Spinal And UE Orthotics

Question 1

What is an orthotic?

Answer 1

something used to support, align, prevent or correct deformities, or improve function

Question 2

Purposes of an orthotic

Answer 2

support and align
immobilize, restrict, or mobilize
prevent or correct deformity
substitute or enhance motion
reduce pain and discomfort

Question 3

Indications for a spinal orthotic

Answer 3

correct or prevent deformity, relieve pain, support fracture healing, post-op protection, prevent further injury, support and align

Question 4

Spinal orthotic principles

• ____ pressure system
• increase ______
• Provide ______
• modify_____

Answer 4

• 3 point
• hydrostatic pressure
• kinesthetic reminder
• support systems

Question 5

Spinal support systems

• muscles
• ligaments
• discs

Answer 5

Muscles- 
-flexors: psoas, abdominals
-extensors: erector spinae, paraspinals
Ligaments- linkage, transfer loads, smooth motion
Discs- shock absorption

Question 6

• Extrinsic stability

- Intrinsic stability

Answer 6

• muscles

- ligaments/discs

Question 7

Soft collars

• facilitate_____
• limit _____
• provide _____

Answer 7

• spinal alignment
• some ROM
• kinesthetic reminder

Question 8

What type of collar is a Headmaster collar?

Answer 8

soft

Question 9

Name 3 types of semi-rigid collars

Answer 9

Philadelphia, aspen, miami J

Question 10

Two types of cervical orthoses with thoracic extension

Answer 10

• SOMI (sternal occipital Mandibular immobilizer)- often used for bed bound pts.
• Lerman-Minerva

Question 11

Halos

Answer 11

• tri planar motion control of cervical spine
• maximum immobilization
• restricts 90-95% of normal motion
• poor acceptance, high complication rate

Question 12

Types of LSO

Answer 12

• flexible LSO
• Chairback LSO
• Knight LSO

Question 13

What does a chairback LSO do?

Answer 13

restricts sagittal plane motion, tightening abdominal support reduces lumbar lordosis

Question 14

What does a Knight LSO do?

Answer 14

restricts sagittal and coronal plane motion, tightening abdominal support reduces lumbar lordosis

Question 15

Types of TLSOs

Answer 15

• knight-taylor TLSO
• Jewett Hyperextension TLSO
• CASH hyperextension TLSO
• rigid TLSO (body jacket)
• CTLSO (TLSO with cervical extension

Question 16

Knight-taylor TLSO

Answer 16

• restricts sagittal and coronal plane motion
• tightening abdominal support reduces lumbar lordosis
• tightening axillary straps facilitates thoracic extension

Question 17

Jewett hyperextension TLSO

• restrictions
• indications

Answer 17

• restricts thoracolumbar flexion and some coronal plane movement
• compression fracture, kyphosis, arthritis

Question 18

CASH hyperextension TLSO

• abbreviation
• restricts
• common in

Answer 18

• Cruciform Anterior Spinal Hyperextension
• thoracolumbar flexion
• geriatric pts.

Question 19

Rigid TLSO (body jacket)
-restricts

Answer 19

sagittal, coronal, and transverse plane movement

Question 20

Indications for orthotic mgmt of scoliosis

Answer 20

• skeletal immaturity (premenarche)
• curves between 20 and 40 degrees
• documented progression
• single or double curves

Question 21

Accomodative TLSO
(for scoliosis)
-addresses _____
-aligns head and trunk over pelvis, doing what?

Answer 21

• fixed deformity

- reducing shear forcer, facilitating UE use, enhances mobility, facilitates respiratory function

Question 22

Corrective TLSO
(for scoliosis)
-progressive correction of \_\_\_\_\_\_\_
-stabilization of \_\_\_\_\_
-\_\_\_\_ and or \_\_\_\_\_ deformity

Answer 22

• idiopathic spinal curvatures
• congenital spinal curvatures
• prevent and/or correct

Question 23

Types of corrective TLSOs

Answer 23

• Boston brace
• Milwaukee brace
• Charleston Bending Brace

Question 24

Boston brace

Answer 24

• considered gold standard for adolescent scoliosis

- worn full time (18-23 hours/day)

Question 25

Milwaukee brace

Answer 25

- for upper thoracic and cervical curvature | - worn full time (18-23 hours/day)

Question 26

Charleston bending brace

Answer 26

- for smaller, flexible lumbar curvatures | - worn only at night (8 hours/day)

Question 27

PT for corrective TLSOs

Answer 27

- skin care - trunk mobility and strengthening - aerobic training - postural feedback and training - functional training with brace

Question 28

Indications for UE orthotics

Answer 28

- trauma (burns, MVAs, vocational) - congenital deformity - disease (RA, SLE, neuro impairments, esp. associated with abnormal tone)

Question 29

Designs of UE orthotics

Answer 29

Static, serial static, static progressive, dynamic

Question 30

- static progressive orthotic | - dynamic orthotic

Answer 30

- uses static components to apply force | - uses elastic components to apply force

Question 31

Which tendon mechanism is more prone to shortening and is more difficult to compensate for?

Answer 31

extensor mechanism

Question 32

Intrinsic plus position | anti-deformity position

Answer 32

MCP flexion with DIP and PIP extension. | -positioning MCP in flexion protects IP extension

Question 33

Intrinsic minus position

Answer 33

MCP extension with PIP/DIP flexion - results from intrinsic denervation (ulnar nerve palsy) - unopposed extension cause MCP hyperextension and IP flexion

Question 34

Pressure= - never ____ - accommodate for_____

Answer 34

P=force*area - never eliminated, only distributed - bony prominences

Question 35

prominences

Answer 35

olecranon, humeral epicondyles, stloid processes, base of 1st MC joint, dorsal thumb, MP and IP joints, pisiform

Question 36

Nerves

Answer 36

radial groove of humerus, (radial) cubital tunnel (ulnar), distal forearm (ulnar), carpal tunnel (median), volar digital nerves

Question 37

functional hand splint - wrist - thumb - MCPs - IPs

Answer 37

- 20-30 degrees extension - palmar abduction - 15-20 degrees flexion - slight flexion

Question 38

wrist position in intrinsic plus splint - palmar burn - dorsal burn - crush injury

Answer 38

- 30-40 degrees extension - neutral-slight extension - 0-30 degrees extension

Question 39

MCP position in intrinsic plus splint - burn - crush injury

Answer 39

- 70-90 degrees flexion | - 60-80 degrees flexion

Question 40

IP and thumb position for intrinsic plus splint

Answer 40

- extension | - palmar abduction

Question 41

Thumb immobilization is used for what conditions | -position

Answer 41

- DeQuervain's: inflammation of APL and EPB sheaths, RA, Gamekeeper's thumb: UCL injury - CMC in 35-30 degrees of abduction with MP joint in neutral