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The Wilmington brace is a popular thoracolumbosacral orthosis that is custom-molded to the patient. Fig. 4 The prefabricated Boston brace orthosis is one of the more widely used thoracolumbosacral orthoses in use today. (Photo courtesy of Boston Brace, Inc., Avon, MA. Reprinted with permission.)
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The care of the patient with scoliosis has a history extending back over two millennia with cast and brace treatment being a relatively recent endeavor, the modern era comprising just over half a century. Much of the previous literature provides a modest overview with emphasis on the history of the operative management. To better understand the cur...
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... With X-rays discovery by Wilhelm Conrad Roentgen in 1895 the skeletal anatomy could be understood better without the need for body dissection (4). Initially, this led to a 2D ...
... Park et al. and colleagues showed in their metaanalysis on the effects of the Schroth exercises on idiopathic scoliosis, where 15 studies have been included, that Schroth exercise has a significant influence on idiopathic scoliosis patients being effective in inducing changes in the scoliotic curve, with core muscle training being the key element in achieving stability, where patients with curves between 10-30 degrees having a greater benefit than those with curves greater than 30 degrees (62).BracingBracing of the scoliosis is indicated for curves between 20 and 40 degrees in patients with skeletally immature spine where the spine is still flexible and a curve progression may occur. Contraindications would include sever hypokyphosis and sever rib deformities(4). The goals of brace treatment are to prevent deformity progression and avoid the need for surgical fusion (4).Hippocrates first described the treatment of scoliosis with longitudinal traction in the 5 th century BC(5,68). However the modern era of brace treatment began less than 70 years ago with the development of the Milwaukee brace (45)(Figure 11). ...
Purpose When surgically correcting idiopathic scoliosis, many factors are involved in preoperative decision-making regarding the length of fusion needed. Keeping in mind the need for preserving as many motion segments as possible, however simultaneously preventing distal adding-on and maintaining coronal and sagittal balance; the preoperative planning could be challenging. The goal of or study is to be able to predict, with the help of an AI-based decision-making aid, the postoperative radiological outcome after idiopathic scoliosis correction, enabling the surgeon to adapt the preoperative planning to match the desired postoperative outcome. Methods The data of 300 AIS patients that have received a scoliosis corrective surgery have been identified, and after specific inclusion criteria, enrolled in a single center retrospective comparative study. These were used to implement a deep-learning algorithm. A Random Forest Algorithm was chosen. The aim was to predict the postoperative Cobb angle of the major scoliosis curve, as a major postoperative correction indicator. Results A Random Forest Algorithm with a mean absolute error (MAE) of 2.6114415797358506 on the training data set and a MAE of 4.698643354716271 on the validation data set, has been used. The postoperative Cobb angle was defined to be the target predictive value. Our supervised learning model showed that the preoperative Cobb angle of the major curve would have the greatest impact on the prediction of the postoperative Cobb angle. Other relevant parameters included the Side-bending of the major curve, the preoperative Cobb angle of the minor curve and the preoperative flexibility of the major curve. Discussion & Conclusion The preoperative planning regarding the length of fusion in scoliosis correction surgery is a complex task. Our supervised learning model provides an AI-based tool that could be very helpful in the prediction of the scoliosis correction surgeries outcome; thus, enabling a more accurate preoperative planning. Such a tool is not restricted to the scoliosis surgery field, but can also be applied in other areas of spine and in general in other fields of medicine. This would have a positive impact on different areas of health care, both in the short and the long run.
... [3] İlk başta skolyoz dışı deformitelerde kullanılırken, daha sonra skolyozun cerrahi dışı tedavisinde korse uygulamaları ilk seçenek hâline gelmiş, kolay giyilebilen ve dışarıdan nispeten daha az belli olan torako-lumbo-sakral ortezlerin (TLSO) rahat ve kolay kullanımı sayesinde yaygınlaşmıştır. [4] ...
... The Cobb angle is the gold standard to assess the severity of the spinal deformity and is measured by the angle between the two most-tilted spinal vertebrae in the spinal curve. Non-surgical treatment, such as immobilization with a spinal brace, remains the most effective treatment modality to prevent the progression of spinal curvature for adolescents with a Cobb angle between 20 • and 40 • [3]. However, to effectively control the progression of spinal curvature, the brace should be worn for up to 23 h a day until the adolescent stops growing, which means that the treatment may last for 4-6 years [4]. ...
This study aimed to explore the subjective experiences of adolescents with scoliosis during brace treatment in order to understand their obstacles and make recommendations to enhance brace compliance. Using purposive sampling, 15 adolescents (2 males and 13 females) with scoliosis aged from 10 to 16 years old during brace treatment were recruited to participate in semi-structured in-depth interviews. The data were recorded, transcribed, and coded using thematic analysis with the qualitative software NVivo 10. Significant statements and phrases were organized into categories and themes to understand adolescents’ experiences during brace treatment for scoliosis. In general, the adolescents acknowledged that compliance with brace treatment was essential to reduce or prevent the progression of spinal curvature and tried their best to comply with the treatment. Regarding their subjective experiences during brace treatment, three themes were identified and emerged as obstacles negatively affecting their brace compliance, including physical discomfort due to brace materials and design, reluctance caused by the brace’s visual appearance, and passive patient participation during the treatment process. This study reveals insights into the experiences of adolescents with scoliosis during brace treatment and what they perceive as hindrances to compliance. In order to have better brace compliance, adolescents’ feelings and difficulties during brace treatment should be recognized and addressed. Therefore, active patient participation throughout the treatment process, involving the co-design of a customized brace, psychosocial interventions, and personalized appearance style management should be considered and promoted to facilitate a more acceptable bracing experience to achieve better brace compliance.
... Materials Study III The goal of this challenge was to use an SMA in the design of an externally worn pseudoelastic brace that is more effective and comfortable than conventionally worn devices and offers an alternative to invasive spinal correction surgery [38,39]. The SMA brace would provide effective therapy and maintain tension over time as compared with polymer-based designs. ...
... Rigid braces have a static nature, limiting motion and breathing, and weakening the muscles around the spine causing muscle atrophy. Materials commonly used to fabricate rigid braces are polyethylene, polycarbonate, and stainless steel to support and stabilize the patient's spine [38,39]. Soft braces are typically made of textile fabrics and elastic bands to improve comfort and overall quality of life for the user [39]. ...
This collection of case studies presents a brief introduction of fundamental concepts for four SMA-based applications in the aerospace, energy, and medical fields designed by students and facilitated by professionals. The Consortium for the Advancement of Shape Memory Alloy Research and Technology (CASMART) Student Design Challenge is used as an outreach strategy to promote the implementation of state-of-the-art designs with SMA technology and is meant to inspire the next generation of SMA research. Student design challenge teams address real-world problems facing the SMA community and receive guidance and feedback from CASMART members. Student teams’ hardware and materials deliverables had to meet basic function requirements specific to the application. Key results from seven teams (four hardware designs and three materials designs) highlight the design priorities, processes, and challenges raised during development. The hardware designs used NiTi wires shape set and implemented by the students into prototypes for deployment and reorientation mechanisms in small satellites, linear generators to save energy, and a self-apply tourniquet design. Materials development explored the processability and material properties of CuAl-based and NiTi-based alloys for passive actuators in a deployment and reorientation mechanism for a small satellite, energy recovery from waste heat, and a pseudoelastic spinal curvature correction device.
... Passive correction was provided by direct pressure through the pads or by traction based on the brace design. Active correction was thought to be provided with active body movement away from pressure points (29). Non-compliance and complications, such as mandible and teeth deformities due to the chin pad, emerged as limitations to the device (34). ...
... Non-compliance and complications, such as mandible and teeth deformities due to the chin pad, emerged as limitations to the device (34). However, as a CTLSO, the Milwaukee brace can still be appropriate in some cases, for example, thoracic curves with an apex at or above the T8 level where underarm orthosis is not effective (29,35,36). ...
... Advantages of the brace included a low-profile, lightweight design that was made of thermoplastic material molded to the body. It also offered removability, though full-time wear (23 hours/day) was typically prescribed during the growth period (29). ...
Efforts to treat spinal deformity have a long and fascinating history. The ancient Greek physicians Hippocrates and Galen are credited with early descriptions of the condition, management, and the term scoliosis, though even earlier references are seen in Hindu epics. The first known treatment techniques used axial traction and pressure. Subsequent cast correction required fixation of the pelvis and flattening of lumbar lordosis. Bracing superseded traction as the primary means to treat spinal deformities in the 1900s. The first spinal fusion surgery was performed in the 20th century. Scoliosis treatment was greatly improved with the recognition of the 3-dimensional nature of scoliosis and its symptoms. Advances in nonsurgical treatment alternatives included the Milwaukee brace and the subsequent development of underarm plastic braces, such as the Boston brace, the Wilmington brace, and the Chêneau brace. Today, treatment options include bracing, and scoliosis-specific exercises selected according to the curve type and severity, in addition to surgery.
... The first treatment for scoliosis dates back to the 5th century BC when it was described by Hippocrates as longitudinal traction. This was a painful and crude treatment utilizing a scamnum (similar to a torture rack) and continued until the 2nd century AD [38]. The first torso brace was developed by Ambrose Pare, a French army surgeon in the 16th century. ...
... He hypothesized that spinal deformity was due to the dislocation of the spine. Pare designed a padded iron corset for patients to reduce the progression of the curve [38,39]. Subsequently, additional treatment methods were developed, and in 1946 the Milwaukee brace was introduced, becoming a leading option for treating scoliosis [38]. ...
... Pare designed a padded iron corset for patients to reduce the progression of the curve [38,39]. Subsequently, additional treatment methods were developed, and in 1946 the Milwaukee brace was introduced, becoming a leading option for treating scoliosis [38]. ...
Scoliosis is an abnormal curvature of the spine, which generally develops during childhood or adolescence. It affects 2–4 percent of the global population and is more prevalent among girls. Scoliosis is classified by its etiology: idiopathic, congenital, or neuromuscular. Among these, the former is the most common. Treatment options for scoliosis vary depending on the severity of the curve. Most scoliosis diagnoses tend to be mild and only require monitoring. However, curves between 20 and 40 degrees require bracing, while 40 degrees and above require surgery. There are various bracings available, such as Boston, Charleston, and Milwaukee. In severe cases of scoliosis, either fusion or fusionless surgery may be required. This review aims to discuss etiologies and different treatment interventions for scoliosis.
... Traditionally, scoliosis braces are either created using a patient-specific plaster-cast or by using prefabricated modules that fit the patient geometry [6]. Currently, the most widely used braces for the treatment of AIS are thoracic lumbar sacral orthosis (TLSO) that have high patient acceptance and tolerance [7]. Although there is controversy surrounding the efficacy of bracing AIS patients, TLSOs have been found to decrease the risk of curve progression and can protect against the need for surgery in skeletally immature AIS patients wearing a brace with high compliance [8][9][10][11][12][13][14]. ...
The plaster-casting method to create a scoliosis brace consists of mould generation and rectification to obtain the desired orthosis geometry. Alternative methods entail the use of 3D scanning and CAD/CAM. However, both manual and digital design entirely rely on the orthotist expertise. Characterisation of the rectification process is needed to ensure that digital designs are as efficient as plaster-cast designs. Three-dimensional scans of five patients, pre-, and post-rectification plaster moulds were obtained using a Structure Mark II scanner. Anatomical landmark positions, transverse section centroids, and 3D surface deviation analyses were performed to characterise the rectification process. The rectification process was characterised using two parameters. First, trends in the external contours of the rectified moulds were found, resulting in lateral tilt angles of 81 ± 3.8° and 83.3 ± 2.6° on the convex and concave side, respectively. Second, a rectification ratio at the iliac crest (0.23 ± 0.04 and 0.11 ± 0.02 on the convex and concave side, respectively) was devised, based on the pelvis width to estimate the volume to be removed. This study demonstrates that steps of the manual rectification process can be characterised. Results from this study can be fed into software to perform automatic digital rectification.
... A clear distinction can be made between rigid braces with a constant shape that force the body in a certain position and soft or dynamic orthoses that exert a constant force [52,53]. Another distinction is the prescribed wearing time. ...
Brace treatment is the most common noninvasive treatment in adolescent idiopathic scoliosis (AIS); however it is currently not fully known whether there is a difference in effectiveness between brace types/concepts. All studies on brace treatment for AIS were searched for in PubMed and EMBASE up to January 2021. Articles that did not report on maturity of the study population were excluded. Critical appraisal was performed using the Methodological Index for Non-Randomized Studies tool (MINORS). Brace concepts were distinguished in prescribed wearing time and rigidity of the brace: full-time, part-time, and night-time, rigid braces and soft braces. In the meta-analysis, success was defined as ≤5° curve progression during follow-up. Of the 33 selected studies, 11 papers showed high risk of bias. The rigid full-time brace had on average a success rate of 73.2% (95% CI 61–86%), night-time of 78.7% (72–85%), soft braces of 62.4% (55–70%), observation only of 50% (44–56%). There was insufficient evidence on part-time wear for the meta-analysis. The majority of brace studies have significant risk of bias. No significant difference in outcome between the night-time or full-time concepts could be identified. Soft braces have a lower success rate compared to rigid braces. Bracing for scoliosis in Risser 0–2 and 0–3 stage of maturation appeared most effective.
... Scoliosis is one of the most common musculoskeletal disorders, which usually affects children aged from 7 to 15, and causes deformity in patient's spine that is progressive and may result in severe pulmonary and cardiovascular problems in acute cases. It is a 3-dimensional deformity of the spine and rib cage, which occurs in frontal plane and causes unwanted curves and twists in the spine [1]. The unwanted curves, caused by scoliosis, are classified into three main groups: Lumbar; Thoraco-lumbar; and Thoracic curves, depending on the area of their occurrence [2]. ...
The main goal of this study was to investigate the performance of a night-time
Providence brace, which alters stress distribution in the growth plates and ultimately
result in a reduced Cobb angle, from a biomechanical standpoint, using experimental
and in-silico tools. A patient with a mild scoliosis (Cobb angle= 17) was chosen for this
study. Applied forces from the Providence brace on the patient's rib cage and pelvis
were measured using flexible force pads, and the measured forces were then imported
to the generated FE model, and their effects on both curvature and stress distribution
were observed. The measured mean forces applied by the brace were 29.40 N, 24.75
N, 22.429 N, and 37.61 N in the posterior pelvis, anterior pelvis, superior thorax, and
inferior thorax, respectively, in the supine position. Results of the FE model showed
that there is curvature overcorrection, and also Cobb angle was reduced from 17
degrees, in the initial configuration, to 3.4 degrees right after using the brace. The
stress distribution, resulted from the FE model, in the patient's growth plate with the
brace in the supine position, deviates from that of a scoliotic individual without the
brace, and was in favor of reducing the Cobb angle. It was observed that by wearing
the night time brace, unbalanced stress distribution on the lumbar vertebrae caused by
the scoliotic spine's curvatures, can be somehow compensated. The method
developed in this study can be employed to optimize existing scoliosis braces from the
biomechanical standpoint.
... The development of scoliosis is a complex and dynamic process on sagittal, coronal and transverse planes. Idiopathic Scoliosis (IS) is [1,2] the most common form with unknown etiology, accounting for about 80% of all scoliosis [3,4]. The harmful impact of scoliosis on the body is more than just spinal curvature. ...
This paper presents a new robotic device, designed for the treatment of idiopathic scoliosis (IS). Scoliosis is a complex 3D spine deformity. Hard braces are proved to be effective for its treatment but still have more shortcomings which needed to be overcome. Braces cannot realize specific control over vertebra and they also limit the daily work routine. They can cause pain, skin breakdown and bone deformations. The work performance of brace does not intend as per the users need. To solve these problems, we have designed a new robotic brace exerting “three-point pressure” with considerations of human biomechanics propertie. The robot is described from mechanical to control point of view. The robotic brace, based on a double Stewart-platform, has been designed, produced by rapid prototyping and then equipped with 12 linear actuators. Position control and force control approaches are nowadays available and implemented on an electronics/informatics device. This robotics brace has been used on a healthy person and then validated. The prototype version allows adjust dynamical force applied on human body to rectify the scoliosis.
