary curves?
Load and shift both equally
102
Pad force is the primary mechanism for what?
Reducing spinal curvature.
103
The loading vector for thoracic and lumbar pad of scoliosis orthoses should be what?
Anteromedial, except for hypokyphotic spines.
104
How long should it take for redness to disappear on the skin of a patient after they take off a scoliosis brace? `
35 minutes.
105
If redness dissipates within 15 minutes after a scoliosis orthosis is taken off, what should be done?
The pads should be tightened because they are not providing optimal force.
106
How often should the pads in a milwaukee brace be checked?
Every 3 months.
107
The lumbar pad force of the milwaukee brace is countered by what?
The pelvic interface and the thoracic pad.
108
TLSOs are indicated for treatment of curves with apices at or below what?
T8
109
What is the lyonnaise orthosis?
Developed in France
It was the first TLSO used for treatment of thoracic curves with apices as cephalad as T8 as well as treatment of more caudad lumbar and thoracolumbar curves.
A one piece, anterior opening orthosis custom fabricated from a plaster impression and fashioned from polypropylene.
110
What is the miami orthosis?
A custom molded orthosis similar to the boston brace with variations in trimline.
It is a one piece, postieror-opening polypropylene TLSO that is custom molded from a plaster impression.
The trimlines allow forward bending.
111
What is the Wilmington orthosis?
A custom-molded TLSO fabricated from a Risser frame plaster impression taken with maximal curve correction for scoliosis
One piece, anterior opening orthosis
112
What is the rosenberg orthosis?
A custom molded TLSO fabricated from a plaster impression taken with curvature correction that uses a Dacron thoracic sling to load thoracic curves. It is custom-molded low-density, polyethylene, anterior opening TLSO.
113
All TLSOs for scoliosis use what type of pad placement?
The same pad placement as a milwaukee brace.
114
For Boston, Miami, and Lyonnaise orthoses, how are pad loads adjusted?
Increasing load is down by thickening the pad.
115
What are the advantages of the TLSO for scoliosis compared to the Milwaukee brace?
Minimal orthosis for maximum results
Good cosmesis
Low weight
Lack of metal superstructure that can tear clothing
116
What are the disadvantages of TLSOs for scoliosis compared to the milwaukee brace?
Lack of longitudinal adjustment possible from a superstructure and lack of a neck ring to prevent sway of the cervicothoracic spine.
117
What is the boston brace?
A modular, one-piece posterior opening TLSO made from polypropylene. It extends anteriorly from the xyphoid process to the symphysis pubis, with posterior and lateral trim lines varied for each curve pattern.
118
The boston orthosis does not require what?
A plaster impression, but must be custom fitted to the size and curve pattern of the patient.
119
On the convex side of the curve, how is the boston brace trimmed?
One level superior to the apex of the curve to provide a wall to function as a thoracic or lumbar pad mount.
120
On the concave side of the curve, what are the trimlines of the boston brace?
An opening is cut opposite the pad to allow an open area for the concave-side trunk shift on the level of the primary curve.
121
Above the cutout on the concave side of a boston brace, what is left intact?
A band of plastic to provide concave-side superior endpoint counterforce to function in the same manner as the axillary sling of the milwaukee brace.
122
What are the trimlines of the Rosenberg brace?
Extends anteriorly from the pubis to the xiphid process. The convex-side trim line is one rib level superior to apical height, similar to the boston or miami orthosis, but the concave side is similar to the wilmington orthosis in that there is no cutout for trunk shift. (the shift is built into the brace). The concave trimline terminates at the superor endpoint of the superior curve being treated.
123
What makes the Rosenberg brace unique to the other TLSOs for scoliosis?
It uses adjustable floading slings for curve loading, so that loading can exceed that achieved by the corrected walls of the orthosis.
124
What are the trimlines for the miami brace?
Similar trimlines to the boston and lyonnaise orthoses, but anteriorly trimmed to allow forward bending.
125
What are the trimlines of the lyonnaise brace?
Extends anteriorly from the sternal notch to the symphysis pubis.
Lateral trimlines, opening, and counterforce parameters similar to the boston brace.
126
What are the trimlines of the wilmington jacket?
Anterior trim line from symphysis pubis to sternal notch and bilateral heights to axilla. It does not have a concave side cutout, varied trimlines, or wall-mounted pads because all louds, counterforces, and concave-side area for trunk shift are fabricated into the orthosis.
127
What degree of scoliosis correction was seen in long term full time wears compared to part time wearers?
25% for full-time
| 14% for part time
128
What is an alternative part-time treatment for scoliosis?
The Charleston bending brace. It unbends curves at nightime.
