Uses of spinal orthotics:

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Spinal orthosis

• Uses of spinal orthotics
• Pain (back pain)
• Restriction of spinal motion.
• Postural care and postural correction.
• Augment other therapies

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General classifications of spinal orthosis

• Flexible orthotics
• Or 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.

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Therapeutic benefits of spinal orthosis

• 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.
• Muscle 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.

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• 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.
• The amount of limitation varies between the
  various segments.
• 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.
• E.g. In case of scoliosis, the use of orthosis
  may prevent a spinal progression, stabilize the
  curvature and may offer some degree of posture
  correction

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Flexible Orthoses Or Corsets

• Sacroiliac corset (binder)
• 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.
• Lumbsacral corset
• Made from heavy fabrics with laces and hooks.
• It is designed to limit motion, maintain three
  point pressure system and to reduce pain

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• Thoracolumbosacral corset (TLSO)
• The same construction and function of
  lumbo-sacral corset (LSO) except it includes a
  shoulder strap to restrict spinal motion to the
  thoracic region as well as to the lumber spine

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Rigid Orthoses

• Lumbsacral orthosis (Williams Extension Lateral
  control)
• Fabricated from light weight materials such as
  leather and vinyl.
• Asingle three point pressure system limits trunk
  extension in lumber spine and increase
  interabdominal pressure. Lordosis is decreased,
  pelvic and thoracic bands exert a medial force
  that tend to limit lateral trunk motions, no
  limitation of trunk flexion

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Thoracic lumbo-sacral orthoses

• Taylor (Flexion/extension control)
• A pelvic band connects with two posterior
  uprights terminating at the mid-scapular level of
  the thoracic region.
• The three point pressure systems are coupled
  together to limit both flexion and extension of
  the lumber and thoracic spine.
• Jewett (flexion control)--------------?
• 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
  hyperextension and restricting forward flexion.

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Plastic body jacket (flexion-extension-lateral
rotary control)

• It is fabricated with high temperature copolymer
  plastics
• It will restrict motion in all planes.
• Anterior and lateral trunk support will elevate
  intracavitary pressure, and decrease demands on
  the vertebral disks
• It is used post-surgically or during acute trauma.

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Cervical Orthoses

• Soft collar
• made from soft foam, provides mechanical
  restraint for cervical flexion and extension, and
  to a lesser degree lateral flexion and rotation
• It is a transitional device from more rigid
  orthoses
• It acts as a proprioceptive reminder and to limit
  head and neck motions

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• Hard collars (Philadelphia collar)
• Made from semirigid and rigid plastics
• Provide more stabilization of cervical spine
  andchin and occipital support
• With the inferior collar extending to the sternal
  notch and to the T3 spinous process posteriorly.
• It permit 40 to 50 percent of normal cervical ROM

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• Cervicothoracic orthoses (Sterno-occipital
  mandibullar immobilizer (SOMI)
• It is one of the most common post surgical device
• It consists of a rigid metal frame with a chin
  and occipital rest connected to a chest and back
  plate,with padded shoulder and trunk straps
• It reduces cervical motion to about 55 to75
  percent.

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• Halo cervical orthosis
• It has a greatest reduction in cervical
  mobilization.
• It consists of a cranial ring secured to the
  skull using four metal pins.
• The ring is attached by four metal bars to a
  plastic vest and is worn continuously
• The estimated reduction in all cervical motions
  is 90 to 95 percent.
• It provids spinal stabilization and reduces the
  load of the head on the cervical spine.

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Cervicothoracolumbosacral Orthosis

• The CTLSO is the most commonly used for the
  treatment of scoliosis and Kyphosis.
• Milwaukee brace is designed with a neck ring and
  occipital pad, connected to four metal upright
  bars secured to plastic TLSO extends distally,
  forming a molded pelvic section.
• The advantage of Milwaukee brace is that each
  component pelvic, thoracic, and cervical can be
  molded.
• The disadvantage of this orthosis is that brace
  must be worn for 12 to 18 months, 23 hours a day
  and taken out for exercises or activities, poor
  acceptance psychologicallyand leads to physicians
  rejection as a brace for scoliosis