FW: part 2 of the replies of hyperkyphosis
Lucy Best
Description
Collection
Title:
FW: part 2 of the replies of hyperkyphosis
Creator:
Lucy Best
Date:
8/3/2014
Text:
Thank you to all those who responded to my question about effective
treatment of hyperkyphosis.
There was a great response, so many that I need to put it in 4 emails. Here
is part 2.
The gentleman in question is currently trying out the loaded backpack which
he says helps a lot and lets him look straight ahead and not at the ground.
Many thanks again!
Lucy Best
Orthotist and director of Hampshire Orthotics ltd, UK
On 2014-07-12 17:18, Hampshire Orthotics wrote:
I have a gentleman aged 92 years who came to me asking for a spinal brace to
prevent him doubling up when he walks and stands. He has tried corsets
with shoulder straps and a soft LSO Boston style brace in the past but they
did not help at all. He has a flat rigid lumbar spine and hyperkyphosis
which brings his head very anterior of the central line, so there is a
massive moment pulling him down, mostly flexing at the hips.
I suspect his best option is to use a high walking stick/frame, but want to
look into orthotic options for him.
I think the only way to stop this is to use a body jacket with thigh cuffs,
hip joints set up as in an RGO to enable him to walk (OK to lock for
standing only). He probably wouldn't want to have all that bulk and weight.
He walks his dog every day and is the main carer for his wife.
Does anyone have any suggestions or orthotic braces they have tried (fails
and successes) for this patient group?
I would be grateful for any info and will post all on here.
Thanks, Lucy
Look up spinomed online
Clinical documentation
(Study from journal of phys med and rehab) Showing increased para spinal
strength, reduced pain and reduced kyphosis leading to increased tidal
volume.
You can judge the clinical data for yourself.
Hope this helps.
Robert C. Fetterman (Bob)
MediUSA Mid-Atlantic
Territory Business Manager
Prosthetics/Orthopedics
Cell: 610-416-8536
VMail: 800-230-4017
EMail: <mailto:<Email Address Redacted>> <Email Address Redacted>
There have been a number of patients like this that I have been asked to
manage over the years, with mixed success. First, what specific problem or
problems are you trying to address? I have been asked to address this
malalignment for no other reason than appearance, and I have come to the
conclusion that such is a waste of time. No matter how much I have
explained, and shown by way of samples, and no matter how much they have
said that they wanted it, I cannot recall a single case where it was worn
for more than a very short period of time. If this is the situation with
your patient, I think your suggestion of a walking stick or some equivalent
would be the best option.
The specific symptomatic problems I have encountered were either balance,
pain, or some combination of those two, although there was one case where it
was simply a vision problem in someone who did a lot of walking (couldn't
see ahead, only the ground). Given that your patient walks his dog daily
and cares for his wife I would assume that severe pain is not in the
picture.
I have done 3 or 4 of the RGO setups you describe, and 2 of them worked out
quite well. Both were people who wanted to continue ambulating (4-6 miles
per day, in one case) but for whom their malalignment was causing
unacceptable balance problems, including falls. The other of those 2 had
already had both hips replaced due to hip fractures from falls when walking.
They worked out quite well. One of my somewhat sloppy definitions of a
clinical success is if the device requires repairs due to wear, and both of
these did. The third of those was for a patient with a train wreck of a
spine and severe pain, with no remaining surgical options, primarily due to
age, but also a low likelihood of improvement. In her case the RGO
functioned as intended, and reduced her pain to the point where she could
walk better than she had in years, but there were enough issues related to
her co-morbidities, including CHF and deconditioning, that it did not
actually get used much, so success in her case would depend on how you
defined it. When I said 3 or 4 there was one other that I can picture that
I can't remember for sure if we actually made it, or if the fitting was
terminated at the fitting of the body jacket due to a reality check for the
patient regarding the bulk of the device. It is possible that the fitting
was delayed for a bit, but in any case I can't remember enough about it to
be helpful.
I agree with your assessment that with a rigid spine you have to cross his
hips. Something I always did was to show the prospective patient the pieces
(sample body jacket and thigh section from a KAFO) to help them visualize
what it would be like. Photos and video were not quite the same. That
alone spiked quite a few possible devices, because the patients knew that
they would not want to wear it, or there was no one capable of assisting
with donning, if assistance was necessary.
One thing I did find I could do was to have openings in the various pieces
for improved comfort without compromising the function, since the corrective
forces were in one plane only. The body jacket in particular ended up
looking something like a cross between a CASH and a Jewett, or maybe a
chairback with horizontal crossbar, in terms of the trim lines, although
with a full length central sternal section, and with extra padding if the
sternum was particularly boney.
They were not projects for the faint of heart, but functionally I think you
are thinking appropriately about what might actually work. One thing I did
learn the hard way was that in the presence of a rigid spine, at least in
the area that could improve alignment, any kind of TLSO alone usually made
things worse, and only helped when there were also multiple segmental spinal
pain problems that benefited from partial immobilization. The actual cause
for making things worse was uncertain, but my gut was that the TLSO
interfered with their already challenged balance mechanisms without actually
improving their alignment/posture.
All that said, without having actually seen him I suspect his best option
might be the walking stick you mention. One other thing that a few patients
have done is to wear a small backpack with sand bags in it to function as a
counterweight. This is something I do for backpacking conditioning, but
most folks with this kind of alignment problem do not tolerate it well for
other reasons, probably most commonly fatigue, but many just don't want to
wear a pack, and others have issues with one or both shoulders. I had one
spectacular success this way, but he would be properly classified as
contracted vs. rigid. His pack slowly stretched him out over a period of
2-3 years until his posture was nearly normal. But again, that was anterior
spinal ligament tightness, without any segmental wedging or other
uncorrectable restraints.
Hope that this was helpful, and best of luck.
James Redhed CPO
Cascade Prosthetics & Orthotics
Ferndale, WA
treatment of hyperkyphosis.
There was a great response, so many that I need to put it in 4 emails. Here
is part 2.
The gentleman in question is currently trying out the loaded backpack which
he says helps a lot and lets him look straight ahead and not at the ground.
Many thanks again!
Lucy Best
Orthotist and director of Hampshire Orthotics ltd, UK
On 2014-07-12 17:18, Hampshire Orthotics wrote:
I have a gentleman aged 92 years who came to me asking for a spinal brace to
prevent him doubling up when he walks and stands. He has tried corsets
with shoulder straps and a soft LSO Boston style brace in the past but they
did not help at all. He has a flat rigid lumbar spine and hyperkyphosis
which brings his head very anterior of the central line, so there is a
massive moment pulling him down, mostly flexing at the hips.
I suspect his best option is to use a high walking stick/frame, but want to
look into orthotic options for him.
I think the only way to stop this is to use a body jacket with thigh cuffs,
hip joints set up as in an RGO to enable him to walk (OK to lock for
standing only). He probably wouldn't want to have all that bulk and weight.
He walks his dog every day and is the main carer for his wife.
Does anyone have any suggestions or orthotic braces they have tried (fails
and successes) for this patient group?
I would be grateful for any info and will post all on here.
Thanks, Lucy
Look up spinomed online
Clinical documentation
(Study from journal of phys med and rehab) Showing increased para spinal
strength, reduced pain and reduced kyphosis leading to increased tidal
volume.
You can judge the clinical data for yourself.
Hope this helps.
Robert C. Fetterman (Bob)
MediUSA Mid-Atlantic
Territory Business Manager
Prosthetics/Orthopedics
Cell: 610-416-8536
VMail: 800-230-4017
EMail: <mailto:<Email Address Redacted>> <Email Address Redacted>
There have been a number of patients like this that I have been asked to
manage over the years, with mixed success. First, what specific problem or
problems are you trying to address? I have been asked to address this
malalignment for no other reason than appearance, and I have come to the
conclusion that such is a waste of time. No matter how much I have
explained, and shown by way of samples, and no matter how much they have
said that they wanted it, I cannot recall a single case where it was worn
for more than a very short period of time. If this is the situation with
your patient, I think your suggestion of a walking stick or some equivalent
would be the best option.
The specific symptomatic problems I have encountered were either balance,
pain, or some combination of those two, although there was one case where it
was simply a vision problem in someone who did a lot of walking (couldn't
see ahead, only the ground). Given that your patient walks his dog daily
and cares for his wife I would assume that severe pain is not in the
picture.
I have done 3 or 4 of the RGO setups you describe, and 2 of them worked out
quite well. Both were people who wanted to continue ambulating (4-6 miles
per day, in one case) but for whom their malalignment was causing
unacceptable balance problems, including falls. The other of those 2 had
already had both hips replaced due to hip fractures from falls when walking.
They worked out quite well. One of my somewhat sloppy definitions of a
clinical success is if the device requires repairs due to wear, and both of
these did. The third of those was for a patient with a train wreck of a
spine and severe pain, with no remaining surgical options, primarily due to
age, but also a low likelihood of improvement. In her case the RGO
functioned as intended, and reduced her pain to the point where she could
walk better than she had in years, but there were enough issues related to
her co-morbidities, including CHF and deconditioning, that it did not
actually get used much, so success in her case would depend on how you
defined it. When I said 3 or 4 there was one other that I can picture that
I can't remember for sure if we actually made it, or if the fitting was
terminated at the fitting of the body jacket due to a reality check for the
patient regarding the bulk of the device. It is possible that the fitting
was delayed for a bit, but in any case I can't remember enough about it to
be helpful.
I agree with your assessment that with a rigid spine you have to cross his
hips. Something I always did was to show the prospective patient the pieces
(sample body jacket and thigh section from a KAFO) to help them visualize
what it would be like. Photos and video were not quite the same. That
alone spiked quite a few possible devices, because the patients knew that
they would not want to wear it, or there was no one capable of assisting
with donning, if assistance was necessary.
One thing I did find I could do was to have openings in the various pieces
for improved comfort without compromising the function, since the corrective
forces were in one plane only. The body jacket in particular ended up
looking something like a cross between a CASH and a Jewett, or maybe a
chairback with horizontal crossbar, in terms of the trim lines, although
with a full length central sternal section, and with extra padding if the
sternum was particularly boney.
They were not projects for the faint of heart, but functionally I think you
are thinking appropriately about what might actually work. One thing I did
learn the hard way was that in the presence of a rigid spine, at least in
the area that could improve alignment, any kind of TLSO alone usually made
things worse, and only helped when there were also multiple segmental spinal
pain problems that benefited from partial immobilization. The actual cause
for making things worse was uncertain, but my gut was that the TLSO
interfered with their already challenged balance mechanisms without actually
improving their alignment/posture.
All that said, without having actually seen him I suspect his best option
might be the walking stick you mention. One other thing that a few patients
have done is to wear a small backpack with sand bags in it to function as a
counterweight. This is something I do for backpacking conditioning, but
most folks with this kind of alignment problem do not tolerate it well for
other reasons, probably most commonly fatigue, but many just don't want to
wear a pack, and others have issues with one or both shoulders. I had one
spectacular success this way, but he would be properly classified as
contracted vs. rigid. His pack slowly stretched him out over a period of
2-3 years until his posture was nearly normal. But again, that was anterior
spinal ligament tightness, without any segmental wedging or other
uncorrectable restraints.
Hope that this was helpful, and best of luck.
James Redhed CPO
Cascade Prosthetics & Orthotics
Ferndale, WA
Citation
Lucy Best, “FW: part 2 of the replies of hyperkyphosis,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236641.
