ABSTRACT: We performed a study on 32 idiopathic scoliotic patients (30 females, 2 males) treated with a Chêneau brace. Eighteen patients had a single right thoracic curve and 14 had a single right thoracolumbar curve. We used the TekScan system (ClinSeat Type 5315 Sensor, TekScan, Boston MA, USA) to measure pressures at the skin-brace interface, assess the effect of strap tension and analyze the variation of these pressures with position and activity. The TekScan device enabled identification of the pressure areas corresponding to the brace's three loading points. The pressure under the main pad had a greater mean value than the pressure under the two counter-pads. Tightening the straps led to a significant increase in the pressures, whatever the position studied or the curve pattern. Compared with the standing (reference) position, we observed significantly higher pressures during maximal inspiration (p < 0.001) and lower pressures during maximal expiration, in the prone position and after having risen from a lying position, for both thoracic curves (p < 0.001) and thoracolumbar curves (p < 0.01). The pressures for thoracolumbar curves were lower than those for thoracic curves, whatever the position studied and both before and after strap adjustment. For lying positions, lying on the right side produced the greatest increase pressure. Even though the TekScan system does not provide direct information on the correction of spinal curvature, it appears to be a useful tool in the treatment of scoliotic patients. Strap adjustment clearly influences the applied pressures - particularly those on the rib cage. During activity, there is a natural tendency to decrease the pressure; this justifies efforts to maintain strap tensions in general and during day wear in particular.
Prosthetics & Orthotics International 07/2008; 32(3):345-55. · 0.56 Impact Factor
ABSTRACT: The main objective is to determine the influence of treatment by Chêneau brace on the quality of life (QoL) of adolescents with idiopathic scoliosis.
We used the QoL scale of Climent et al. "the Quality of Life Profile for Spine Deformities" (QLPSD, in which a higher score means a worse QoL) and visual analogue scales (VAS) for pain and for QoL ranging from 0 to 100mm. The study includes 108 subjects divided in three groups, a control group of 32 patients without brace, a full-time treated group (wearing a Chêneau brace 23/24 hours) of 41 patients, and a part-time treated group (wearing the brace during the night only) of 35 patients.
The QoL is significantly worse in the full-time treated group than in the group with night treatment and in the group without brace for the psychosocial functioning, the sleep disturbances, the back flexibility (P<0.001), the body image (P<0.01), as well as the overall score (P<0.001). On the other hand, there was no difference for the back pain. Among patients wearing the brace, the girls had an average QLPSD score higher than the boys for the psychosocial functioning, the body image, the overall score (P<0.05) and the back flexibility (P<0.01). Whereas there was no significant difference between the sexes for the sleep disturbances and the back pain. The QoL of patients who wear the brace was significantly correlated with degrees corrected wearing the brace and the patient's satisfaction on his or her health status. However, this correlation was very weak. On the other hand, there was no correlation between the quality of life and the age, the duration of brace treatment or the skeletal maturity (Risser sign). On VAS, the patients without brace have the highest score of QoL, followed the part-time treated patients while the full-time treated patients have the lowest score.
The wearing of the Chêneau brace involves a significant reduction in the QoL whatever instruments of evaluations of QoL, QLPSD or VAS. The QoL of the full-time treated patients was the lowest followed part-time treated patients while the QoL of the patients without brace was the highest. However, the brace does not influence the back pain in idiopathic scoliosis at teenage.
Annales de Réadaptation et de Médecine Physique 01/2008; 51(1):3-8, 9-15.
ABSTRACT: We aimed to evaluate the Chêneau brace in the orthopedic treatment of adolescent idiopathic scoliosis to better determine the indications under which it could be prescribed.
This was a retrospective study including 63 patients treated by Chêneau brace for adolescent idiopathic scoliosis between 1997 and 2006. The Cobb angles of the curves in the frontal and sagittal planes as well as rotations and rib hump were measured at the beginning of treatment, with the brace, at the end of treatment and 2 years after discontinuing the brace. A variation of+/-10 degrees in angle was selected to judge the results.
At the end of the treatment, 25.4% of the curves were improved and 60.3% stabilized, with 14.3% aggravated; 5 patients (7.9%) required surgery. At 2 years, the reduction in angle was 1.8 degrees, on average. The best results were obtained for the lumbar and dorsolumbar curves. A significant improvement was noted for the dorsal curves; the major double curves are not as accessible to the treatment. For curves whose initial angle was less than 30 degrees , an initial reduction of higher than 50% with the brace presented the best improvement at the end of the follow-up. We note a significant reduction of the rib hump but not accompanied by a reduction of rotation. Finally, we note a deleterious effect in the sagittal curves, with a slight flatness of the spinal profile.
The continuous wearing of the Chêneau brace can stabilize the evolution of adolescent idiopathic scoliosis, apart from the forms with major double curves, which are not as accessible to the treatment. However, the improvement comes at the price of a slight flatness of the curves of the spine in the sagittal plane. The loss of the correction after discontinuing the brace is minor. We emphasize, therefore, the necessity to monitor the sagittal aspect of the spine as well as the possibility of early treatment, strict surveillance and prolonged follow-up.
Annales de Réadaptation et de Médecine Physique 05/2007; 50(3):125-33.