O&P Library > Orthotics and Prosthetics > 1977, Vol 31, Num 4 > pp. 67 - 71

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Report: Panel On Spinal Orthotics

Since the area for discussion was quite large, we chose to eliminate from consideration "total-body" orthoses or those which incorporated limb orthoses with trunk orthoses. Spinal orthoses were then considered from two aspects, purpose and anatomical area of application. Purpose was subdivided into general immobilization and special purpose. Orthoses for special purpose were corrective, preventive, and assistive and included devices for patients with scoliosis, kyphosis, and neuromuscular disorders with and without sensory deficit. Because orthoses for myelomeningocele frequently encompass both the torso and the lower limbs, this category was discussed only briefly.

The classification system used along with some comments is shown in Table. 1   and Table. 2.

RECOMMENDATIONS
(IN ORDER OF PRIORITY WITHIN EACH SECTION)

1. GENERAL
   1.  Evaluation and analysis of basic spinal orthoses both those presently used and those in experimental study are needed so that prescription and application can be done more nationally. A method of evaluation using objective engineering principles should be developed first, however.
   2.  Summary and review articles compiled from orthopaedic journals and texts in orthotic and prosthetic publications should be carried in the journals as appropriate to allow each half of the team to read more efficiently in the other's area of expertise.
   3.  Promotion of the "image" of the orthotist and the patient wearing an orthosis should be supported.
2. ORTHOSES FOR GENERAL IMMOBILIZATION
   1. A method to "unload" or distract the spine and immobilize the head without skull pins should be developed. Mandible and anterior neck should be free.
   2.  A new orthosis for immobilization of the upper thoracic spine, (T-l — T-8) should be developed.
   3.  Development of a semi-flexible lumbar support probably of molded plastic is needed.
   4.  A better method of orthotic fixation of the pelvis should be developed for lumbo-sacral orthoses.
   5.  Corset supports should be redesigned to be more comfortable, more stable, more easily applied, more easily adjusted, and constructed of better fabrics.
3. ORTHOSES: SCOLIOSIS AND KYPHOSIS
   1.  Development of an orthosis to correct preferably without a neck ring.
   2.  An organization of orthotists interested in scoliosis should be formed to work with the Scoliosis Research Society.
   3.  Design improvement is needed for upper thoracic and cervical curves in scoliosis and improvement in treatment of rib deformity and rotation.
   4.  A better orthosis for the elderly kyphotic with pain is needed.
   5.  The education of orthotists should include x-ray evaluation of spinal deformities using standardized positioning of the patient.
   6.  Improved cosmesis is needed in orthotics for adolescents for treatment of scoliosis and kyphosis.
   7.  An improved orthosis for scoliosis in infants should be developed.
   8.  Specialized local treatment center for scoliosis and kyphosis should be established.
   9.  Designs in orthoses for scoliosis and kyphosis should be more adjustable in the clinic to provide a wider range of fitting possibilities.
4. ORTHOSES FOR NEURO-MUSCULAR DISORDERS
   1.  Improved materials and design for orthoses that allow use on patients with sensory deficit are needed.
   2.  Development of a "dynamic" orthosis which utilizes external forces to provide both support and assistance should be initiated.
   3.  There should be a coordination of educational efforts in the field of genitourinary surgery and general surgery with orthotic advances to accomplish more optimal placement of urinary "ostomies."
5. DELIVERY OF NEW DEVICES AND SERVICES
   With the demise of the Committee on Prosthetics Research and Development, there is at present no organization to coordinate, evaluate and disseminate information on new devices and services. An organization to meet this need is imperative. It is needed to work with the educational system so that prosthetists, orthotists, physicians, therapists and other interested persons can become familiar with worthy devices and services in order that they be delivered properly to the public. Unrealistic regulations and inadequate fee schedules are a barrier to delivery of new devices and services. Education of governmental agencies and other "third-party" organizations should be the best means to achieve modification.
6. WHO SHOULD PROVIDE SPINAL CORSETS?
   This special charge was considered at length. It was pointed out that some corsets are custom fitted and others are not. Presumably one important factor involved in provision of "unfitted" or "off-the-shelf" corsets is economy of time and /or money. There was unanimous agreement that all "fitted" corsets should be provided by an orthotic facility. If no fitting was desired by the purchaser, agreement was not unanimous but strongly in favor of supply by an orthotic facility. Most agreed that fitting a corset was "best patient care."

O&P Library > Orthotics and Prosthetics > 1977, Vol 31, Num 4 > pp. 67 - 71