Transcript Spinal Orthoses

Spinal Orthoses
• Objectives for application of orthosis
• controlling the position of the spine
• applying the corrective forces to abnormal
curvatures
• aiding in spinal stability
• restricting spinal segment movement after acute
trauma or after surgical procedure to protect
against further injury
• mechanical effect/sensory feedback
Spinal Orthoses
The function of rigid and flexible orthosis are the
consequence of the forces that they apply on the body
The location, magnitude and direction of these forces
vary with the design of the orthosis ,tightness with
which it is worn and the patients attempts to move
against it
As a result of force application nearly every spinal
orthosis produce three effect
1)Increase intracavitary pressure
2)Restrict trunk motion
3)Modify skeletal alignment
• Kyphosis - flexion
• Lordosis - extension
• Normal
– cervical lordosis 20-40º
– thoracic kyphosis 20-40º
– lumbar lordosis 40-60º
• Scoliosis - twisting (rotation) with
hump formation, more common
in females than males
– usually first appears in late
childhood/early teenage
– causes :polio or other condition
causing muscle imbalance
– 90% curve to the right, only 2%
require treatment
– unsightly
Spinal Orthoses
• Based on the joints they encompass and analysis
of their control motion the Spinal orthoses are
divided into the following types:
1) CO: Cervical Orthoses
2)CTLSO: Cervical thoracic ,lumbosacral Orthoses
3)TLSO: thoracic ,lumbosacral Orthoses
4)LSO: lumbosacral Orthoses
Cervical Orthoses
• These are used to restrict head and neck motion, and
limit flexion,extension,rotation of the head and the
cervical spine
• The cervical orthoses are further divided into
1)Soft collar-for soft tissue injury, arthritic change
2) Hard collar
3)Philadelphia collar
4)SOMI
5)Post appliance
6)Custom molded
7)Halo type
Cervical Orthoses
• Collar: A basic collar is a device that wraps
around the neck and is adjustable
circumferentially. It may have a provision for
height adjustment ,be single or multiple layered
as is of variable firmness. Materials used include
resilient polyethylene, sponge rubber etc
• Functions:1) It provides some mechanical restrain
to flexion, extension,& (to a lesser degree) lateral
flexion and rotation.
2)It reminds the wearer to limit head and neck
motions
Types Of Collars
• Soft collar: A soft collar is made of foam rubber covered with
stockinette(An elastic knitted fabric used especially in making bandages)
The soft collar will be used for patients who have pain in the neck due to
strain or stress. It acts as a reminder for the patient to not flex his/her
neck through a sensory feedback. It can be made to measure or pre-made
with fasteners of lay-on Velcro at the posterior of the neck. In some cases
the Velcro strap will be adjusted so that the patients cannot don or doff
the collar themselves.
Types Of Collars
• Hard Collar
A hard collar provides a more effective way of
controlling flexion and extension of the
cervical vertebrae of the spine. It is made of
padded polyethylene.
Types Of Collars
• Philadelphia Collar
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A Philadelphia collar prefabricated of polyethylene foam reinforced with rigid anterior
and posterior plastic strips, this device covers most of head and neck than the basic
collars. The Philadelphia collar terminates superiorly over the mandible and it’s lower
border is at the proximal thorax.
It easy to fit and adjust on the patient. It comes with different sizes and depths
In Philadelphia collar the motion restriction is increased by the reinforcing anterior
and posterior strips, which also permit selective adjustment of head position
Post Appliance
• Post Appliance: It has an anterior section consisting of a sternal plate ,1 or
2 anterior straps ,2 anterior uprights and a mandibular support as well as a
posterior section consisting of a inter scapular plate ,1 or 2 posterior
uprights and an occipital support.
• The anterior and posterior straps are usually connected by straps between
anterior and posterior support and by shoulder straps between the
interscapular and sternal plates
Sternal plate
Madibular
support
Post Appliance
• The uprights are adjustable for height.
• The post appliance is commonly pre fabricated
of aluminum ,with plastic or leather padding
of parts that contact the body.
• Functions: 1)It resist flexion and extension of
the head and cervical spine by forces applied
under the mandible. These forces also limit
lateral flexion and rotation.
2) It permits selective positioning of the head
by varying the length of the uprights.
Sterno-occipital mandibular
immobilizer
• Sterno-occipital mandibular immobilizer : It has a single anterior upright
with attached mandibular support ,can be quickly and easily moved from
sternal palte.This allows the patient to eat, wash while remaining in supine
semi immobilized position. The posterior uprights arise from a sternal
plate ,extend upwards and backwards and attach to the occipital support.
Anterior upright
Sterno-occipital mandibular
immobilizer
• Fixtures are available to enable the SOMI to
attach to custom made spinal jacket ,thus
increasing overall orthotic control of vertebral
column.
• Functions:1)It resist flexion and extension of
the head and cervical spine by forces applied
under the mandible. These forces also limit
lateral flexion and rotation.(control if cervical
extension and lateral flexion is significantly
less as compared to post appliance.
Custom molded appliances
• Custom molded appliances: Custom molded orthoses may be made of
thermoplastic or leather formed over a modified plaster model of the
patients skull and torso or of low temperature thermoplastic formed
directly on the patient.
• They are designed to restrict all neck motions also thoracic motion of
varying degrees depending on the extend of their downward extension on
the thorax
• Those which extend distally beyond the upper thorax are classified as
cervicothoracic devices ,while cuirass extend superiorly over the chin
,mandible .It may terminate just above the inferior angles of scapula or
may continue further downwards to inferior coastal margin depending
upon the type of control required.
Custom molded appliances
• The Minerva type includes entire posterior
skull and includes a band around the forehead
,extends downward to the inferior coastal
margin. If better control is needed it may
terminate in a pelvic girdle.
Cuirass type
Minerva type
Halo Cervical Orthoses
• The Halo assembly provides the greatest control of all cervical orthosis .It’s
basic components are a halo ring ,distraction rods ,shoulder bars, and a
distal fixation component. The halo encircles the skull and is secured by
fixation pins that penetrate the outer table of the skull. The upper and
lower ends of the length adjustable distraction straps are attached
respectively to the Halo and shoulder bars .The latter in turn are attached
to distal fixation components ,which may be a vest, body jacket, pelvic
girdle or cast.
Shoulder bars
Halo ring
Distraction bars
Jacket, vest
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Lumbosacral
orthoses
The Lumbosacral orthoses are of
two types:
1)Flexible:
• The lumbosacral corset is made
of fabric (cloth garment)that
encompasses the torso with
adjustable front ,side or back
Velcro fasteners (hooks)allow
user to control degree of tension
for proper support and comfort.
• It extends just below the xiphoid
process to above the pubic
symphysis.
• If a prefabricated garment cannot
be used then custom corsets may
be fabricated based on the
measurements of the individual
patient
Lumbosacral orthoses
• Functions: They support the lower spine,
reduce pressure on the lumbar sacral region
by increasing intra-abdominal pressure also
acting as a reminder to the patient to
maintain correct posture(restrict motion). This
orthosis is very popular in the treatment of
lower back pain.
Sacroiliac Belt
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The sacroiliac belt encircles the pelvis
between iliac crest and the greater
trochanter. Perineal straps prevent
upward displacement
Functions: The sacroiliac belt is used for
patients with postpartum or traumatic
separation of the sacroiliac or
symphysis pubis.
The sacroiliac corset: is a cloth garment
which encompasses the pelvis and is
adjustable in circumference by means
of side, front, back laces or hook
Functions: Although most effective in
restraining motion this orthosis may
assist in elevating intra-cavity pressure
and may be useful for postpartum and
posttraumatic stabilization of pelvis
joint.
Three Point Pressure system
• The three point pressure principle of an
example of parallel force system used in brace
design
• The supporting force of the brace is arranged
such that two forces pressing against the
trunk or limb are opposed by a third force
,which is located between the other two.
F1
F2
F3
Three Point Pressure system
• The single opposing force is equal in
magnitude to the two forces acting in the
same direction
• F3=F1+F2
• This three point pressure system is used for
immobilization or support of the body part
• E.g. 1)Spinal Bracing
2)Leg Bracing/Genu Valgum
3) Correction of foot deformity
Genu Valgum
Foot deformity
LSO Flexion Extension Control
• This rigid orthosis consist of
two posterior uprights
attached inferiorly to a pelvic
band and superiorly to a
thoracic band. A full front
abdominal support is fastened
to the aluminum or plastic
frame by means of straps.
• In case of full front abdominal
support and related straps a
corset may be worn over the
orthosis
• The lateral end of the pelvic
band may be located below
the anterior superior iliac
spines and should extend to
midtrochanteric line to
stabilize the orthosis
LSO Flexion Extension Control
• Functions: This orthosis applies 2 3-point force
systems .The first restricts trunk extension,
increases intracavitary pressure, the second
acts to restrict trunk flexion
LSO Flexion Extension Lateral Control
• The addition of lateral uprights
to the previously described
lumbosacral orthosis provides
a lumbosacral F-E-L orthosis.
To avoid pressure on iliac crest
the lateral uprights must be
fitted carefully.
• Functions: The functions of
the lumbosacral F-E-L orthosis
are identical to those F-E
control LSO except for the
degree of limitation of lateral
trunk motion
• Restrictions of these motions
is more effective because the
ends of pelvic and thoracic
bands are anchored by lateral
uprights
LSO Extension Lateral Control
• This orthosis has pelvic and
thoracic bands joined by
lateral uprights that are
pivotably attached to the
thoracic band but not to the
pelvic band. Two oblique
lateral uprights are attached
pivotably to the lateral
uprights and rigidly to the
pelvis band
• Functions: It provides a single
3-point force system that
limits trunk extension in the
lumbar spine and also
increases intracavity pressure.
If the forces are of sufficient
magnitude yet tolerable to the
patient they will decrease
lordosis
Thoracolumbosacral corset
• The thoracolumbosacral corset is
made of fabric (cloth
garment)that encompasses the
torso and the pelvis with
adjustable front ,side or back
Velcro fasteners (hooks)
Posteriorly it’s superior border is
at mid-capsular level .
• Shoulder straps encircle the
shoulder ,cross posteriorly and
fasten anteriorly
• The corset is usually reinforced
with posterior rigid or semi rigid
stays extending the full length of
orthosis also it should fit all body
contours smugly
• Functions: used to restrict trunk
motion.
Thoracolumbosacral orthoses
• TLSO F-E control orthosis: This
orthosis consist of 2 posterior
uprights attached inferiorly to
a pelvic band;
• An interscapular band
stabilizes the upright and
serves as an attachment for
auxiliary straps .
• Anteriorly there may be a
corset or a full front
abdominal support or and
related straps. the auxiliary
straps which have superior
ends of upper upright ,extend
anterior over the shoulders
and pass under the axillae to
buckle at each end of the
interscapular band
TLSO Flexion Control
• This orthosis consist of
an anterior and a lateral
torso frame to which
are attached a sternal
pad, a suprapubic pad,2
lateral pads, a
thoracolumbar pad
• Functions: A single 3-pt
pressure s/m is
provided that restricts
forward flexion
TLSO F-E-L Control
• This aluminum or plastic
orthosis consist of plastic and
thoracic bands connected to a
pair of thoracolumbosacral
posterior uprights and a pair
of lateral uprights .A
intrascapular band is fastened
to the posterior uprights and
serves as an attachment for
auxillary straps. An abdominal
support is laced to the lateral
uprights
• Functions: There is a greater
tendency to limit rotation and
lateral trunk motion in F-E-L
control
TLSO F-E-R Control
• This aluminum orthosis consist
of pelvic and thoracic bands
connected by two lateral
uprights. An abdominal
support is laced to the lateral
uprights. The thoracic band
extends anteriorly, superiorly
and subcavicular pads are
provided
• Functions: the F-E-R provides 2
three pt force s/m’s 1)to limit
trunk flexion in thoracic and
upper lumbar spine 2)The
other restricts trunk extension
in lumbar spine
TLSO F-E-L-R Control
• When maximum
immobilization of the thoracic
and lumbar spine are desired a
custom-made plastic body
jacket may be used. The
design is quite effective in
maintaining trunk alignment
,contact is essentially a jacket
which may be made of
thermoplastic material
• Functions: A well fitted and
essentially total contact jacket
applies firm counterforces to
restricts motion in all planes
Cervico-thoracic-lumbo-sacral orthosis
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Milwaukee brace: used for scoliosis
consists of a rigid plastic pelvic girdle
connected to a neck ring over the
upper thorax by one anterior, broad
aluminum bar and two posterior
paraspinal bars.
The cervical ring has mandibular and
occipital bars, which rest 20–30mm
inferior to occiput and mandible
Pads strapped to the bars apply a
transverse load to the ribs and spine
to correct scoliotic curvatures
Indications:
– Idiopathic or flexible congenital scoliosis