Spinal & Cranial Orthotic Mgmt.

/ OPSCO 66201
Course Syllabus for Spring, 2020

Course Director:
Joshua B. Utay, M.Ed., CPO, LPO
Associate Program Director, Orthotics and Prosthetics Program
Assistant Professor, School of Health Professions
One Baylor Plaza, MS: BCM115
Ben Taub Annex Bldg., Ste. 107
Houston, Texas 77030

Contact Information:
utay@bcm.edu
Office: 713-798-3151
Fax: 713-798-7694
Mobile: 832-654-5226

Classroom & Lab Space:

Orthotics and Prosthetics Learning Laboratory
Smith Building, Area P122

Total Contact Hours: ~ 86 total

• Lecture: 53.5 online / ~ 4 in person
• Lab: 21.0 (all in person)
• Assessment: 7.0
Total Credit Hours: 6

Course Description:
Spinal & Cranial Orthotic Management (SCOM) covers a comprehensive range of orthotic
management of the head and all spinal regions. Musculoskeletal anatomy, surface anatomy, kinesiology,
and biometrics relative to the spine and head are covered in depth. Pathologies and conditions
commonly treated with spinal orthoses are explored, historical orthotic approaches are reviewed, and
modern treatment philosophies are covered in depth. Students learn about, observe, and perform
essential aspects of both custom-fitted and custom-fabricated spinal and cranial orthotic care, including
patient assessment and communication, device design recommendation, measurement and casting,
component and material selection, positive model optimization, device fabrication, device application
and fitting principles, patient device training, device maintenance, and patient follow up. Education of
patients, care-takers, referral sources, and peers is prioritized and exemplified.

Course Learning Objectives

At the end of this course, students shall be able to:
1) Articulate the clinical presentations, natural histories, sequelae, and biomechanical goals of
orthotic intervention of relevant conditions and surgical procedures pertaining to spinal and
cranial clinical practice.
 2) Derive and justify orthotic prescription recommendations, including anticipated time and
conditions of use and disuse, for persons with spinal and/or cranial disorders warranting
orthotic intervention using results from individual clinical histories and physical examinations.
3) Select appropriate pre-fabricated spinal orthoses for custom-fitted application.

4) Safely generate anatomically-contoured, negative impression of the torso and/or head using
casting materials and/or digital means in conjunction with appropriate measurements.

5) Identify materials necessary to fabricate completely plastic spinal and cranial orthoses balancing
needs for strength and minimizing weight; Fabricate and finish spinal and cranial orthoses free
from deleterious textures and sharp edges.

6) Evaluate fit and function of custom-fitted and custom-fabricated spinal and cranial orthoses for
persons with conditions warranting such intervention.

7) Educate patients, caregivers, and related healthcare professionals on spinal orthotic services,
processes, devices, and ongoing orthotic needs.

8) Articulate rationale for various surgical and post-operative methods related to spinal and
cranial orthotic services.

9) Code and articulate medical necessity of spinal and cranial devices and services within the
context of Local Coverage Determination (LCD) policies established by the Centers for Medicare
& Medicaid Services (CMS).

Content Sources:
Content in SCOM is derived from the following texts and articles provided to you through
BlackBoard or available in your texts. These optional readings are noted on the Course Schedule below
on the date by such content is introduced.

• Fisk, JR, Lonstein, JE, Malas, BS. Atlas of Spinal Orthotics. Hillsborough, UK: Exceed Worldwide. 2017
(300 pages). Free in the public domain at: www.exceed-worldwide.org/atlas-of-spinal-orthotics .

• Webster JB, Murphy DP. Atlas of Orthoses and Assistive Devices, Fifth Edition. Philadelphia, PA:
ELSEVIER. 2019 (463 pages). ISBN: 978-0-323-48323-0.

• Lusardi MM, Jorge M, Nielsen CC. Orthotics and Prosthetics in Rehabilitation, 3rd Edition. Philadelphia,
PA: Saunders. 2013 (864 pages).

• Devlin, VJ. Spine Secrets Plus. St. Louis, MO: ELSIVIER / MOSBY. 2012 (527 pages). Free in the public
domain at: https://epdf.pub/spine-secrets-plus-2nd-edition.html

• Negrini S, et al. 2016 SOSORT Guidelines: Orthopedic and Rehabilitation Treatment of Idiopathic
Scoliosis During Growth. Scoliosis and Spinal Disorders, 2018, 13:3. Free in the public domain at:
https://doi.org/10.1186/s13013-017-0145-8

• Additional sources are supplied by instructor(s) via web link and/or BlackBoard throughout the course.
 Instructional Methods:
SCOM features multiple instructional methods such as live presentation, laboratory
demonstration and practice, and clinical interactions with live patient models.
Program Expectations:
• Professionalism in every action, word, decision, and non-decision is always expected.
• Assigned reading should be completed prior to the class in which the content is covered.
• Professionalism is always expected in everything you do.

Institutional Expectations and Student Services available at Baylor College of Medicine:

• Learning Environment – When situations arise that could impede success in learning, students should
access support and report concerns. Students may address concerns directly with faculty, staff, program
directors, and deans, and should also review the following policies regarding grievances, mistreatment,
and qualifying disabilities.

• The Ombudsman provides confidential guidance for handling problems, conflicts and concerns
(https://intranet.bcm.edu/index.cfm?fuseaction=Policies.Display_Policy&policy_number=32.1.01).
Reports through avenues described below are addressed confidentially to the extent possible to resolve
the issue. BCM enforces an anti-retaliation policy to encourage everyone at BCM to take proper steps to
point out problems and to recommend solutions.

• Professional Conduct – Students are expected to conduct themselves in a professional manner and
abide by all policies of Baylor College of Medicine, the School of Health Professions (formerly the School
of Allied Health Sciences) and their Programs. Any conduct not in keeping with the ethical or
professional standards of BCM is defined as professional misconduct. Academic misconduct is defined
as dishonesty (e.g. cheating, plagiarism, etc.) that occurs in conjunction with academic requirements
such as coursework including homework and examinations.

• Student Grievances – BCM is committed to treating all students respectfully and fairly and providing a
quality educational environment and experience. Student Services Policy 23.8.01 describes how to
appeal a grade, adverse academic action, other academic issue, or conduct, and to report nonacademic,
professionalism, and mistreatment issues (https://media.bcm.edu/documents/2015/56/23.1.08-
student-grievances-policy-web.pdf). Report grievances using the Integrity Hotline
(https://secure.ethicspoint.com) or via the Intranet (www.bcm.ethicspoint.com). Appeals of grades and
adverse academic actions must occur within 10 days of the grade being posted to the Student Portal or
within 10 business days following personal notice of an adverse action.

• Grade Verification – Due process involves providing students with a clear description of course
expectations, including grading requirements. Students may have questions about their final grade or
the grading process. If students want to verify their final grade, they are first encouraged to meet with
the course director informally to discuss those questions. After grade verification and discussion, the
student may choose to proceed with a formal grade appeal if they believe they have received a grade
unjustly. Grievances are not the same as disagreements. A student cannot file a grievance merely
because s/he disagrees with the grade. A student can file a grievance if they believe the grade was
unfair, for example, if it is felt to be an act of discrimination. Formal grievances can be filed via the
Integrity Hotline portal.
• Mistreatment – BCM is committed to providing a safe and supportive environment for all members of
the BCM community. All individuals have the right to be free from all forms of sex and gender-based
discrimination which includes sexual harassment, acts of sexual violence, domestic violence, dating
violence and stalking. BCM enforces policies related to Harassment, Discrimination, and Retaliation
(https://intranet.bcm.edu/index.cfm?fuseaction=Policies.Display_Policy&policy_number=02.2.25) and
sexual misconduct and other prohibited conduct (https://media.bcm.edu/documents/2015/88/02.2.26-
sexual-harassment-and-sexual-violence-policy-web.pdf). These policies define prohibited conduct,
describe mechanisms for reporting alleged violations, explain BCM’s centralized investigation and
adjudication procedures, and identify potential disciplinary actions and remedies. Report prohibited
conduct you experience or witness via the Integrity Hotline (https://secure.ethicspoint.com) or the
Intranet (www.bcm.ethicspoint.com). Anonymous reports are investigated to the extent allowed by the
information provided, and a system exists to provide confidential follow-up about steps taken.

• Disability Services – BCM is committed to providing equal educational access for qualified students with
disabilities in accordance with state and federal laws including the Americans with Disabilities Act of
1990, as amended in 2008, and Section 504 of the Rehabilitation Act of 1973. The goal is to provide
students with disabilities access to needed resources so that they are afforded every opportunity to do
their best work. Further information about these services is available at:
https://www.bcm.edu/education/academic-faculty-affairs/student-services/student-disability-services.
Students with documented disabilities can seek accommodations by contacting Student Disability
Services (713-798-8137) or by the Title IX Coordinator, Ms. Mikiba Morehead
(mikiba.morehead@bcm.edu). If an accommodation is granted, the student is responsible for informing
the course director of the approved accommodation prior to the first examination.

Assessments:
1. Quiz 1 15 %
2. Quiz 2 15 %
3. Quiz 3 15 %
4. Quiz 4 15 %
5. Case Presentation 15 %
6. Final Exam 25 %

The course’s final grade is assigned with a letter according to the grading scale listed below.
A passing grade in this course is a B as defined in the grading policy section of the student manual.

Grading Scale
Grade Score Range Quality Pts Interpretation
A 90 – 100 4.0 Exceptional performance
B 76 – 89 3.0 Performance meeting expectations
C 70 – 75 2.0 Below passing performance (failure)
D 60 – 69 1.0 Performance below expectations (failure)
F 0 – 59 0.0 Unsatisfactory performance (failure)
 Spinal Presentations and Source Material, Spring, 2020
Date Hrs. Content and Source Material
SCOM Course Intro; Syllabus, Case Assignments; Spinal Anatomy Review
3/18 2.0 Spine Secrets Plus, Ch. 18: Spinal Orthoses (11 pgs)
Lusardi, Ch. 13: Orx for Spinal Dysfunction (17 pgs)
History of Spinal Orthotics (self-paced, personal use only)
3/18 --
Spinal Atlas, Ch. 3: A Short History of Spinal Orthoses
Overview of Spinal Biomechanics
Unit 3/20 2.0 Spinal Atlas, Ch. 5: Biomechanics of the Spine and Spinal Orx
1 Orx Atlas, Ch. 5: Biomechanics of Spine
Team Care in Spinal Orthotic Treatment
3/23 1.0
Spinal Atlas, Ch. 2: Team Care in Spinal Orthotic Treatment
Spinal Orthotic Principles & Designs
3/23 2.0 Orx Atlas, Ch. 6: Principles and Components of Spinal Orthoses
Spine Secrets Plus, Ch. 18: Spinal Orthoses
1.0 Quiz 1 (15%)
3/24 2.0 Orthotic Options for Thoraco-Lumbo-Sacral Regions
3/24 2.0 Orthotic Options for Cervical & Thoracic Regions
Spondylolysis, Spondylolisthesis, Stenosis, Vertebral Infection, Vertebral
Metastasis, Compression & Burst Fractures
3/25 2.0
Spinal Atlas, Ch. 19: Orthotic Mgmt. of Spondylolysis and Spondylolisthesis
Spinal Atlas, Ch. 21: Orx Mgmt. of Infectious Disorders of the Spine
Spinal Trauma
3/25 2.0 Spinal Atlas, Ch. 20: Orthotic Mgmt. of Spinal Trauma
Orx Atlas, Ch. 9: Orx for Spinal Trauma & Post-Operative Care
Unit
3/26 1.5 Spotlight on: Jewett & C.A.S.H. Hyperextension TLSO’s, and S.O.M.I. CTO
2
3/26 1.5 Halo CTO’s for the Unstable Cervical Spine
4/01 1.0 Round 1 Case Pres (3 cases)
The Pediatric and Adolescent Spine
4/01 1.5
Spinal Atlas, Ch. 4: Growth & Maturity in Musculoskeletal Care
Spinal Pain and Osteoporosis
Orx Atlas, Ch. 7: Orx for Spinal Pain
4/01 1.0
Spinal Atlas, Ch. 22: Orx Mgmt. of Osteoporosis of the Spine
Spinal Atlas, Ch. 23: Orthoses for Low Back Pain
4/01 1.0 Intro to Custom-Molded TLSO’s
4/03 1.0 Quiz 2 (15%)
4/13 2.0 Pres.: TLSO by Meas & Scanning (Special Guest: Spinal Tech)
Demo by Video: TLSO Casting & TLSO Positive Model Modification
4/15 1.0
www.youtube.com/watch?v=MxSRtuCFXbM
4/17 1.0 Round 2 Case Pres (3 Cases)
Unit
3 Cranial Remodeling Orthosis Carnival (Special Guest: Jim Brookshier, CPO)
4/20 4.0
Orx Atlas, Ch. 35: Cranial Remodeling Orthoses
4/20 1.0 Face Masks: Fracture & Burn
Scoliosis Festival: Intro / Part 1
4/22 3.0
Readings: TBD
 4/24 1.0 Round 3 Case Pres (3 Cases)
4/24 2.0 Children’s Hospital of Boston / Boston Brace technique (Video)
Scoliosis Festival: Part 2
4/24 1.5
Readings: TBD
4/27 1.0 Round 4 Case Pres (2 Cases)
4/27 2.0 Special Guest on Wear, Care, & Impact of Custom TP TLSO
4/27 2.0 (( TBD ))
4/28 1.0 Quiz 3 (15%)
Scoliosis Festival, Part 3
4/29 4.0
Readings: TBD
Scoliosis Festival, Part 4
Final 5/01 2.0
Readings: TBD
Exam
5/04 1.5 Round 5 Case Pres: (4 Cases)
5/04 2.0 Comprehensive Review w/ Q&A
5/07 2.5 Final SCOM Exam (30%)

Postponed due to Online Delivery @ Isolation

2.0 LAB: Spinal Evaluation (Coordinated with PE II)
2.0 LAB: Measurement for Custom TP TLSO (Send to Spinal Tech)
1.0 Demo: Custom TLSO Casting & Meas. Demonstration
3.0 LAB: Student TLSO C&M (Each Other, Groups of 3)
2.5 LAB: Fitting Pre-Fab CO’s & CTO’s
1.0 Demo: Halo CTO Fitting
Unit 2.5 Lab: Modification and Simulated Fitting of CRO
4 1.5 LAB: Fitting Pre-Fab TLSO, LSO, & LSO Corsets
2.0 LAB: Finishing & Strapping TP TLSO’s (Made by Spinal Tech)
0.5 LAB: Round Table Forum: Technical Checkout of TP TLSO’s
0.5 DEMO: Fitting Custom TP TLSO à LSO
2.5 LAB: Fitting Custom TLSO’s à LSO’s
1.0 Critique Custom TP TLSO Fittings & Processes
?? 1.5 Quiz 4: (Demonstrations, Fittings, & Labs after Final Exam) 15%

SCOM Fitting and Fabrication Projects

Projects (Student-Fitted Devices):

v Spinal orthoses of the following qualifications are custom-fitted to patient models:

§ Cervical Orthoses (CO’s): Soft, Semi-rigid, and Rigid varieties
§ Cervical-Thoracic Orthosis (CTO’s): Semi-rigid, and Rigid varieties
§ Thoracic-Lumbar-Sacral Orthoses (TLSO’s): Sagittal, Sagittal-Coronal
§ Lumbar-Sacral Orthoses (LSO’s): Rigid, Sagittal, Sagittal-Coronal, LSO Corsets
§ Sacral Orthoses (SO’s)

v Spinal orthoses of the following qualifications are fabricated and fitted to patient models, including
casting, positive model formation, device finishing, and strapping:
§ Rigid, Sagittal, Sagittal-Coronal Control, Custom, Thermoplastic TLSO’s and LSO’s