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SPINAL PRECAUTIONS: stability is not yet determined or there is spinal instability
- Log rolling
- Supine only; no prone
- No HOB elevation (some clearance to < 30’)
- Turning limited to what is necessary to alleviate skin erythema
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STABILITY PRECAUTIONS: stability determined by MD
- Log rolling
- Supine only; no prone
- No HOB elevation (some clearance to < 30’)
- Prescribed orthosis on at all times OOB to limit motion/promote healing
- No lifting > 5lbs.
- No pushing or pulling
- No rotation or excessive flexion/extension of spine
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Stable Without Orthosis
spine is stable and mobility is permitted without use of spinal orthoses
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Stable With Orthosis
- ----stability has been determined and an orthosis must be utilized for mobility
- ----No prone
- ----No higher level w/c skills without MD order
- Stable for Orthosis Hygiene:
- ----either half of orthosis may be removed for skin care and hygiene daily
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Showering
- may shower with waterproof orthosis in place
- may substitute cervical orthosis with Philadelphia collar for showering with MD order
- halo open vest front from supine only (hygeine)
- TLSO supine: remive half of shell (hygine)
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Orthosis Weaning
- begin when surgeon/neurologist determines the patient’s spine is stable (boney fusion)
- dont need another orthosis
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Donning/Doffing TLSO (bivalve, a.k.a. clamshell, custom thermoplastic design)
- complete in supine HOB < 30’
- log roll to sidelying position
- don posterior shell first; use ribs and iliac crest as landmarks
- slide under patient as much as possible and log roll to supine position
- check posterior shell alignment
- don anterior shell; overlap posterior shell
- adjust straps beginning with middle
- tighten both straps simultaneously and symmetrically to avoid lateral displacement
- subsequently tighten superior and inferior straps
- check alignment
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Supine Donning cervical collar
- Patient in supine without pillow placed
- Second person assist at head of bed to stabilize patient’s head
- Primary person prepares posterior panel to be placed under crevice of patient’s neck
- Press down (flaten) on the panel with one hand and push through with the other, being careful not to move the head and neck
- Make sure the posterior panel is centered under the neck (Velcro straps come to the same position on each side) and centered between ear and upper trapezius
- Position the anterior panel with the chin piece directly under the chin
- Hold firmly with one hand, while pushing the sides of the anterior panel in place over the shoulder muscles
- While still holding firmly, attach the Velcro straps with symmetrical tension
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Upright donning cervical collar
- Need MD approval for donning upright
- Maintain head in neutral position or according to Physician instructions
- Position the anterior panel, with the chin piece directly under the chin
- Push the sides of the anterior panel up and over the shoulder muscles and around the neck
- While holding the anterior panel in place, center the posterior panel behind the head
- If requires adjustment for patient who is cleared only for supine application, must have second person assist to stabilize head/c-spine while brace is realigned and tightened
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POSTURAL ASSESSMENTS
- 1. Standing
- 2. Adams Foreard Bend Test
- 3. Cobb Angle
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Standing
- Sagittal Plane: view curvature of spine, note lordosis/kyphosis
- gravity line is located:
- ---- anterior to the ankle joint's lateral axis, producing an ankle DF moment, necessitating activity in the ankle PFers
- ---- anterior to the knee joint's lateral axis, producing a knee extensor moment, necessitating no muscle activity, just passive tension in posterior knee ligaments
- ---- posterior to the hip joint’s lateral axis, producing a hip extensor moment, necessitating no muscle activity, just passive tension in anterior hip ligaments (iliofemoral ligament).
- Frontal Plane: with use of plumb line account for asymmetries, assess for pelvic obliquities
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Adam’s Forward Bend Test
- In standing have patient bend forwards as far as possible
- Assess spine for asymmetries with one side of rib cage higher than respective rib on contralateral side
- Positive test if rib hump is detected
- Rib hump indicates convexity because as vertebrae laterally flex they must rotate to opposite side 2’ facet alignment
- Test most accurate for detecting thoracic scoliotic curves
- Place Scoliometer at site of rib hump, align center of scoliometer with center of spine
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Cobb Angle
- Review spinal radiograph and choose the most tilted vertebrae above and below the apex of the curve
- Using CobbMeter draw line parallel to superior edge of proximally tilted vertebra and inferior edge of distally tilted vertebra
- Using CobbMeter draw perpendicular lines to initial findings
- Using CobbMeter measure angle of intersecting perpendicular lines to find Cobb angle
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PROVIDENCE BRACE
- Rigid, custom total contact orthosis
- Treatment goal: correct scoliosis by holding patient in maximum side-bending correction
- Wearing schedule: worn overnight
- Indications:
- ----curve of 20-25° with 10° progression over 1 year
- ----curve of 25-30° with 5° progression over 1 year
- ----Skeletally immature patients with a curve of 30° or greater
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