scoliosis patient, treat by Boston TLSO

Case Presentation on Scoliosis
Patient: Adina Fatima

Layout of the Presentation
*Subjective Assessment
*Objective Assessment
*Diagnosis
*Treatment Objectives
*Prescription & its Justification
*Education to the patient
*Conclusion

Subjective Assessment
Personal information
*Name : Adina Fatima
*Father N : Syed Wajid Ali Shah
*Address : Forest Colony Police st. Gul Bahar Peshawar city
*Contact No. : 03339162684
*Age : 6 Years
*Gender : Female
*Height : 76 cm
*Weight : 15 kg

Social condition

*Assistance available: parents
*Financial Condition: Poor
Past medical History: The patient was born normal. Her parent realize that she had the deformity at the age of 3 years, then they consult doctor, doctor refer her to PPCC for orthotic treatment. She has chest infection. Up till now she has used 1 Orthosis.
Present Complaint : Patient come for review of her appliance. Patient feel uncomfortable with the abdominal pressure in her previous appliance.

Objective Assessment
Observations:
*Posture: Left Lateral Curve
*Mental Status : The patient was well oriented at the time and space
*Position of Upper Limb: Right Side Down
*Pelvic Level: Normal (Level)
*Clearance test:
*Low squat test: negative
*Faber Test: negative
*Toe standing test: negative
*Back scratch test: negative
*Coordination test: negative

Objective Assessment cont.
Special Tests:
*List Test : negative
*Adam’s Test: positive, Hump at the Left side
*Lateral bending test: flexible curve, the curve reduce when the patient tilt toward convexity.


Radiological examination (X-Ray)
Apical Vertebrae: T10.
Upper End Vertebra T7
Lower End Vertebra L1
Cobb’s Angle: 15°
Single curve thoraco lumbar (C shape)
Diagnosis
Scoliosis
Detail of Diagnosis:
Left lateral thoraco lumbar Single curve (C shape)
Apical Vertebrae: T10.
Upper End Vertebra T7
Lower End Vertebra L1
Cobb’s Angle: 15°
Cause of Deformity: Idiopathic

Treatment objectives
*Prevent the progression of deformity
*Reduce the magnitude of curvature
*Improve Cosmesis

Prescription

Thoraco Lumbo Sacral Orthosis (TLSO)
(Low Profile Orthosis)
Detail of Prescription:
*Boston Design
*Three Point Pressure System
*Anterior Opening
*Made out of Poly Propylene Sheet (4mm)
*Straps, made of Webbing Belts & Velcros (5cm)
*5mm Tape foam for Pressure pads at Axilla (right side) & diagonal direction of apical vertebra
*6mm Plastozote for Relief Pads on iliac crest
Justification of Prescription
*TLSO with Boston Design because apical vertebrae are below T8 and curve is C-shaped
Three point pressure system correction
* Primary pressure, medially directed force (from left side on diagonal direction of apical vertebra) toward apical vertebra
* two counter pressures;
1) below axilla
medially directed force
(from right toward left)
2) at the pelvis
medially directed force
(from right toward left)
*Anterior opening for easy donning & doffing, as well as good cosmesis
*Polypropylene Sheet(4mm)for appropriate pressures & strength.
*Webbing belts & Velcros for intimate fitting and holding
*Pressure pads for application of pressures on exact areas.
*Relief pads to avoid pain on bony prominences (iliac crest)

Education to the patient
*Patient is asked to:
*Use the appliance for 23 hours per day
*Come for review after 3 months an bring X-ray
*Exercises, those are: hanging and manual traction twice a day.

Conclusion
The patient is diagnosed having scoliosis deformity, and TLSO with Boston Design is prescribed. Patient & father are satisfied, patient is asked to come after o3 month, and bring the X-ray of patient (with & without appliance). to know effect of Orthosis and the alteration of the Cobb angle magnitude.

8 responses to “scoliosis patient, treat by Boston TLSO

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