OandP 3

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  1. Boston overlap brace (BOB)
    • immobilizes with neutral pelvis or lordosis/lumbar flexion
    • prefabricated shell with custom fit
    • controls motion in sagittal-conronal plane
    • posterior shell: encloses trunk from inferior angle of scapula to sacrococcygeal level
    • anterior shell: xiphoid to pubis
    • treat: stable non-displaced fx mid-low L-spine, spondylosis, spondylolisthesis
    • For L1-L3 custom molded TLSO recommeneded
    • Image Upload 1
  2. Custom molded TLSO
    • limits trunk in all 3 planes of motion fabricated as a single piece with anterior opening or bivalve with anterior and posterior shells
    • straps: decrease intra-abdominal pressure
    • treat: post-op surgical repair of fx or spinal deformity of T-spine and/or upper L-spine (T5-L3)
    • Trimlines
    • ----superior/anterior: below clavicle
    • ----superior/posterior: below spine of scapula
    • ----inferior/anterior: distal pubis, arch up laterally for thigh
    • ----inferior/posterior: low at sacrococcygeal level
    • Modifications
    • ----shoulder flanges or extensions to enhance contro of spine with UE AROM
    • ----Addition of cervical component (proximal to T5)
    • ----Addition of thigh cuff (L4-S1) hip spika
    • Image Upload 2
  3. Cervical spine info
    • total excursion 160’
    • 1/2 rotation occurs at C1-C2
    • greatest flexion/extension occurs at C5-C6
    • greatest lateral flexion occurs at C3-C7
  4. Classification of cervical orthoses
    • Mechanism of Control
    • Magnitude of Motion Control
    • Material construct
  5. Soft collars
    • treat mild whiplash injury or neck pain
    • soft and comfortable, minimally restricts motion in any plane
    • kinesthetic reminder
    • Image Upload 3
  6. Reinforced cervical collars
    • outer plastic/semi rigid frame with inner soft pad or closed cell foam
    • anterior opening to accommodate respiratory apparatus
    • decrease ROM: C2-C5
    • if C6-C7 add T/S component
    • Indications:
    • ----Anterior cervical fusion, after Halo removal, Dens type I cervical fractures of C2 (type 1 vs 2 depending on severity), Anterior diskectomy, suspected cervical trauma in unconscious patients, Teardrop fracture of the vertebral body (before/after surgical intervention), Cervical strain
    • Ex: Philadelphia, Miami J, Newport/Aspen
  7. Philadelphia cervical collar
    • low trimline does not prevent lateral bending or rotation (doesn’t give much support)
    • can be used in the shower
    • Image Upload 4
  8. Miami J, Newport/Aspen
    • distal trimline and padding anteriorly against manubrium and posteriorly against spinous processes of first several thoracic vertebrae
    • proximal trimline and padding encompass lateral surface and underside of mandible and fit snugly against lateral and posterior surface of skull
    • Image Upload 5
  9. Cervicothoracic orthoses (CTO)
    • C5-C7
    • Indications:
    • ----stable cervical or high thoracic fractures or dislocations; Post-operative immobilization; Trauma
    • ----distal end point encompasses at least upper T-spine and trunk
    • Guidelines
    • ----Snug fit
    • ----Pressure relief and skin care
    • Image Upload 6
  10. Yale CTO
    • treat instability below C4
    • controls flexion/extension
    • thermoplastic
    • reinforced cervical collar and thoracic band
    • for stable fx
    • Image Upload 7
  11. Minerva CTO
    • treat instability C3-T2 requiring aggressive control of gross and segmental motion
    • custom molded, bivalve design
    • anterior shell: jaw to umbilicus
    • posterior shell: occiput to midback
    • Image Upload 8
  12. 4 poster designs
    • often incorporate with TLSO for multiple injuries or extensive spinal surgery
    • 2 A/P (bars in front and 2 in front)posts connect to lateral undersurface of mandibular support and occipital support to thoracic component
    • greater than reinforced cervical but less than CTO
    • Image Upload 9
  13. Sterno-occipito-mandibular immobilizer (SOMI)
    • treat instability at or above C4
    • good flexion control
    • T shaped yoke over shoulders and anterior chest connects to occiput support via U shaped metal rod
    • distal end of yoke anchored by strap around mid trunk
    • uses mandibular support or headband to stabilize head
    • Image Upload 10
  14. Halo
    • provides complete control of cervical and thoracic spinal motion in all 3 planes (triplanar control)
    • rehab consideration: changes COG becoming “top heavy”
    • pin care essential
    • For C1-C2/3
    • Image Upload 11
Card Set:
OandP 3
2016-06-05 15:57:22

OandP 3
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