SPINE ORTHOTICS

BY DR.PRADEEP P.G(ORTHO).

USES OF ORTHOTICS

• TO RELIEVE LOW BACK PAIN• RESTRICTION OF SPINAL MOTION• POSTURAL CARE AND POSTURAL CORRECTION• AUGUMENT OTHER THERAPIES(POST

SURGICAL)

CLASSIFICATION OF ORTHOTICS

• SUPPORTIVE ORTHOTICS• -FABRIC SPINAL ORTHOTICS• -RIGID SPINAL ORTHOTICS• CORRECTIVE SPINAL ORTHOTICS

FABRIC ORTHOTICS/CORSETS• They are constructed out of

strong fabrics or elastic materials with a variety of stiffer supports

RIGID SPINAL ORTHOTICS• They are used when greater

control of motion or posture is required.

• They are fabricated from high temperature thermoplastics or light weight metals.

• There are wide varieties with a broad selection of pads and coverings.

THERAPUETIC BENEFITS OF ORTHOTICS

• TO INCREASE INTRA ABDOMINAL PRESSURE -They create cylinder effect, exert pressure on the abdomen, and raise intra-cavitary pressure and reduce the intra-discal pressure especially during forward bending.• MUSLE RELAXATION -Support the vertebral column and relaxing the abdominal and erector spinae muscles

-Decreasing the need for contractile support of the vertebral column may relax the muscles and reduce existing pain.• RESTRICTION OF MOTION-The primary method employed for motion control is the three point pressure system.A rigid system is used when cervical, thoracic and lumbosacral motions are sought to be limited to the greatest possible degree.

-Reduction of motion will reduce pain and spinal instability and offer constant proprioceptive feedback, reinforcing positive behaviors.• POSTURAL REALIGNMENT-↑intra abdominal pressure, relaxation in muscle spasm, and restriction of movement can assist in facilitation of improved posture and reduce compensatory posture related pain.

Flexible OrthosesOr

Corsets

Sacroiliac corset(binder)

Lumbsacral corsetThoracolumbosacral

corst

FLEXIBLE ORTHOSES

• SACROILIAC CORSET-Made from a combination of fabrics, elastic, laces and velcro offering multiple adjustments-Encircle the waist from the iliac crest to the greater trochanter and extending anteriory to the symphysis pubic.-Provide postural stability and reinforcement.• LUMBOSACRAL CORSET-Made from heavy fabrics with laces and hooks.-It is designed to limit motion, maintain three point pressure system and to reduce pain

• DORSO LUMBO SACRAL CORSET

-The same construction and function of lumbosacral corset except it includes a shoulder strap to restrict spinal motion to the thoracic region as well as to the lumber spine

RIGID ORTHOSES

• TAYLOR SPINAL BRACE-a pelvic band connects with two posterior uprights terminating at the midscapular level of the thoracic region, with an anterior abdominal closure and axillary straps. Two three point pressure systems are coupled together to limit both flexion and extension of the lumber and thoracic spine.

-it increases the movement at the lumbo sacral junction

• FISHER SPINAL BRACE- A pelvic band to which two pelvic hoops,& two

posterior upright rods connected. Another horizontal rod at the level of infra scapular area connects the long rods. It also has long lateral rods

- It does not designed for axillary weight - Limits forwards flexion & extension of the lower

thoracic and upper lumbar spine. Lateral flexion limited more than taylors brace.

ANTERIOR HYPEREXTENSION BRACE-a three-point pressure system is created with two pads, one across the sternum and one at the symphysis pubis, providing the counterforce with a single pad posteriorly to promote hyper extension and restricting forward flexion

CORRECTIVE SPINAL ORTHOSES

• Milwaukee brace- Used in pts with structural scoliosis who is ambulatory

CORRECTIVE SPINAL ORTHOSES

• BOSTON BRACE- The pelvic corset opens

posteriorly.- It is designed for

treatment of dorso-lumbar scoliosis in which the apex of the curve below T8

ORTHOSES FOR C-SPINE

• SOFT COLLAR-made from soft foam, the collar provides mechanical restraint for cervical flexion and extension and, to a lesser degree, lateral flexion and rotation.- Although the soft collar provides minimal restriction of movement, it is a good transitional appliance from more rigid orthoses, and acts as a proprioceptive reminder to the wearer to limit head and neck motions.

• HARD COLLARS -Constructed from semirigid and rigid plastics. Hard collars provide more rigid stabilization of the cervical spine and typically offer some type of chin and occipital support, with the inferior collar extending to the sternal notch and to the T3 spinous process posteriorly. - Generally, hard collars such as the Philadelphia collar limit motion much more than soft collars, but on average still permit 40 to 50 percent of normal cervical ROM

• SOMI BRACE -it does not have the back plate, thus allows the pt to lie comfortably on bed. -it has a chest plate and two shoulder extensions. - three adjustable uprights, two for the occiput and one for the mandibular support.- More effective in controlling of flexion at upper c-spine. But not so effective for extension an lateral rotation of cervical spine.

• FOUR POST CERVICAL COLLAR- It consists of two padded plastic plates one anteriorly

over chest one posteriorly between interscapular area.

- Also contain one chin cup and one occipital cup.the ant&post cups are connected by plates with two vertical stems.

- Limts flexion ,extension& lateral rotation of lower and middle parts of c-spine.

• HALO BODY ORTHOSES

• MINERVA JACKET

-if a lesion present in the upper most part of c-spine along with c-spine the forehead also include in external immobilisation.