Term
| 3 basic reasons for spinal orthoses: |
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Definition
1 abdominal support
2 pain management
3 motion/position control |
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Term
| indication for trunk support |
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Definition
| patient has weakened spinal or abdominal musculature |
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Term
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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 |
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Term
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Definition
| 24 mm (2.4 cm) distal to the inferior angle of the scapula |
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Term
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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 |
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Term
| spinal hyperextension orthosis |
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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 |
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Term
| TLSO tri-planar control custom body jacket |
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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
- |
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Term
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Definition
-easier to donn and doff
-does not accommodate fluctuations in volume as well |
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Term
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Definition
-1 inch superior to the xyphoid
-1 inch distal to sternal notch |
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Term
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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 |
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Term
| 2 primary reasons for cervical orthoses |
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Definition
-pain manegment
-motion control |
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Term
| classifications of cervical orthosis |
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Definition
generally categorized as
-soft
-semi rigid
-hard |
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Term
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Definition
-generally serves as a kinesthetic reminder
- |
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Term
| semi rigid cervical orthosis |
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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 |
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Term
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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 |
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Term
| goal of orthosis for spinal deformity |
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Definition
| preventing further progression of the aberrant curvature |
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Term
| method of preventing progression of curve |
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Definition
| stabilizing the spine of the pelvis |
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Term
| basic principles of curve stabilization |
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Definition
-endpoint control
-transverse load
-curve correction
- and a combined effect |
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Term
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Definition
-denotes the mechanical constraints on the spine provided by the orthosis
-increases the critical load of the spine by means of a hinge |
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Term
| critical load on curved spine |
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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 |
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Term
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Definition
-effect of transverse support is reduced
-critical load of a 45 degree curve increases from 20 to 30% approx of normal |
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Term
| curve correction: greatest effect |
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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 |
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Term
| reduction of curve magnitude |
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Definition
| -curves greater then 40 degrees require a reduction of curve magnitude of approx. 50% of the initial curve |
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Term
| control of of larger magnitude curves |
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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 |
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Term
| scoliosis orthosis lumbar pad |
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Definition
-triangular
-placed inferior to the costal ribs and superior to the iliac crest
-placed directly over the curve apex |
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Term
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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 |
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Term
| scoliosis orthosis pad force |
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Definition
| -pad force is the primary mechanism for reducing spinal curvature |
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Term
| optimization of scoliosis treatment results |
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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 |
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Term
| indication for treatment with scoliosis TLSO |
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Definition
| -curve apices at or below T8 |
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Term
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Definition
system of prefabricated TLSO modules custom fitted for specific needs
-TLSO most widely used for scoliosis treatment |
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Term
| Scoliosis pad placement in TLSOs |
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Definition
| all scoliosis orthosis have the same parameters of pad placement, pad loading, pad force, and outcome expectations |
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Term
| effect of not having a neck ring like the Milwaukee brace does |
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Definition
- ensures compensated alignment of the cervicothorasic spine
-lack of ring can lead to spinal decompensation with improper placement of counterforce in a TLSO |
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Term
| scoli TLSO loading sequence |
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Definition
| -primary curves are loaded and shifted first, ensures that compensatory curve loading is performed with minimal translation of the trunk |
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Term
| boston TLSO load increased by: |
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Definition
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Term
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Definition
-uses minimal orthosis for maximum result
-good cosmesis
-low weight
-lack of metal superstructure which can tear clothes |
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Term
| scoli TLSO disadvantages: |
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Definition
-lack of longitudinal adjustment possible from a superstructure
-lack of a neck ring to prevent sway of the cervicothoracic spine |
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Term
| features of the boston TLSO |
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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 |
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Term
| features of Rosenberger scoli TLSO |
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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 |
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Term
| features of the Miami scoli TLSO |
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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 |
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Term
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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 |
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Term
| Wilmington jacket scoli TLSO features |
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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 |
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Term
| Charleston bending brace features: |
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Definition
-nighttime orthosis
-over corrects the scoliatic spine |
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Term
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Definition
| low back pain that occurs in the absence of an identifiable cause |
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Term
| unknown diagnosis of disabling lower back pain |
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Definition
| this occurs in 80%-90% of cases |
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Term
| potential sources of back pain |
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Definition
| almost all structures of the back: intervertebral disc, supporting spinal ligaments, facet joint capsules, and paraspinal musculature |
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Term
| difficulty in localizing pain in the spine |
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Definition
| innervation of the spine is complex and overlapping which may partially explain difficulty in localizing pain to specific anatomic elements |
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Term
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Definition
| vast majority of non-specific low back pain is managed conservatively with rest, analgesics, antiinflammatory medications, PT, manipulation, and orthoses |
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Term
| one of most common treatments |
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Definition
| lumbar supports-despite overall lack of knowledge of their true physiological effect or their effectiveness in relieving symptoms |
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Term
| mechanical effectiveness of spinal orthoses |
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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 |
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Term
| spinal restriction of motion by orthoses |
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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 |
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Term
| spinal gross motion restriction |
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Definition
| maybe more important then restricting intersegmental motion for an effective spinal orthosis |
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Term
| direct unloading of the spine |
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Definition
| orthosis actually bears the weight of the load that would otherwise be transmitted through the lumbar trunk |
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Term
| indirect unloading of the spine |
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Definition
| the orthosis transmits little load but raises the inter abdominal pressure enough to unload the vertebral column |
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Term
| compression of the abdomen |
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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 |
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Term
| spinal muscle voluntary activation |
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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%. |
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Term
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Definition
| lateral curve of the spine greater then 10*. lateral curvature with concomitant rotation |
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Term
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Definition
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Term
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Definition
| segment of the spine where apical vertebra is located |
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Term
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Definition
| determined by the side of convexity |
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Term
| difference between a structural curve and nonstructural curve |
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Definition
-nonstructural-rotary component will correct on lateral flexion
-structural-rotary component present will not correct on lateral flexion |
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Term
| 2 types of congenital scoliosis |
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Definition
-failure of formation
-failure of segmentation |
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Term
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Definition
| -often creates wedged shaped vertebra |
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Term
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Definition
| multiple vertebra "fuse" at a point |
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Term
| possible deficits due to congenital scoliosis |
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Definition
-gentitourinary tract
-heart disease |
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Term
| traits of congenital scoliosis |
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Definition
-growth pattern is unpredictable
-progression: once it starts it will get worse, add on curves |
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Term
| pathologies that may include neuromuscular scoliosis |
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Definition
-spina bifida
-duchenne MD
-spinal muscular atrophy
-CP
-polio |
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Term
| goals of treatment of neuromuscular scoliosis |
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Definition
-reduce effects of gravity
-improve respiration
-improve support
-free upper limbs
-prevent deformity |
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Term
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Definition
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Term
| 3 types of idiopathic scoliosis |
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Definition
-infantile 0-3
-juvenile 3-adolescent
-adolescent |
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Term
| characteristics of idiopathic scoliosis |
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Definition
-vertebral rotation
-curve patterns
-decomposition
-gender
-clinical signs |
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Term
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Definition
-pedicles rotate towards concavity
-apical vertebra: has the greatest rotation within curve span |
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Term
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Definition
-head/pelvis relationship
-malalignment of the head over the pelvis in the coronal plane
-C7/T1 aligned with S1
-CSL (center sacral line) |
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Term
| scoliosis population: gender |
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Definition
-girls are affected more then boys
-4:1 (>10*)
-12:1 (>20*) |
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Term
| clinical signs of scoliosis- |
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Definition
-rib hump (Adams forward flexion test)
-arm gap
-shoulder asymmetry
-pelvic obliquity
-prominent scapula |
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Term
| Heuter-Volkman's principle |
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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 |
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Term
| determinants of curve progression |
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Definition
-curve magnitude
-age
-skeletal maturity (risser sign, tanner sign, menarche)
-curve pattern |
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Term
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Definition
-apophyseal plate of the iliac crest
-excursion: lateral to medial
-five stages
-1=begining 5=finished (skeletal maturity) |
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Term
| probability of curve progression: |
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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% |
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Term
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Definition
| -orthotic treatment for 1 1/2 years post first menstrual cycle-better results if started pre-menarche |
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Term
| age of peak height velocity |
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Definition
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Term
| summary of the natural history of scoliosis curves |
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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 |
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Term
| indication to use a milwaukee CTLSO |
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Definition
| -apex of curve is superior to T8 |
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Term
| target correction from scoliosis orthosis |
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Definition
-target=50% correction of existing curve
-current thinking:
-minimum 70% for rigid curves
-minimum of 90% for flexible curves
-ideal if possible |
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Term
| indicators for weaning from orthosis |
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Definition
-18 months from menarche
-risser sign of 4
-slowed or ceased growth |
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Term
| scoliosis orthosis weaning protocol |
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Definition
-4 hour reduction at 4 month increments
-nights only for 1 year |
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Term
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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 |
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Term
| principles of boston brace blueprint: |
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Definition
-focuses attention on the tilt of individual vertebrae, not cobb angle
-pad pressure at the apex and below |
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Term
| position of trochanteric pad |
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Definition
| -usually used on the side L5 is angled towards (side of decomposition) |
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Term
| position of trochanteric pad if L5 and decomposition are in opposite directions: |
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Definition
-use bilateral trochanteric pads/extensions
-if L5 and decomp. are in same direction remove trochanteric extension on the opposite side |
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Term
| purpose of the trocanteric extension |
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Definition
-works as force couple with the lumbar pad to decrease lumbar curve
-with axillary extension it extends the lever arm to address decomposition |
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Term
| effect of adding a pad to the trochanteric extension |
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Definition
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Term
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Definition
| -addresses lumbar, thoracolumbar, and T10,T11 thoracic curves |
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Term
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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 |
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Term
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Definition
| addresses thoracic curves with apices of T11-T8 |
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Term
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Definition
| -apply a medially directed force from the lateral aspect of the orthosis through the body to correct thoracic curves |
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Term
| purpose of the thoracic windows |
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Definition
located on the contralateral side of the thoracic pad
-always larger then the thoracic pad to allow for the excursion of the ribs |
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Term
| purpose of the thoracic extension |
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Definition
-used as a constraining force for the thoracolumbar curves
-usually seen with thoracolumbar curves with L5 angulation to the right |
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Term
| purpose of the axillary extension |
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Definition
| used on the side of decomposition and possibly along the trochanteric extension |
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Term
| force from axillary extension |
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Definition
applies a medially directed force to compensate patient and ensure the maximum critical load.
-also acts as a constraining force |
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Term
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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 |
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Term
| greater trochanter position related to trim line |
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Definition
| greater trochanter should be 1cm below the trim line |
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