To evaluate whether continuous training and education of posture can help children to improve kyphosis. A smart harness consisting of a tight-fitting harness and a posture sensing system was developed to measure kyphosis and to provide vibratory feedback during daily activities. The posture sensing system consisted of two sensor units and both units contained a 3-axis accelerometer and a 2-axis gyroscope to calculate the orientation. The dimensions and weight of each unit were 55 mm x 35 mm x 15 mm and 25g, respectively. One unit served as a master (placed at the T3 vertebral level) and the second unit served as a slave (placed at the T12 level) and they communicated wirelessly. The master unit calculated the kyphotic angle, similar to the vertebral centroid method but based on the sagital profile, and provided the vibratory feedback. One volunteer wore the unit and performed different postures and activities (walking, sitting, bending and sudden change from sitting to walking) in a gait analysis laboratory. The posture sensing system was sampled at 30Hz and a gait analysis 8-camera system was sampled at 60Hz. The kyphotic angles captured by the smart harness and camera system were compared. After this validation, the system was tested by 5 normal subjects (M, 25 10 years old) 3 hours per day for 4 consecutive days. For the first 2 days there was no feedback and the last 2 days there was feedback. The system took a sample every 30 seconds. When an undesirable posture was detected, the system switched to a fast sample mode at which time the system took ten measurements with a sample rate of 10 Hz for 1 second to further validate the measured kyphotic angle. These 10 measures were averaged to avoid feedback for postures that lasted only for a very short period of time. Posture orientation data was stored in the sensing unit memory and downloaded for outcomes evaluation.Purpose
Method
To correlate the initial brace correction with quantity and quality of brace wear within the first 6 months for the treatment of adolescent idiopathic scoliosis (AIS). Brace treatment for AIS has been debated for years. Prediction of treatment outcomes is difficult as the actual brace usage is generally unknown. As technology became more advanced, electronic devices were able to measure adherence in both quantity (how much time the brace has been worn) and quality (how tightly the brace has been worn) of brace usage without need for patient interaction. The developed adherence monitor consisted of a force sensor and a data acquisition unit. Subjects were monitored within the first 6 months of brace wear. The data sample rate was set to be one sample per minute. Data was downloaded at the patients routine clinical visits. The prescription, first in-brace and first follow-up out-of-brace Cobb angles were measured. Twelve AIS subjects (10F, 2M), age between 9.8 and 14.7 years, average 11.9 1.5 years, who were prescribed a new TLSO and full-time brace wear (23 hours/day) participated. All braces were made by the same orthotist. The force value at the major pressure pad at the prescribed tightness level was recorded as the individualized reference value. The normalized force value (measured force magnitude relative to the individualized reference value) was used for the quality factor. The time of brace usage relative to the prescribed time was used as the quantity factor.Purpose
Method
Introduction: Trunk asymmetry has been acknowledged as an important aspect of scoliosis that is difficult to treat. Recent innovations in the surgical management of idiopathic scoliosis have attempted to improve trunk symmetry as well as spine curvature. But there have been few reports in the literature describing the effectiveness of these procedures on trunk alignment. The objective of this study was to determine the long-term changes in spine and trunk alignment after surgery for scoliosis. Methods and Results: 38 subjects were identified as candidates for this study. Fifteen were lost to follow-up. Of the remaining 23 subjects, 20 (15 female, 5 male; age at surgery 16±5 years) agreed to participate and had posterior-anterior radiographs and surface topography prior to derotational surgery, within six months of surgery, at two years post-operatively and 5-10 years after surgery. Three subjects had anterior instrumentation and 17 had posterior instrumentation. Cobb angles, surface trunk rotations, and cosmetic scores were measured at each visit. A questionnaire assessed back appearance and pain at the 5–10 year follow-up and the results compared to a group who had recently undergone surgery. A paired two tailed Student’s t-test with p=0.01 was used to compare the deformity between visits. The Cobb angle and cosmetic score improved after surgery; the initial Cobb angle improved to 35±11° (42%). Trunk rotation change was insignificant (p=0.25). Between the two and seven year reviews, the Cobb angle had significantly increased while the cosmetic score (p=0.07) and surface trunk rotation (p=0.10) were unchanged. The mean back appearance and pain scores were 4.3 for both compared to 4.2 and 4.0 for the control group where 1 is worst and 6 is best. Imperfect surgical correction of spinal curvature leads to continued changes to spine alignment as well as to cosmesis and trunk alignment, although the increases were not all statistically significant. Responses to the patient questionnaire suggest that these changes are not clinically significant. Conclusion: Surgery significantly improves trunk symmetry but not trunk rotation. There is mild deterioration of the deformities associated with scoliosis after surgery but these changes do not appear to be clinically significant.
