POAT Unit 3 Spinal and MSK Orthotic Interventions Flashcards
(32 cards)
Spinal Orthosis: Principles - 1
What are the 4 objectives of Spinal Orthosis?
- Control spinal positions by external forces
- Apply corrective forces to abnormal curvatures
- Provide spinal stabilization when soft tissues are inadequate
- Restrict spinal segment movement after trauma
Spinal Orthosis - Prinicple 2
Orthoese work through the biomechanical effects of a three-point pressure system on what aspects of the body?
- Trunk and head for support
- Motion conrol
- Spinal alignment
- Partial weight transfer of the head to the trunk when in upright positions
Spinal Orthoses: Principles - 3
Spinal Orthoses’ effectiveness relies on what?
- The points of force/pressure application
- The direction and magnitude of the forces applied
- The tightness of the device
- The type of trauma/injury and the instability produced
- The body habits of the individual wearing it
Spinal Orthoses: Principles - 4
What are some Negative Effects that Spinal orthoses may have?
- Axial muscle atrophy secondary to reduced activity
- Immobilization can promote contractures
- Excess pressure, irritation, and moisture build-up can result in skin breakdown
- Psychological dependency can occur that increases physical dependence
What is the three-column concept?
This was used as a basis for classification of traumatic spinal injuries.
- Anterior, middle and posterior column
With the three-column concept, what does the Middle Column consist of?
- Posterior Longitudal Ligament (PLL)
- Posterior annulus fibrosus
- Posterior aspect of the vertebral body
With the three-column concept, what does the Anterior Column consist of?
- Anterior aspect of the vertebral body
- Anterior annulus fibrosus
- Anterior Longitudinal Ligament (ALL)
With the three-column concept, what does the Posterior Column consist of?
- Posterior vertebral arch
- Supraspinous Ligament
- Interspinous Ligament
- Facet Joint
- Ligamentum Flavum
To be effective, what must Cervical Orthoses (COs) control?
Both gross and intersegmental movements of the head and neck
What movements are the C0-C1 segments involved in?
Significant flexion-extension, minor lateral bending and little rotation
What movements are the C1-C2 segments involved in?
Primarily rotation (50% of all rotation) with limited flexion-extension
What movements are the C3-C7 segments involved in?
Flexion-extension, lateral bending and rotation
With Cervical Orthoses, what are some challenges to immobilization and compliance?
These are extremely mobile joints complexes with mutiple 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 characteristics of the Four Posture Cervical Thoracic Orthosis? How much motion does this allow?
Has mandibular/occipital supports with struts to anterior/posterior thoracic plates
- Excellent limitation of flexion/extension
- Allows 10-28% of normal motion
In Doc
When is the Sternooccipitalmandibular Immobilizer (SOMI) indicated?
When there is an instability at or above C4
When is the Yale Cervicothoracic Orthosis indicated?
When there is instability at C4 or below
- This is basically a rigid reinforced cervical collar with the attachements of rigid anterior and posterior extensions attached to a thoracic band
In Doc
What are the Indiations of the Halo Orthosis? What are the characteristics?
Indications: When direct stabilization of the cervical occipital region is required
- Primarily used for unstable cervical fractures
- Screw placement on lateral 1/3 of eyebrow
- Torque of 5 nm for screws
- Comprised of outriggers and other parts which make donning and doffing difficult
From PCM 2
- This is an Invasive orthoses, it is fixed to the skull with 4 pins/screws piercing through the skin to the skull and the outer layer of the periosteum is penetrated.
- Its attached to a super structure that is used for attachment and stabilization to that thoracic vest. That vest must fit very intimately with the patient
- If there is movement of the vest, it can translate movement of the C-Spine, which is a contraindication
- The Halo creates increased mass at the head and the neck (“top-heavy”), and it tends to create a leaning forward of the trunk
What are the characteristics of the Minerva CTO?
CTO = Cervicothroacic orthosis
- The Minerva is non-invasive and has 3 points of control to further reduce motion. Point of control are at the Mandible, the occiput and forehead.
- There is also a custom molded body jacket that helps encase the chin and a posterior skill portion that is extending to the costal margin or pelvis
- Less “Top-heavy” than Halo
- Its been reported to have better stabilization than a Halo, execpt for injuries at C1 and C2
CO and CTO Utility 1
Do CO and CTO’s achieve total C-spine immobility?
They DO NOT achieve total or near total cervical spine immobility
CO and CTO Utility 1
Those with Neurological deficits, how long do non-surgical patients required to wear an orthosis?
3+ months
CO and CTO Utility 1
Those patient that underwent surgery, how long are they required to wear an orthosis?
6+ weeks
Recall basic anatomy and osteokinematics of the thoracic spine, describe the motions its limited to and the degrees its permitted at each segment?
Thoracic motion is limited in the uppper region and more allowed in the lower T-Spine.
- Only about 6-9°of lateral bending and rotation is permitted at each segment
Recall basic anatomy and osteokinematics of the lumbar spine, which motion has the largest available motion?
Flexion and extension have the largest available motion followed by lateral bending then rotation
- The greatest flexion/extension and least bending/rotation at L5-S1
What are the Characteristics of the Knight-Taylor Brace?
Limits Flexion and Extension
- A Thoracolumbar corset with axillary straps
- Anterior corset/apron, Mid-axillary and Posterior paraspinal molded metal uprights
- Controls sagittal and some coronal movements
- Also provides some restrictions to lateral flexion of the thoracolumbar spine
