Orthopædists deal with the correction of skeletal deformities and injuries, and with the treatment of chronic diseases of the joints and spine.
Spencer Technicians, because of their long experience and skill, are particularly well-equipped to create supports that meet orthopædists' specifications exactly. They design a large percentage of all orthopædic supports made in the Kingdom. Many famous clinics prescribe Spencer Orthopædic Supports, and they are supplied under N.H.S. to hospitals throughout the Kingdom.
Every Spencer Support is an orthopædic support in the sense that it improves the posture and protects the bony structure from the dangers of imperfect posture. The supports and features explained on the following pages are those in which most orthopædists are particularly interested, although some of the best-known among them prescribe the Spencer Posture Support for patients who require light orthopædic treatment-aid.
Many of the orthopædist's patients are in danger of becoming permanently crippled if not treated skilfully. The Fitter who assists the orthopædist finds a great reward in the joy of helping those in need. The field is interesting, profitable, and the Fitter who enters it enjoys prestige not only among those in the medical profession but throughout her community.
Measurements required for orthopædic supports must be taken very carefully. The instructions in this chapter describe additional measurements which may be necessary in unusual cases.
The Spencer Dorso-lumbar Spinal Support is designed to give general body support, with specific support for the back. It is built high at back according to the patient's needs.
|Fig. 209 |
Spencer Dorso-lumbar Spinal Support
With "O" Shoulder Straps
Spencer Dorso-lumbar Spinal Support
Without "O" Shoulder Straps
This support is especially designed to incorporate Rigid Steels.
The Dorso-lumbar Spinal Support is used in cases of spondylarthritis, fractured vertebrae, spondylolisthesis, protruding disc, osteoporosis, congenital spinal weakness, kyphosis, scoliosis, as an aid to treatment following poliomyelitis, and for support following spinal injury and spinal operations.
When a doctor prescribes a Spencer Dorso-lumbar Spinal Support for a patient, you should ask his advice regarding height of the support and the degree of rigidity required. If he asks you to make these decisions, you may be guided by the information under "Height of Supports with Rigid Steels" (page 236), "Rigid Steels" (page 245), and "Stiff Steels" (page 244).
|Fig. 211 |
Spinal Support for Men
Without "O" Shoulder Straps
Spinal Support for Men
With "O" Shoulder Straps
Special Steels. The Spencer Dorso-lumbar Spinal Support is usually ordered with 4 rigid steels at back. For scoliosis cases and any case where immobilisation is required rigid steels are also required under both arms. These steels are described in detail on pages 245 and 246, under the headings "Rigid Steels." No supports designed with Rigid Steels should be ordered in open-weave materials as these materials are too lightto stand the strain imposed by the steels.
Spinal Support With Rigid Steels for Day and Night Wear. Doctors frequently recommend that patients wear Spencer Supports day and night to provide twenty-four hour treatment. The Spencer Spinal Support with Rigid Steels is comfortable when bed wear is prescribed. It is often used for this purpose following removal of cast and after spinal operations or injuries.
Because a support worn constantly requires more frequent laundering, it is to the advantage of such a patient to have two supports for alternate wear.
Perineal Straps. When a Spinal Support is to be used for bed wear, order Perineal Straps. Otherwise the support may slip up on the body when the patient lies down and much of the benefit may be lost. On supports for men, Perineal Straps, when ordered, are supplied without extra charge.
When both hose supporters and Perineal Straps are ordered on Spinal Supports, an extra charge is made for the Perineal Straps (see price list). When Perineal Straps are ordered instead of hose supporters on a woman's support, the difference in price will be charged.
Outside Pelvic Binder. The Spinal Support is especially adapted to the use of the Outside Pelvic Binder (see page 242). The Curve Out Over Groin permits the Outside Pelvic Binder to be adjusted perfectly, giving maximum effectiveness.
Type of Fastening. The Spencer Spinal Support fastens at centre-front with special slides which provide secure fastening and permit the desired tension in all parts. Cloth is curved out over groin (see Figs. 213, 214 and 215).
Hose Supporters. Four hose supporters are supplied when support is for a woman
Adjustment. After the Rigid Steels are properly moulded (page 247), place the support on patient and adjust it loosely. Have patient lie on back, draw up knees toward abdomen and, while in this position, tighten all adjustment slides.
Orthopædic or "O" Shoulder Straps. "O" Shoulder Straps are described and instructions for measurements are given under "Orthopædic or 'O' Shoulder Straps" (page 240).
Measurements. Measurements taken according to the Spencer System. The Extra Top Measurement required when support is to be made with extra high back is explained under "To Control, Outline and Measure a Woman for an Extra-High-Back Support" (see page 237) and "To Control, Outline and Measure a Man for an Extra-High-Back Support" (see page 239).
To Order. When ordering for a woman, check space for Dorso-lumbar Spinal Support on Order Form. When ordering for a man, check space for Dorso-lumbar Spinal Support on Order Form.
On the Spencer Spinal Support for women, the cloth is curved out over groin as shown in Fig. 213
When Straps and Slide Fastening is ordered, this same shaping of cloth over groin may be specified on the Spencer Corset, Abdominal Supporting Corset, Sacroiliac and Lumbosacral Corset. Check "Curve Out Over Groin" on the order form.
Curve Out Over Groin is recommended for any support ordered with Rigid Steels. The close fitting over groin permits the support to hold the Rigid Steels tightly against the back for the greatest effectiveness. When thigh control is also desired, the Spensupport, which has a thigh control section, should be considered.
When Perineal Straps are ordered, and hose supporters are not, the shaping of Curve Out Over Groin is different. Unnecessary cloth at side front normally provided for attachment of hose supporters is eliminated (see Fig. 214).
On the Spencer Belt, Spensupport, or any support Curved Out Over Groin, the Length Cloth at Front will be the same as the Waist to Pubic Bone Measurement.
In all Spencer Supports for men, the cloth is curved over groin as shown in Figure 215.
When a woman is measured for a support with Rigid Steels, it is important that she also have at least two Spencer Breast Supports. Breast supports aid in improvement of posture and help to hold body against Rigid Steels of support. They also relieve strain on muscles of upper back and shoulders.
It is advisable to order Built-up Shoulders. It is also advisable to specify for the breast support, under Additional Instructions, a Length Top to Waist at Centre-Back Measurement. This should be at least as high above waist as the back of the body support with which the breast support will be worn. The breast support should cover the top of the body support.
It is important to remember that extra allowance for the rigid steels must be made when taking circumference measurements for a brassiere to be worn over a Spinal Support incorporating rigids. Unless this is done the brassiere will be too tight when adjusted over the Support containing rigid steels
When Rigid Steels are ordered and the doctor asks you to decide on the necessary Height Above Waist at Back, the following procedure is recommended:
Find out from the doctor or from the case history where in the back or spine the condition to be helped is located.
Lower Spine—Side View
1. When the condition is in the 4th or 5th lumbar vertebra or lower, the Height at Back should be about one inch below the shoulder blades, approximately 4 inches waist up. (There are five lumbar vertebrae. Number 1 is nearest the waistline and number 5 is the vertebra next to the sacrum. See Fig. 216).
2. When the condition is above the 4th lumbar vertebra, the Height at Back should be at least 212 inches above the bottom of the shoulder blades and not less than 7 inches above waist. Frequently the doctor will specify a much greater height.
In all Orthopædic cases Rigid Steels should be ordered (see pages 244 and 245).
When supports are prescribed for back conditions, the Height at Front and Height Under-arm should be as follows:
For Women. As high under breasts as can be worn with comfort ; higher under-arm, guided by Height at Back and by consideration of client's comfort.
For Men. Height Under-arm about one-half inch lower than Height at Back or, in the case of Extra-High-Back supports, as high as can be worn with comfort ; front about one-half inch lower than under-arm.
The high front helps to balance the high back and gives a maximum of support and immobilization.
Average height for Lumbo-Sacral Support, 4 inches above waist all round. Dorso Lumbar Supports extend, according to condition requiring treatment, to any height up to dorso-cervical juncture.
Control. Control with both Control Support and Breast Control Support in the usual way.
Outline. Detailed information on how to determine the height of the support is given on page 236 under "Height of Supports with Rigid Steels."
When it is determined that the support should extend above the bottom of the shoulder blades, the following procedure may be used :
1. Have client sit with head erect, shoulders well back, feet flat on floor, and hands relaxed in lap.
2. Place pins in shoulder straps over both shoulder blades where the top of support is to come at back.
3. Place pins as high as support can be worn with comfort, at each under-arm, each under-bust and one at centre-front.
4. When the Height at Back is to be four or more inches greater than Height Under-arm, place a pin at each side back, one inch higher than under-arm pin for Extra Top Measurement (Fig. 218).
Edge Top Measurement
Top Edge. The Top Edge Measurement is taken following the pins already placed. (It is more convenient to take this and the Extra Top 'Measurement with the tape measure starting at centre-back. To show entire back of client, photographs were taken with tapes starting at front).
Extra Top Measurement
Extra Top Measurement. This measurement is taken in addition to the Top Edge Measurement, when the Height at Back is to be four or more inches greater than the Height Under-arm.
Take the measurement following the outline pins across the front and under-arm, and across the back as outlined, one inch higher than the under-arm pin.
Other Measurements. All remaining measurements are taken as usual.
Unless he is a bed patient, the client should be controlled and measured over undervest and trousers, with coat and waistcoat removed. Detailed instructions for controlling, outlining, and measuring a man are given starting on page 88. These instructions should be followed, with these exceptions :
1. Outline and measure Top Edge. When the support is to extend above the bottom of the shoulder blades :
(a). Have client sit with head erect, shoulders well back, feet flat on floor and hands relaxed in lap.
(b). Place pins over both shoulder blades where the top of support is to come at back.
(c). Place a pin under-arm as high as the support can be worn with comfort.
(d). Place a pin at front one-half inch lower than pin at under-arm.
(e). The Top Edge Measurement will be taken following these outline pins (see Fig. 217).
2. Outline and measure for Extra Top Measurement when the Height at Back is to be four or more inches greater than the Height Under-arm. Place a pin at each side back, one inch higher than under-arm pin. Take this measurement following the outline pins, across the front and under-arm, and across the back as outlined, one inch higher than under-arm height (see Fig. 218).
Orthopædic Shoulder Straps are needed on Dorso-lumbar supports extending more than 7 inches above waist at back. They are necessary in cases involving forward flexion of the Dorsal Spine, i.e. Kypho-dorsal conditions. These include Kyphosis, Osteoarthritis, Spondylarthritis and others.
Purpose. The purpose of "O" Shoulder Straps is to hold the shoulders and upper back snugly against the support. They are most helpful combined with the Rigid Steels.
Description. A small stud is placed at the top edge of the support at each shoulder. Metal loops on the shoulder straps fasten to these studs and make the straps detachable. The straps pass over the shoulders to the front, down under the arms, and cross at back. They fasten and adjust conveniently at each side front in slides attached to studs (see Fig. 219).
The portion of the "O" Shoulder Straps at front of and under client's arm is made of soft, tubular knit material to prevent irritation.
The stud and loop attachments at back permit the shoulder straps to conform to the wearer's figure.
The straps may be easily detached for laundering.
To Order. Check space for "O" Shoulder Straps on Order Form and fill in measurements as explained below.
If ordered separately from support use Order Form 137 and state : colour, length strap, length under-arm, "Size Waist" of major support, and "Height at Back" of major support.
To determine the correct length of "O" Shoulder Straps, measure from the pin that indicates the top of the support at back, up over the shoulder and down to a point at front half-way between the top of the shoulder and the top of under-arm crease (see Fig. 220). Fill in this measurement on the order form under "O" Shoulder Straps, Strap...... Inches.............
Then measure from this point halfway between the top of the shoulder and the top of underarm crease to a point just back of client's under-arm (see Fig. 221) and use this measurement to fill in Plush ............ Inches.
These measurements will ensure that plush material is put in exactly the right place to prevent irritation in front of and under the client's arm.
The Outside Pelvic Binder is made of strong, non-stretchable fabric and is quickly adjusted to the desired tension by means of fulcrum straps and slides. It is designed and located to give maximum benefit.
When it is desirable to limit the motion of both spine and pelvis and hold them firmly and comfortably, the Dorso-lumbar Spinal Support with Rigid Steels and Outside Pelvic Binder is recommended.
As the Outside Pelvic Binder is tightened around the pelvis, and pulls over the outside of the Rigid Steels and boned portion of the support, it gives stability to the pelvis and holds the Rigid Steels firmly against the body.
A steel back brace or plaster cast is sometimes prescribed to limit motion of the spine. However, a Spencer Spinal Support with Outside Pelvic Binder, when designed with 4 Rigid Steels at back and with rigid steels at underarm and a rigid steel up the front, will prove as effective—and in some cases more effective—than a steel and leather brace, whether the brace is used separately or in conjunction with a corset. The Spencer is lighter in weight, less bulky, and far more comfortable than a steel and leather brace. It may be worn with comfort while sleeping—for continuous treatment (see "What is a Back Brace ?" page 250).
Most orthopædists are pleased to know that a Spencer Support can be individually designed for patients who might otherwise have to wear a steel and leather brace. Some doctors have given up the use of back braces in favour of the Spencer Spinal Support with Rigid Steels and Outside Pelvic Binder.
Other doctors replace steel and leather braces or casts prescribed for early treatment with a comfortable Spencer Support. There are innumerable instances of patients declining to wear a steel and leather brace both because of discomfort and unsightliness.
The supports best adapted to the use of Rigid Steels and the Outside Pelvic Binder are :
The Spencer Dorso-lumbar Spinal Support for Men and Women.
The Spencer Posture Support for Men.
The Spencer Lumbo-Sacral Support, when ordered with Slide Fastening and Curve Out Over Groin.
The Outside Pelvic Binder may also be ordered on these same supports.
Adjustment. The Outside Pelvic Binder is adjusted the same as the pelvic binder in the Sacroiliac Corset, except that the Outside Pelvic Binder is outside the support (see "Spencer Sacroiliac and Lumbosacral Supports" in Booklet No. 515).
To order, check "Outside Pelvic Binder" (see price list).
When there is an abnormal condition, wrong posture, or a need to limit motion, unusual support is demanded and the use of less flexible steels is necessary.
From our experience, we. have selected steels of two thicknesses and widths for use in those Spencer Supports in which extra stiffness is required. One steel, because of its extreme stiffness, is called a Rigid Steel. It is made to the famous Goldthwait formula. The other, less stiff than a Rigid Steel, is called a Stiff Steel.
Unless either Stiff Steels or Rigid Steels are to be ordered, there is no advantage in having the Height at Back more than 6 inches. When Height at Back is more than 6 inches, stiff steels or rigids should be ordered.
Stiff Steels are nine-sixteenths of an inch wide and about half as stiff as a Rigid Steel and may be placed in the back of supports when the doctor wants very firm boning but does not want Rigid Steels.
Stiff Steels cannot give immobilisation to the Spine. They do not hold the body as firmly as Rigid Steels or prevent movement of the spine as Rigid Steels do, but they give more support and restrain motion to a greater degree than normal Spencer boning. Stiff Steels are most effective when the support extends 4 inches or more above the waist at back.
One, two, or in some cases three Stiff Steels may be placed each side of spine. Stiff Steels may be ordered at under-arm.
The number and location of Stiff Steels are usually specified by the doctor, depending upon the condition to be treated and the size of the patient. This information should be indicated in the space provided on the order form.
Spencer Rigid Steels are made to Goldthwait Specifications and are rigid enough to give the required support, yet may be moulded into the most effective shape for the treatment of the individual patient.
The purpose of Rigid Steels in a support is to control the posture and to restrict motion of the spine. (In many conditons, motion causes pain and prevents recovery). Because motion in any part of the spine transmits motion to other parts, supports with Rigid Steels are most effective when the Height at Back is over 4 inches above waist. Rigid Steels have very little value in a support which is low above waist at back.
Supports Suitable for Use With Rigid Steels should be ordered. "Curve Out Over Groin" in the space provided on the order form.
For men, Rigid Steels are most frequently ordered in the Dorsolumbar Spinal Support, Lumbosacral Support, and Posture Supports. Also in Belts, when the patient has a heavy abdomen or hernia.
Number of Rigid Steels Needed. One Rigid Steel each side of spine will give firmness to the support. Four rigids at back are essential to achieve approximate rigidity. Usually the number and location of Rigid Steels are prescribed by the doctor, depending on the condition to be treated and the size of the patient.
Immobilisation of the Spine or of a part can be obtained only where 4 rigid Steels at Back, rigids under each arm, and rigid in front are used.
There is an extra charge for each Rigid Steel ordered (see price list).
Length of Rigid Steels. When Rigid Steels are ordered each side of spine, it is especially important that Length Back Bones Measurement be taken correctly.
Rigid Steels Are Numbered. It is important that Rigid Steels be replaced in their proper casings after they have been removed for shaping or when support is laundered.
To avoid errors, all Rigid Steels at the back of a support are numbered from left to right. They are numbered at the top just below the coated tip, so that numbers fall outward when the steels are correctly placed (see Fig. 224).
To order Supports with Rigid Steels fill in "(Number) Rigid Steels Each Side of Spine," and write under Additional Instructions, "(Number) Rigid Steels under (left or right) arm" if steels are wanted there.
These casings are made of webbing and are open at the top so that Rigid Steels may be easily removed. This simplifies the matter of laundering the support and of shaping the steels. Shaping steels in the casings, if they were not removable, might damage the casings.
As a patient's condition improves, the doctor may wish that the rigidity of the support be reduced. Casing openings permit easy removal of some or all the Rigid Steels.
Rigid Steels are moulded before the support leaves the workrooms. They are intentionally moulded with slightly more curve than is thought necessary for the individual figure, because it is easier for you to straighten Rigid Steels slightly than to give them more curve.
It must be remembered that the doctor may wish the Rigid Steels shaped :
1. To follow the curve of patient's back as it is.
2. To increase the curve of patient's back.
3. To bridge and reduce lordotic curve.
To change the shape of these steels effectively, Rigid Steel Wrenches must be used, and these can be ordered from Banbury. For price see price list.
Moulding should be completed after you have adjusted the support on the client's figure and the Surgeon has determined how the steels should be shaped to accomplish the results he desires. Moulding may be accomplished under the Surgeon's directions as follows :
1. Remove the support from the figure.
2. Remove a11 Rigid Steels from the casings.
3. Readjust support. on figure (less tightly than it will be worn, to avoid pulling unboned back sections out of shape).
4. Hold one of the centre-back Rigid Steels against the casing from which it was removed, with top edge of steel about one-half inch below top of support. This will indicate where shape is to be changed.
5. Shape steel accordingly.
6. Shape other centre-back steel. (Unless figure is badly misshapen, shape of the two centre-back steels will be the same.)
7. Remove support ; replace these two steels in their casings ; and adjust support on figure.
8. If there are more than two Rigid Steels in the back of the support, the others should now be moulded, the support removed and the steels replaced.
9. When there are two or more Rigid Steels each side of the spine, and those on the same side are close together, it may be difficult to remove, shape, and replace them individually. We suggest that you remove and replace all the steels on one side at the same time. When this is done the steels will slide out of and into the casings easily.
10. Make final adjustment of the support on the figure. Slight additional changes may still have to be made, especially in extreme cases.
After Rigid Steels are properly moulded, place the support on the body and adjust it loosely. Have the patient lie on back, draw knees up toward abdomen, and, while in this position, tighten all adjustment straps.
By using Rigid Steel Wrenches (see Fig. 226), you can easily mould Rigid Steels into the exact shape desired by the doctor.
When the steel is to be bent into a long gradual curve, use only one wrench. One hand holds the wrench, while the other hand bends the steel to the desired shape (see Figs. 227 and 228).
When the curve is to be shorter and more abrupt, use both wrenches (see Figs. 229 and 230).
When a slight twist in the steel is necessary to shape it over a protruding shoulder blade, the twist can be made with both wrenches. Have one in the left hand resting on a firm desk or table. Do the twisting with the wrench in the right hand (see Fig. 231). Usually the doctor will help when shaping of this nature is necessary.
Rigid Steel Wrenches may be ordered on Order Form 137.
Back braces are made by many manufacturers, in a large variety of types. The type is usually decided by the doctor, but is often left to the judgment of the brace maker.
Braces (see Fig. 232) are usually made of a very heavy and rigid steel, leather and canvas. Other metals and materials are sometimes used. Metal parts are often padded, and the padding is covered with leather, canvas or chamois.
The shape of the brace cannot be altered or moulded by the Surgeon on the patient as it can in Spencer, because the metal is of the solid heavy type which can be moulded only under heat pressure.
Such braces are usually expensive, bulky, conspicuous, heavy and uncomfortable, and most patients dread to wear them.
It can be a source of great satisfaction to supply comfortable, inconspicuous and effective Spencer Supports to doctors' patients who might otherwise have to wear the heavy steel and leather back braces.
Some clients are larger on one side of the body than on the other at one or more points. This condition may be due to an abnormal flesh development on one side, a lateral curvature of the spine (Scoliosis) or some other condition.
Before starting to control or measure such a client, be sure she is standing with her weight evenly distributed on both feet.
Control. In controlling a client whose figure is asymmetrical, the front panel of the Control Support should be adjusted so that the bone down the centre-front of the panel is on a line with the centre of the breast bone at the top and the centre of the pubic bone at the bottom.
It is important, as with all other figures, that the hip seam of the Control Support be kept vertical on both sides. To do this, place hip seam in vertical position on more normal side, in line with under-arm. Adjust back lacer to bring the other hip seam into proper position (client holds support in position while this is done). If the hip seam must be straightened later, readjust the back lacer. This may make some readjustment of the front necessary, but be sure to keep the centre of the front panel in line with the centre of the breast bone at top and the centre of the pubic bone at bottom.
This means, in most cases of uneven figures, that the lacing space at back will not be parallel, or may not be exactly centred between the shoulder blades and the crease that separates the buttocks.
Outline. To outline centre-front and centre-back of the figure, tie a key or some other small weight on one end of a cord suspended around the client's neck, and let it hang down the front. Suspend another cord with a similar weight down the centre of the back.
To locate the centre-front of the figure, fasten the cord at the centre of the breast bone (point "B," Fig. 233). Have the cord extend downward from this point to the centre of the pubic bone. Pin the cord in several places to hold it securely in this position.
|Fig. 233||Fig. 234|
To locate the centre-back of the figure, centre the cord between the shoulder blades at a point approximately where the top edge of the support is to come, and have the cord extend downward from this point to the crease which separates the buttocks (see Fig. 234). Pin the cord in several places to hold it securely in this position.
Place the waistline tape by locating the smallest part of the figure between the hipbone and the lower ribs on each side. This tape ("A" in Figs. 233 and 234) generally will be at right angles with the weighted lines, at the front ("B" in Fig. 233) and at back ("C" in Fig. 234), instead of being parallel with the floor as is the case with a figure of even proportions. Pin tape at each side, front and back.
Measurements. By measuring from the cord at front to the cord at back, you can get separate measurements for the right and left sides of the body. Use two order forms. Mark one "Right Side of Body," and the other "Left Side of Body." Give measurements for each side on the respective order form. When you send these forms to the Company, fasten them together.
If the difference is in one circumference measurement only, two order forms are not needed. In such a case you need only print, under Additional Instructions on the order form, the two measurements, such as "Right hip......... inches, Left hip......... inches."
When weighted line is used, measurement for Length Back Bones is taken 12 inches from the weighted line, Measure down from the middle of tape at waist to the chair, and deduct 1 inch when the support is for a woman, or deduct 2 inches when the support is for a man.
Note. See price list for extra charge when two or more measurements are different.