FW: 4th part of replies on bracing for hyperkyphosis
Lucy Best
Description
Collection
Title:
FW: 4th part of replies on bracing for 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 such a great response so much that I had to put in 4 e-mails. Here
is the 4th part (including original question)
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
He needs to stretch his iliopsoai that are pulling him forward and
strengthen his hip extensors and hamstrings. Bet you major hip flexion
contracture.
His lumbar is likely self fused, unless someone did it for him.
Strengthening upper paraspinals to hold upper trunk and head will help, but
what are the chances of him actually doing this? At 92? Why do you think he
is the way he is to start with? Unless, of course, it's MS or any other
similar conditions.
Otherwise, nothing will work, as it will be either too much bulk, too
awkward, or he won't tolerate pressure from corrective forces. You know this
and I know this. Seen plenty of them. And it's not that brace is pushing
into me too much, it's that they jackknife into it too hard. Of course it
can be technically done. But will YOU wear something like this? As you know,
braces only weaken structures supported.
I'd say, as last resort, you can try this:
<URL Redacted>
but it will need to be heavily modified, as it is very awkward to put on.
Likely adding transverse chest strap to pull deltopectoral ones together,
and larger pelvic strap with maybe small abdominal panel.
Maybe even small rigid foam sternal pad attached to transverse strap.
Got to anchor that spinal piece somewhere, right? And he will need to be
coached to put it on with back against the wall, to lock it straight into
the brace. Or, laying flat.
Spinomed IV by Medi? Google it and call the rep. Needs to be used with a
program of PT but good success can be made if patient complies despite age
Lucy,
I believe you are probably right about the body jacket etc. Would end up in
the closet if it ever got that far!
My wife is a PT and we have a PT clinic in conjunction with our orthotics
office. We do a fair amount of osteoporosis patients who have significant
kyphosis issues, usually pivoting at T9. We do a combination of therapy and
bracing. I think that if you are only looking for an orthotic remedy to
this, you and your patient will be disappointed. My experience is that you
need to have a multiple discipline approach here. First of all, I would have
a therapist work with this patient who is an osteoporosis expert. They are
out there. Sara Meeks is a PT who performs osteoporosis seminars around the
country and is one of the preeminent experts on osteoporosis. You can go on
her website (not sure what it is but could google) and she can provide you
with a therapist in your area that is trained in such therapy. Secondly, in
tandem with the therapy which is the most important intervention in my
opinion, we use the Spinomed IV TLSO (not III) If you go through SPS, they
will try to sell the three to you as they are trying to lower their
inventory. Specify the IV as it is this new edition is much easier for the
older patients to don. It is the ONLY orthosis that has studies that prove
it's efficacy. Others such as Ossur are duplicating it. Cant remember the
name of Ossurs but you could check with your ossur rep. Looks ok.
Orthomerica has one but I don't like it. Also, don't recall the name of
theirs either. Sorry bout that. But remember that over 50% of women over the
age of 50 have osteoporosis and over 25% of men over 50, surprisingly, have
osteoporosis. Chances are this patient has it as well. If not, due to his
kyphosis, we would treat him as he did have it.
Good luck. Hope this little diatribe of mine is helpful.
Gil Gulbrandson CO/LO
Gulbrandson Orthotics, LTD
Cary, IL
<URL Redacted>
definition/con-20019766
Ed Herman, CPO.
Tom Gavin has a custom post shell design that may work for him, he is out of
Burr Ridge IL, BioConcepts. Give them a call to discuss casting and design
Dan
I m working with someone like this - really tough condition to try and
correct! I had the same idea about adding a thigh shell but I know it
wouldn't be tolerated. I think the best idea is the stand up walker - it is
amazing how much forward flexion a standard rollator causes.
Good Luck
cheryl
Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670
treatment of hyperkyphosis.
There was such a great response so much that I had to put in 4 e-mails. Here
is the 4th part (including original question)
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
He needs to stretch his iliopsoai that are pulling him forward and
strengthen his hip extensors and hamstrings. Bet you major hip flexion
contracture.
His lumbar is likely self fused, unless someone did it for him.
Strengthening upper paraspinals to hold upper trunk and head will help, but
what are the chances of him actually doing this? At 92? Why do you think he
is the way he is to start with? Unless, of course, it's MS or any other
similar conditions.
Otherwise, nothing will work, as it will be either too much bulk, too
awkward, or he won't tolerate pressure from corrective forces. You know this
and I know this. Seen plenty of them. And it's not that brace is pushing
into me too much, it's that they jackknife into it too hard. Of course it
can be technically done. But will YOU wear something like this? As you know,
braces only weaken structures supported.
I'd say, as last resort, you can try this:
<URL Redacted>
but it will need to be heavily modified, as it is very awkward to put on.
Likely adding transverse chest strap to pull deltopectoral ones together,
and larger pelvic strap with maybe small abdominal panel.
Maybe even small rigid foam sternal pad attached to transverse strap.
Got to anchor that spinal piece somewhere, right? And he will need to be
coached to put it on with back against the wall, to lock it straight into
the brace. Or, laying flat.
Spinomed IV by Medi? Google it and call the rep. Needs to be used with a
program of PT but good success can be made if patient complies despite age
Lucy,
I believe you are probably right about the body jacket etc. Would end up in
the closet if it ever got that far!
My wife is a PT and we have a PT clinic in conjunction with our orthotics
office. We do a fair amount of osteoporosis patients who have significant
kyphosis issues, usually pivoting at T9. We do a combination of therapy and
bracing. I think that if you are only looking for an orthotic remedy to
this, you and your patient will be disappointed. My experience is that you
need to have a multiple discipline approach here. First of all, I would have
a therapist work with this patient who is an osteoporosis expert. They are
out there. Sara Meeks is a PT who performs osteoporosis seminars around the
country and is one of the preeminent experts on osteoporosis. You can go on
her website (not sure what it is but could google) and she can provide you
with a therapist in your area that is trained in such therapy. Secondly, in
tandem with the therapy which is the most important intervention in my
opinion, we use the Spinomed IV TLSO (not III) If you go through SPS, they
will try to sell the three to you as they are trying to lower their
inventory. Specify the IV as it is this new edition is much easier for the
older patients to don. It is the ONLY orthosis that has studies that prove
it's efficacy. Others such as Ossur are duplicating it. Cant remember the
name of Ossurs but you could check with your ossur rep. Looks ok.
Orthomerica has one but I don't like it. Also, don't recall the name of
theirs either. Sorry bout that. But remember that over 50% of women over the
age of 50 have osteoporosis and over 25% of men over 50, surprisingly, have
osteoporosis. Chances are this patient has it as well. If not, due to his
kyphosis, we would treat him as he did have it.
Good luck. Hope this little diatribe of mine is helpful.
Gil Gulbrandson CO/LO
Gulbrandson Orthotics, LTD
Cary, IL
<URL Redacted>
definition/con-20019766
Ed Herman, CPO.
Tom Gavin has a custom post shell design that may work for him, he is out of
Burr Ridge IL, BioConcepts. Give them a call to discuss casting and design
Dan
I m working with someone like this - really tough condition to try and
correct! I had the same idea about adding a thigh shell but I know it
wouldn't be tolerated. I think the best idea is the stand up walker - it is
amazing how much forward flexion a standard rollator causes.
Good Luck
cheryl
Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670
Citation
Lucy Best, “FW: 4th part of replies on bracing for hyperkyphosis,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236642.
