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SCI Orthotics

SCI Orthotics. SCI Orthotics. Review. Nomenclature Spine support orthoses Neck, ThoracoLumbarSacral Joint support orthoses Typically lower limb motor loss adaptations Motor augmentation orthoses Typically upper limb motor presence augmentation Protection orthoses. Orthotic Definition.

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SCI Orthotics

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  1. SCI Orthotics SCI Orthotics

  2. Review • Nomenclature • Spine support orthoses • Neck, ThoracoLumbarSacral • Joint support orthoses • Typically lower limb motor loss adaptations • Motor augmentation orthoses • Typically upper limb motor presence augmentation • Protection orthoses

  3. Orthotic Definition • Device used to assist, resist, align or simulate function of a body part or system. • Typically applies forces to affected extremity. • Force has magnitude, direction and application point. • Effectiveness depends on all 3. • Movement = rotation, translation or combination of 2. • Torque is strength of rotational force.

  4. Orthotic Nomenclature • 1971 – American Orthotic and Prosthetic Association promoted standardized nomenclature • 1972 – new language put into use

  5. Committee on Prosthetic-Orthotic Education of the National Academy of Sciences • All exoskeletal devices called orthotics • Described by joints they encompass • Abbreviate each joint name to 1 letter • Combination of symbols to indicate desired control of designated function

  6. Orthotic Materials • Thin metal, plastic, foam, epoxy, plaster. • Short use = low durability need • High frequency & load = high durability need

  7. Spine Support • Goal is stabilization in desired plane of motion • Flex/ext, sidebending, rotation • Absolute vs. relative restriction

  8. Cervical Orthoses • Halo • SOMI, molded MINERVA cervical orthosis • ASPEN, Miami, PHILLY • MNDA for weak extensors (ALS) • Headmaster collar • Soft collar

  9. Cervical Orthoses • Philly: AP motion limited to 30% normal, 43% rotation, 67% side bend. • SOMI: 13-27% sagittal motion, 34% rotation, 66% side bend • HALO: believed most restrictive, least overall C-spine motion but individual “snaking” of vertebrae. • Koch – 31% sagittal motion reduction in tetraplegia, suggested intimate fit body vest was best. 1978

  10. ASPENCollar

  11. Miamicollar

  12. MNDA

  13. ThoracoLumbarSacral Orthoses • 3 point force application theory • No true immobilization, just limitation of interspinous motion • Limited sagittal control • For effectiveness, must provide “inhibitory feedback signal” over bony prominences to reduce patient movement efforts.

  14. LS Orthoses • Commonly used for back pain syndromes • Little consistent data to support idea that disk pressures reduced in lifting tasks. • Nachemson A.

  15. TLSO types • Jewitt • Knight-Taylor • LS corsett • Clamshell or turtleshell

  16. Limb Support Orthoses • Reciprocating gait orthosis • HKAFO • KAFO • AFO

  17. Motor Augmentation Orthoses • Cervical deficits can use substitution or enhancement • Upper limb’s job = terminal device (hand) placement in environment • Feeding most important! • Balanced forearm orthosis (BFO), tenodesis devices, hand & digit flexion or extension assist orthoses, built up grips for grip loss. • General environmental control units • Oromotor adaptive equipment

  18. Static Position Maintenance Orthoses • Common use in SCI, CVA • Prevent contracture, maintain functional position of hand.

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