Flexible and Rigid Orthoses (Unit 4)

corsets/belts

flexible TO

Flexible SIO

Flexible LSO

flexible TLSO

5 types of flexible trunk orthoses

flexible TO / rib belt

circumferential pressure to thorax to prevent discomfort associated with rib fractures or disloations

goal of flexible TO

indication for flexible TO

which device are these indications for?

rib fractures or dislocations

multiple rib fractures that compromise mechanical stability of thorax

contraindication of flexible TO

wrap around ribs, axilla, to xiphoid

fitting of flexible TO for males

inferior breast margin to waist

fitting of flexible TO for females

elastic or canvas

materials of flexible TO

total contact and circumferential pressure around pelvis to reinforce or compress sacroiliac joints

goal of flexible SIO

flexible SIO / SI belt

indication for flexible SIO

which device are these indications for?

back pain attributed to SI joint hypo- or hypermobility

SI strain

construction workers or weightlifters (risk for spinal strain)

pregnancy-related pelvic pain

between iliac crests and greater trochanter

fitting for flexible SIO

elastic

material of flexible SIO

flexible LSO corset

provide variable hold (not control) in sagittal and coronal plane for lumbar spine

motion control of flexible LSO corset

total contact and circumferential pressure contribute to increase intraabdominal pressure and create axial unloading of lumbar spine

goal of flexible LSO corset

traditional corset

flexible LSO constructed from canvas with metal paraspinal stays

contemporary corset

Flexible LSO corset constructed from elastic or neoprene with a moldable insert or a flexible plastic insert

provide structural integrity to the fabric

prevent the fabric edges from rolling when corset is worn

2 benefits of stays in flexible LSO

structural rigidity

improves total contact on the spine

2 benefits of low-temp thermoplastic material in flexible LSO

indications of flexible corset LSO

which device are these indications for?

low back pain

muscle strain

severe respiratory distress

contraindications of flexible corset LSO

hip circumference

measurement needed for flexible corset LSO

mid-buttocks (tailbone)

where should posterior inferior edge of flexible corset LSO be

bottom strap

which strap should be pulled first to close flexible corset LSO

traditional corset LSO

variable hold in sagittal and coronal plane for thoracic and thoracolumbar

total contact and circumferential pressure

increase intracavity pressure

goals of flexible TLSO

limit thoracic flexion

what do the straps of flexible TLSO that wrap around shoulders and axilla do?

indications of flexible TLSO

which device are these indications for?

soft tissue injuries to thoracic and lumbar spine

flexible osteoporotic thoracic kyphosis

severe respiratory compromise and asymmetry of spine

rigid osteoporotic thoracic kyphosis

contraindications for flexible TLSO

custom fab thoracolumbar corsets

what do adults with scoliosis who have pain but no progression or have spinal injury get?

osteoporotic thoracic kyphosis (dowager's hump)

spinal deformity where upper back develops forward, hunched curvature due to osteoporosis-induced compression fractures of vertebrae

back pain

height loss

visible hump

breathing difficulty

impacting daily activities

common symptoms of osteoporotic thoracic kyphosis

gibbus deformity

may occur as a result of tuberculosis which causes vertebral fractures

LSO knight type

LSO chairback type

LSO williams flexion type

3 types of rigid LSOs

TLSO taylor type

TLSO kight taylor type

TLSO cowhorn-triplane type

TLSO jewett or CASH type

4 types of rigid TLSOs

knight LSO

sagittal and coronal or FEL control LSO

control of knight LSO

thoracic band

pelvic band

paraspinal bars

anterior corset panel (apron)

lateral bars (for lateral control)

components of Knight LSO

flexion, extension, lateral bend

what does 3-point system of knight LSO control?

L1-L4

where is flexion and extension limited from knight LSO?

rotation minimally

lateral bending by 45% in thoracolumbar spine

amount the knight LSO limits rotation and lateral bending?

increases intracavity pressure to unload intervertebral discs

transmit load to soft surrounding tissue

what does anterior corset panel of knight LSO do?

aluminum

what is traditional custom knight LSO made from?

2 fingers inferior to inferior angle of scapule

trimline for superior border of thoracic band for knight LSO

between PSISs and posterior margin of buttocks

laterally between iliac crest and greater trochanter

trimline for inferior border of pelvic band for knight LSO

follow apex of paraspinal muscles

trimline of paraspinal bars for knight LSO

xiphoid process to pubic symphysis

length of abdominal front for knight LSO

lateral midline of torso

where does each lateral upright of knight LSO lay?

frame

belt with pulley system

components of chairback orthosis

contemporary knight LSO (cybertech chairback orthosis)

lightweight and breathable

better patient comfort and compliance

benefits of contemporary knight LSO

sagittal or FE

control of chairback LSO

thoracic band

pelvic band

paraspinal bars

anterior corset

(no lateral bars)

parts of chairback LSO

chairback LSO

chairback LSO

knight LSO

these indications are for which devices?

low back pain and disc herniation

stable mid-lumbar noncompression fracture management

kinesthetic reminder to limit motion for pain control

williams flexion orthosis (extension control LSO)

anterior elastic apron

lateral uprights

thoracic band

pelvic band

oblique bars

parts of extension control LSO

extension and lateral

side bending at terminal ends

motions restricted by williams flexion orthosis

williams flexion LSO

possible spondylolysis and spondylolisthesis is indication for which device?

spinal compression fractures

contraindication for williams flexion LSO

taylor TLSO

sagittal or FE

which motion control does taylor TLSO do

just inferior to scapular spine

where does taylor TLSO superior-posterior trimline extend to?

limit upper trunk or thoracic flexion

what is primary purpose of the axillary-shoulder straps

ends of orthosis at cervical and lumbosacral spine

where may motion be increased for taylor TLSO?

taylor TLSO

which device is osteoporotic thoracic kyphosis indication for?

elderly patients

what patient population with osteoporotic thoracic kyphosis may be difficult to have compliance with taylor TLSO?

adolescent scheuermann's kyphosis

contraindication for taylor TLSO

paraspinal bars

interscapular band

pelvic band

which parts of taylor tlso provide motion control?

spinomed back orthosis

counteract dowagers hump and resulting impariments

goal of spinomed back orthosis

Knight-Taylor TLSO

sagittal, coronal, FEL

motion control of knight taylor TLSO

thoracic and lumbar

spine regions that knight taylor TLSO controls

lateral and sagittal 3-point force systems

circumferential pressures

intracavitary pressure

where does knight taylor TLSO add pressure/forces?

knight taylor tlso

which device are these indications for?

post-surgical or non-surgical stable fracture management of thoracic and lumbar spine

pain due to severe muscle strain

unstable fractures

contraindication for knight taylor TLSO

lateral midline of patient

where should knight taylor TLSO lateral bars be positioned?

apex of paraspinal muscles starting at pelvic band and ending at spine of scapule

where should paraspinal bars for knight taylor tlso be?

cowhorn-triplane TLSO

FELR

sagittal

coronal

what motions does cowhorn-triplane TLSO control?

pelvic stabilization in conjunction with counter-pressures from the superior subclavicular projections from thoracic band

how does cowhorn-triplanar orthosis achieve control in transverse plane?

cowhorn-triplane TLSO (not all prefabs work)

what device is indicated by fracture management of thoracic and lumbar spine?

high thoracic injuries

contraindication for cowhorn-triplane TLSO

slide in from the side

how may the cowhorn-triplane TLSO orthosis may need to be donned?

CASH brace

jewett brace

flexion (anterior) control or hyperextension TLSO

what are two alternative names for jewett or CASH orthoses?

jewett or CASH

which orthoses are classic examples of three-point force system of orthotic management?

distance from sternal notch to symphysis pubis minus 3 inches

measurement for Jewett or CASH brace

supine

how do Jewett and CASH braces need to be fit?

thoracolumbar junction

where does posterior pad of jewett brace sit?

stabilization of orthosis

what are two jewett brace bilateral pads for?

between jugular notch and sternal angle

where does sternal plate of jewett brace sit?

between anterior superior iliac spines and pubic symphysis

where does suprapubic plate of jewett go?

stop flexion

goal of jewett brace motion control

jewett brace

which device are these indications for? traumatic compression fractures of the thoracolumbar spine and possible thoracolumbar scheuermann's disease

osteoporotic thoracic kyphosis

unstable fractures

any pathology that needs limited spinal extension like spondylolisthesis

contraindications of jewett brace

chair back

knight

body jacket LSO

order of lumbar spine devices to limit motions

FE

FEL

FELR