Cervical orthosis Made by: Armghan Anjum Orthotist & Prosthetist Government College University Faisalabad

overview Introduction Function of cervical orthoses Classification Flexion/Extension Control Devices Flexion/Extension/Lateral Flexion/Rotation Control Devices Normal Motion Vs Restriction of Neck Movement with Orthosis

introduction Cervical orthosis includes devices used in treatment of disorders around the region of neck and skull Immobilizing cervical spine is difficult because: Most mobile part in spine Has small body surface Limited pressure tolerant areas like chin, occiput Different types of predominant movement at different levels

Function of Cervical Orthosis (Co) Positions the head in position Limits movement in flexion, extension, rotation and lateral rotation Unload the cervical spine by weight bearing part of skull.

classification Cervical orthosis can be classified as: Cervical collars Poster appliances Cervicothoracic orthosis Halo devices

Flexion/Extension Control Devices Soft cervical collar Semirigid cervical collar with chin—Occiput support Philadelphia orthosis SOMI brace (Sterno Occiputo Mandibular Immobilization Brace)

Flexion/Extension/Lateral Flexion/Rotation Control Devices Poster orthosis Halo brace Minerva body jacket

Cervical collars Soft cervical collar Construction Advantages It is made of foam and rubber covered by a stockinet. Advantages Low cost Easy to fabricate Tolerated by patient Provides warmth and psychological comfort Disadvantage Does not restrict cervical motion in any plane and serves only as a remainder to hold neck and avoid excessive movement.

Contd… Semi-rigid Cervical Collar Construction Advantages: It is made of rigid polypropylene. Height of the orthosis can be changed by adjusting the two parts of collar. Advantages: Easy to apply and remove Some restriction of flexion and extension Chin and occipital extension can be added. Disadvantage: Does not restrict lateral bending and rotation. Can press on clavicle and give discomfort.

Philadelphia Orthosis Construction Philadelphia orthosis is made of plastozote reinforced with anterior and posterior struts. It has molded mandibular and occipital support. Anteriorly and posteriorly it extends to upper thorax. Advantages Restricts flexion extension due to chin and occiput support and thoracic extension. Disadvantages Ineffective in controlling rotation and lateral bending Pressure over clavicle.

SOMI Brace Construction It consists of: Advantages: It is a modified poster appliance It consists of: Sternal plate One anterior strip which hold chin support Two rigid metal rods from anterior to posterior to occiput support Advantages: There is no posterior post. So it can be used with patient lying supine. Light weight donning and doffing

Poster appliances It has anterior section consisting of sternal support, one or two uprights and chin support. Posterior section consist of thoracic plate, one or two uprights and an occipital support It limits flexion, extension, rotation and lateral flexion. It also unloads the cervical spine by chin and occiput support

Contd… Two varieties are Four poster orthosis (Thomas collar) Two poster orthosis (Peter Cervicothoracic orthosis) which provides less lateral stability

Yale Cervicothoracic Orthosis Yale cervicothoracic orthosis is a modified philadelphia collar with plastozole reinforced with struts It extends down to mid thorax anteriorly and posteriorly. Occipital support extends higher on skull. With extended area of support stability is increased

Halo brace Halo devices are used for treating cervical fractures and dislocation. It consist of: Rigid metal or graphite ring attached to skull by four fixation pins Four posters which are attached to ring proximally-two anteriorly, two posteriorly and distally to polypropylene vest Polyethylene vest: The vest may be of: Half vest—Level of nipples for upper cervical injuries Short extended vest up to the level of 12th rib Full vest—Level of iliac crest for lower cervical injuries.

Minerva Body Jacket This is an orthosis made of Plaster of Paris or Thermo Plastic It consist of: Forehead adaptation with occipital support Chin support Body jacket that extends up to the level of twelfth rib or umbilicus Advantages Light weight (plastic) No invasive pins like halo device It limits flexion, extension, rotation and lateral rotation like halo brace

Contd… Halo device and Minerva body jacket are the choice in ambulant management of unstable cervical spine

NORMAL MOTION VS RESTRICTION OF NECK MOVEMENT WITH ORTHOSIS Orthosis Name Flexion/Extension Lateral bending Rotation 1. Normal 100% 2. Soft collar 25% restriction 8% restriction 16% restriction 3. Philadelphia 71% restriction 33% restriction 56% restriction 4. SOMI 72% restriction 34% restriction 64% restriction 5. Four poster 80% restriction 54% restriction 82% restriction 6. Halo 89% restriction 92% restriction 98% restriction 7. Minerva body jacket 77% restriction 76% restriction 100% restriction