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Guy A, Coulombe M, Labelle H, Barchi S, Aubin CÉ. Automated design of nighttime braces for adolescent idiopathic scoliosis with global shape optimization using a patient-specific finite element model. Sci Rep 2024; 14:3300. [PMID: 38332053 PMCID: PMC10853218 DOI: 10.1038/s41598-024-53586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine, the moderate forms of which require treatment with an orthopedic brace. Existing brace design approaches rely mainly on empirical manual processes, vary considerably depending on the training and expertise of the orthotist, and do not always guarantee biomechanical effectiveness. To address these issues, we propose a new automated design method for creating bespoke nighttime braces requiring virtually no user input in the process. From standard biplanar radiographs and a surface topography torso scan, a personalized finite element model of the patient is created to simulate bracing and the resulting spine growth over the treatment period. Then, the topography of an automatically generated brace is modified and simulated over hundreds of iterations by a clinically driven optimization algorithm aiming to improve brace immediate and long-term effectiveness while respecting safety thresholds. This method was clinically tested on 17 patients prospectively recruited. The optimized braces showed a highly effective immediate correction of the thoracic and lumbar curves (70% and 90% respectively), with no modifications needed to fit the braces onto the patients. In addition, the simulated lumbar lordosis and thoracic apical rotation were improved by 5° ± 3° and 2° ± 3° respectively. Our approach distinguishes from traditional brace design as it relies solely on biomechanically validated models of the patient's digital twin and a design strategy that is entirely abstracted from empirical knowledge. It provides clinicians with an efficient way to create effective braces without relying on lengthy manual processes and variable orthotist expertise to ensure a proper correction of scoliosis.
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Affiliation(s)
- Aymeric Guy
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Maxence Coulombe
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Soraya Barchi
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Carl-Éric Aubin
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
- Sainte-Justine University Hospital Center, Montreal, QC, Canada.
- Université de Montréal, Montreal, QC, Canada.
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Coulombe M, Guy A, Barchi S, Labelle H, Aubin CÉ. Optimized braces for the treatment of adolescent idiopathic scoliosis: A study protocol of a prospective randomised controlled trial. PLoS One 2024; 19:e0292069. [PMID: 38324512 PMCID: PMC10849249 DOI: 10.1371/journal.pone.0292069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/11/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Adolescent Idiopathic Scoliosis (AIS) is a 3D deformity of the spine that affects 3% of the adolescent population. Conservative treatments like bracing aim to halt the progression of the curve to the surgical threshold. Computer-aided design and manufacturing (CAD/CAM) methods for brace design and manufacturing are becoming increasingly used. Linked to CAD/CAM and 3D radiographic reconstruction techniques, we developed a finite element model (FEM) enabling to simulate the brace effectiveness before its fabrication, as well as a semi-automatic design processes. The objective of this randomized controlled trial is to compare and validate such FEM semi-automatic algorithm used to design nighttime Providence-type braces. METHODS AND ANALYSIS Fifty-eight patients with AIS aged between 10 to 16-years and skeletally immature will be recruited. At the delivery stage, all patients will receive both a Providence-type brace optimized by the semi-automatic algorithm leveraging a patient-specific FEM (Test) and a conventional Providence-type brace (Control), both designed using CAD/CAM methods. Biplanar radiographs will be taken for each patient with both braces in a randomized crossover approach to evaluate immediate correction. Patients will then be randomized to keep either the Test or Control brace as prescribed with a renewal if necessary, and will be followed over two years. The primary outcome will be the change in Cobb angle of the main curve after two years. Secondary outcomes will be brace failure rate, quality of life (QoL) and immediate in-brace correction. This is a single-centre study, double-blinded (participant and outcome assessor) randomized controlled trial (RCT). TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT05001568.
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Affiliation(s)
- Maxence Coulombe
- Department of Medecine, University of Montreal, Montreal, Quebec, Canada
- Department of Orthopedics, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Aymeric Guy
- Department of Orthopedics, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Department of Mechanical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - Soraya Barchi
- Department of Orthopedics, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Hubert Labelle
- Department of Orthopedics, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Carl-Éric Aubin
- Department of Orthopedics, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Department of Mechanical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
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Breskovic T, Stefanovic B, Bednarcikova L, Ferencik N, Ondrejova B, Zivcak J. Predictive analysis of the scoliotic curve using a subject's 3D model. Proc Inst Mech Eng H 2023; 237:1001-1007. [PMID: 37439448 DOI: 10.1177/09544119231187295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
A predictive analysis of the conservative scoliosis treatment is necessary, in which a 3D model of an optimal treatment algorithm is a basic part in the design of a prosthetic corset. Since CAD technology has proven to be very useful in the field of prosthetics and orthotics, we used an open-source software to plan the correction of the scoliotic curve on a virtual model of the subject's torso. The shape of the scoliosis was simplified by means of a directional polygon, which was drawn in a reverse manner depending on the directional arcs of the scoliotic curve. The resulting scoliosis correction, simulated in a predictive analysis, was defined by changing the Cobb angle, eccentricity, and torso height. With the proposed low-cost method of predictive analysis, it is possible to help CPOs to a more accurate and effective design of orthoses and corrective aids and to comprehensively determine the entire treatment procedure.
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Affiliation(s)
- Tomas Breskovic
- Department of Mechanical Engineering, Technical University of Kosice, Kosice, Slovakia
| | - Branko Stefanovic
- Department of Mechanical Engineering, Technical University of Kosice, Kosice, Slovakia
| | - Lucia Bednarcikova
- Department of Mechanical Engineering, Technical University of Kosice, Kosice, Slovakia
| | - Norbert Ferencik
- Department of Mechanical Engineering, Technical University of Kosice, Kosice, Slovakia
| | - Bibiana Ondrejova
- Department of Mechanical Engineering, Technical University of Kosice, Kosice, Slovakia
| | - Jozef Zivcak
- Department of Mechanical Engineering, Technical University of Kosice, Kosice, Slovakia
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Nathan P, Chou SM, Liu G. A review on different methods of scoliosis brace fabrication. Prosthet Orthot Int 2023; 47:424-433. [PMID: 36723398 DOI: 10.1097/pxr.0000000000000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/08/2022] [Indexed: 02/02/2023]
Abstract
Adolescent idiopathic scoliosis is a 3D spinal deformity and mostly affects children in the age group of 10-16 years. Bracing is the most widely recommended nonoperative treatment modality for scoliosis in children. Scoliosis brace fabrication techniques have continuously evolved and currently use traditional plaster casting, computer-aided design (CAD) and computer-aided manufacturing (CAM), or 3D printing. This is a mini narrative literature review. The objective of our study is to conduct a narrative review of traditional, CAD-CAM and 3D printed brace manufacture. A narrative literature review of scoliosis brace manufacturing methods was conducted using PubMed, Cochrane, and other databases with appropriate keywords. Data were also collected from white papers of manufacturing companies. A total of 53 articles on scoliosis bracing manufacture were selected from various sources and subjected to detailed review. The shortlisted papers focused on Chêneau derivatives and Boston braces. Computer-aided design-CAM brace fabrication had similar curve correction compared with traditional plaster-cast braces; however, patient satisfaction may be greater in CAD-CAM braces. Traditional brace fabrication using plaster casting may be uncomfortable to patients. Computer-aided design-CAM and 3D printed braces may enhance comfort by augmenting the breathability and reducing brace weight. 3D printing is the most recently used brace fabrication method. 3D printing enables the manufacture of customized braces that can potentially enhance patient comfort and compliance and curve correction. 3D printing may also ease the bracing experience for patients and enhance the productivity of brace making.
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Affiliation(s)
- Parvathi Nathan
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Siaw Meng Chou
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Gabriel Liu
- University Spine Centre, Department of Orthopaedic Surgery, National University Hospital, Singapore
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Zheng Q, He C, Huang Y, Xu T, Jie Y, Ma CZH. Can Computer-Aided Design and Computer-Aided Manufacturing Integrating with/without Biomechanical Simulation Improve the Effectiveness of Spinal Braces on Adolescent Idiopathic Scoliosis? CHILDREN (BASEL, SWITZERLAND) 2023; 10:927. [PMID: 37371158 DOI: 10.3390/children10060927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
The CAD/CAM technology has been increasingly popular in manufacturing spinal braces for patients with adolescent idiopathic scoliosis (AIS) in clinics. However, whether the CAD/CAM-manufactured braces or the CAD/CAM-manufactured braces integrating with biomechanical simulation could improve the in-brace correction angle of spinal braces in AIS patients, compared to the manually manufactured braces, has remained unclear. The purpose of this systematic review and meta-analysis was to compare the in-brace correction angle of (1) computer-aided design and computer-aided manufacturing (CAD/CAM)-manufactured braces or (2) the CAD/CAM-manufactured braces integrating with biomechanical simulation with that of (3) manually manufactured braces. The Web of Science, OVID, EBSCO, PUBMED, and Cochrane Library databases were searched for relevant studies published up to March 2023. Five randomized controlled trials (RCTs) or randomized controlled crossover trials were included for qualitative synthesis, and four of them were included for meta-analysis. The meta-analysis effect sizes of the in-brace correction angle for CAD/CAM versus manual method, and CAD/CAM integrating with biomechanical simulation versus the manual method in the thoracic curve group and the thoracolumbar/lumbar curve group were 0.6° (mean difference [MD], 95% confidence intervals [CI]: -1.06° to 2.25°), 1.12° (MD, 95% CI: -8.43° to 10.67°), and 3.96° (MD, 95% CI: 1.16° to 6.76°), respectively. This review identified that the braces manufactured by CAD/CAM integrating with biomechanical simulation did not show sufficient advantages over the manually manufactured braces, and the CAD/CAM-manufactured braces may not be considered as more worthwhile than the manually manufactured braces, based on the in-brace correction angle. More high-quality clinical studies that strictly follow the Scoliosis Research Society (SRS) guidelines with long-term follow-ups are still needed to draw more solid conclusions and recommendations for clinical practice in the future.
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Affiliation(s)
- Qian Zheng
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan 430030, China
| | - Chen He
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yan Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan 430030, China
| | - Tao Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan 430030, China
| | - Yi Jie
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Department of Rehabilitation Engineering, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Research Institute for Smart Aging, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
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Peeters CMM, Pijpker PAJ, Wapstra FH, Kempen DHR, Faber C. Are torso asymmetry and torso displacements in a computer brace model associated with initial in-brace correction in adolescent idiopathic scoliosis? BMC Musculoskelet Disord 2023; 24:361. [PMID: 37158905 PMCID: PMC10165790 DOI: 10.1186/s12891-023-06440-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Lack of initial in-brace correction is strongly predictive for brace treatment failure in adolescent idiopathic scoliosis (AIS) patients. Computer-aided design (CAD) technology could be useful in quantifying the trunk in 3D and brace characteristics in order to further investigate the effect of brace modifications on initial in-brace correction and subsequently long-term brace treatment success. The purpose of this pilot study was to identify parameters obtained from 3D surface scans which influence the initial in-brace correction (IBC) in a Boston brace in patients with AIS. METHODS Twenty-five AIS patients receiving a CAD-based Boston brace were included in this pilot study consisting of 11 patients with Lenke classification type 1 and 14 with type 5 curves. The degree of torso asymmetry and segmental peak positive and negative torso displacements were analyzed with the use of patients' 3D surface scans and brace models for potential correlations with IBC. RESULTS The mean IBC of the major curve on AP view was 15.9% (SD = 9.1%) for the Lenke type 1 curves, and 20.1% (SD = 13.9%) for the type 5 curves. The degree of torso asymmetry was weakly correlated with patient's pre-brace major curve Cobb angle and negligible correlated with major curve IBC. Mostly weak or negligible correlations were observed between IBC and the twelve segmental peak displacements for both Lenke type 1 and 5 curves. CONCLUSION Based on the results of this pilot study, the degree of torso asymmetry and segmental peak torso displacements in the brace model alone are not clearly associated with IBC.
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Affiliation(s)
- Charles M M Peeters
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Peter A J Pijpker
- Department of Orthopaedics, & 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frits-Hein Wapstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | | | - Chris Faber
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces. Prosthet Orthot Int 2022; 46:383-391. [PMID: 35320151 DOI: 10.1097/pxr.0000000000000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
This review presents the state of the art according to the current evidence on nonoperative treatment for adolescent idiopathic scoliosis, focusing on bracing. The definition of braces for the treatment of adolescent idiopathic scoliosis and a short history are provided. The analysis includes biomechanics, types, existing classifications, indications for treatment, time of brace wear and weaning, adherence, three-dimensional modeling, use of ultrasound imaging for bracing, management of treatment, issue of immediate in-brace correction, and documentation of the outcomes usually assessed for brace treatment, including the quality-of-life issues. According to the current evidence, there are two randomized control trials in favor of bracing. There are insufficient data on the superiority of one brace over another, although it is possible to classify and grade braces for efficacy from nonrigid to rigid and very rigid. Nevertheless, there is consensus on patients' management on the need for teamwork focusing on adherence to treatment, acceptability, and family and patient involvement.
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Guy A, Coulombe M, Labelle H, Rigo M, Wong MS, Beygi BH, Wynne J, Hresko MT, Ebermeyer E, Vedreine P, Liu XC, Thometz JG, Bissonnette B, Sapaly C, Barchi S, Aubin CÉ. Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis: A Comprehensive Multicenter Study. Spine (Phila Pa 1976) 2022; 47:1103-1110. [PMID: 35275852 DOI: 10.1097/brs.0000000000004353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter numerical study. OBJECTIVE To biomechanically analyze and compare various passive correction features of braces, designed by several centers with diverse practices, for three-dimensional (3D) correction of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA A wide variety of brace designs exist, but their biomechanical effectiveness is not clearly understood. Many studies have reported brace treatment correction potential with various degrees of control, making the objective comparison of correction mechanisms difficult. A Finite Element Model simulating the immediate in-brace corrective effects has been developed and allows to comprehensively assess the biomechanics of different brace designs. METHODS Expert clinical teams (one orthotist and one orthopedist) from six centers in five countries participated in the study. For six scoliosis cases with different curve types respecting SRS criteria, the teams designed two braces according to their treatment protocol. Finite Element Model simulations were performed to compute immediate in-brace 3D correction and skin-to-brace pressures. All braces were randomized and labeled according to 21 design features derived from Society on Scoliosis Orthopaedic and Rehabilitation Treatment proposed descriptors, including positioning of pressure points, orientation of push vectors, and sagittal design. Simulated in brace 3D corrections were compared for each design feature class using ANOVAs and linear regressions (significance P ≤ 0.05). RESULTS Seventy-two braces were tested, with significant variety in the design approaches. Pressure points at the apical vertebra level corrected the main thoracic curve better than more caudal locations. Braces with ventral support flattened the lumbar lordosis. Lateral and ventral skin-to-brace pressures were correlated with changes in thoracolumbar/lumbar Cobb and lumbar lordosis (r =- 0.53, r = - 0.54). Upper straps positioned above T10 corrected the main thoracic Cobb better than those placed lower. CONCLUSIONS The corrective features of various scoliosis braces were objectively compared in a systematic approach with minimal biases and variability in test parameters, providing a better biomechanical understanding of individual passive mechanisms' contribution to 3D correction.
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Affiliation(s)
- Aymeric Guy
- Polytechnique Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Maxence Coulombe
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Surgery Department, University of Montreal, Montreal, Quebec, Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Surgery Department, University of Montreal, Montreal, Quebec, Canada
| | - Manuel Rigo
- Institute Rigo Quera Salvá S.L.P. Scoliosis Rehabilitation Center, Barcelona, Spain
| | - Man-Sang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Babak Hassan Beygi
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Michael Timothy Hresko
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
- Boston Children's Hospital, Boston, MA
| | - Eric Ebermeyer
- LBM/Georges Charpak Human Biomechanics Institute, Arts et Métiers ParisTech, Paris, France
- Spine Unit, Bellevue University Hospital Center, Saint-Étienne, France
| | | | - Xue-Cheng Liu
- Department of Orthopedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee, WI
| | - John G Thometz
- Department of Orthopedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee, WI
| | | | | | - Soraya Barchi
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
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Li H, Yang Z, Li D, Qiao F. A Novel Low-Cost 3D Printed Brace Design Method for Early Onset Scoliosis. J Med Device 2022. [DOI: 10.1115/1.4054998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Early onset scoliosis (EOS) is a type of spine deformity that presents before 10 years of age. The biomechanical properties in scoliosis have been found to be di?erent, especially in the case of the concave and convex paraverte-bral muscles. Based on this fact, a novel 3d printed patient-specific asymmetric stiffness brace design method is proposed in this paper, aiming to provide asymmetric stiffness to match "imbalanced" biomechanical properties of the concave and convex paravertebral muscles, respectively, and treat EOS by applying the block-structure brace.A 3d CAD draft model of the brace contour was implemented from 3D scanning. The asymmetric stiffness block-structure brace was designed in Rhinoceros and the Finite Ele-ment (FE) model was imported into ABAQUS. FE simulation was employed to study the mechanical characteristics of the brace, which provided a quan-titative index for the "imbalanced" property of brace stiffness. The results of the FE simulation showed that the stiffnesses of the concave and convex sides were 145.88 N/mm and 35.95 N/mm, respectively. The block-structure brace was fabricated using 3d printing. Asymmetric stiffness was evaluated by corrective force measurements, which were obtained from a thin-film pressure sensor equipped on the brace. The patient-specific asymmetric stiffness brace was applied to clinical practice in a one-year old EOS patient. A novel low-cost 3D printed brace design method for EOS was proposed in this study that could potentially be useful in patient treatment acceptance.
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Affiliation(s)
- Hongwei Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University , Xi'an, Shaanxi 710049, China
| | - Zhangkai Yang
- Department of Neurosurgery, Xi'an Children's Hospital, The Affiliated Children's Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi 710003, China
| | - Dichen Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University , Xi'an, Shaanxi 710049, China
| | - Feng Qiao
- Honghui Hospital, Xi'an Jiaotong University , No.555, Youyidong Rd, Xi'an, Shaanxi 710054, China
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Predictive Factors on Initial in-brace Correction in Idiopathic Scoliosis: A Systematic Review. Spine (Phila Pa 1976) 2022; 47:E353-E361. [PMID: 35500086 DOI: 10.1097/brs.0000000000004305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE The aim of this study was to systematically review the literature and provide an overview of reported predictive factors on initial in-brace correction in patients with idiopathic scoliosis (IS). SUMMARY OF BACKGROUND DATA Brace therapy is the best proven non-surgical treatment for IS. There is strong evidence that lack of initial in-brace correction is associated with brace treatment failure. To improve initial in-brace corrections and subsequently long-term brace treatment success, knowledge about factors influencing initial in-brace correction is a prerequisite. METHODS A systematic literature search was performed in Pubmed, Embase, Web-of-Science, Scopus, Cinahl, and Cochrane in November 2020. Studies which reported factors influencing initial in-brace correction in IS patients treated with brace therapy were considered eligible for inclusion. RESULTS Of the 4562 potentially eligible articles identified, 28 studies fulfilled the inclusion criteria and were included in this systematic review. Nine studies (32%) were classified as high quality studies and the remaining 19 studies (68%) as low quality. Thirty-four different reported factors were collected from the included studies. Strong evidence was found for increased curve flexibility as favorable predictive factor for initial in-brace correction. Moderate evidence was found for thoracolumbar or lumbar curve pattern as favourable predictive factor, and double major curve pattern as unfavourable predictive factor for initial in-brace correction. Also moderate evidence was found that there is no significant difference on initial in-brace correction between computer-aided design and manufacturing systems (CAD/CAM) braces with or without finite element models (FEM) simulation, and braces fabricated using the conventional plaster-cast. CONCLUSION The results of this systematic review indicate that increased curve flexibility is strongly associated with increased initial in-brace correction.Level of Evidence: 1.
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Wei W, Zhang T, Huang Z, Yang J. Finite element analysis in brace treatment on adolescent idiopathic scoliosis. Med Biol Eng Comput 2022; 60:907-920. [DOI: 10.1007/s11517-022-02524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
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Diarbakerli E, Charalampidis A, Abbott A, Gerdhem P. PReventing Idiopathic SCOliosis PROgression (PRISCOPRO): A protocol for a quadruple-blinded, randomized controlled trial comparing 3D designed Boston brace to standard Boston brace. PLoS One 2021; 16:e0255264. [PMID: 34370760 PMCID: PMC8351964 DOI: 10.1371/journal.pone.0255264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Idiopathic scoliosis is the most common spinal deformity in children. Treatment strategies aim to halt progression of the curve. Patients are treated mainly with thoracolumbosacral orthosis (TLSO) if indicated. This form of brace treatment has been shown to be cumbersome and tough on growing individuals. However, computer aided design and manufactured (CAD/CAM) braces might increase comfortability and ultimately outcome if compliance is improved. In a multicenter, randomized controlled trial, we aim to compare CAD/CAM designed Boston 3D-brace to standard Boston brace. METHODS Subjects: 170 previously untreated and skeletally immature children diagnosed with idiopathic scoliosis, aged 9-17 years of age (curve magnitude Cobb 25-40 degrees) will be included. Interventions: Both groups will receive a physical activity prescription according to the World Health Organization recommendations. Randomization will be performed 1:1 to a 3D CAD/CAM designed Boston 3D-brace or a standard Boston brace, both with prescribed daily wear time of 20 hours. Outcome: The subjects will participate in the study until curve progression or until skeletal maturity. The primary outcome variable is failure of treatment, defined as progression of the Cobb angle more than 6 degrees compared to the baseline x-ray. The progression is confirmed if seen on two consecutive standing spinal x-rays. Radiographs will be taken at each six-month follow-up. Secondary outcome measures include patient and clinical reported outcomes, including number of individuals requiring surgical intervention. DISCUSSION This study will show if efficacy in brace treatment can be improved with new brace designs. TRIAL REGISTRATION The protocol has been registered on ClinicalTrials.gov, identifier: NCT04805437.
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Affiliation(s)
- Elias Diarbakerli
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Anastasios Charalampidis
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Characterising the Mould Rectification Process for Designing Scoliosis Braces: Towards Automated Digital Design of 3D-Printed Braces. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Cheung JPY, Cheung PWH, Shigematsu H, Takahashi S, Kwan MK, Chan CYW, Chiu CK, Sakai D. Controversies with nonoperative management for adolescent idiopathic scoliosis: Study from the APSS Scoliosis Focus Group. J Orthop Surg (Hong Kong) 2021; 28:2309499020930291. [PMID: 32529908 DOI: 10.1177/2309499020930291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine consensus among Asia-Pacific surgeons regarding nonoperative management for adolescent idiopathic scoliosis (AIS). METHODS An online REDCap questionnaire was circulated to surgeons in the Asia-Pacific region during the period of July 2019 to September 2019 to inquire about various components of nonoperative treatment for AIS. Aspects under study included access to screening, when MRIs were obtained, quality-of-life assessments used, role of scoliosis-specific exercises, bracing criteria, type of brace used, maturity parameters used, brace wear regimen, follow-up criteria, and how braces were weaned. Comparisons were made between middle-high income and low-income countries, and experience with nonoperative treatment. RESULTS A total of 103 responses were collected. About half (52.4%) of the responders had scoliosis screening programs and were particularly situated in middle-high income countries. Up to 34% obtained MRIs for all cases, while most would obtain MRIs for neurological problems. The brace criteria were highly variable and was usually based on menarche status (74.7%), age (59%), and Risser staging (92.8%). Up to 52.4% of surgeons elected to brace patients with large curves before offering surgery. Only 28% of responders utilized CAD-CAM techniques for brace fabrication and most (76.8%) still utilized negative molds. There were no standardized criteria for brace weaning. CONCLUSION There are highly variable practices related to nonoperative treatment for AIS and may be related to availability of resources in certain countries. Relative consensus was achieved for when MRI should be obtained and an acceptable brace compliance should be more than 16 hours a day.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Braces Designed Using CAD/CAM Combined or Not With Finite Element Modeling Lead to Effective Treatment and Quality of Life After 2 Years: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2021; 46:9-16. [PMID: 32991513 DOI: 10.1097/brs.0000000000003705] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Single-center prospective randomized controlled trial. OBJECTIVE The aim of this study was to assess the computer-aided design/manufacturing (CAD/CAM) brace design approach, with and without added finite element modeling (FEM) simulations, after 2 years in terms of clinical outcomes, 3D correction, compliance, and quality of life (QoL). SUMMARY OF BACKGROUND DATA .: Previous studies demonstrated that braces designed using a combination of CAD/CAM and FEM induced promising in-brace corrections, were lighter, thinner, and covered less trunk surface. Yet, their long-term impact on treatment quality has not been evaluated. METHODS One-hundred twenty adolescent idiopathic scoliosis patients were recruited following Scoliosis Research Society standardized criteria for brace treatment; 61 patients in the first subgroup (CAD) were given braces designed using CAD/CAM; 59 in the second subgroup (CAD-FEM) received braces additionally simulated and refined using a patient-specific FEM built from 3D reconstructions of the spine, rib cage and pelvis. Main thoracic (MT) and thoraco-lumbar/lumbar (TL/L) Cobb angles, sagittal curves, and apical rotations were compared at the initial visit and after 2 years. Patient compliance and QoL were tracked respectively by using embedded temperature sensors and SRS-22r questionnaires. RESULTS Forty-four patients with CAD-FEM braces and 50 with CAD braces completed the study. Average in-brace correction was 9° MT (8° CAD-FEM, 10° CAD, P = 0.054) and 12° TL/L (same for both subgroups, P = 0.91). Out-of-brace 2-year progression from initial deformity was <4° for all 3D measurements. Sixty-six percent of all cases (30 CAD-FEM, 35 CAD) met the ≤5° curve progression criterion, 83% (38 CAD-FEM, 43 CAD) stayed <45°, and 6% (5 CAD-FEM, 1 CAD) underwent fusion surgery. 3D correction, compliance, and QoL were not significantly different between both subgroups (P > 0.05). CONCLUSION After 2 years, patients with braces designed using CAD/CAM with/without FEM had satisfying clinical outcomes (compared to the BrAIST study), 3D corrections, compliance and QoL. A more comprehensive optimization of brace treatment remains to be accomplished. LEVEL OF EVIDENCE 2.
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Zhang Y, Liang J, Xu N, Zeng L, Du C, Du Y, Zeng Y, Yu M, Liu Z. 3D-printed brace in the treatment of adolescent idiopathic scoliosis: a study protocol of a prospective randomised controlled trial. BMJ Open 2020; 10:e038373. [PMID: 33247008 PMCID: PMC7703428 DOI: 10.1136/bmjopen-2020-038373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. Brace treatment is effective for eligible patients with AIS and the effectiveness is significantly correlated with the average brace-wear time per day. Three-dimensional (3D) printing technology is a recent advancement that offers unique opportunities for biomedical applications, and customisation of scoliosis braces might lead to greater patient satisfaction and improved compliance. We present here the design of a randomised controlled trial on the clinical effectiveness of 3D-printed braces versus thoracolumbosacral orthoses (TLSO) for patients with AIS. METHODS AND ANALYSIS Patients with AIS (age 10-16 years) with Risser sign 0-II, Cobb angle of main curve of 20°-40°, premenarchal or no more than 1-year postmenarchal (for women), and no history of treatment are eligible, unless they are unable to tolerate the treatment or refuse participation. A total of 88 patients will be randomised into either the 3D group or TLSO group on a 1:1 basis. Participants in the 3D group will choose between a 3D-printed brace and TLSO, according to the Zelen's design of the trial. Primary outcome measures will include the average brace-wear time per day, health-related quality of life and Cobb angle progression of the primary curve. Secondary outcome measures will include immediate in-brace correction of Cobb angle of the primary curve, rate of conversion to surgery and incidence of any adverse events. This study is designed as a single-centre, two-arm, superiority and open-label randomised controlled trial. The sample size is calculated with reference to the preliminary study and based on the sample size calculation formula. ETHICS AND DISSEMINATION This study was approved by the Peking University Third Hospital Medicine Science Research Ethics Committee (No: 2019-017-02). Results of the trial will be submitted for publication in a peer-reviewed journal and as conference presentations. TRIAL REGISTRATION NUMBER ChiCTR1900027379, pre-results.
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Affiliation(s)
- Youyu Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Junyang Liang
- Department of Spinal Surgery, Weihai Wei People's Hospital, Weihai, China
| | - Nanfang Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Chaojun Du
- Department of Orthotics and Prosthetics, Peking University Third Hospital, Beijing, China
| | - Yaoxu Du
- Department of Orthotics and Prosthetics, Peking University Third Hospital, Beijing, China
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
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Guan T, Zhang Y, Anwar A, Zhang Y, Wang L. Determination of Three-Dimensional Corrective Force in Adolescent Idiopathic Scoliosis and Biomechanical Finite Element Analysis. Front Bioeng Biotechnol 2020; 8:963. [PMID: 32903545 PMCID: PMC7438412 DOI: 10.3389/fbioe.2020.00963] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/24/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS In this study we have considered the three dimensional corrective forces for correction of scoliosis by using a patient specific finite element model. MATERIALS AND METHODS An objective function of corrective forces in three-dimensional space was defined. Computed tomography images were used to reconstruct three dimensional model of scoliotic trunk. Computer aided engineering software Abaqus was used to establish finite element model of deformed spine and its biomechanical characteristics were analyzed. By adjusting magnitude and position of corrective forces, objective function was minimized to achieve best orthopedic effect. The proposed corrective conditions were divided into three groups: (1) thoracic deformity; (2) lumbar deformity; (3) both thoracic and lumbar deformities were considered. RESULTS In all three cases, the objective function was reduced by 58, 52, and 63%, respectively. The best correction forces point was located on convex side of maximum displacement of vertebral body. CONCLUSION Using minimum objective function method, spinal deformity in three-dimensional space can be sufficiently reduced. This study provides scientific basis for design of a new corrective brace for treatment of scoliosis.
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Affiliation(s)
- Tianmin Guan
- School of Mechanical Engineering, Dalian Jiaotong University, Dalian, China
| | - Yufang Zhang
- School of Mechanical Engineering, Dalian Jiaotong University, Dalian, China
| | - Adeel Anwar
- School of Orthopedic Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | | | - Lina Wang
- Xunxian Shantang Central Health Center, Hebi, China
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Bidari S, Kamyab M, Ghandhari H, Komeili A. Efficacy of Computer-Aided Design and Manufacturing Versus Computer-Aided Design and Finite Element Modeling Technologies in Brace Management of Idiopathic Scoliosis: A Narrative Review. Asian Spine J 2020; 15:271-282. [PMID: 32321200 PMCID: PMC8055460 DOI: 10.31616/asj.2019.0263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/05/2019] [Indexed: 11/23/2022] Open
Abstract
The efficiency and design quality of scoliosis braces produced by the conventional casting method depends highly on the orthotist's experience. Recently, advanced engineering techniques have been used with the aim of improving the quality of brace design and associated clinical outcomes. Numerically controlled machine tools have provided enormous opportunities for reducing the manufacturing time and saving material. However, the effectiveness of computer-aided brace manufacturing for scoliosis curve improvement is controversial. This narrative review is aimed at comparing the efficacy of braces made by the conventional method with those made by two computer-aided methods: computer-aided design and manufacturing (CAD-CAM), and computer-aided design and finite element modeling (CAD-FEM). The comparison was performed on scoliosis parameters in coronal, sagittal, and transverse planes. Scientific databases were searched, and 11 studies were selected for this review. Because of the diversity of study designs, it was not possible to decisively conclude which brace-manufacturing method is most effective. Similar effectiveness in curve correction was found in the coronal plane for braces made by using advanced manufacturing and conventional methods. In the sagittal plane, modern braces seem to be more effective than traditional braces, but there is an ongoing debate among clinicians, about which CAD-CAM and CAD-FEM brace provides a better treatment outcome. The relative effectiveness of modern and conventional methods in correcting deformities in the transverse plane is also a controversial subject. Overall, advanced engineering design and production methods can be proposed as time- and cost-efficient approaches for scoliosis management. However, there is insufficient evidence yet to conclude that CAD-CAM, and CAD-FEM methods provide significantly better clinical outcomes than those of conventional methods in the treatment of scoliosis curve. Moreover, for some factors, such as molding and the patient's posture during the data acquisition, in brace curve-correction plan, the orthotist's experience and scoliosis curve flexibility should be explored to confidently compare the outcomes of conventional, CAD-CAM, and CAD-FEM methods.
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Affiliation(s)
- Shahrbanoo Bidari
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Komeili
- Mechanical Engineering Group, School of Engineering, University of Guelph, Geulph, Canada
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20
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Barrios-Muriel J, Romero-Sánchez F, Alonso-Sánchez FJ, Salgado DR. Advances in Orthotic and Prosthetic Manufacturing: A Technology Review. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E295. [PMID: 31936429 PMCID: PMC7013385 DOI: 10.3390/ma13020295] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 01/16/2023]
Abstract
In this work, the recent advances for rapid prototyping in the orthoprosthetic industry are presented. Specifically, the manufacturing process of orthoprosthetic aids are analysed, as thier use is widely extended in orthopedic surgery. These devices are devoted to either correct posture or movement (orthosis) or to substitute a body segment (prosthesis) while maintaining functionality. The manufacturing process is traditionally mainly hand-crafted: The subject's morphology is taken by means of plaster molds, and the manufacture is performed individually, by adjusting the prototype over the subject. This industry has incorporated computer aided design (CAD), computed aided engineering (CAE) and computed aided manufacturing (CAM) tools; however, the true revolution is the result of the application of rapid prototyping technologies (RPT). Techniques such as fused deposition modelling (FDM), selective laser sintering (SLS), laminated object manufacturing (LOM), and 3D printing (3DP) are some examples of the available methodologies in the manufacturing industry that, step by step, are being included in the rehabilitation engineering market-an engineering field with growth and prospects in the coming years. In this work we analyse different methodologies for additive manufacturing along with the principal methods for collecting 3D body shapes and their application in the manufacturing of functional devices for rehabilitation purposes such as splints, ankle-foot orthoses, or arm prostheses.
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Kaelin AJ. Adolescent idiopathic scoliosis: indications for bracing and conservative treatments. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:28. [PMID: 32055619 DOI: 10.21037/atm.2019.09.69] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) represents the most frequent tridimensional spinal deformity. Progression of curves is linked mainly to the rapid growth around puberty. The natural history can lead to large spinal and thoracic deformities, which could impose surgical treatments. In that specific adolescent period, it is possible with very accurate treatments to alt curves progression. We describe the different types of braces used worldwide their indications, technical applications, results and failures, as well our own experience. The literature agrees that with proper indications that means, still growing patients, and documented progressive curves between 20° and 45°, a well-designed and adapted brace providing a correction of 50% can stop the curve's progression in most of the cases.
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Affiliation(s)
- André J Kaelin
- Department of Orthopaedics, Clinique des Grangettes, Chêne-Bougeries, Switzerland
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22
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Karavidas N. Bracing In The Treatment Of Adolescent Idiopathic Scoliosis: Evidence To Date. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2019; 10:153-172. [PMID: 31632169 PMCID: PMC6790111 DOI: 10.2147/ahmt.s190565] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022]
Abstract
Brace effectiveness for adolescent idiopathic scoliosis was controversial until recent studies provided high quality of evidence that bracing can decrease likelihood of progression and need for operative treatment. Very low evidence exists regarding bracing over 40ο and adult degenerative scoliosis. Initial in-brace correction and compliance seem to be the most important predictive factors for successful treatment outcome. However, the amount of correction and adherence to wearing hours have not been established yet. Moderate evidence suggests that thoracic and double curves, and curves over 30ο at an early growth stage have more risk for failure. High and low body mass index scores are also associated with low successful rates. CAD/CAM braces have shown better initial correction and are more comfortable than conventional plaster cast braces. For a curve at high risk of progression, rigid and day-time braces are significantly more effective than soft or night-time braces. No safe conclusion on effectiveness can be drawn while comparing symmetrical and asymmetrical brace designs. The addition of physiotherapeutic scoliosis-specific exercises in brace treatment can provide better outcomes and is recommended, when possible. Despite the growing evidence for brace effectiveness, there is still an imperative need for future high methodological quality studies to be conducted.
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Affiliation(s)
- Nikos Karavidas
- Schroth Scoliosis & Spine Clinic, Physiotherapy Department, Athens, Greece
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Courvoisier A, Nesme M, Gerbelot J, Moreau-Gaudry A, Faure F. Prediction of brace effect in scoliotic patients: blinded evaluation of a novel brace simulator—an observational cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1277-1285. [DOI: 10.1007/s00586-019-05948-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/08/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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Vergari C, Aubert B, Lallemant-Dudek P, Haen TX, Skalli W. A novel method of anatomical landmark selection for rib cage 3D reconstruction from biplanar radiography. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2018. [DOI: 10.1080/21681163.2018.1537860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Claudio Vergari
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Benjamin Aubert
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | | | - Thomas-Xavier Haen
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
- Ramsay Générale de Santé, Clinique Jouvenet, Paris, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
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Thometz J, Liu X, Rizza R, English I, Tarima S. Effect of an elongation bending derotation brace on the infantile or juvenile scoliosis. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:13. [PMID: 30094340 PMCID: PMC6080392 DOI: 10.1186/s13013-018-0160-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/27/2018] [Indexed: 11/10/2022]
Abstract
Background A wide variety of braces are commercially available designed for the adolescent idiopathic scoliosis (AIS), but very few braces for infantile scoliosis (IS) or juvenile scoliosis (JS). The goals of this study were: 1) to briefly introduce an elongation bending derotation brace (EBDB) in the treatment of IS or JS; 2) to investigate changes of Cobb angles in the AP view of X-ray between in and out of the EBDB at 0, 3, 6, 9, and 12 months; 3) to compare differences of Cobb angles (out of brace) in 3, 6, 9, and12 month with the baseline; 4) to investigate changes (out of brace) in JS and IS groups separately. Methods Thirty-eight patients with IS or JS were recruited retrospectively for this study. Spinal manipulation was performed using a stockinet. This was done simultaneously with a surface topography scan. The procedure was done in the operating room for IS, or in a clinical setting for JS. The brace was edited and fabricated using CAD/CAM method. Radiographs were recorded in and out of bracing approximately every 3 months from baseline to 12 months. A linear mixed effects model was used to compare in and out of bracing, and out of brace Cobb angle change over the 12 month period. Results Overall, 37.5% of curves are corrected and 37.5% stabilized after 12 months (Thoracic curves 48% correction, 19% stabilization; thoracolumbar curves 33% correction, 56% stabilization and lumbar curves 29% correction, 50% stabilization). The juvenile group had 25.7% correction and 42.9% stabilization, while the infantile group had 50% correction and 32.1% stabilization. There was a significant Cobb angle in-brace reduction in the thoracic (11°), thoracolumbar (12°), and lumbar (12°) (p < 0.001). There was no statistically significant change in out of brace Cobb angle from baseline to month 12 (p > 0.05). No patients required surgery within the 12 month span. Conclusions This study describes a new clinical protocol in the development of the EBDB. Short-term results show brace is effective in preventing IS or JS curve progression over a 12 month span.
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Affiliation(s)
- John Thometz
- Department of Orthopedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA.,Musculoskeletal Functional Assessment Center, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA.,Pediatric Orthopaedics, 9000 W. Wisconsin Ave., Suite 360, PO Box 1997, Milwaukee, WI 53201 USA
| | - XueCheng Liu
- Department of Orthopedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA.,Musculoskeletal Functional Assessment Center, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | - Robert Rizza
- 3Department of Mechanical Engineering, Milwaukee School of Engineering, Milwaukee, WI USA
| | - Ian English
- 3Department of Mechanical Engineering, Milwaukee School of Engineering, Milwaukee, WI USA
| | - Sergery Tarima
- 4Division of Biostatistics, Institution for Health & Society, Medical College of Wisconsin, Milwaukee, WI USA
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Dupuis S, Fortin C, Caouette C, Leclair I, Aubin CÉ. Global postural re-education in pediatric idiopathic scoliosis: a biomechanical modeling and analysis of curve reduction during active and assisted self-correction. BMC Musculoskelet Disord 2018; 19:200. [PMID: 30037348 PMCID: PMC6055339 DOI: 10.1186/s12891-018-2112-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background Global postural re-education (GPR) is a physiotherapy treatment approach for pediatric idiopathic scoliosis (IS), where the physiotherapist qualitatively assesses scoliotic curvature reduction potential (with a manual correction) and patient’s ability to self-correct (self-correction). To the author’s knowledge, there are no studies regarding GPR applied to IS, hence there is a need to better understand the biomechanics of GPR curve reduction postures. The objective was to biomechanically and quantitatively evaluate those two re-education corrections using a computer model combined with experimental testing. Methods Finite elements models of 16 patients with IS (10.5–15.4 years old, average Cobb angle of 33°) where built from surface scans and 3D radiographic reconstructions taken in normal standing and self-corrected postures. The forces applied with the therapist’s hands over the trunk during manual correction were recorded and used in the FEM to simulate this posture. Self-correction was simulated by moving the thoracic and lumbar apical vertebrae from their presenting position to their self-corrected position as seen on radiographs. A stiffness index was defined for each posture as the global force required to stay in the posture divided by the thoracic curve reduction (force/Cobb angle reduction). Results The average force applied by the therapist during manual correction was 31 N and resulted in a simulated average reduction of 26% (p < 0.05), while kyphosis slightly increased and lordosis remained unchanged. The actual self-correction reduced the thoracic curve by an average of 33% (p < 0.05), while the lumbar curve remained unchanged. The thoracic kyphosis and lumbar lordosis were reduced on average by 6° and 5° (p < 0.05). Self-correction simulations correlated with actual self-correction (r = 0.9). Conclusions This study allowed quantification of thoracic curve reducibility obtained by external forces applications as well as patient’s capacity to self-correct their posture, two corrections commonly used in the GPR approach.
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Affiliation(s)
- Sarah Dupuis
- Department of Mechanical Engineering, École Polytechnique de Montréal, P.O. Box 6097, Downtown Station, Station "Centre-ville", Montreal, Quebec, H3C 3A7, Canada.,Research Centre, Sainte-Justine University Hospital Centre, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Carole Fortin
- Research Centre, Sainte-Justine University Hospital Centre, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.,School of rehabilitation, Faculty of Medicine, University of Montreal, 2900 Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Christiane Caouette
- Department of Mechanical Engineering, École Polytechnique de Montréal, P.O. Box 6097, Downtown Station, Station "Centre-ville", Montreal, Quebec, H3C 3A7, Canada.,Research Centre, Sainte-Justine University Hospital Centre, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Isabelle Leclair
- Research Centre, Sainte-Justine University Hospital Centre, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.,School of rehabilitation, Faculty of Medicine, University of Montreal, 2900 Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Carl-Éric Aubin
- Department of Mechanical Engineering, École Polytechnique de Montréal, P.O. Box 6097, Downtown Station, Station "Centre-ville", Montreal, Quebec, H3C 3A7, Canada. .,Research Centre, Sainte-Justine University Hospital Centre, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada. .,School of rehabilitation, Faculty of Medicine, University of Montreal, 2900 Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada.
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Pea R, Dansereau J, Caouette C, Cobetto N, Aubin CÉ. Computer-assisted design and finite element simulation of braces for the treatment of adolescent idiopathic scoliosis using a coronal plane radiograph and surface topography. Clin Biomech (Bristol, Avon) 2018; 54:86-91. [PMID: 29571032 DOI: 10.1016/j.clinbiomech.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthopedic braces made by Computer-Aided Design and Manufacturing and numerical simulation were shown to improve spinal deformities correction in adolescent idiopathic scoliosis while using less material. Simulations with BraceSim (Rodin4D, Groupe Lagarrigue, Bordeaux, France) require a sagittal radiograph, not always available. The objective was to develop an innovative modeling method based on a single coronal radiograph and surface topography, and assess the effectiveness of braces designed with this approach. METHODS With a patient coronal radiograph and a surface topography, the developed method allowed the 3D reconstruction of the spine, rib cage and pelvis using geometric models from a database and a free form deformation technique. The resulting 3D reconstruction converted into a finite element model was used to design and simulate the correction of a brace. The developed method was tested with data from ten scoliosis cases. The simulated correction was compared to analogous simulations performed with a 3D reconstruction built using two radiographs and surface topography (validated gold standard reference). FINDINGS There was an average difference of 1.4°/1.7° for the thoracic/lumbar Cobb angle, and 2.6°/5.5° for the kyphosis/lordosis between the developed reconstruction method and the reference. The average difference of the simulated correction was 2.8°/2.4° for the thoracic/lumbar Cobb angles and 3.5°/5.4° the kyphosis/lordosis. INTERPRETATION This study showed the feasibility to design and simulate brace corrections based on a new modeling method with a single coronal radiograph and surface topography. This innovative method could be used to improve brace designs, at a lesser radiation dose for the patient.
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Affiliation(s)
- Rany Pea
- Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada
| | - Jean Dansereau
- Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada
| | - Christiane Caouette
- Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada
| | - Nikita Cobetto
- Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada
| | - Carl-Éric Aubin
- Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada.
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Cobetto N, Aubin CÉ, Parent S, Barchi S, Turgeon I, Labelle H. 3D correction of AIS in braces designed using CAD/CAM and FEM: a randomized controlled trial. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:24. [PMID: 28770254 PMCID: PMC5525241 DOI: 10.1186/s13013-017-0128-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/16/2017] [Indexed: 11/13/2022]
Abstract
Background Recent studies showed that finite element model (FEM) combined to CAD/CAM improves the design of braces for the conservative treatment of adolescent idiopathic scoliosis (AIS), using 2D measurements from in-brace radiographs. We aim to assess the immediate effectiveness on curve correction in all three planes of braces designed using CAD/CAM and numerical simulation compared to braces designed with CAD/CAM only. Methods SRS standardized criteria for bracing were followed to recruit 48 AIS patients who were randomized into two groups. For both groups, 3D reconstructions of the spine and patient’s torso, respectively built from bi-planar radiographs and surface topography, were obtained and braces were designed using the CAD/CAM approach. For the test group, 3D reconstructions of the spine and patient’s torso were additionally used to generate a personalized FEM to simulate and iteratively improve the brace design with the objective of curve correction maximization in three planes and brace material minimization. Results For the control group (CtrlBraces), average Cobb angle prior to bracing was 29° (thoracic, T) and 25° (lumbar, L) with the planes of maximal curvature (PMC) respectively oriented at 63° and 57° on average with respect to the sagittal plane. Average apical axial rotation prior to bracing was 7° (T) and 9° (L). For the test group (FEMBraces), initial Cobb angles were 33° (T) and 28° (L) with the PMC at 68° (T) and 56° (L) and average apical axial rotation prior to bracing at 9° (T and L). On average, FEMBraces were 50% thinner and had 20% less covering surface than CtrlBraces while reducing T and L curves by 47 and 48%, respectively, compared to 25 and 26% for CtrlBraces. FEMBraces corrected apical axial rotation by 46% compared to 30% for CtrlBraces. Conclusion The combination of numerical simulation and CAD/CAM approach allowed designing more efficient braces in all three planes, with the advantages of being lighter than standard CAD/CAM braces. Bracing in AIS may be improved in 3D by the use of this simulation platform. This study is ongoing to recruit more cases and to analyze the long-term effect of bracing. Trial registration ClinicalTrials.gov, NCT02285621
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Affiliation(s)
- Nikita Cobetto
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Carl-Éric Aubin
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Stefan Parent
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Soraya Barchi
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Isabelle Turgeon
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Hubert Labelle
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
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Grant A. Letter to the Editor: The Effectiveness of the SpineCor Brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston Brace. Spine J 2016; 16:1028-9. [PMID: 27545402 DOI: 10.1016/j.spinee.2016.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/18/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Alison Grant
- Millennium House, R&D, SpineCor Ltd, Peak Business Park, Foxwood Rd, Chesterfield, Derbyshire S419RF, United Kingdom
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Sattout A, Clin J, Cobetto N, Labelle H, Aubin CE. Biomechanical Assessment of Providence Nighttime Brace for the Treatment of Adolescent Idiopathic Scoliosis. Spine Deform 2016; 4:253-260. [PMID: 27927513 DOI: 10.1016/j.jspd.2015.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 12/22/2015] [Accepted: 12/24/2015] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN Biomechanical study of the Providence brace for the treatment of adolescent idiopathic scoliosis (AIS). OBJECTIVES To model and assess the effectiveness of Providence nighttime brace. SUMMARY OF BACKGROUND DATA Providence nighttime brace is an alternative to traditional daytime thoracolumbosacral orthosis for the treatment of moderate scoliotic deformities. It applies three-point pressure to reduce scoliotic curves. The biomechanics of the supine position and Providence brace is still poorly understood. METHODS Eighteen patients with AIS were recruited at our institution. For each patient, a personalized finite element model (FEM) of the trunk was created. The spine, rib cage, and pelvis geometry was acquired using simultaneous biplanar low-dose radiographs (EOS). The trunk surface was acquired using a three-dimensional surface topography scanner. The interior surface of each patient's Providence brace was digitized and used to generate an FEM of the brace. Pressures at the brace/skin interface were measured using pressure sensors, and the average pressure distribution was computed. The standing to supine transition and brace installation were computationally simulated. RESULTS Simulated standing to supine position induced an average curve correction of 45% and 48% for thoracic and lumbar curves, while adding the brace resulted in an average correction of 62% and 64% (vs. real in-brace correction of 65% and 70%). Simulated pressures had the same distribution as measured ones. Bending moments on apical vertebrae were mostly annulled by the positioning in the supine position, and further overcorrected on average by 10% to 13%, but in the opposite direction. CONCLUSIONS The supine position is responsible for the major part of coronal curve correction, while the brace itself plays a complementary role. Bending moments induced by the brace generated a rebalancing of pressure on the growth plates, which could help reduce the asymmetric growth of the vertebrae. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Amjad Sattout
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada
| | - Julien Clin
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada
| | - Nikita Cobetto
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada
| | - Hubert Labelle
- Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada
| | - Carl-Eric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada.
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Vergari C, Courtois I, Ebermeyer E, Bouloussa H, Vialle R, Skalli W. Experimental validation of a patient-specific model of orthotic action in adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3049-3055. [DOI: 10.1007/s00586-016-4511-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
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Effectiveness of braces designed using computer-aided design and manufacturing (CAD/CAM) and finite element simulation compared to CAD/CAM only for the conservative treatment of adolescent idiopathic scoliosis: a prospective randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3056-3064. [DOI: 10.1007/s00586-016-4434-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 01/05/2016] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
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Akiyama Y, Okamoto S, Yamada Y, Ishiguro K. Measurement of Contact Behavior Including Slippage of Cuff When Using Wearable Physical Assistant Robot. IEEE Trans Neural Syst Rehabil Eng 2015; 24:784-93. [PMID: 26276994 DOI: 10.1109/tnsre.2015.2464719] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Continuous use of wearable robots can cause skin injuries beneath the cuffs of robots. To prevent such injuries, understanding the contact behavior of the cuff is important. Thus far, this contact behavior has not been studied because of the difficulty involved in measuring the slippage under the cuff. In this study, for the first time, the relative displacement, slippage, and interaction force and moment at the thigh cuff of a robot during sit-to-stand motion were measured using an instrumented cuff, which was developed for this purpose. The results indicated that the slippage and relative displacement under the cuff was uneven because of the rotation of the cuff, which suggests that the risk of skin injuries is different at different positions. Especially, the skin closer to the hip showed larger dynamism, with a maximum slippage of approximately 10 mm and a displacement of 20 mm during motion. Another important phenomenon was the individual difference among subjects. During motion, the interaction force, moment, and slippage of some subjects suddenly increased. Such behavior results in stress concentration, which increases the risk of skin injuries. These analyses are intended to understand how skin injuries are caused and to design measures to prevent such injuries.
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Vergari C, Courtois I, Ebermeyer E, Bouloussa H, Vialle R, Skalli W. Simulation of orthotic treatment in adolescent idiopathic scoliosis using a subject-specific finite element model. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:2076-7. [DOI: 10.1080/10255842.2015.1069629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Vergari
- LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers ParisTech, Paris, France
| | - I. Courtois
- Unite Rachis, CHU – Hopital Bellevue, Saint-Etienne, France
| | - E. Ebermeyer
- Unite Rachis, CHU – Hopital Bellevue, Saint-Etienne, France
| | - H. Bouloussa
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie, Paris, France
| | - R. Vialle
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie, Paris, France
| | - W. Skalli
- LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers ParisTech, Paris, France
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