Design and validation of transducers to measure interface force distribution in a spinal orthosis

Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces

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.

Scoliosis Brace Finite Element Model and Preliminary Experimental Testing Using Electronic Speckle Pattern Interferometry

This article presents the results of numerical finite element method (FEM) simulations in the Ansys environment of a Boston orthopaedic brace. The geometric model was developed based on the results of digitisation performed by means of a three-dimensional (3D) optical scanner. A test stand for measurement of the brace’s field of displacements, utilising a laser electronic speckle pattern interferometer (ESPI), was used to experimentally verify the FEM model. During experimental testing, special attention was given to applying the loads and boundary conditions used in the numerical simulations. As a result, the relative difference between the experimentally and numerically determined displacements in the central part of orthoses amounted to approximately 0.6%. The experimentally verified FEM model was used to determine the force flow lines characteristic of the brace, indicating the general working method of the brace’s structure. The primary parts of the orthoses, carrying loads correcting the spine and the position of sites exerting little effort from the perspective of their participation in the orthoses’ essential therapeutic application were identified. The results obtained allow for the proposal of methods for mechanical optimisation of the brace’s design. The analysis conducted is universal in nature and can be adapted to other types of orthopaedic braces.

Idiopathic scoliosis and brace treatment: an innovative device to assess corrective pressure

The biomechanical influence of brace treatment for scoliosis is not understood. This prospective pilot study analyzed reliability of a system based on 100% textile sensors for measurement of pressure exerted by brace on trunk. Evaluation of modifications during changes in the location of the support zones and variations in amplitude of the pressure was observed in four patients, when considering three main daily positions mimicking day and nighttime wear. A calibration step allowed the determination of a conversion law between sensor data and pressure unit using a second order polynomial function with a high r² of 0.99. This prototype is the first of a new generation. Experimental pressure distribution could be useful for the further brace development.

The intra- and inter-observer reliability of interface pressure measurements of the Milwaukee brace in adolescents with hyperkyphosis

BACKGROUND

There is a lack of evidence in reliability of the modified sphygmomanometer to measure the brace-interface pad pressure in adolescents with Scheuermann's kyphosis (SK).

OBJECTIVES

To evaluate the intra- and inter-observer reliability of modified sphygmomanometer for measuring interface pad pressure in the Milwaukee brace.

METHODS

Two observers measured the pressure of the shoulder and kyphosis pads in Milwaukee brace on 33 adolescents with SK with an average age of 14.67 ± 1.72 years and Cobb angle 64.48∘± 7.53∘. All measurements were obtained in one day. The measurements were done in the inhalation and exhalation of tidal breathing during standing and sitting positions. The intraclass correlation coefficient (ICC), 95% confidence interval (CI), and linear mixed model ANOVA effects were calculated.

RESULTS

The intra-observer reliability varied from a good ICC of 0.81 (0.66-0.90) to an excellent of 0.97 (0.95-0.98). The inter-observer reliability also varied from a good ICC of 0.82 (0.67-0.91) to an excellent of 0.96 (0.93-0.98). The linear mixed model ANOVA analysis showed that the rater, position, and breathing had a significant effect on the pad pressure measurements.

CONCLUSIONS

The modified sphygmomanometer is a reliable tool to measure the pad pressure of the Milwaukee brace for adolescents with SK.

The current status of bracing for patients with adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis affects about 3% of children. Non-operative measures are aimed at altering the natural history to maintain the size of the curve below 40° at skeletal maturity. The application of braces to treat spinal deformity pre-dates the era of evidence-based medicine, and there is a paucity of irrefutable prospective evidence in the literature to support their use and their effectiveness has been questioned. This review considers this evidence. The weight of the evidence is in favour of bracing over observation. The most recent literature has moved away from addressing this question, and instead focuses on developments in the design of braces and ways to improve compliance.

Review of current technologies and methods supplementing brace treatment in adolescent idiopathic scoliosis

PURPOSE

To report on the current technologies and methods supplementing brace treatment in adolescent idiopathic scoliosis.

METHODS

A comprehensive literature review was performed to determine the effectiveness of bracing, to report on imaging techniques that can assist in the assessment of bracing, to understand the roles of the biomechanical treatment concepts on bracing and to address the importance of the quality of life of the brace wearers.

RESULTS

The effectiveness of bracing still remains controversial. Many technologies are still in development to improve the bracing process and quantify the effects of bracing. Imaging techniques with decreased or no radiation are promising in providing more frequent data on curve progression for patients. Computer-assisted design models have been used for both fitting and manufacturing the brace to patient contours. Ultrasound has been developed as a new means of diagnosing scoliosis and determining the effects of a brace on a patient's spine in real time. The brace treatment outcomes are correlated to the quantity and the quality of brace usage. Compliance monitors and force sensors have been developed to track the quality of brace usage. Improvements to brace wear also require consideration of patient quality of life. Surveys have been developed to describe the effects of family influence and self-image on bracing effectiveness of patient quality of life.

CONCLUSIONS

Bracing remains a highly qualitative process, relying on the empirical judgment of the physicians and orthotists, along with buy-in with the patient. The suggested improvements will help to push bracing into a more evidence-based practice.