Department of Rehabilitation Nakornping hospital Spinal orthosis Department of Rehabilitation Nakornping hospital

References Delisa JA : Physical medicine and rehabilitation, 4th ed. Williams and Wilkins. 2005. • Braddom RL : Physical medicines and rehabilitation, 4th 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, 4th ed. Philadelphia. 2008.

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

General basis of spinal orthosis Mechanism of action Indications Negative effects

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

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

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

Philadelphia collar Indication Unstable Fx > Surgery > Rigid CTO > Philadelphia Indication 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. Flexion control C1-4 Function Indication F-E-R control Pressure system : control motion and distraction Provide supine position Good for bed restricted pt. Stable spinal injury above C5 Post op. management

Cervical control Flexion Extension Lateral flexion Rotation Axial load Flexion control C1-4 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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Halo Function Indication F-E-L-R control - 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-C1) Post op. management

Cervical control Flexion Extension Lateral flexion Rotation Axial load 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

Thoracolumbar orthosis TLSO LSO Flexible Thoraco-lumbosacral corset 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 Single three-point force system Stable compression fracture of T12-L1 Obesity

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

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

Taylor control F-E control of T-L spine Flexion Extension Lateral Rotation Thoracic S F S- Lumbar Lumbosacral CI 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 Indication Post-op of traumatic fractures,spondylolisthesis. scoliosis, spinal stenosis, HNP, and disk infection Stable multiple compression fracture of TL spine TLS F-E-L control Immobilize lower T & upper L

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

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

Chairback control F-E only!!! Flexion Extension Lateral flexion Rotation Lumbar S S- Lumbosacral 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

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Don - Doff

Willium control Flexion Extension Lateral flexion Rotation Lumbar F S Lumbosacral