4. Lean on anterior vest while tightening anterior vest-upright connectors (Figure 20). Then log roll enough to
tighten the posterior vest-upright connectors at the attachment points. If necessary, re-tighten shoulder straps,
waist stabilizers, and/or waist straps to obtain firm support of vest against sternum.
PROPER SUPERSTRUCTURE FIT (Figure 21)
A. Transverse bars parallel to ring and in the same plane (alignment may vary in certain conditions).
B. Anterior uprights rods out of peripheral vision
C. All bolts tightened (upright-transverse clamps, distraction assembly clamps, vest-upright connectors)
DISTRACTION/COMPRESSION
The distraction assembly is adjustable in the vertical plane to allow for fine-tuning of distraction or compression.
Use the T-handle allen wrench to rotate adjustable height screw located in the distraction assembly (Figure 22).
The adjustable upright is for fine-tuning only. For gross distraction, loosen all four transverse- upright clamps and
distract on the vertical uprights.
CAPITAL FLEXION/EXTENSION
Loosen the ring attachment disk and position the patient as needed. Re-tighten both connections (Figure 23).
FULL FLEXION/EXTENSION
Loosen all four upright-transverse clamps, hold patient by transverse rods, and manipulate patient into desired full
flexion or extension of the spine. Tighten all four upright-transverse clamps (Figure 24).
A/P TRANSLATION
Loosen both distraction assembly clamps and slide the patient anterior or posterior to achieve desired A/P
translation. Re-tighten clamps. This technique may be necessary for a patient with kyphosis (Figure 25).
FINAL CHECKLIST (Figures 8, 15, 21)
• Bolts tight
• Superior lateral vest Uprights out of peripheral vision
• Transverse bars parallel to ring and all four uprights at the same height (if possible)
• Shoulder pieces in close contact with patient's shoulder
• Shoulder straps secure
• Upper edge of vest within 2 inches of sternal notch and centered on chest
• Anterior extensions in firm contact with delto-pectoral groove, no contact on clavicles
• Lateral borders cover lower costal margins
• Two threaded knobs secure
• Waist straps secure and in alignment tabs on waist stabilizers
• Upper edge of vest midline with C7
• Ends of crossplate in firm contact with trapezius muscles not on the spine of the scapula
• Superior edges of waist stabilizers at level of xyphoid process
• Central relief openings in line with spinous processes
OPTIONAL/HELPFUL HINTS
Stockinette: To wick moisture away from the skin, it may be useful to use a body sock or stockinette under the vest.
To apply, roll it up from patient's waist to under their arms prior to vest application. Ensure there are no wrinkles or
bunching of the stockinette. Slits may be cut in stockinette to feed shoulder and waist stabilizers and prevent
stockinette from rolling down during wear. Stockinette should be replaced during liner changes (Figure 26).
Clearing ear space: Reversing the adjustable upright can bring the transverse rod higher, and clear the space in front
of the ear; however there may be height restrictions in the length of the upright rods of the superstructure (Figure 27).
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