Spinal Orthotics in CP What can we do? Andrew Schneider Snr Orthotist BCH ROH

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1 Spinal Orthotics in CP What can we do? Andrew Schneider Snr Orthotist BCH ROH

2 Talk outline From referral to prescription Measurement methods Treatment options

3 Orthoses Intro bit Externally applied item/device to improve mechanical function, mobility,reduce pain progression of deformity. Orthotist Me, moved north to Birmingham last year and now work between ROH and BCH Currently most of the spinal work is through ROH orthotic department.

4 Orthotic Assessment Begins with referral,x ray and report from spinal team, stating type, location and a hint towards the aim of orthotic intervention for this patient Physical examination of patient to determine level of correction possible ( forward bend test) the scoliometer to monitor rib angulation

5 Cobb Angle Measuring Perpendicular intersector of most proximal and most distal most angled vertebrae i.e.

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7 Audience participation

8 Experiment A.1 Stand up Look around at everyone as you do and Sit down again

9 Control Some stood, some didn t, some quick, some slow Not every person can be controlled using the same method and the rate of response varies widely across individuals. Whether it s a verbal request from me or a physical request from a brace

10 Measurement options Plaster or Fibreglass cast( distraction method, supine,bivalved or full wrap ideally with extra hands to aid in cast correction) Measures ( useful for all options to add further info or used alone if casting or scanning are not appropriate) 3d scan, also either full circumferential or bivalved ( structure scanner for ipad) or D. all of the above

11 Corsetry Orthotic prescription Options Defos( dynamic elastomeric fabric orthosis) Soft bracing Rigid bracing No brace

12 Corsetry Not used much for scoliosis Potentially for mild maintenance of long term curve Seen in past in very elderly patients Not willing to change feels good to them ( if it aint broke )

13 Lycra(Defos) Scoliosis bracing as well as for postural stability Work on a basis of increasing proprioceptive feedback with compression over specific areas No cast or scan required More tolerable to patient and can be modified for growth 2 types of lycra scoliosis suit

14 Lycra measuring chart

15 Postural scoliosis suit For patients who have a curve showing due to poor muscle balance or low spinal muscle tone. designed to correct spinal curvature and improve posture. Strategically placed panelling re-aligns the pelvis and shoulders to provide improved balance and proximal core stability. Unlike traditional rigid splinting, this design improves balance and stability whilst allowing range of movement.

16 Postural Scoliosis Suit Provides Spinal curve reduction by up to 50% Spinal curvature up to 30 Full range of spinal movement Sensory feedback Encouragement of correct muscle function Pain relief

17 Postural Scoliosis Suit

18 Structural scoliosis suit For idiopathic scoliosis for patients who have more advanced scoliosis. It has been designed to correct spinal curvature and rotation. Strategically placed panelling provides counterrotation and gradual compression over the curved side of the spine. Unlike traditional rigid splinting, this design improves balance and stability whilst allowing range of movement.

19 Structural Scoliosis Suit

20 Spinecor

21 Blocked leather Soft bracing Produces well fitting breathable leather jacket that moulds further into shape with use Not widely used as skills are rare very labour intensive

22 Soft bracing Eva/ Foam construction with/without internal skeletal frame Seen as more comfortable than rigid brace but still can be very effective in holding correction Combination corset front and more rigid back good for comfort but less controlling

23 Soft Bracing

24 Rigid Bracing Material choice by clinician to provide rigidity required Usually Polyethylene or Copolymer polypropylene more aggressive correction possible lateral and rotational influence added to improved posture. For ALL Cast or Scanned braces Cast or scan rectified to orthotist instructions and additional pads within brace applied at trial fit of brace before sent for completion

25 Rigid Bracing

26 Gensingen Brace More comfortable type of rigid bracing developed by Dr Weiss in Germany. More asymmetrical in appearance Improved rotational control Voids built in brace movement into corrected alignment Used in conjunction with specific physio input ( the schroth method) Currently not available on the NHS. Blatchford private clinic in Sheffield

27 Gensingen Brace

28 Results

29 The Unbraceable

30 Question?