3. Cervical orthosis Made by: Armghan Anjum Orthotist & Prosthetist
Government College University
Faisalabad

4. overview Introduction Function of cervical orthoses Classification
Flexion/Extension Control Devices
Flexion/Extension/Lateral Flexion/Rotation Control Devices
Normal Motion Vs Restriction of Neck Movement with Orthosis

5. introduction
Cervical orthosis includes devices used in treatment of disorders around the region of neck and skull
Immobilizing cervical spine is difficult because:
Most mobile part in spine
Has small body surface
Limited pressure tolerant areas like chin, occiput
Different types of predominant movement at different levels

6. Function of Cervical Orthosis (Co)
Positions the head in position
Limits movement in flexion, extension, rotation and lateral rotation
Unload the cervical spine by weight bearing part of skull.

7. classification Cervical orthosis can be classified as:
Cervical collars
Poster appliances
Cervicothoracic orthosis
Halo devices

8. Flexion/Extension Control Devices
Soft cervical collar
Semirigid cervical collar with chin—Occiput support
Philadelphia orthosis
SOMI brace (Sterno Occiputo Mandibular Immobilization Brace)

9. Flexion/Extension/Lateral Flexion/Rotation Control Devices
Poster orthosis
Halo brace
Minerva body jacket

10. Cervical collars Soft cervical collar Construction Advantages
It is made of foam and rubber covered by a stockinet.
Advantages
Low cost
Easy to fabricate
Tolerated by patient
Provides warmth and psychological comfort
Disadvantage
Does not restrict cervical motion in any plane and serves only as a remainder to hold neck and avoid excessive movement.

11. Contd… Semi-rigid Cervical Collar Construction Advantages:
It is made of rigid polypropylene. Height of the orthosis can be changed by adjusting the two parts of collar.
Advantages:
Easy to apply and remove
Some restriction of flexion and extension
Chin and occipital extension can be added.
Disadvantage:
Does not restrict lateral bending and rotation.
Can press on clavicle and give discomfort.

12. Philadelphia Orthosis
Construction
Philadelphia orthosis is made of plastozote reinforced with anterior and posterior struts. It has molded mandibular and occipital support. Anteriorly and posteriorly it extends to upper thorax.
Advantages
Restricts flexion extension due to chin and occiput support and thoracic extension.
Disadvantages
Ineffective in controlling rotation and lateral bending
Pressure over clavicle.

13. SOMI Brace Construction It consists of: Advantages:
It is a modified poster appliance
It consists of:
Sternal plate
One anterior strip which hold chin support
Two rigid metal rods from anterior to posterior to occiput support
Advantages:
There is no posterior post. So it can be used with patient lying supine.
Light weight donning and doffing

14. Poster appliances
It has anterior section consisting of sternal support, one or two uprights and chin support. Posterior section consist of thoracic plate, one or two uprights and an occipital support
It limits flexion, extension, rotation and lateral flexion. It also unloads the cervical spine by chin and occiput support

15. Contd… Two varieties are Four poster orthosis (Thomas collar)
Two poster orthosis (Peter Cervicothoracic orthosis) which provides less lateral stability

16. Yale Cervicothoracic Orthosis
Yale cervicothoracic orthosis is a modified philadelphia collar with plastozole reinforced with struts
It extends down to mid thorax anteriorly and posteriorly.
Occipital support extends higher on skull.
With extended area of support stability is increased

17. Halo brace
Halo devices are used for treating cervical fractures and dislocation. It consist of:
Rigid metal or graphite ring attached to skull by four fixation pins
Four posters which are attached to ring proximally-two anteriorly, two posteriorly and distally to polypropylene vest
Polyethylene vest: The vest may be of:
Half vest—Level of nipples for upper cervical injuries
Short extended vest up to the level of 12th rib
Full vest—Level of iliac crest for lower cervical injuries.

18. Minerva Body Jacket
This is an orthosis made of Plaster of Paris or Thermo Plastic
It consist of:
Forehead adaptation with occipital support
Chin support
Body jacket that extends up to the level of twelfth rib or umbilicus
Advantages
Light weight (plastic)
No invasive pins like halo device
It limits flexion, extension, rotation and lateral rotation like halo brace

19. Contd…
Halo device and Minerva body jacket are the choice in ambulant management of unstable cervical spine

20. NORMAL MOTION VS RESTRICTION OF NECK MOVEMENT WITH ORTHOSIS
Orthosis Name
Flexion/Extension
Lateral bending
Rotation 1.
Normal
100% 2.
Soft collar
25% restriction
8% restriction
16% restriction 3.
Philadelphia
71% restriction
33% restriction
56% restriction 4.
SOMI
72% restriction
34% restriction
64% restriction 5.
Four poster
80% restriction
54% restriction
82% restriction 6.
Halo
89% restriction
92% restriction
98% restriction 7.
Minerva body jacket
77% restriction
76% restriction
100% restriction