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spinal orthosis
questions for ABC boards for orthotics
101
Health Care
10/03/2010

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Term
3 basic reasons for spinal orthoses:
Definition
1 abdominal support
2 pain management
3 motion/position control
Term
indication for trunk support
Definition
patient has weakened spinal or abdominal musculature
Term
corsets
Definition
-can provide some degree immobilization
-can be used to accommodate deformity and encourage postural correction
-provide intracavity pressure to contribute to abdominal support and reduced axial load on vertebral bodies
-reduce activity of spinal and abdominal musculature
-long term use can cause muscle atrophy and increase chance of reinjury
Term
thoracic band
Definition
24 mm (2.4 cm) distal to the inferior angle of the scapula
Term
williams flexion LSO
Definition
-fig 7.5 atlas
-articulates to allow motion in sagittal plane
-inelastic strap is tightened so that free flexion can occur, but extension is stopped
-indicated for the treatment of spondylolisthesis
Term
spinal hyperextension orthosis
Definition
-Jewett, cash
-control through a single 3 point pressure system. applies two posteriorly directed forces, one anterior
-restricts flexion of the spine
-indicated for thoracic fracture
Term
TLSO tri-planar control custom body jacket
Definition
-when maximum control is required
-fabricated over mold of the patient
-provides most effective control due to intimate fit of the torso and the pelvis
-
Term
anterior opening TLSO
Definition
-easier to donn and doff
-does not accommodate fluctuations in volume as well
Term
proximal TLSO trim lines
Definition
-1 inch superior to the xyphoid
-1 inch distal to sternal notch
Term
soft TLSO body Jacket
Definition
-relativly new design
-rigid frame with a soft foam outer layer
-frame terminates 1-1.5 from edge of foam
-typically use anterior opening
-softer and lighter then normal
-maybe helpful for geriatric population
Term
2 primary reasons for cervical orthoses
Definition
-pain manegment
-motion control
Term
classifications of cervical orthosis
Definition
generally categorized as
-soft
-semi rigid
-hard
Term
soft cervical collar
Definition
-generally serves as a kinesthetic reminder
-
Term
semi rigid cervical orthosis
Definition
-available in a great variety of prefabricated styles
-reduce cervical motion in sagital plane
-provide little control of lateral flexion and rotation
-can provide increased stabilization with thoracic extension
Term
halo orthosis
Definition
-provides triplaner motion control in the cervical spine
-provides the best endpoint control of the cervical spine
-lack of total contact may lead to intersegmental snaking
Term
goal of orthosis for spinal deformity
Definition
preventing further progression of the aberrant curvature
Term
method of preventing progression of curve
Definition
stabilizing the spine of the pelvis
Term
basic principles of curve stabilization
Definition
-endpoint control
-transverse load
-curve correction
- and a combined effect
Term
endpoint control
Definition
-denotes the mechanical constraints on the spine provided by the orthosis
-increases the critical load of the spine by means of a hinge
Term
critical load on curved spine
Definition
-for curves of 15-30 degrees transverse support raises critical load from approx. 50% to 70% of normal
-this increase may be enough to prevent curve from progressing
Term
increasing curvature
Definition
-effect of transverse support is reduced
-critical load of a 45 degree curve increases from 20 to 30% approx of normal
Term
curve correction: greatest effect
Definition
curve correction in an orthosis has the greatest effect on critical load
-reducing a curve from 30 to 20 degrees increases the stability of the curve from 50 to 80% of normal
-curve 0f 45 to 30 degrees critical load increases to 50% of normal
Term
reduction of curve magnitude
Definition
-curves greater then 40 degrees require a reduction of curve magnitude of approx. 50% of the initial curve
Term
control of of larger magnitude curves
Definition
-cumulative orthosis adjustment
-reset pads to provide continued lateral support to the curve
-critical load may be increased from 20 to 70%
-significant curve correction with continued lateral support
Term
scoliosis orthosis lumbar pad
Definition
-triangular
-placed inferior to the costal ribs and superior to the iliac crest
-placed directly over the curve apex
Term
double curves protocol
Definition
-curve with the greatest mechanical stiffness or primary curve should be loaded and shifted first
-once this curve is shifted the more flexible compensatory curve can be loaded
- double primary curves-both curves should be loaded and shifted equally
Term
scoliosis orthosis pad force
Definition
-pad force is the primary mechanism for reducing spinal curvature
Term
optimization of scoliosis treatment results
Definition
-pads should be kept at the maximum force through treatment
-force is determined by redness of skin under pads-redness should disappear after 30 min or too much pressure, redness disapears less then 15 min, not enough pressure
-check pads after 1 month and then every 3 months
Term
indication for treatment with scoliosis TLSO
Definition
-curve apices at or below T8
Term
boston brace
Definition
system of prefabricated TLSO modules custom fitted for specific needs
-TLSO most widely used for scoliosis treatment
Term
Scoliosis pad placement in TLSOs
Definition
all scoliosis orthosis have the same parameters of pad placement, pad loading, pad force, and outcome expectations
Term
effect of not having a neck ring like the Milwaukee brace does
Definition
- ensures compensated alignment of the cervicothorasic spine
-lack of ring can lead to spinal decompensation with improper placement of counterforce in a TLSO
Term
scoli TLSO loading sequence
Definition
-primary curves are loaded and shifted first, ensures that compensatory curve loading is performed with minimal translation of the trunk
Term
boston TLSO load increased by:
Definition
thickening the pads
Term
scoli TLSO advantages:
Definition
-uses minimal orthosis for maximum result
-good cosmesis
-low weight
-lack of metal superstructure which can tear clothes
Term
scoli TLSO disadvantages:
Definition
-lack of longitudinal adjustment possible from a superstructure
-lack of a neck ring to prevent sway of the cervicothoracic spine
Term
features of the boston TLSO
Definition
-on convex side of curve TLSO is trimmed one level superior to the apex of the curve to provide a wall to function as a pad mount
-window is fplaced on the concave side of the curve
Term
features of Rosenberger scoli TLSO
Definition
-fabricated from a plaster impression with corrective forces applied during the casting.
-convex trim is one level superior to apex
-no cutout for trunk shift
-uses adjustable floating slings for curve loading
Term
features of the Miami scoli TLSO
Definition
-made from plaster cast
-in contrast to the boston it is trimmed short enough to allow forward bending of the patient
-convex and concave side trims are similar to the Boston
Term
Lyonnaise scoli TLSO
Definition
-trim lines similar to the Boston
-originally used two lateral shells of custom molded plastic joined by longitudinal aluminum bars
-modern brace is all plastic with a posterior seam used for a hinge function
Term
Wilmington jacket scoli TLSO features
Definition
-made from a plaster cast that was casted on a Risser frame.
-curves are reduced in casting and then examined by x-ray before proceeding with the fabrication of the brace
-one piece anterior opening
-bilateral heights to the axilla
-all loads (pads) are fabricated into the orthosis
Term
Charleston bending brace features:
Definition
-nighttime orthosis
-over corrects the scoliatic spine
Term
nonspecific back pain
Definition
low back pain that occurs in the absence of an identifiable cause
Term
unknown diagnosis of disabling lower back pain
Definition
this occurs in 80%-90% of cases
Term
potential sources of back pain
Definition
almost all structures of the back: intervertebral disc, supporting spinal ligaments, facet joint capsules, and paraspinal musculature
Term
difficulty in localizing pain in the spine
Definition
innervation of the spine is complex and overlapping which may partially explain difficulty in localizing pain to specific anatomic elements
Term
back pain treatment
Definition
vast majority of non-specific low back pain is managed conservatively with rest, analgesics, antiinflammatory medications, PT, manipulation, and orthoses
Term
one of most common treatments
Definition
lumbar supports-despite overall lack of knowledge of their true physiological effect or their effectiveness in relieving symptoms
Term
mechanical effectiveness of spinal orthoses
Definition
-may result from intersegmental motion restriction, gross motion reduction, or decreased load on the spinal column
-increased abdominal pressure
-reduced muscle fatigue, increased postural awareness or proprioception
-most likely it is a combination of some of these factors
Term
spinal restriction of motion by orthoses
Definition
-ability of orthoses to restrict spinal motion has had inconsistent results in studies
-excessive trunk motion is believed to cause back injury, thus orthoses are many times prescribed to prevent "excessive" motion and thus reduce back pain
Term
spinal gross motion restriction
Definition
maybe more important then restricting intersegmental motion for an effective spinal orthosis
Term
direct unloading of the spine
Definition
orthosis actually bears the weight of the load that would otherwise be transmitted through the lumbar trunk
Term
indirect unloading of the spine
Definition
the orthosis transmits little load but raises the inter abdominal pressure enough to unload the vertebral column
Term
compression of the abdomen
Definition
compressing the abdomen converts the trunk into a rigid cylinder, reducing the spinal musculature workload by shifting a portion of the load from the spine to the entire trunk
Term
spinal muscle voluntary activation
Definition
-a healthy subject can stabilize spine with as little as 2% of maximal voluntary activation
-muscle contractions sustained above 5% lead to muscle fatigue and pain
-a small reduction in muscle activity maybe enough to bring contractions below 5%.
Term
definition of scoliosis
Definition
lateral curve of the spine greater then 10*. lateral curvature with concomitant rotation
Term
magnitude of curve
Definition
-degree value of curve
Term
location of curve
Definition
segment of the spine where apical vertebra is located
Term
direction of curve
Definition
determined by the side of convexity
Term
difference between a structural curve and nonstructural curve
Definition
-nonstructural-rotary component will correct on lateral flexion
-structural-rotary component present will not correct on lateral flexion
Term
2 types of congenital scoliosis
Definition
-failure of formation
-failure of segmentation
Term
failure of formation
Definition
-often creates wedged shaped vertebra
Term
failure of segmentation
Definition
multiple vertebra "fuse" at a point
Term
possible deficits due to congenital scoliosis
Definition
-gentitourinary tract
-heart disease
Term
traits of congenital scoliosis
Definition
-growth pattern is unpredictable
-progression: once it starts it will get worse, add on curves
Term
pathologies that may include neuromuscular scoliosis
Definition
-spina bifida
-duchenne MD
-spinal muscular atrophy
-CP
-polio
Term
goals of treatment of neuromuscular scoliosis
Definition
-reduce effects of gravity
-improve respiration
-improve support
-free upper limbs
-prevent deformity
Term
idiopathic scoliosis
Definition
-80% of all scoliosis
Term
3 types of idiopathic scoliosis
Definition
-infantile 0-3
-juvenile 3-adolescent
-adolescent
Term
characteristics of idiopathic scoliosis
Definition
-vertebral rotation
-curve patterns
-decomposition
-gender
-clinical signs
Term
vertebral rotation
Definition
-pedicles rotate towards concavity
-apical vertebra: has the greatest rotation within curve span
Term
what is decomposition?
Definition
-head/pelvis relationship
-malalignment of the head over the pelvis in the coronal plane
-C7/T1 aligned with S1
-CSL (center sacral line)
Term
scoliosis population: gender
Definition
-girls are affected more then boys
-4:1 (>10*)
-12:1 (>20*)
Term
clinical signs of scoliosis-
Definition
-rib hump (Adams forward flexion test)
-arm gap
-shoulder asymmetry
-pelvic obliquity
-prominent scapula
Term
Heuter-Volkman's principle
Definition
-physiological principle
-epiphyseal growth is slowed when the epiphyses are compressed
-concave side epiphysis develops at a slower rate than the convex side due to compression
Term
determinants of curve progression
Definition
-curve magnitude
-age
-skeletal maturity (risser sign, tanner sign, menarche)
-curve pattern
Term
Risser sign
Definition
-apophyseal plate of the iliac crest
-excursion: lateral to medial
-five stages
-1=begining 5=finished (skeletal maturity)
Term
probability of curve progression:
Definition
-5-19* -10 and under=45%, 11-12=23%, 13-14=8%, 15 and over=4%

-20-29* 10or under=100%, 11-12=61%, 13-14=37%, 15 and over=16%
Term
menarche/tanner signs
Definition
-orthotic treatment for 1 1/2 years post first menstrual cycle-better results if started pre-menarche
Term
age of peak height velocity
Definition
-girls=12
-boys=14/15
Term
summary of the natural history of scoliosis curves
Definition
-age: older children are less likely to progress then younger children
-magnitude: larger curves are more "unstable" then smaller curves
-curve pattern: thoracic and double primary curves progress less then single lumbar or thoracolumbar curves
Term
indication to use a milwaukee CTLSO
Definition
-apex of curve is superior to T8
Term
target correction from scoliosis orthosis
Definition
-target=50% correction of existing curve
-current thinking:
-minimum 70% for rigid curves
-minimum of 90% for flexible curves
-ideal if possible
Term
indicators for weaning from orthosis
Definition
-18 months from menarche
-risser sign of 4
-slowed or ceased growth
Term
scoliosis orthosis weaning protocol
Definition
-4 hour reduction at 4 month increments
-nights only for 1 year
Term
peak height velocity
Definition
growth rate of at least 9cm per year, as calculated by standing height at 6 month intervals for a minimum of 2.5 years
Term
principles of boston brace blueprint:
Definition
-focuses attention on the tilt of individual vertebrae, not cobb angle
-pad pressure at the apex and below
Term
position of trochanteric pad
Definition
-usually used on the side L5 is angled towards (side of decomposition)
Term
position of trochanteric pad if L5 and decomposition are in opposite directions:
Definition
-use bilateral trochanteric pads/extensions
-if L5 and decomp. are in same direction remove trochanteric extension on the opposite side
Term
purpose of the trocanteric extension
Definition
-works as force couple with the lumbar pad to decrease lumbar curve
-with axillary extension it extends the lever arm to address decomposition
Term
effect of adding a pad to the trochanteric extension
Definition
-increases acting forces
Term
purpose of lumbar pad
Definition
-addresses lumbar, thoracolumbar, and T10,T11 thoracic curves
Term
forces of lumbar pad
Definition
-apply an anteriorly directed force from the posterior panel
-force is transmitted through the body to the transverse processes of the lumbar spine to derotate lumbar curves
Term
purpose of thoracic pads
Definition
addresses thoracic curves with apices of T11-T8
Term
forces of thoracic pads
Definition
-apply a medially directed force from the lateral aspect of the orthosis through the body to correct thoracic curves
Term
purpose of the thoracic windows
Definition
located on the contralateral side of the thoracic pad
-always larger then the thoracic pad to allow for the excursion of the ribs
Term
purpose of the thoracic extension
Definition
-used as a constraining force for the thoracolumbar curves
-usually seen with thoracolumbar curves with L5 angulation to the right
Term
purpose of the axillary extension
Definition
used on the side of decomposition and possibly along the trochanteric extension
Term
force from axillary extension
Definition
applies a medially directed force to compensate patient and ensure the maximum critical load.
-also acts as a constraining force
Term
purpose of gussets
Definition
-made of elastic material and plastic welded to the module
-provide structural integrity to the orthosis as well as helps with the righting reflex of the patient
Term
greater trochanter position related to trim line
Definition
greater trochanter should be 1cm below the trim line