Spinal orthosis Department of Rehabilitation Nakornping hospital References

Spinal orthosis Department of Rehabilitation Nakornping hospital

References Delisa JA : Physical medicine and rehabilitation, 4 th ed. Williams and Wilkins. 2005. • Braddom RL : Physical medicines and rehabilitation, 4 th ed. Saunder Elsevier. 2011. • Spinal Orthosis. NYU 1983. • Hoppenfeld S : Orthopaedic neurology: a diagnosis guide to neurologic levels, Philadelphia, Lippincott Williams & Wilkins, 1977. • Hsu JD, Michael JW, Fisk JR : AAOS Atlas of orthoses and assistive devices, 4 th ed. Philadelphia. 2008.

Outline General basis of spinal orthosis Classification CO, CTO, CTLO, TLSO, SO, CTLSO Prescription and things to consider

General basis of spinal orthosis Mechanism of action Indications Negative effects

Mechanism of action Trunk support • Increase in intraabdominal pressure Control of motion • Reminder >> Limit spinal motion Spinal alignment • Three-point force system

Indications Soft tissue injury Spinal instability Fracture Dislocation Post-op • Spinal deformity

Cervical orthosis CO Flexible Soft collar Hard collar Rigid Philadephia Miami J Malibu Aspen Newport CTO Halo SOMI TMBJ Yale Four-poster

Philadelphia collar Indication Unstable Fx > Surgery > Rigid CTO > Philadelphia • • Prehospital trauma immobilization Soft tissue injury Post-op stabilization Post Halo removal

SOMI ( Sterno-Occipital-Mandibular Immobilizer) @ Chest piece connected by uprights (going from ant. to post. ) to occipital plate. So, easily applied to supine pt. @ Removable chin piece so pt. can eat, wash, or shave while lying supine. Function Indication Flexion control C 1 -4 F-E-R control Good for bed restricted pt. Pressure system : control motion and distraction Stable spinal injury above C 5 Post op. management Provide supine position

Cervical control Flexion S Extension S- Lateral flexion S- Rotation S- Axial load S Flexion control C 1 -4 Only !!! F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

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Don - Doff

Halo - Rigid metal or graphite ring attached to skull with 4 pins, 4 posters, plastic body vest Function Indication F-E-L-R control Greatest restrict motion (all planes) Post-op. unstable cervical fracture (esp. occiput-C 1) Post op. management

Cervical control Flexion S Extension S Lateral flexion S Rotation S F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion Axial load S

Thoracolumbar orthosis TLSO Flexible Thoraco-lumbosacral corset Lumbar binder Rigid Taylor Knight- Taylor Cowhorn Jewett, CASH Chairback Knight Williams

Rigid TLSO : Jewett Brace Ant. hyperextension brace Function Indication TLS flexion control Immobilize lower T & upper L Stable compression fracture of T 12 -L 1 Obesity Single three-point force system

Jewett control Flexion Extension Lateral flexion Rotation Axial load Thoracic S F F or S- Lumbar S F F or S- Lumbosacral S- F F or S- Flexion control only!!! of T-L spine

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Rigid TLSO : Taylor brace Function TLS flexion control Immobilize lower T & upper L Elevate intraabdominal pressure Indication Post-op of traumatic fractures, spondylolisthesis. scoliosis, spinal stenosis, HNP, and disk infection Stable multiple compression fracture of T spine (osteoporosis)

Taylor control Flexion Extension Lateral flexion Rotation Thoracic S S F S- Lumbar S S F S- Lumbosacral CI CI F F F-E control of T-L spine F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

Rigid TLSO : Knight-Taylor brace Function TLS F-E-L control Immobilize lower T & upper L Indication Post-op of traumatic fractures, spondylolisthesis. scoliosis, spinal stenosis, HNP, and disk infection Stable multiple compression fracture of TL spine

Knight-Taylor control Flexion Extension Lateral flexion Rotation Thoracic S S S- F Lumbar S S- Lumbosacral CI CI S- S-

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Rigid LSO : Chairback brace Function Increase intraabdominal pressure F-E control Indication Lower lumbar pathology Post surgical support

Chairback control Flexion Extension Lateral flexion Rotation Lumbar S S S- S- Lumbosacral S S S- S- F-E only!!! F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

Checkout

Don - Doff

Willium control Flexion Extension Lateral flexion Rotation Lumbar F S S S- Lumbosacral F S S S-