Purpose

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

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).

Purpose: Clinical gait analysis is considered the “gold standard” for evaluating individual walking patterns. However, in conditions where an individual may exhibit transient voluntary control of gait (such as idiopathic toe walking), their walking pattern in a gait lab may not accurately reflect their gait during daily activities. An accurate assessment of such patients’ functional gait is essential in determining appropriate management options and response to treatment. Therefore, a battery-powered, wireless data acquisition system (WDAS) was developed to record daily functional walking patterns. The goal of the present study was to compare the tilt angle and load data obtained from the WDAS with those measured by gait lab equipment in a sample of healthy adult volunteers.

Method: Seven members of the research team participated in our validation study. Following informed consent, the WDAS was attached to the dorsum (laces) of each subject’s right shoe. Two thin film load sensors were wired to the device and placed under the sole of the foot, inside the shoe. Three spherical markers were placed on the same foot (head of first metatarsal, head of fifth metatarsal, calcaneous). Data were simultaneously recorded by the WDAS (30 Hz) and gait lab (60 Hz). To calibrate the device, each subject performed three static standing tasks (normal standing, weight bearing on toes, weight bearing on heels). Each subject then performed five normal walking trials and five toe-walking trials over a ten-metre, level course.

Results: From the WDAS and gait lab, the average percentage of time spent on the toes (load values under first toe greater than zero) during the stance phase of normal gait was 50.2% and 67.4%, respectively. During toe walking, this increased to 98.9% and 99.8%, respectively. This indicates that the WDAS and gait lab are similar in their ability to discern between normal and toe-walking gait. For the inclination angle, within-subject correlation values of r = 0.76 and r = 0.92 were observed during normal walking and toe walking, respectively. This indicates acceptable levels of agreement between the inclination measures of the WDAS and gait lab.

Conclusion: The validity of angle data from the WDAS was confirmed, when compared to data retrieved from a formal, gait analysis lab. Furthermore, the WDAS was able to clearly differentiate between a normal and a toe walking pattern. The WDAS may assist clinicians in the diagnosis and treatment of gait abnormalities, based on information retrieved during daily activities.

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.

Brace correction based upon mechanical action requires appropriate interface pressure between the body and the brace.

A smart orthotic was developed to record how much time (quantity) a brace was used, how well (quality) it was used and maintain the interface pressure to the prescribed level. Six subjects were recruited and they all used Boston style braces. Each subject used the system for two weeks without the force maintenance system activated to serve as the control period, and the remaining two weeks with the force maintenance system activated. During the automatic feedback mode, the pressure maintenance system was activated only during the daytime (8:00–22:00hrs) to avoid disturbing the patients during sleep. The subject could either return the system to us after one month or continue to use the system until the next clinic.

The time that the pressure level was in the target level range during the study period was increased from 53 +/− 9% to 68 +/− 14% with the feedback activated. The average brace wear time for the study period was 72 +/− 15% (12.6hr/day) of the prescribed time (17.5 +/− 3.8 hours). The curve severity of all subjects on the following clinical visit was the same (within measurement error) as the first visit (32 +/− 5 vs 31 +/− 5 degrees). Compliance was not affected when wearing the monitor.

The smart orthotic was able to improve the efficiency of a conventional brace by maintaining the prescribed interface pressure automatically. This proposed work helps brace candidates wear their braces more effectively and gets the most benefit from the brace treatment. As a result, all participated subjects maintained their Cobb angle within ± two degrees during the study period.

The efficiency of brace treatment for adolescent idiopathic scoliosis is correlated to how the brace has been worn. A smart orthosis was developed to maintain the interface pressure between the brace and the body within the prescribed range during daily activity. Six patients with scoliosis, with Cobb angles of 31 +/− 5 degrees, who were new brace candidates were recruited. They used the system for four weeks: two weeks with monitoring only and two weeks with an automatic feedback activated. The time that the pressure level was in target level range during the study period was increased from 53 +/− 9% to 68 +/− 14% with the feedback activated. This work helps brace candidates wear their braces more effectively and receive the most benefit from the brace treatment. As a result, all subjects who participated in the study maintained their Cobb angles within + two degrees during the study period.

Brace correction based upon mechanical action requires appropriate interface pressure between the body and the brace. A smart orthosis was developed to record how much time (quantity) a brace was worn, how well (quality) it was used and how well the interface pressure was maintained to the prescribed level. Six subjects were recruited and they all were fitted with Boston style braces. Each subject wore the brace for 2 weeks without the force maintenance system activated to serve as the control period, and the remaining 2 weeks with the force maintenance system activated. During the automatic feedback mode, the pressure maintenance system was activated only during the daytime hours (8:00–22:00hrs) to avoid disturbing the patients during sleep. The subject could either return the system to us after 1 month or continue to use the system until the next clinic.

The time that the pressure level was in the target level range during the study period was increased from 53 +/− 9% to 68 +/− 14% with the feedback activated. The average brace wear time for the study period was 72 +/− 15% (12.6hr/day) of the prescribed time (17.5 +/− 3.8 hours). The curve severity of all subjects on the following clinical visit was the same (within measurement error) as the first visit (32 +/− 5 vs 31 +/− 5 degrees). Compliance was not affected when wearing the monitor.

The smart orthosis was able to improve the efficiency of a conventional brace by maintaining the prescribed interface pressure automatically. This project helps brace candidates wear their braces more effectively and gets the most benefit from the brace treatment. As a result, all participating subjects maintained their Cobb angle within +/− 2 degrees during the study period.

To determine the pattern of brace wear compliance over time in both day and night time wear by using objective force measurements within the brace.

Twenty subjects who were diagnosed of AIS, age between nine and fifteen years, and new to brace treatment were recruited in this study. To use the data for analysis, only subjects who used the brace for five hours continuously either in daytime or nighttime were considered. For daytime wear, the selected five hour intervals had to begin with an initial spike in force after a period of non-activity as recorded by the transducer, which would indicate that they had just put on the brace. At night, the measurements began at one am and ended at six am.

Among the twenty subjects, only nine subjects’ data were used for daytime and eleven subjects’ data were used in nighttime. The average wear period was 11.4 ± 4.3 days for the day group, 11.6 ± 3.9 days for the night group. There was a statistically significant decrease in force within the first five hours of consecutive brace wear during daytime hours. The decrease was from 1.4 ± 0.6 (140% of prescribed force) in the first hour to 1.0 ± 0.6 in the fifth hour, a difference of 0.4, which is a 29% drop from the initial force. Most of the drop in force happened between hour one and hour two, as the difference in those two hours is 0.2 ± 0.1 (p = 0.001); between hours two and five the difference did not reach statistical significance. The observed difference between hours one and five for the night group was 0.2 ± 0.2, p = 0.06, which did not reach significance as well. Daytime forces in a Boston Brace tend to decrease over a period of time, but the nighttime forces seem to be maintained at the same level. These results show that daily adjustment of the brace tightness may be required to maintain the tightness level and the efficiency of brace treatment.

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.

Introduction: Braces are the most generally accepted form of non surgical treatment for adolescent idiopathic scoliosis (AIS). Despite decades of usage controversy still exists regarding the efficacy of this treatment. We believe this controversy continues in part because there are few studies describing the mechanical effect of bracing and linking mechanically effective bracing to changes in the natural history of AIS. If braces are effective, is it because they apply significant mechanical support to a collapsing spine or are they effective for other reasons? A first step towards answering this question is to document the mechanical action of braces during activities of daily living. This would enable researchers to examine the effect of mechanical support on progression of the scoliosis. The objective of this study was to determine the temporal pattern of forces exerted by the pressure pad in Boston braces prescribed for the treatment of AIS.

Methods and results: A force transducer and a programmable data logger were designed to measure loads exerted by the pressure pad over extended periods of time. The loads were recorded at one minute intervals. Braces were adjusted to a prescribed load level and the patients were asked to set the brace tightness to match this target any time the brace was donned. Brace wear data were stratified into: not worn, worn at less than 80% of target, 80–120% of target and greater than 120% of target. Bracing was considered mechanically effective if the load was at least 80% of the prescribed level. Patients were aware of the study and consented to participate.

Thirteen patients were followed from 1 to 16 days, average was 9±5 days. Nine patients were asked to wear their braces 23 hours per day, two for 20 and two for 16 hours per day. Braces were not worn 34±27% of the time logged. When they were worn, patients adjusted the tightness of the brace such that it was < 80% of the target 29±20% of the time, within 20% of target 19±19% and over 120% of target 18±13% of the time. Patients wore their braces at or above the target levels 33% of the time logged or 8 hours in a typical day. Subjects had no difficulties using the data logger and none complained that it interfered with brace wear. Reviewing individual histories suggested that subjects did not alter their brace wear pattern because of the data logger.

Conclusion: The mechanical effectiveness of the brace varies considerably over the normal course of wear but seldom does it provide the support intended. While patients wear their braces for about 16 hours per day, it is mechanically effective for 8 hours only.