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Orthotics > Spinal Orthotics > Flashcards

Spinal Orthotics Flashcards

1
Q

Orthotic Goals

A
  • Correction
  • Accommodation
  • Stabilize
  • Reduce Pain
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2
Q

Correction

A
  • Flexible deformity
  • Restore follower load
  • Reduce moment
  • Measure correction by measuring Cobb angle
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3
Q

Accommodation

A
  • Fixed Deformity
  • If you have a deforming moment, it is likely going to progress
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4
Q

Stabilization

A
  • Local Stabilization
  • Limit gross vertebral sway (ADLs)
  • Decrease moment and increase carrying capacity
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5
Q

Reduce Pain

A
  • Pain index scale
  • Visual analog scale
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6
Q

Free orthosis

A

Orthosis is not impairing any motion control whatsoever
** Elastic binder

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7
Q

Stop orthosis

A

Part of the plane allows motion to occur, but the other part of the motion is stopped
** ex: specifically stopping extension but allowing flexion

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8
Q

Hold orthosis

A
  • Limiting motion throughout the entire plane
  • Ex: Burst fracture: greatest instability is transverse plan bc all soft tissue is on lax and you’ll have a lot of available rotation
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9
Q

Hold-Variable Orthosis

A
  • Typically for transverse plane; “way out;” not a “true” hold
  • allows micro movement within the orthosis
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10
Q

Biomechanics Principles of Spinal Orthoses

A
  • End-point control
  • Total contact
  • Three point pressure system
  • Kinesthetic reminder
  • Increased Intracavitary pressure
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11
Q

End-Point Control

A
  • Euler’s Theory
  • Motion control of a free body
  • Ultimately trying to increase the stability of a column (spine)
  • Critical load: upper limit of load that the spine can withstand before bending
  • When the critical load is less, the chance of progressing is greater
  • The stable base is the pelvis
  • The longer the length, the more stability we can impart
    *** See the slide for critical load
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12
Q

How End-Point Control Applies

A
  • If you saw a 10% increase in height for a given curve magnitude, you will automatically see a 20% decrease in critical load/spinal stability
  • Gotta get something on that spine to restore stability
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13
Q

Total Contact

A
  • Pressure = Force/Area
  • You have to be able to re-distribute pressure to get aggressive stability –> if you don’t, you get skin breakdown
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14
Q

Three- Point Pressure

A
    • 2 pressures going in an equal and opposite direction of the third (in between the two)
  • Trying to limit motion
  • Trying to encourage person to withdraw from a stimulus
  • Used for someone who has a compression
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15
Q

What is the problem with 3 point pressure system

A
  • Middle point (the opposite point) bc of a higher sheer to moment ratio right where the fracture is
    ◦ May address alignment but causes pain
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16
Q

What does the alternative 3 point pressure system have

A
  • Bending Moment
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17
Q

Kinesthetic Reminder

A
  • Kinesthetic
  • Intact righting reflex
  • Free orthotics help impart a kinesthetic reminder to withdraw from stimulus
  • Will tell you if a design is indicated or contraindicated
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18
Q

Increased Intra-cavitary Pressure

A
  • Trying to reduce discal pressure
  • History: controversial bc they didn’t measure interstitial pressure
  • can decrease discal pressure but not really sure what the mechanism is (is the orthosis creating load sharing?)
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19
Q

Optimal Sagittal Position

A
  • Lumbar (hyper) extension for burst fracture, compression fracture, seatbelt fracture, disc herniation
  • Lumbar flexion for spondylolysis, spondylolysthesis, central or lateral stenosis to reduce pressure on nerve roots
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20
Q

Cast Syndrome

A

Anything where you have a loss of extension or lordosis that draws superior mesenteric artery to the duodenum thus blocking it

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21
Q

Corset materials

A
  • canvas
  • cotton mesh
  • elastic
22
Q

Corset closures

A
  • snap
  • hook and eye
  • pull straps/velcro
23
Q

What is important to do with patients using a corset?

A

Need to watch them don and doff the device to ensure they can tighten it enough
* typically used by older patients, so arthritis may prevent them from putting it on properly

24
Q

Biomechanical principles of corsets

A
  • total contact
  • kinesthetic reminder
  • increased intracavitary pressure
  • modified three point pressure system
25
Q

Corsets - pathologies

A
  • muscle strain
  • post-surgical
  • low back pain
  • maternity (elastic in the front)
    ** pretty rare post-op
26
Q

Research on corsets says:

A
  • Least effective spinal orthosis for limiting gross trunk motion when compared to other devices
  • Effects of reducing myoelectric activity in the paraspinal musculature has inconsistent results and needs further investigation
27
Q

Components of contact spinal systems

A
  • Kydex
  • Polyethylene
  • Copolymer
28
Q

Openings of total contact spinal systems

A
  • Overlapping
  • Interlocking
  • Posterior-opening
  • anterior-opening
  • often 2 piece because it is easier to don
29
Q

Total contact spinal systems - biomechanical principles

A
  • three point pressure
  • end point control
  • kinesthetic reminder
  • increased intracavitary pressure
30
Q

At what angle do we see significant axial load on the spine

A

30 degrees or higher

31
Q

Total contact spinal system - donning/doffing

A
  • in supine to reduce axial load of the spine
32
Q

Sequence for tightening the straps of total contact spinal system

A
  • Lay the person down before tightening can reduce the deformity
  • Start with inferior strap to lock the orthosis onto the pelvis
    ◦ Facilitates better end point control
    ◦ Less problems with orthosis migrating up into axilla
  • Work up to the top strap
  • Wait a few minutes for disco-elastic change
  • Go back to bottom strap
33
Q

Post surgical

A
  • internal construct
  • healing
  • pain reduction
34
Q

Do patients s/p idiopathic scoliosis get orthoses?

A

Not often because integrity of other structures is good
* typically used for neuromuscular scoliosis

35
Q

If internal construct fails from scoliosis surgery, what motions is it typically from?

A

flexion and rotation

36
Q

What gender does idiopathic adolescent scoliosis affect most?

A

Females > males (4:1)

37
Q

Progression indicators for idiopathic adolescent scoliosis

A

◦ Skeletal maturity
‣ The more skeletally immature, the more likely it will progress
‣ Menarche to 18 mo later is typically the time of maturity cessation
◦ Magnitude of the curve
‣ Bigger the curve, the more likely it is going to progress

38
Q

Orthoses options for idiopathic adolescent scoliosis

A

TLSO
CTLSO

39
Q

TLSO is most effect for what?

A

curve apex T7 and below
- axilla limits how high you can bring it up

40
Q

Types of data acquisition

A
  • casting
  • scanning: sit or lay down in a frame, get into corrected position then scan
41
Q

What degree range is typically the curves that orthoses can help?

A

25-45 degrees

42
Q

Mechanism to manage curves for idiopathic adolescent scoliosis

A
  • curve correction
  • end point control
  • transverse load
  • As degree of curvature increases, stability decreases
  • 60 degree curve = almost no stability at all to the spine = not much we can do from an orthotics stand point
    ◦ Still likely to progress
    ◦ Likely need surgery
  • Looking for 60-70% correction in the brace
    ◦ When they stop using it, it progresses again until they reach skeletal maturity
43
Q

Window for orthotic management

A

◦ Curve is very steep
◦ 30 degree curve is at 50% stability
‣ But if we can decrease it down to 20 degrees, we increase that stability to 80%

44
Q

BRAIST Study Results

A
  • 75% of subjects that wore an orthosis did not require surgery compared to only 42% in the observation group that did not require surgery
45
Q

Wearing the orthosis BLANK hours per day is the same as not wearing an orthosis

A

0-6 hours/day

46
Q

Wearing the orthosis greater than BLANK hours a day is overkill

A

> 18 hours/day

47
Q

BRAIST primary study conclusions

A
  • Bracing significantly decreased progression in high risk curves in AIS to the threshold of surgery
  • Gains in benefit were seen with increasing hours of brace wear
    ** Dosage is the variable that had the greatest impact
48
Q

Greatest influence on patient compliance regarding wearing of the orthosis

A
  • Difficulty paying attention in school
  • Emotional about having to wear orthosis
  • Problems with eating
  • Difficulty in sitting
  • Breathing
  • Look worse in clothes
49
Q

Neuromuscular Scoliosis

A
  • Can’t really change it.. trying to delay surgery
  • Trying to restore overall balance
  • Prevent curve from getting worse and improve physiologic function and ADLs
50
Q

Review Spondylolisthesis

A
51
Q

Review Burst Fracture

A
52
Q

3 region coupling system

A
  • Purely a bending moment, taking away the shear
  • Decreases pain
  • Great for kyphosis as well

Orthotics (9 decks)

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