MD in scoliosis rehabilitation and orthopaedic treatment, Instituto Elena Salvá Scoliosis Rehabilitation Center Barcelona, Spain
|15.30-15.35 hrs||René M. Castelein (NL)||Introduction|
|15.35-15.55 hrs||Manuel Rigo (ES)||Is it possible to standardize a 3D Brace concept?|
|15.55-16.15 hrs||Ane Simony (DK)||Providence Night time bracing|
|16.30-16.50 hrs||Diederik Kempen (NL)||Long term effects of brace treatment of adolescent idiopathic scoliosis|
|16.50-17.10 hrs||Dirk Schrander (NL)||The development and early clinical results of the M-brace in AIS|
|17.25-17.35 hrs||René M. Castelein (NL)||Wrap Up|
Is it possible to standardize a 3D Brace concept?
From the first time I met Dr. Jacques Chêneau (France), 32 years ago, I have been using his approach in brace construction. Around 1979 he presented, together with Professor Mathias (Münster) a corrective brace, inspired in derotational Abbot plaster cast. For its design, Chêneau was using clinical-anatomical descriptions and a very simple classification (3 curves pattern -single structural- and 4 curves pattern – double structural).
My personal contribution for standardization was about re-defining the corrective principles using biomechanical explanations and developing a reliable specific classification.
The new principles were based on the Dubousset’s idea of scoliosis and its 3D nature, being the Transversal plane of highest importance to understand the process of progression. Consequently, the brace started to be called 3D brace and its principle of correction defined as Detorsional. A better understanding of the 3D nature of IS allowed to conclude that a real 3D correction is not possible throughout bracing.
The objective is to achieve the best possible balanced frontal plane correction, throughout a detorsional mechanism, maintaining a previously normal Sagittal plane geometry or partially restoring a previously abnormal Sagittal geometry.
However, looking at the ‘state of the art’ of this knowledge, the brace construction is still based on the particular skills of the brace maker, clinical experience and intuition. Standardization is very poor when based on that premise, so we cannot advocate for using this type of brace in a general way, but only by experienced Teams.
Providence Night time bracing
Fulltime Brace treatment has been proved, to have a negative impact on the adolescent patients quality of life and the Providence night time brace is a well-documented alternative.
The brace combines the natural curve correction achieved when the patients is lying down with pressure on the ribcage, correcting the spine into a straight position, 7-8 hours at nighttime. The curve correction is maintained while the spine is unloaded, and most of the growth occurs. During the day, the patients can maintain an active lifestyle and maintain full muscle strength during the treatment period.
Treating the patients while lying down allows the orthoptist to achieve bigger curve correction, since the pelvis and trochanter region can be included in the brace without any discomfort for the patients.
The lecture will include patient data from a retrospective study, and also data from a matched retrospective study comparing patients treated with Providence Nighttime Braces with patients treated with Boston braces 23 hours daily.
Long term effects of brace treatment of adolescent idiopathic scoliosis
Although bracing aims to prevent curve progression and future problems in adulthood, information on the long term effects of idiopathic scoliosis is scarce. Most recent studies show a favorable course without major impairments in the quality of life. However, there is limited information on the quality of life of untreated idiopathic scoliosis patients and whether treatment improves the long term outcome. This presentation focusses on the prognoses of moderate and untreated severe curves and our experience with adult idiopathic scoliosis patients treated 25 years ago in the OLVG hospital in Amsterdam.
The development and early clinical results of the M-brace in AIS
The lecture will include the development of the Maastricht brace and results of the first studies. Then ongoing research will be presented, with preliminary results if available.
Idiopathic scoliosis is a complex three-dimensional deformation of the spine and trunk of a previously normal person, usually a girl, that normally develops during the adolescent growth spurt. It carries a life-long burden of disease and may, in its more severe forms, lead to a lowered self-esteem, back pain, and pulmonary compromise. Depending on its severity, different treatment strategies may be chosen. Despite the fact that surgery has a better outcome than ever in terms of safety, cosmetic and functional results, still, the ambition should be to avoid surgery if at all possible.
Brace treatment has been proven to be effective beyond natural history to prevent or slow deterioration of a scoliosis. This webinar will address the more popular bracing philosophy’s both in brace type (Boston-type, Providence, M-Brace and Rigo-Cheneau) as well as in required brace wear (full time and night time concepts). Our faculty includes well known clinicians and scientists who will present on their concept of choice, and there will be time for discussion.