suggestions from the field
J. E. GARZIONE, BS, and S. J. CLIFTON, BS
At the New York State Veterans Home, geri atric patients who have sustained vertebral fractures are confined to minimal activity un til they are fitted with a spinal support. Prompt fitting of an orthosis to a patient is difficult in a small community with limited facilities. In order to keep the geriatric pa tients active and maintain their physical capa bilities, we constructed an effective and com fortable brace. Since vertebral fractures usually occur at the anterior portion of the vertebral body, the spine maintained in extension will keep the fractured fragments aligned against the ante rior longitudinal ligament. Sudden or exces sive flexion of the spine may cause cord (or cauda equina) damage, or further collapse of the vertebral bodies with invariably more pain. 1
CONSTRUCTION The spinal brace is made of perforated Plastazote®* and four posteriorly placed ver tical strips of Orthoplast®t- Two nylon webbed belts with Velcro®t+ or buckles are used to fasten the orthosis. Elastic thigh bands attached to the brace with nylon belts prevent upward displacement (Fig. 1).
Mr. Garzione is the physical therapist at the New York State Veterans Home, Oxford, NY 13830. Ms Clifton is the occupational therapist at the New York State Veterans Home, Oxford, NY 13830. * Smith and Nephew—USA—Inc, 330 Madison Ave, New York, NY 10017. f Johnson and Johnson, New Brunswick, NJ 08903. tt Smalley & Bates, Inc, 88 Park Ave, Nutley, NJ 07110.
1034
Figure 2 shows the basic pattern which is drawn on a full sheet of 1.3 cm perforated Plastazote®. The midspinal width of the or thosis is the distance from the fifth vertebra above the fracture site to the fifth vertebra below the site. The abdominal portion meas ures 1.3 cm inferior to the xiphoid process and 1.3 cm superior to the pubic symphysis. The Orthoplast®f strips and the width at the back and the front of this orthosis maintain the spine in the desired extension. The Plastazote® is heated according to in structions and molded around the patient po sitioned in spinal extension. Two belts of 2.5 cm nylon webbing are riveted to the Plastazote® and used to close the orthosis in a "cinch-like" manner. Velcro® sewn to the webbing or safety buckles secure the web bing around the patient. Four double thick nesses of vertical Orthoplast® strips are riv eted to the brace at 5 cm intervals, measured laterally from the vertebrae. Large rivets, 0.3 cm x 1 cm, are used on 1.3 cm Piastazote®. To prevent the rivets from breaking through this soft thermoplastic, washers 2.5 cm in diameter are cut out of low density polyethyl ene and placed between the rivet and the Plastazote®. All rivets on the inside of the brace are covered with pressure sensitive foam padding (.65 cm). The thigh bands are made of elastic 5 cm wide and sewn to two belts of nylon webbing that are riveted to the brace, one placed anterior and the other pos terior to the femur.
EXPERIENCE WITH ORTHOSIS An 85-year-old woman developed a sudden onset of extreme pain and muscle spasm in the lumbar spine. Roentgenograms revealed a recent collapse of the L1 vertebral body with decalcification and osteoarthritic PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/56/9/1034/4568044 by Washington University in St. Louis user on 19 February 2019
Orthosis for Geriatric Patients with Vertebral Fracture
(Left) Fig. 1. Spinal orthosis for geriatric patients. (Right) Fig. 2. Pattern drawn on full sheet of Plastazote®. A. abdominal portion, B. cut out for the anterior superior iliac spine.
The brace may not be suitable for younger, more active patients.
Acknowledgment. The authors wish to express their sincere thanks to Anita L. Garzione for the drawings in this report. REFERENCE Hollinshead WH: Functional Anatomy of the Limbs and Back. Philadelphia, WB Saunders Co, 1969
Automobile in Clinic Permits Car Transfer Practice JOHN P. McGIFFIN A 1967 Plymouth was donated to Sunnyview Hospital and Rehabilitation Center by an auto junk yard. A local high school industrial arts class cut off the front and rear portions of the car to enable it to be easily disassembled and moved. The half-car was then moved into the physical therapy department at the Center and was mounted on a wooden frame 5 cm by 30 cm. Patients and staff are able to practice car transfers at will and, to patients, the car is their ticket home. This example of community ingenuity and cooperation has produced a useful addition to the department. Hand controls can be added for demonstration and practice. Mr. McGiffin is director of physical therapy at Sunnyview Hospital and Rehabilitation Center, Schenectady, NY 12308.
Volume 56 / Number 9, September 1976
Figure. Half-car for transfer practice.
1035
Downloaded from https://academic.oup.com/ptj/article-abstract/56/9/1034/4568044 by Washington University in St. Louis user on 19 February 2019
changes of the thoracic and lumbar verte brae. She also demonstrated a marked tho racic kyphosis. This patient adjusted to the described brace after three days of use and was able to walk with minimal discomfort. Approximately three months after the initial construction of the brace, she remained active and pain free and was gradually freed from her brace. The durability of this brace has been proven only with use for geriatric patients.
J. E. GARZIONE, BS, and S. J. CLIFTON, BS
At the New York State Veterans Home, geri atric patients who have sustained vertebral fractures are confined to minimal activity un til they are fitted with a spinal support. Prompt fitting of an orthosis to a patient is difficult in a small community with limited facilities. In order to keep the geriatric pa tients active and maintain their physical capa bilities, we constructed an effective and com fortable brace. Since vertebral fractures usually occur at the anterior portion of the vertebral body, the spine maintained in extension will keep the fractured fragments aligned against the ante rior longitudinal ligament. Sudden or exces sive flexion of the spine may cause cord (or cauda equina) damage, or further collapse of the vertebral bodies with invariably more pain. 1
CONSTRUCTION The spinal brace is made of perforated Plastazote®* and four posteriorly placed ver tical strips of Orthoplast®t- Two nylon webbed belts with Velcro®t+ or buckles are used to fasten the orthosis. Elastic thigh bands attached to the brace with nylon belts prevent upward displacement (Fig. 1).
Mr. Garzione is the physical therapist at the New York State Veterans Home, Oxford, NY 13830. Ms Clifton is the occupational therapist at the New York State Veterans Home, Oxford, NY 13830. * Smith and Nephew—USA—Inc, 330 Madison Ave, New York, NY 10017. f Johnson and Johnson, New Brunswick, NJ 08903. tt Smalley & Bates, Inc, 88 Park Ave, Nutley, NJ 07110.
1034
Figure 2 shows the basic pattern which is drawn on a full sheet of 1.3 cm perforated Plastazote®. The midspinal width of the or thosis is the distance from the fifth vertebra above the fracture site to the fifth vertebra below the site. The abdominal portion meas ures 1.3 cm inferior to the xiphoid process and 1.3 cm superior to the pubic symphysis. The Orthoplast®f strips and the width at the back and the front of this orthosis maintain the spine in the desired extension. The Plastazote® is heated according to in structions and molded around the patient po sitioned in spinal extension. Two belts of 2.5 cm nylon webbing are riveted to the Plastazote® and used to close the orthosis in a "cinch-like" manner. Velcro® sewn to the webbing or safety buckles secure the web bing around the patient. Four double thick nesses of vertical Orthoplast® strips are riv eted to the brace at 5 cm intervals, measured laterally from the vertebrae. Large rivets, 0.3 cm x 1 cm, are used on 1.3 cm Piastazote®. To prevent the rivets from breaking through this soft thermoplastic, washers 2.5 cm in diameter are cut out of low density polyethyl ene and placed between the rivet and the Plastazote®. All rivets on the inside of the brace are covered with pressure sensitive foam padding (.65 cm). The thigh bands are made of elastic 5 cm wide and sewn to two belts of nylon webbing that are riveted to the brace, one placed anterior and the other pos terior to the femur.
EXPERIENCE WITH ORTHOSIS An 85-year-old woman developed a sudden onset of extreme pain and muscle spasm in the lumbar spine. Roentgenograms revealed a recent collapse of the L1 vertebral body with decalcification and osteoarthritic PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/56/9/1034/4568044 by Washington University in St. Louis user on 19 February 2019
Orthosis for Geriatric Patients with Vertebral Fracture
(Left) Fig. 1. Spinal orthosis for geriatric patients. (Right) Fig. 2. Pattern drawn on full sheet of Plastazote®. A. abdominal portion, B. cut out for the anterior superior iliac spine.
The brace may not be suitable for younger, more active patients.
Acknowledgment. The authors wish to express their sincere thanks to Anita L. Garzione for the drawings in this report. REFERENCE Hollinshead WH: Functional Anatomy of the Limbs and Back. Philadelphia, WB Saunders Co, 1969
Automobile in Clinic Permits Car Transfer Practice JOHN P. McGIFFIN A 1967 Plymouth was donated to Sunnyview Hospital and Rehabilitation Center by an auto junk yard. A local high school industrial arts class cut off the front and rear portions of the car to enable it to be easily disassembled and moved. The half-car was then moved into the physical therapy department at the Center and was mounted on a wooden frame 5 cm by 30 cm. Patients and staff are able to practice car transfers at will and, to patients, the car is their ticket home. This example of community ingenuity and cooperation has produced a useful addition to the department. Hand controls can be added for demonstration and practice. Mr. McGiffin is director of physical therapy at Sunnyview Hospital and Rehabilitation Center, Schenectady, NY 12308.
Volume 56 / Number 9, September 1976
Figure. Half-car for transfer practice.
1035
Downloaded from https://academic.oup.com/ptj/article-abstract/56/9/1034/4568044 by Washington University in St. Louis user on 19 February 2019
changes of the thoracic and lumbar verte brae. She also demonstrated a marked tho racic kyphosis. This patient adjusted to the described brace after three days of use and was able to walk with minimal discomfort. Approximately three months after the initial construction of the brace, she remained active and pain free and was gradually freed from her brace. The durability of this brace has been proven only with use for geriatric patients.
