2. • Spinal orthotic device is an
external apparatus applied to
the body
- to limit the motion
- to correct deformity
- reduce axial loading on
-improve the function of
particular spinal segment in
the body
3. Spine biomechanics
• Transfer load from head and trunk
to pelvis
• Protects spinal cord
• Permit motions in three planes
• Vertebral bodies progressively
larger in caudally to sustain
increased superimposed weight
7. Spine Stability
• Based on ability of the spine which undergoes
physiological loads to prevent displacement
-`which would injure or irritate neural tissues.
2types
- Intrinsic type
-Extrinsic type
18. FUNCTIONS of Spinal orthics
• Alignment of the spinal skeletal structure.
• Reduction of gravitational loading.
• Post-operative immobilization.
• Restriction of motion.
• Prevent progression of deformity
• Muscle relaxation.
• Protection of head from impact.
19. CLASSIFICATION
According To Region Crossed:
1.Cervical (CO)
2.Head Cervical Orthoses (HCO)
3.Cervicothoracic Orthoses (CTO)
4.Thoracolumbar Orthoses (TLO)
5.Lumbosacral Orthoses (LSO)
6.Thoracolumbosacral orthosis (TLSO)
20. According to material used
• Flexible Orthotics or Corsets:
It provide the most cush- ioning, constructed out of strong
fabrics or elastic materials with a variety of stiffer supports.
• Rigid Spinal Orthotics :
-Rigid thermoplastics provide the most functional support.
-Used when greater control of motion or posture is required.
-Fabricated from high temperature thermoplastics or light
weight metals.
-Wide varieties with a broad selection of pads and coverings.
22. A) SOFT COLLAR
Made from soft foam.
Provide mechanical restraint (5-
15%)
Psychologic comfort.
Indication:
• Used in acute neck pain
• Relief from minor muscle spasm.
• Relief from cervical strain.
23. (B) Hardcollars
- rigid or Semi-rigid plastics with
superior and inferior padding .
-Provide more rigid stabilization of
the cervical spine.
-Include Occiput & Chin to decrease
ROM.
- Used in stable spine conditions.
-Long-term use associated with
decreased muscle function.
24. PHILADELPHIA COLLAR
• Semirigid with a 2-piece system of
Plastazote foam.
• Plastic struts present anterior &
posterior give support to cervical
region.
• Upper portion supports lower .
jaw and occiput,
• Lower portion covers upper
thoracic region.
• Anterior hole for a tracheostomy
• Difficult to clean.
• Thoracic extension can be added to
increase motion restriction and
treat C6-T2 injuries
25. PHILADELPHIA COLLAR
Indications:
• Anterior cervical discectomy
or fusion.
• Dens type I cervical fractures
of C2.
• Suspected cervical trauma in
unconscious patients.
• Most of teardrop fracture of
the vertebral body.
26. Miami J collar
• Semirigid 2 - piece System
made of polyethylene , with
a Soft , Washable lining
• Same indications for use as
those for the Philadelphia
Collar
• The front piece has a chin
cup. The back piece is
curved and fits against the
lower part of your head.
• Thoracic extension can be
added to increase support
and treat C6 - T2 injuries .
27. Malibu collar
• semi - rigid , 2 - piece orthosis
• anterior opening for a tracheostomy
• indications similar to those for the
Miami J and Philadelphia collars .
• comes in only one size
• adjustable in multiple planes to
ensure proper fit
• Padding around the chin can be
trimmed to ensure proper fit
• Thoracic extension can be added to
increase support and treat C6 - T2
injuries .
29. Sternal - Occipital - Mandibular Immobilizer
( SOMI)
• In this, anterior chest plate
extending to the Xiphoid process
• Straps from the bars over the
shoulder & Cross to opposite side
of the anterior plate for fixation .
• 2 - poster CTOs start from the
chest plate and attach to the
occipital component .
• SOMI is ideal for bedridden
patients because it has no
posterior rods .
30. SOMI Advantages:
• Removable chin piece with an
optional headpiece can be used
if chin piece is
removed for eating
• Comfortable .
• Proper adjustment is
crucial for motion
restriction .
31. Indication :
• Used in Atlantoaxial instability
• Neural arch fractures of C2 ( flexion causes
instability ) .
• SOMl controls flexion in C1 - C3 segments.
32. Halo Cervical traction
- A halo-vest is used to
immobilize and protect the
cervical spine and neck after
surgery or accident
- Reduction in all cervical
motions by 90%.
33. Halo Cervical traction
• The ring (or halo) around your head is held in place
by four screws (or pins) in your skull
• The ring is attached by four bars to a stiff,
lightweight vest that fits around your chest
34. Indications
• Dens type I,II, or III fractures of C2
• C1 fractures With rupture of the transverse
ligament
• Atlantoaxial Instability .
• Cervical arthrodesis - Postoperative
• Debridement and drainage of infection in an
unstable spine - Postoperative
• Spinal cord injury.
35. Complication of halo cervical traction
• Pin-track infection
• Sometimes reduction cannot be achieved
• Spinal instability following orthotic
immobilization for 3 months
• cerebrospinal fluid leakage from a halo
pinhole
• pneumonia causing death
37. TLS ORTHOSES
• Extends from sacrum to above the inferior angle
of scapula
• Contain thoracic and pelvic bands
• Used to support and stabilize the trunk
• Used in cases of post - spinal fusion , post
Scoliotic Surgery and intervertebral disc diseases
• To prevent mild scoliosis
• Work through increase intra - abdominal
pressure and reduce weight on vertebralbody
38. KNIGHT-TAYLOR’S brace
• Indication: Dorsolumbar
immobilization
• Used for
• Anterior compression
fracture of the thoracic and
lumbar vertebral body,
• osteoporosis ,
• trauma and degenerative
spine disease.
39. • Control of flexion , extension and minimal
axial rotation
• Apron anteriorly extends from xiphoid to just
above pubic area
40. CASH ORTHOSIS
(Crusiform Anterior Spinal
Hyperextension)
INDICATIONS :
• Immobolization of compression
fracture from T6-L1
• Reduction of kyphosis not in
patient with osteoporosis
CONTRAINDICATIONS:
• Three column spinal fracture
involving anterior , middle and
posterior spinal structure
• Patient with osteoporosis.
41. CASH orthosis
• ADVANTAGES:
• Prevent flexion of spine but
doesn’t prevent extension
• Controls thoracic spine
• More comfortable
42. Custom fabricated body jacket
• Biomechanics: controls flexion ,
extension, lateral bending and rotation.
• Provides three point pressure system
and circumferential compression
43. • Anterior trim lines
usually located from
inferior to the sternal
notch and superior to
the pubic symphysis.
• Posterior trim lines
have superior border at
spine of scapula and
inferior border at the
level of coccyx
• These trim lines are
adjusted during fitting
to make the patient
comfortable
45. LUMBOSACRAL CORSET
Biomechanics:
• Anterior and lateral trunk assists in the elevation of
intra-abdominal pressure.
• Restriction of flexion and extension can be achieved
with the addition of steel stays posteriorly.
46. Indications
• Low back pain,
• herniated disks
• lumbar muscle strain,
Contraindications
• Unstable fractures.
• Special considerations
• Muscle atrophy can also potentially occur after long-term
use, causing an increased risk of reinjury.
• patients can also develop a psychological dependence on the
support after injury.
47. Chairback brace
• Rigid short LSO with 2 posterior uprights with
thoracic and pelvic bands.
• The abdominal strap in front for adjustments to
increase Intra-cavitary pressure.
• The thoracic band is located 1inch below the
inferior angle of scapula.
48.
49. Spinal orthotics in scoliosis
• High thoracic curves :
- MILWAUKEE BRACE
• Low thoracic ( T8) or below :
- BOSTON BRACE ( prefabricated )
- Wilmington brace ( custom made)
50. MILWAUKEE
• The Milwaukee brace is used
for high thoracic curve
correction.
• It consists of
neck ring with a throat mould
• two occipital pads to avoid a
high pressure in the neck.
• plastic pelvic girdle
• thoracic pads in the back
And metal bars in the front and
51.
52. The Boston brace
• Fits under the arms and
around the rib cage,lower
back ,hips.
• Four point fixation.
• Minimum limitations of
activities.
• Wear 18-23 hours / day
53. WILMINGTON BRACE
• A Wilmington brace ( custom made )plaster
jacket is molded to a patient placed on a
Risser frame.
56. WALKING AIDS
• Walking aid is a device
designed to assist walking
and improve the mobility
of people who have
difficulty in walking or
people who cannot walk
independently
57. Purpose of walking aids
•Increase area of support or base of support
• Maintain center of gravity over supported area
• Redistribute Weight - by decreasing load on
injured or inflamed part or limb .
•Can also compensate for weak muscles
• Decrease pain
•Improve balance
59. Selection depends on
• Stability of the patient
• Strength of upper and lower limbs
• Co - ordination of upper and lower limbs
• Degree of relief from weight - bearing
60. clinical description of weight bearing
status
• Non weight
bearing
• Toe touch weight
bearing
• Partial weight
bearing
• Weight bearing
as tolerated
• Full weight
bearing
61. Parallel Bars
• Rigid
• Support through the
length of bars
• Enables patients to
Concentrate on lower
limbs
• A full length mirror
placed at one end
• Adjustment : height of
the bar should be at the
level of greater trochanter
62. Canes
• Most common mobility aid
• Commonly made of wood or
aluminium
• Transmits 20 - 25 % of body weight
• Held in hand opposite the involved
side
• Compensates for muscle weakness
• Relieves pain
• Elbow at 30° flexion
63. • Improves balance & postural stability
• Widens Base of support
• Reduces forces on hip while walking
• Reduces knee pain in OA patients
• Restricted in Non weight bearing and partial
weight bearing .
64. ADJUSTMENT OF WALKING-STICKS
• Place the handle of the
walking-stick on the
ground beside the heel of
the patient's shoe.
• Adjust the length of the
walking-stick so that its
(lower) end is level with
the most prominent part
of the greater trochanter
or radial styloid process.
• Reverse the walking-stick
and check that the
patient's elbow is in 30
degree of flexion.
65. Choosing the correct walking-stick
• A patient when using a walking-
stick should have his elbow in
30 degrees of flexion.
• Too long-The shoulder is
elevated, the elbow is flexed
more than30 degrees, ulnar
deviation of the wrist is
increased unless the grip on the
handle is changed and support
is decreased.
• Too short -The patient leans
forward and the elbow is flexed
less than 30 degrees
66. Standard cane
• Straight cane
• Made of wood or acrylic
• Has half circle or t-shaped handle
• Inexpensive and easily available.
• Not adjustable
67. Standard aluminum adjustable cane
• Same as standard ,made of aluminum
and handle with molded plastic
covering
• Adjustable height with a push button
mechanism
• Approximate height is 27-38.5 inches
(68-98cm)
• Light weight and costly than standard.
68. Tripods
• Made of aluminum alloy or steel
• Three rubber tipped legs at
Corner of an equilateral triangle
• Handgrip in same plane as a line
joining two legs nearest and
parallel to patient's foot
• Elbow at 30° flexion
• More stable
69. Quadrupeds
• Has four rubber tipped legs
• Adjustable hand grip height
• Provides broad base
• Disadvantage - pressure exerted on
handle may not be centered ,
• causes instability: may not be used fon
stairs
• slower gait pattern
70. Rolling cane
• Provides wide , wheeled base
allowing uninterrupted forward
progression
• Includes multiple handgrip , height
adjustments
• Wheeled based - no need to lift &
lace it forward
• Provides faster forward progression
• Not suitable for patients with
propulsive gait pattern ( parkinsons
) and Costly
71. Laser cane
• Incorporates bright red laser line projected
along the floor to assist episodes While
Walking
72. Measuring canes
• Cane is placed approximately 6 inches from
the lateral border of the toes .
• 2 important landmarks for measurement are
Greater trochanter & angle of elbow
• Top of cane should come at the level of
greater trochanter & elbow flexed to 20 - 30
degrees ( allows arm to shorten & lengthen
during gait Cycle -provides shock absorption
(mechanism ) .
74. • Used to improve balance & relieve weight
bearing
• Greatest stability - anterior & lateral stability
• Provide wide base of support
• Typically made of aluminum with moulded
vinyl handgrip & rubber tips
• Adjustable adult size - 32 - 37inches ( 81 -
92cms ) .
75. How to Walk with Walker
• Push or lift your walker a few
inches, or a few centimeters, or
an arm's length in front of you.
• Make sure all 4 tips or wheels of
your walker are touching the
ground before taking a step.
• Step forward with your weak leg
first. If you had surgery on both
legs, start with the leg that feels
weaker.
• Then step forward with your
other leg, placing it in front of the
weaker leg.
77. Standard walking frame
• Consist of four vertical aluminum
tubes joined on three sides by upper
and lower horizontal tubes.
• One side is left open
• Hand grips on the upper horizontal
tubes
• Rubber tips at the lower end of
vertical tubes
79. Advantages
- Allows unilateral forward progression
• Useful for patients incapable of lifting the
Walker to move it forward
• Relatively light Weight & easily adjustable
Disadvantage :
-Less stability
-Eliminate arm swing
-Can not be Used on stairs
80. Rollator walking aid
• Two Small wheels at front and
two legs without Wheels at
back
• No need for lifting the whole
device
• Care to be taken for elderly
patients
• Best suited for children
82. • Used most frequently to improve
balance & to relieve Weight
bearing ( fully / partially ) .
• -Typically used bilaterally - to
increase Base of support
• -allows upper extremity to
transfer body weight to the floor
• 2 basic designs of crutches in
clinical use are :
• • Axillary crutches
• Forearm Crutches
83. Perquisites for crutches
• Good strength of upper limb muscles is
required .
• Range of motion of upper limb should be good
• Muscle group which should be strong are
• Shoulder flexor , extensors and depressor
• Shoulder adductors
• Elbow and wrist extensors
• Finger flexors
84. Axillary crutches /under arm crutches
• Referred as standard crutches
• they are made up of light weight
wood or metal with a axillary bars.
A hand piece and double upright
rod joined distally by single leg
covered with rubber suction
• Both overall height of the crutches
and hand grip can be adjusted
• Adjustable adult crutch size is 48-60
inches.
85. Advantages
• Improve balance & lateral stability
• Provide functional ambulation with restricted
weight bearing
• Easily adjustable
• Inexpensive
• Can be used for stair climbing easily
86. Disadvantage
• Should be safe when using In Crowded place
• Axillary Crutch require good standing balance by
the patient
•improper use may cause compression to
neurovascular structures in axillary region
• Old age group people may feel insecure or
may not have necessary upper-body strength
87. Precautions
• Have someone nearby for assistance until
accustomed to the Crutches
• Check screws in crutches at least once a week
• Remove small , loose rugs from walking paths
•Avoid use in crowds
• Never carry anything in hands and use of
backpack
88. Measurement of length
• Several methods are used but most
common is standing and supine position.
• STANDING: measure the distance 2inches
below the anterior axillary fold to a point 2
inches lateral and 6inches anterior to fifth
toe with the patient standing.
• Patient elbow should be flexed 30degree
and the wrist should be in maximum
extension and the fingers should be in a fist
• The patient should be able to raise the
body 1-2 inches by performing complete
elbow extension
89. • Supine :
from the anterior axillary fold to point 6-8
inches lateral to the border of the heel
90. FOREARM CRUTCHES
• Also known as canadian /elbow
/lofstrand crutches
• It can adjust both proximally and
distally
• Proximal: Position of forearm cuff
• Distal : height of the crutches using
push button mechanism.
• Usually adult sizes are 29 – 35
inches
91. Advantages
• Forearm cuff allows use of hand
• No damage to axillary neurovascular structures
• Easily adjusted & allows functional stair climbing
• Most usefull for patient with bilateral KAFOs
• Using forearm crutches requires less energy than
axillary .
• Disadvantages
• Less lateral support
• They require good standing balance and good
upper body strength
• Old patient sometimes feel insecure
92. MEASUREMENT
• Position of choice: standing
• From 1-1.5 inches below the elbow joint to 2
inches lateral and 6 inches anterior to the
foot.
• Shoulder should be relaxed and elbow at 30
degree flexion.
• Cuff should be placed at the proximal one
third of the forearm.
93. platform crutch
• platform acts as a padded
armrest with hand grip
attaches to the top of
the crutch.
• Used when weight bearing
is contraindicated through
wrist or hand
• Also used with walkers
94. Gait pattern with crutches
• Four point gait
• Three point gait
• Two point gait
• Two point swing through gait
• Two points swing to gait
95. Four-point gait
• In this gait pattern : the left
crutch is moved forward,then
the right lower extremity,
followed by the right crutch
and then the left lower
extremity.
• Slow ,good stability.
• Weight is on both lower
extremities and used with
bilateral involvement due to
poor balance, in coordination
(ataxia)and muscle weakness.
96. THREE POINT GAIT
• In this type of gait three points of support
contact the floor.
• Non weight bearing gait for lower limb
fracture or amputation
97. Two point gait
• In this ,the opposite lower
and upper extremity more
together.
• This gait pattern is similar to
the normal walking gait but it
is less stable because only
two points contacts the floor
• Thus,use of this gait requires
better balance.
98. Swing-through gait
• Fastest gait, requires
functional abdominal
muscles.
• In the swing-through gait,
the crutches are moved
forward together and
then lower extremities are
beyond the crutches
99. Swing-to gait
• In the swing-to gait, the
crutches are moved
forward together and
then lower extremities
swings to the crutch
level
103. THANK YOU
REFERENCES:
• O sullivan susan B, THOMAS j physical rehabilitation
assessment and treatment
• Traction and Orthopaedic Appliances J.D.M.
Stewart (Author), J.P. Hallett (Author)
• M Dena gardiner- The principles of exercise theraphy.
