Spine & Back Disorders – Flashcards

1. The spinal column has 3 very important functions - • Supports the body's weight- Posture control and spinal stability • Provides flexibility for movement • Protects nerve roots and fibers and forms a protective surrounding for the spinal cord- Supports the main pathway of communication between the brain and the rest of the body 2. Three natural curves • Help withstand large amounts of stress and allow for even weight distribution of body weight.

• Scoliosis: Spine deviating from the normal in the coronal plane • Kyphosis: Increased concave curvature of the spine in thoracic area • Decreased breathing, ROM in shoulders, and cervical extension • Lordosis (Swayback): increased convex curvature of the spine in the lumbar area • Obesity, muscular dystrophy • Kyphosis and lordosis -may require Exercise, bracing, surgery

• 4 out of 5 adults will experience some type of back pain •Low back pain (LBP) is the most common, and 80% experience LBP at some point in life span • LBP is the 2nd most frequent cause of lost work days in adults younger than 45 years •Most common cause of job related disability • Back pain is more common in men than women (emedicne) •NIH reports no difference • Most back pain occurs among people aged 45-64

1. Acute Back Pain • Lasts 12 weeks even after treatment

1. Common Causes • Poor body mechanics • Poor conditioning • Decreased strength/endurance • Obesity • Smoking • Age • Wear & Tear 2. Mechanical Problems • Muscle strain • Ligament sprain • Muscle spasm 3. Structural Problems •Osteoporosis •Arthritis •Compression fractures •Herniated disk- Bone changes secondary to age, Nerve entrapment/impingement (sciatica) •Spinal stenosis -Bone changes secondary to age • Spondylosis- Degeneration of the spine • Spondylolisthesis- Slippage of a vertebra •

• Client • OT • PT • Physician • Social worker • Caseworker • Discharge planner • Nutritionist • Nurse • Psychologist - anxiety, increased stress

A. Conservative Tx • Medication • Heat and/or ice • Activity restrictions/ADL retraining • Exercise guidelines / PT • Lifestyle changes B. Surgical Intervention • To decompress the nerve to reduce pain • To stabilize the spine to reduce pain 1. Laminectomy 2. Fusion 3. Disk Dissection 4. Vertebroplasty 5. Kyphoplasty

• Removes the lamina to create space and relieve pressure on the spinal nerves • Most commonly done on cervical and lumbar spine segments • Following sx: Pts usually go home POD 1, Bracing not required

1. Fusing painful vertebrae together into a solid bone • Eliminates motion between vertebrae and prevents pressure on nerves • Uses allograft or bone graft and/or rods/screws/plates • Can be anterior or posterior 2. Posterior Spinal Fusion (PSF) -Primarily used to tx neck fxs, dislocations, and deformities of the spine curvature

• Avoid flexion with posterior cervical fusion • Avoid extension with anterior cervical fusion • Limit overhead movements • No heavy lifting (<5 lbs.) • Follow surgeon's recommendations for use of collars

A minimally invasive surgical procedure used to stabilize a spinal fx and stop the associated pain • Uses cement

1. A certified health care professional that makes and fit braces and splints for patients • Works with doctors and allied health professionals to custom fit • Applied to spine or limb injuries and developmental deformities 2. An orthosis is a brace or appliance that is designed and fitted to the body

• Flexible brace, made of soft foam • Provides relief from minor muscle spasm and cervical strain • May be used as transitional support after a hard collar has been used for major healing

Used for conditions such as relatively stable cervical fracture, cervical fusion surgery, or a cervical strain

• Immobilizes head and neck • The Halo is worn 24 hours a day until the spine injury heals. • Used with complex cervical spine surgery or unstable cervical fracture • Generally worn for approximately 12 weeks- Do not allow anyone to pull on the rods or vest -- 1. Therapy and ADL considerations • Log roll for bed mobility • Provide a towel roll under the neck for sleep • Unbalanced when first getting up due to additional weight • Oversized shirts and easy to slip on shoes work best • Necessary to take small bites and chew food well 2. Care for HALO • Watch for infection at pin sites • Never adjust anything on the HALO - contact Neurosurgeon • Do not get liner of HALO vest wet • Not able to shower - must take sponge bath

• Sterno • Occipital • Mandibular • Immobilization • Provides rigid support ideal for bed ridden patients • Holds neck in a straight line with spine and controls for flexion at atlantoaxial segment and c2-c3 • Chin piece can be removed for eating, and optional head piece can be used • Prevents cervical flexion, lateral bending, and rotation (twisting)

1. Thoracic - Lumbar - Sacral - Orthosis (TLSO) • Post-op stabilization • Further stabilization of non-surgical thoracic or lumbar fractures • Fractures btw T6-L3 2. Back Braces Jewett Hyperextension Brace • Used c stable spinal compression fxs • 3-point pressure system- Sternum and pubis symphysis -anteriorly, Mid thorax -posteriorly • Limits flexion & extension between T6 - L1- Limits symptomatic fractures in T6- L1

1. OT Treatment / Management Physical Therapy • Pain • Spasms • Limited flexibility & strength • Posture & neutral spine 2. Occupational Therapy • GOAL: To improve occupational performance, and prevent recurrence & chronicity 3. Education: • Anatomy & Physiology: Spine and back mechanics as related to injury, repair, and occupational performance • Back Precautions • Neutral Spine • Body Mechanics • Ergonomics / Home modifications • AE and DME • Energy Conservation • Pain management & coping strategies 4. ADL retraining • Appropriate body mechanics • Toilet Transfers • Tub/Shower Transfers • Bed mobility • Engaging in ADLs 5. Use of AE • Donning/Doffing Brace • Incorporating energy conservation in everyday living 6. Ergonomics: •Create environment for better fit of client's needs: Home and work site evaluation-Ex: furniture used at home and work environment • Task analysis/activity analysis • Make recommendations to employers • ADA specialist 7. Occupations to increase strength and endurance • PT initiates rote exercises, • OT can utilize rote exercises • Use favored occupations to enhance strength and endurance of targeted muscles and tasks- Making a meal, Sitting at a computer with a neutral spine

• No Bending • No Lifting • No Twisting • No Pushing • No Pulling • Follow surgeon's recommendations for use of back braces

• Strategies for stress and Coping • Relaxation techniques • Deep breathing • Meditation • Guided imagery • Behavioral management

● The natural curves help cushion and protect the spine 1. Cervical: Mild lordosis 2. Thorax: kyphosis 3. Lumbar: Lordosis ● It places the least amount of stress on the body's tissues ● It is the optimal way to attain balance and proportion ● It optimizes breathing and affects the circulation of bodily fluids ● It uses the least amount of energy to maintain a desired position ● It allows activation of the right muscles during movement

• Straight back: Position body close to and facing task- Bend from hip - Hip flexors/extensors • Avoid twisting body • Lifting with legs for safe performance • carry objects close to body • Avoid prolonged (>30 minutes) repetitive activity or static positions - avoid back stress • Balance activity with rest (Energy Conservation) • Use a wide base of support when lifting • Keep back in proper alignment • Avoid picking up or carrying any item weighing more than 10 pounds. • Bed mobility: Log roll technique • Picking up objects from the floor & reaching for objects:- Squat: Bending at knees to achieve a squat position. The retrieved object kept close to the body when return to a standing position. Diagonal squat- Tighten abs and ensure smooth movement , without holding breadth. Golfers lift • Standing for extended period of time (reducing back stress): Place one foot on a step stool (puts the pelvis into a posterior tilt, decreasing the strain placed on the lumbar spine) -- Functional Mobility • Sitting to standing from a chair, bed, or toilet: Forward lean -anterior tilt of pelvis , followed by knee flexion and a straight back (Spine)-Use UEs for additional power- Avoid low, soft couches and instead opt for a firm, supportive chair with arms. • Low toilet seats (between 15 to 17 inches in height)- Elevated toilet seat or taller toilet, with arm rests. • Walking should be encouraged!- AD secondary to PT recommendation- Walker/cane vs. no device

1. Inability to bend forward: •Donning pants, underwear, socks, and shoes: •Cross leg over the opposite leg in sitting to access foot (as opposed to bending forward). •What If the patient lacks the trunk flexion? 2. Difficulty standing for long periods of time: •When bathing and showering what AE is recommended? • A tub bench or shower chair/seat, a long-handled sponge and/or hand-held shower head will be helpful. •When cooking? •Doing groceries/ 3. Difficulty with trunk rotation: •Toilet aid increases the length of their reach, decreasing the amount of spinal twisting.