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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 36 - 36
1 Sep 2012
Lou E Hill DL Moreau MJ Mahood JK Hedden DM Raso JV
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Purpose

To evaluate whether continuous training and education of posture can help children to improve kyphosis.

Method

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.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 30 - 30
1 Sep 2012
Lou E Hill DL Hedden DM Moreau MJ Mahood JK Raso JV
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Purpose

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).

Method

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.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 585 - 585
1 Nov 2011
Hill DL Parent EC Lou E Moreau MJ Mahood JK Hedden DM
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Purpose: Rigid full-time braces are the most common non-surgical treatment for adolescents with moderate severity of scoliosis and demonstrated growth remaining. The Scoliosis Research Society (SRS) has established guidelines on which patients with adolescent idiopathic scoliosis (AIS) should be offered brace treatment. This study surveyed Canadian surgeons on the demographics of patients with scoliosis attending specialty clinics and for their protocols for prescribing braces.

Method: An on-line survey of 41 questions was developed to document patient profiles and surgeon protocols for prescribing braces. Surgeons also selected whether they would recommend a brace in females with AIS based on a combination of three levels of maturity, with six levels of curve severity, and whether or not the curve was progressive. The survey was administered between July and November 2008 to the 30 paediatric spine surgeon members of the Canadian Paediatric Spinal Deformities Study Group. After one reminder, the response rate was 70% (21/30), representing 12 Canadian spine centres.

Results: The average age of referral to the scoliosis clinic was 11–12 years (10 of 20 respondents) and 13–14 years (nine of 20 respondents). Most (81%) of the centers required radiographs prior to the first clinic visit. All surgeons recommended bracing, but there was broad variation on who they considered should be braced, with three to twenty six of the 36 potential scenarios defined by maturity, progression, and curve severity variables selected. This high variability was also observed among surgeons in the same spine centre. All considered parental or family issues and patient acceptance when recommending a brace. Age and curve severity were criteria for bracing; skeletal maturity was the primary criteria for discontinuing bracing. The majority (81%) of braces prescribed were rigid full-time braces followed by rigid night-time braces (14%). Weaning was common (76%), but protocols varied. Detection of curve progression increased the likelihood of bracing for curves 80% agreement on bracing. Braces were not recommended by > 50% of respondents for females with less than 1 year growth remaining regardless of progression or curve size.

Conclusion: In spite of SRS guidelines and general agreement that braces are effective, there is little agreement among surgeons on which females with AIS should receive brace treatment. The likelihood that a female with AIS will be prescribed brace treatment primarily depends on surgeon brace prescription patterns, rather than actual curvature of the spine.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 112 - 112
1 Feb 2004
Lou E Raso V Hill D Moreau MJ Mahood JK
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Objectives: To determine the correlation between brace treatment and the brace tightness and treatment compliance

Design: A monitoring device [1] was designed to measure and record the time and temporal profile of the loads on the pressure pad imposed on the trunk during daily activity. The device consists of a programmable digital data acquisition system and a force transducer. Three light emitted diodes (LEDs) were used to indicate the tightness level below 80%, between 80 to 120%, and above 120% of the load level prescribed. Each subject used the indicator on the device to adjust the tightness of the brace so as to achieve the prescribed pad load. The prescribed pad load had been set by his/her physician after the transducer was installed.

Subjects: Eighteen brace candidates, 3 males and 15 females age 13.6 ± 1.8 years, who had worn their braces from 6 months up to 1 year were recruited. All subjects gave their informed consent to participate in this study. The selection criteria were 1) diagnosis of idiopathic scoliosis, 2) ages between 9 – 15 years and 3) prescribed brace treatment. The exclusion criteria were anyone who 1) had other musculoskeletal or neurological disorders, 2) refused to wear the brace, 3) was being weaned from treatment, or 4) was a surgical candidate. Twelve of eighteen subjects have completed their brace treatment. Loads were measured one sample per minute. These twelve subjects used the systems from 3 to 14 days (9.4 ± 4.9 days). All subjects reported that the time they wore their braces was not influenced by wearing the monitor.

Outcome measures: The quality of the brace wear was assessed by how often the brace was worn with zero force (i.e., not worn), below 80%, between 80 to 120%, and above 120% of the load level prescribed in the clinic. The quantity of brace wear was determined by how many hours per day they wore their braces. Three treatment outcomes were defined: improvement, no change, and deterioration. Improvement was defined as a reduction of the Cobb angle, compared to the pre-brace measurement, by more than 5 degrees after weaning; no change was defined as a Cobb angle change of ± 5 degrees after weaning, and deterioration was defined as a Cobb increase greater than 5 degrees after weaning.

Results: One subject had curve improvement, 7 subjects had no change and 4 subjects had curve deterioration. The improvement subject was 84% compliant and wore her brace above or in the target load range 62% of prescribed time. No change subjects were 70 ± 12.5% compliant and wore their braces above or in the target load range 40 ± 24% of prescribed time. Deterioration subjects were 64 ± 10% compliant and wore their braces above or in the target load range only 26 ± 9% of prescribed time.

Conclusions: It appears that tightening the straps to the prescribed level and wearing the brace as much as the prescribed time is important for successful brace treatment. Simply wearing a brace is not enough; it has to be worn tightly and often.