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Week 5 Spine orthoses Flashcards

1
Q

CO

A

cervical orthosis

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2
Q

CTO

A

cervical-thoracic orthosis

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3
Q

TLSO

A

thoracic lumbo-sacral orthosis

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4
Q

LSO

A

lumbo-sacral orthosis

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5
Q

CTLSO

A

cervical-thoracic-lumbo-sacral orthosis

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6
Q

SO

A

sacral orthosis

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7
Q

Goals of spinal orthose

A
  1. Limit motion to:
    – Reduce pain
    – Protect unstable segments
    – Facilitate healing
  2. Support trunk/neck to
    reduce loads
  3. Correct or limit
    progression of deformity
  4. Remind user to maintain
    appropriate posture
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8
Q

Soft

A

Made from fabrics, elastic,
neoprene
May have rigid elements to
add support
Examples: Corset, Belts

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9
Q

Rigid

A

Made from polyethylene or
other plastics
Single piece or multiple
pieces attached with
straps

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10
Q

Effectiveness of spinal orthoses relies on

A

Point of application
Direction and magnitude of forces
Device fit
Compliance

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11
Q

What are some immobilization challenges

A

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)

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12
Q

What are the negative effects of spine Orthosis

A

Axial muscle atrophy secondary to
disuse
Immobilization can promote
contracture
Excess pressure, irritation and
moisture can lead skin
breakdown
Psychological dependency

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13
Q

C0-C1 normal motion

A

primarily flexion

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14
Q

C1-C2 normal motion

A

primarily rotation

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15
Q

C2-C7 normal motion

A

involve flexion

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16
Q

C5-C7 normal motion

A

extension

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17
Q

C2-C3 normal motion

A

lateral bending

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18
Q

C2-C3 normal motion

A

rotation

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19
Q

T spine greater rotation ________

A

than L spine

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20
Q

Does a soft cervical orthosis limit cervical spine motion

A

no

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21
Q

Soft cervical orthosis is ineffective for providing _______

A

protection or
stabilization for
acute and chronic
whiplash or other
mechanical
disorders

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22
Q

What does semi-rigid cervical orthoses used for?

A

To stabilize the spine post-trauma
there is also a hole for tracheotomy

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23
Q

What does a semi-rigid cervical orthoses provide?

A

general support, but not rigid immobilization

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24
Q

Does a semi-rigid orthoses control flexion or extension better?

A

flexion

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25
What is the semi-rigid cervical orthoses least effective in controlling
frontal plane and transverse plane motion
26
Use of cervical collars is not supporterd for
Post anterior cervical discectomy and fusion and Post posterior cervical discectomy and fusion
27
What does the CPG recommend regarding whiplash
The CPS does NOT recommend cervical orthoses for post whiplash
28
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
29
NecLoc CO are better at controlling ROM than _______
Philadelphia and aspen collars
30
CO indications according to CPG
Acute neck pain with radiating pain
31
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
32
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.
33
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
34
CTO provides greater restriction of
segmental and regional motion, particularly of the lower cervical spine
35
How is CTO more effective than a CO
CTO is more effective at controlling frontal plane and transverse plane motion
36
Post-Type CTO
more restrictive and cooler than collar
37
What is difficult post-type CTO
don/doff
38
two and four post CTO control
flex/ext well
39
Four post CTO better controlling
frontal and transverse plane motion
40
Three post
sternal occipital mandibular
41
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
42
When is a three post indicated
instability at or above C4
43
What is the three post most effective at controlling
flexion C1-C3
44
What is the three post least effective at controlling
extension
45
Uses for Halo orthosis
Can also be used to create traction (uni- or bilateral) Reduce cervical dislocation Cervical fractures with or without SCI
46
Halo orthosis contraindications
unstable skull fx traumatized skin overlying pin sites
47
Halo orthosis complications
6th cranial nerve palsy pin loosening/infection
48
Cervical collars do not immobilize _______
unstable vertebrae
49
Halo orthosis controls ______ best
upper C spine
50
Minera orthosis controls _______ best
Lower c spine
51
Halo orthosis are best at resisting motions compared to
minerva brace and miami collar
52
What are rigid trunk orthoses most often made of
molded plastic
53
Purpose of rigid trunk orthoses
protect spine and/or facilitate healing it also utilizes three-point counterforce system
54
Purpose of TLSO
Restrict spinal motion Limiting thoracic flexion or supporting an excessive thoracic kyphosis Preventing the progression of scoliotic curves
55
How can TSLO design alter breathing
reduced tidal volume and increase respiration rate
56
Trunk control for sagittal plan
rigid anterior/posterior panel
57
Trunk control frontal plane
rigid panel in the mid-axillary line
58
LSO in transverse plane
less effective at controlling trunk rotation primarily occurs in T spine vs L spine
59
TSLO for transverse plane
more effective at controlling transverse plane trunk movement
60
Chairback rigid LSO
sagittal plane control
61
Knight rigid LSO
sagittal and frontal plane control
62
Clamshell body jacket rigid LSO
sagital, frontal, and transverse plane control
63
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
64
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
65
Halo orthosis is gold standard for
Upper C spine immobilization and restriction of frontal and transverse plane
66
TLSO indication for OA and RA
Restricts motion from T6 to L1 limits flexion and allows extension
67
TLSO indication for Kyphosis
Evidence suggests similar outcomes to posture training in older adults
68
LSO Indication: Chronic LBP due to Degenerative Joint Disease
Use of a custom rigid lumbar brace for three months may reduce pain intensity
69
Soft Lumbosacral corsets have minimal impact on
sagittal and transverse plane movement
70
Soft lumbosacral corsets restrict
some frontal plane movement
71
Soft Lumbosacral corset evidence
Mixed evidence on impact on back and abdominal muscle strength
72
LSO indications for LBP due to weightlifting
back braces may relieve pain per self report also important to education on proper form
73
Sacroiliac Belts
Used in patients with LBP due to hypo- or hypermobility. Assists with stabilizing the SIJ
74
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.
75
Scoliosis is common in
adolescents and females
76
Scoliosis LBP prevalence
40 %
77
Scoliosis onset at younger age and larger =
worst prognosis
78
Scoliosis types
Idiopathic Congenital Neuromuscular
79
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
80
Scoliosis diagnosis
rib hump standing radiograph to measure cobb angle
81
Scoliosis Orthotic Management Goal
prevent worsening of the curve until growth stops
82
Daytime Braces for scoliosis
worn for minimum of 16 hr, preferable 23 hr/day
83
Nighttime braces for scoliosis
worn 8-10 hr per day on 5-7 nights per week
84
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
85
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
86
Milwaukee Orthosis
Custom CTLSO
87
Milwaukee orthosis is good for
superior curves
88
Milwaukee orthosis is typically used for
curves with apex T6 or above
89
Boston Orthosis
Custom TSLO
90
Boston Orthosis is good for
lower thoracic and lumbar curves
91
Wilimington Brace
custom, total contact TLSO
92
Charleston Bending Brace
Custom TLSO
93
Charleston Bending Brace is most effective
for curves with apexes below T7 over-corrects curve
94
Charleston Bending Brace Recommended for
curves 20-40 deg
95
Providence Scoliosis System
Custom TLSO Over corrects curve
96
Providence scoliosis system is often used for S curves than
Charleston bending brace
97
SpineCor
Dynamic brace good for early prevention should be worn > 20hrs/day Might not be as effective as rigid braces
98
Surgical management of scoliosis
long spinal fusion common if curve is greater than 45 degrees

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