Upload
cecily-hodge
View
226
Download
7
Embed Size (px)
Citation preview
Concepts of Bracing Adolescent Idiopathic Scoliosis
David Speers, CPO,LPO
Scheck and Siress
Scoliosiscoronal plane deformity (primarily)
1) Congenital – present at birth due to anomalies in the vertebrae (hemi-vertebrae)
2) Neuromuscular – deformity due to weakness or paralysis (cerebral palsy, spina bifida)
3) Idiopathic – (infantile, juvenile, adolescent) – unknown cause
When to brace(Scoliosis Research Society Guidelines)
• Skeletally Immature Patients (Risser 0,1,2)
• Curves with the magnitude of 25-40 degrees
• Curves over 20 degrees with documented progression
A Brief Review of Natural History (untreated adolescent
idiopathic scoliosis)….
Lonstein :1984 JBJS
Risk of Progression(Percent)
RISSER SIGN 5-19° 20-29° 30° 0,1 22% 68% 90+%
2,3,4 1.6% 23% 50-70%
Assessing skeletal maturity:Risser Sign
Bracing Concepts for scoliosis
• TLSO (thoraco-lumbar-sacral orthosis)
• Three point pressure system to correct the curve(s)
• Daytime,night time, both
• Anterior or posterior open designs
Expectations for scoliosis bracing
• Brace to prevent progression of the scoliotic curve(s) during growth
• Curve will be corrected in the brace (40-50% daytime, 90-100% night time brace)
• Curve will be present when brace is removed
Out of Brace vs. In Brace
Out of Brace vs. In Brace
Many styles of scoliosis tlso braces
Daytime tlso concepts
• 3 point pressure system
• 16 – 23 hour wear
• Can be worn at night as well
• Made from CAD measurements or molding
Essential componentsDaytime tlso
ThoracicPadLumbar
Pad
AxillaryPad
Trochanteric Extension
Night time tlso concepts
• “over correction” with lower wear time
• 90 – 100% correction achieved
• Providence and Charleston styles
• Single curves• Increased compliance
Night time tlso
Providence TLSO Charleston TLSO
“bending brace”
When to discontinue(skeletal maturity)
• Look for plateau in height
• Risser sign (4 or 5)
• Menstrual cycle: 1.5 – 2 years after start
• Tri radiate cartilage in hips should be closed
• Check height of parents if possible
• Girls mature sooner than boys
Wear time monitors(temperature)
Tidbit I-button (Maxim)
Wear time monitors
• Placed inside of the brace
• Monitors average hours worn
• Displays 24 hour wearing profile
• Graphs daily hourly use
• Accurately shows how the brace is being worn
Thank you