OandP 9

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  1. 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
  2. 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
  3. Stable Without Orthosis
    spine is stable and mobility is permitted without use of spinal orthoses
  4. 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
  5. 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)
  6. Orthosis Weaning
    • begin when surgeon/neurologist determines the patient’s spine is stable (boney fusion)
    • dont need another orthosis
  7. 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
  8. 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
  9. 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
    • 1. Standing
    • 2. Adams Foreard Bend Test
    • 3. Cobb Angle
  11. 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
  12. 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
    • Image Upload
  13. 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 angleImage Upload
    • 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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OandP 9
2016-06-06 15:51:13

OandP 9
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