Spinal and Pediatric Orthoses

Flexible Spinal Orthosis - components

mostly cloth and bendable materials

Main purpose of Flexible Spinal Orthosis

for sensory feedback

True/False: Flexible Spinal Orthosis does not restrict movement at all

True

Identify the Orthosis

sacroiliac belt

Sacroiliac belt - placement

under, at the level of sacrum; does not reach the level of the iliac crest

Sacroiliac belt - Feature

• Pre-fabricated belt, 5.1 cm to 10.2 cm wide

• Encircles the pelvis b/w the iliac crests and trochanters

Sacroiliac belt - Special Consideration

Used in post-partum and posttraumatic sacroiliac separations.

Features of this Orthosis

• Traditional type; belt placed under perineum for further support which pushes the pelvis upward.

• Disadvantage: uncomfortable in the groin area dt friction

• Advantage: lifts the entire perineum up which lessens the pain

Features of this Orthosis

• Pushes the pelvis, particularly the SI joint together to avoid separation

• Acts as a support to approximate the SI joint together

Features of this Orthosis

• For postpartum and pregnant women specially during the latter part of the trimester

• Lifts the belly up to prevent conditions such as low back strain

Sacroiliac Corset - Features

• A cloth garment with the superior border located at the iliac crest both anterior and posterior sides.

• Inferior border is located at the pubic symphysis and gluteal bulge, respectively.

• Entire pelvis including the gluteus maximus is lifted up.

• It has strings which allows additional pressure

Sacroiliac Corset - Function

• Assist in elevating intraabdominal pressure

• Postpartum

• Post-traumatic stabilization of pelvic joints (SI and pubic symphysis)

Sacroiliac Corset - Special Considerations

Posterior rigid to lessen movement of the pelvis, posterior sacral pad to prevent irritation on the sacrum, and perineal straps

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Sacroiliac Corset

Lumbar Binder - Feature

Wrapped around the lumbar region and held in place by Velcro closure.

Lumbar Binder - Function

Trunk support through increasing intra-abdominal pressure and provides sensory feedback for proper posture.

Lumbar binder is usually for patients who suffers from ___________

mild cases of lumbar strain

Most common flexible orthosis

Lumbosacral corset

Lumbosacral Corset - Features

• Encompasses the torso and hips

• Anterior Sup border: xiphoid process; Posterior Sup border: inferior angle of the scapulae

Lumbosacral Corset - Function

• Unloads pain on the pelvis and lumbar spine

• Decrease loading on the vertebrae and discs on minimal cases

• Sensory feedback to restrict motion.

• May limit FEL but not rotation (rotation of the spine happens on the thoracic level)

Thoracolumbar Corset - Feature

• Encompasses torso and hips

• Anterior sup border: same LS; will be painful especially for females if to be extended until the bosom/chest and might compromise breathing

• Posterior sup border: level of the scapular spines

Thoracolumbar Corset - Function

• Trunk Stabilization

• Dec loading on vertebrae and discs

• May restrict motion: FELR

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Lumbosacral corset

Identify this orthosis

Thoracolumbar Corset

Rigid Spinal Orthosis - Effecting in elevating _______ pressure

intraabdominal pressure

• Issues in lower spine may tend to be affected by

  gravity; adds to pain

Rigid spinal orthosis - Can lessen pain for about __ folds as compared to flexible spinal orthosis

5 fold

True/False: Rigid spinal orthosis may modify skeletal alignment

True; but not entirely corrected - need a lot of treatment not just orthosis

Identify Parts

Identify parts

Rigid Spinal Orthosis Components - Pelvic Band

• level of greater trochanters, above the inferior edge of the sacrum below the PSIS

• Rigid component made of metal or aluminum

Rigid Spinal Orthosis Components - Thoracic Band

Sup border: T9-T10 (below the inf angle) 2.5 cm

Rigid Spinal Orthosis Components - Anterior Extensions of Thoracic band with subclavicular band

• curving around pec. Major, ends just below the clavicle and lat to deltopectoral groove; 5.1 cm in diameter

• Rigid component for those exceeding the lumbar spine

Rigid Spinal Orthosis Components - Lumbosacral and Thoracolumbosacral posterior uprights

• Sup border: Scapular spine/

• Inf angle / Inf border: inferior edge of the pelvic band

• Placed along the paraspinal muscles and must avoid bony prominence

Rigid Spinal Orthosis Components - Lateral uprights

• ends at the edge of the thoracic and pelvic bands

• Restricts lateral movements

Rigid Spinal Orthosis Components - Oblique lateral uprights

• obliquely placed on both thoracic and pelvic bands

• Restricts rotational movements

Rigid Spinal Orthosis Components - Interscapular band

• crosses the distal 3rd of the scapulae

• When orthosis extends beyond the lumbar spine

• Holds posterior uprights together and limits friction during scapular movements

Rigid Spinal Orthosis Components - Full-front abdominal support

• Placed on the abdomen

• Restricts flexion when tight

L-S FE Control is AKA

Chairback orthosis

Chairback orthosis limits:

Slightly limits lateral flexion and rotation since it doesn’t have lateral uprights; only has posterior upright and abdominal support

LS FEL Control is AKA

Knight brace

Chairback vs Knight brace

knight brace has lateral uprights

Knight brace limits what movements?

LS EL Control is AKA

William

William limits?

• Limits extension and lateral motion but encourages flexion; reduces lumbar lordosis

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Chairback Orthosis

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Knight Brace

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Wiliiam

TLSO FE control is AKA

Taylor

Taylor limits what movements?

Limits the trunk extension, primarily in the mid-to-lower

thoracic and upper lumbar areas with a compensatory

increase in motion at the upper thoracic, lower lumbar, and

lumbosacral junction

Identify this Orthosis

Taylor

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Knight-Taylor

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Cowhorn

Identify this Orthosis

anterior hyperextension/Jewett brace

Identify this orthosis

• cash-cruciform anterior spinal hyperextension

TLSO FEL Control is AKA

Knight-Taylor

Knight-Taylor limits what movements?

• Addition of lateral uprights in an attempt to limit lateral trunk motion

• Lumbosacral segment - may increase flex/ext depending on how the orthosis is made

TLSO FLR is AKA

Cowhorn

Cowhorn limit what movements?

• Will not limit ext on thoracic area d/t thoracic band stopping below the scapular spine; it has to go higher if you want to limit thoracic extension

• Ext in LS greatly limited d/t thoracic and pelvic band

TLSO F Control is AKA

Anterior hyperextension / Jewett brace

True/False: Jewett only limits extension

False; Flexion

Jewett brace tends to _____ spine

hyperextend spine to avoid kyphosis; promote extension posture

Cash-Cruciform Anterior Spinal Hyperextension vs Jewett

• Jewett will provide much of the restriction however, there are some forms of inconvenience.

• Cash will provide restrictions on the flexion movement and is more comfortable for the patient but is recommended for pts who has a much more stable spine (orthopedic specialists will tell PT)

Identify this Orthosis

Plastic Body Jacket

TLSO Plastic Body Jacket limits what movements?

• maximum immobilization

TLSO Plastic Body Jacket is for?

Recommended for pts c severe destabilization of the spine or severe immovability of spine (pts who underwent motor vehicular accidents, spinal fractures)

Cervical Orthosis - Usually used for soft-tissue injury or arthritic changes

FE Control

Cervical FE Control - Basic Collar

• Provides sensorium

• Not totally restricts movement

Cervical FE Control - Rigid Collar

• Has some forms of restriction of movement

• Pressure ulcer formation is a potential complication of rigid collar use

• Fragile or insensate skin is particularly vulnerable to ulceration.

• Common areas susceptible to damage are the occipital protuberance, mental protuberance of the mandible (chin), clavicles, and ears

• Shearing forces can arise due to facial hair and skin sliding over the collar surface, or from positional changes

Philadelphia Collar has a _____ component compared to a basic collar

Chin component

Philadelphia Collar - Hole in the collar

• pts who underwent neck surgery

• less irritation

Philadelphia Collar - purpose

• for short-term use

• For pre-hospital emergency stabilization

• does not provide significant mechanical immobilization in unstable cervical spine and may be ineffective in preventing displacement

Cervical - FER Control is AKA

SOMI - Sterno Occipital Mandibular Immobilizer

Cervical FER Control Features

• Presence of uprights

  • Good restriction for cervical flexion

  • Since this device lacks posterior thoracic support it cannot limit extension

• The longer it is, the more it will provide axial load and approximate the chin.

• The mandibular support can be removed/lowered for eating, etc

Uses of cervical FER Control

• May be an appropriate option for bedridden patients since

  it lacks posterior thoracic coverage

• Because the SOMI limits flexion it may be used in cases of atlantoaxial instability with an intact dens, such as in patients with rheumatoid arthritis and in C2 neural arch fractures

FER Control - No Mandibular Support

• Used primarily for eating but not definitive for treatment

• Indicated for pts who does not have concerns with axial loading

• Not for pts with severe neck injuries

Cervical - FELR Control is AKA

Post Appliance / Four Poster

Four Poster - Features

Restricts all four movements, with flexion & extension being more limited than lateral flexion & rotation

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Basic Collar

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Cervical FER Control / SOMI

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Philadelphia Collar

Custom Molded - Cuirass Orthosis - Features

• Restricts all neck motions including some thoracic motions

• Extends up to level of chest

• Indicated for severe cervical injuries

Custom Molded - Minerva Orthosis - Features

• Restricts all neck motions including some thoracic motions

• Indicated for much more severe cervical injuries concerning mobility e.g. high cervical cord injuries

• Extends up to mid-level of thoracic area up to cervical area c forehead support

• Permanent use

• aka CTO (Cervical thoracic Orthosis)

Custom Molded-Halo Orthosis - Features

• Restricts all neck motions including some thoracic motions

• Indicated for acute injuries but not permanent use (only to accommodate healing) before changing to more permanent orthosis such as Minerva.

• aka CTO (Cervical thoracic Orthosis)

Halo Orthosis has been used postoperatively as an adjunct to?

to internal fixation for upper cervical and mid-cervical fractures and dislocations and as the primary method for conservative fracture stabilization

Advantages of Halo Orthosis

Provides immediate cervical spinal stability in

patients sustaining an acute fracture or subluxation

○ Nonsurgical alternative for patients refusing operative

care or for whom surgical intervention is

contraindicated

○ Permits early mobilization without risk of

compromising spinal alignment

Precautions for the halo vest:

• limit the patient’s shoulder abduction to 90 degrees and avoid shoulder shrugging.

• In general, ample space should exist between the shoulders and the shoulder vest straps to prevent excessive distraction forces on the cervical spine.

• When this space is reduced, the shoulders press against the straps and changes in forces are created.

• Care must be taken not to lift, turn, or move the patient by pulling on the plastic vest, the rods, or the superstructure. External forces applied to these areas could affect the spinal alignment and loosen pins.

True/False: Halo Orthosis are not compatible for X-ray

False

Scoliosis - TLS is AKA

Boston

Boston Orthosis is used for?

• Used for mid-thoracic or lower scoliosis curves of 40° or less

• As high as T6

• Common TLSO for S type or double curve

• Open side area is for concave side;covered contralateral side for convex

• Also used to treat spondylolisthesis and conditions of

  severe trunk weakness (muscular dystrophy)

Scoliosis - CTLS is AKA

Milwaukee Orthosis

Milwaukee is used for?

Maybe used for all kyphotic and scoliotic curves of 40 deg or less

• Used for scoliosis management that provides control of

  flexion, extension, and lateral bending of the cervical,

  thoracic, and lumbar spine.

Wilmington Orthosis

• Presence of posterior uprights

• T10-T12

• The TLSO low-profile scoliosis orthoses provide dynamic action using three principles (end-point control, transverse loading, and curve correction) to prevent curve progression and to stabilize the spine.

Pediatric Orthosis - Standing Frame

• Consists of broad base, posterior non articulated uprights extending from a flat base to a mid torso chest band, a posterior thoracolumbar band

• Training upright position and only permits standing with knees straight

• For children and adults

Pediatric Orthosis - Swivel Walker

• Similar to standing frame

• Base has two distal plates that rock slightly to enable swiveling gait

• A swivel walker is a modification of the parapodium that translates trunk rotation into forward movement of a dual footplate mechanism

Pediatric Orthosis - Parapodium

• Differs from the standing frame by virtue of joints that permit the wearer to bend the knee to sit

• Children with myelodysplasia

• Articulated

• For children only (school use)