How to improve aesthetics in patients with Adolescent Idiopathic Scoliosis (AIS): a SPoRT brace treatment according to SOSORT management criteria

Actuator and Contact Force Modeling of an Active Soft Brace for Scoliosis

Scoliosis is an abnormality of the spinal curvature that severely affects the musculoskeletal, respiratory, and nervous systems. Conventionally, it is treated using rigid spinal braces. These braces are static, rigid, and passive in nature, and they (largely) limit the mobility of the spine, resulting in other spinal complexities. Moreover, these braces do not have precise control over how much force is being applied by them. Over-exertion of force may deteriorate the spinal condition. This article presents a novel active soft brace that allows mobility to the spine while applying controlled corrective forces that are regulated by varying the tensions in elastic bands using low-power light weight twisted string actuators (TSAs). This article focuses on the actuator and contact force modeling of the active soft brace (ASB). The actuator modeling is required to translate the twisting of string in terms of contraction of the string’s length, whereas the contact force modeling helps in estimating the net resultant force exerted by the band on the body using single point pressure/force sensors. The actuators (TSAs) are modeled as helix geometry and validated using a laser position sensor. The results showed that the model effectively tracked the position (contraction in length) with root mean square error (RMSE) of 1.7386 mm. The contact force is modeled using the belt and pulley contact model and validated by building a custom testbed. The actuator module is able to regulate the pressure in the range 0–6 Kpa, which is comparable to 0–8 Kpa pressure regulated in rigid braces. This makes it possible to verify and demonstrate the working principle of the proposed active soft brace.

Spinal Deformities and Advancement in Corrective Orthoses

Spinal deformity is an abnormality in the spinal curves and can seriously affect the activities of daily life. The conventional way to treat spinal deformities, such as scoliosis, kyphosis, and spondylolisthesis, is to use spinal orthoses (braces). Braces have been used for centuries to apply corrective forces to the spine to treat spinal deformities or to stabilize the spine during postoperative rehabilitation. Braces have not modernized with advancements in technology, and very few braces are equipped with smart sensory design and active actuation. There is a need to enable the orthotists, ergonomics practitioners, and developers to incorporate new technologies into the passive field of bracing. This article presents a review of the conventional passive braces and highlights the advancements in spinal orthoses in terms of improved sensory designs, active actuation mechanisms, and new construction methods (CAD/CAM, three-dimensional (3D) printing). This review includes 26 spinal orthoses, comprised of passive rigid/soft braces, active dynamics braces, and torso training devices for the rehabilitation of the spine.

Treatment of bracing for adolescent idiopathic scoliosis patients: a meta-analysis

PURPOSE

A meta-analysis was conducted to compare the efficacy and safety of bracing and other treatments in adolescent idiopathic scoliosis (AIS) patients.

METHODS

PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials that investigated bracing and other treatments for AIS. The Mantel-Haenszel method with fixed-effects or random-effects model was used to calculate the relative risks and 95% confidence intervals (CIs). The results of heterogeneity, sensitivity analysis, and publication bias were analyzed.

RESULTS

Seven studies that met the eligibility criteria with 791 participants were included. The results of meta-analysis suggested significant differences between bracing and observation groups in successful outcomes [OR 3.58, 95% CI (1.92, 6.68), P < 0.0001; P for heterogeneity = 0.008, I² = 65%], quality of life [MD = 2.13, 95% CI (0.51, 3.75), P = 0.01; P for heterogeneity = 0.89, I² = 0%], and adverse events [OR 5.31, 95% CI (2.42, 11.66), P < 0.0001; P for heterogeneity = 0.78, I² = 0%].

CONCLUSION

The findings of this meta-analysis suggested that bracing is efficient and safe for the treatment of AIS. These slides can be retrieved under Electronic Supplementary Material.

INVESTIGATION OF ROBOTIC BRACES OF PATIENTS WITH IDIOPATHIC SCOLIOSIS (IS) — REVIEW OF THE LITERATURE AND DESCRIPTION OF A NOVEL BRACE

Idiopathic scoliosis (IS) is a complex three-dimensional (3D) deformity. The non-operative treatments for IS have been developed for a long time. According to current studies, hard braces are more effective than soft braces for the treatment of scoliosis. Though current braces are proved to be effective for the treatment of IS, there are several shortcomings needed to be overcome: (i) Braces cannot realize precise control over a specific vertebra. (ii) Braces affect cardiopulmonary efficiency (braces limit maximal exercise performance). (iii) The brace is not modulated based on user’s needs. (iv) Braces, including motions during eating, tying shoes, sitting, and standing. (v) Braces apply forces on skin, which causes pain, skin breakdown, and abnormal deformation of bone. In order to solve these boring problems of the current braces, this paper proposed a new intelligent robotic spine brace based on the principle of human biomechanics, three point pressure treatment theory and parallel mechanism theory. This novel brace can offer 3D active dynamic adjustable corrective forces for the treatment of IS and some experiments are employed for verifying the effect of the proposed brace.

Bracing and exercise-based treatment for idiopathic scoliosis

BACKGROUND

Various conservative therapies are available for treating adolescent idiopathic scoliosis (AIS), however, the disparities between them and the evidence of their efficacy and effectiveness is still unclear.

OBJECTIVES

To evaluate the effectiveness of different conservative treatments on AIS.

METHODS

A literature-based narrative review of the English language medical literature.

RESULTS AND CONCLUSIONS

The most appropriate treatment for each patient should be chosen individually and based on various parameters. Bracing has been found to be a most effective conservative treatment for AIS. There is limited evidence that specific physical exercises also an effective intervention for AIS. Exercise-based physical therapy, if correctly administered, can prevent a worsening of the curve and may decrease need for bracing. In addition, physical exercises were found to be the only treatment improving respiratory function. Combining bracing with exercise increases treatment efficacy compared with a single treatment. Additional, well-designed and good quality studies are required to assess the effectiveness of different conservative methods in treating AIS.

Adolescent idiopathic scoliosis and eating disorders: is there a relation? Results of a cross-sectional study

A recent study suggests a correlation between idiopathic scoliosis in adolescence and eating disorders. However, this does not correspond with our clinical experience in the same population. The aim of this study was to verify the correlation between scoliosis and eating disorders in adolescence. A cross-sectional study was designed including 187 consecutive adolescent girls with a diagnosis of idiopathic scoliosis (mean Cobb angle 26°, range 11-73°, age 15.2±2.5; 24% juveniles, 76% adolescent type) and 93 schoolgirls as controls (age 14.9±1.0). All of the participants answered the Italian validated questionnaire EAT-26 about eating habits in order to identify any eating disorders. Body mass index (BMI) was calculated for all participants and compared to reference data.

STATISTICAL ANALYSIS

chi-square test, Student's t-test, Pearson's correlation coefficient. Only 3 (1.6%; 95% CI -0.2-3.4%) participants in the scoliosis group showed EAT-26 scores suggestive for eating disorders versus 7 (7.5%; 95% CI 2.2-12.9%) in the school population (p<0.05). The BMI was slightly lower (p<0.05) for scoliosis patients (19±0.2) than for school girls (21±0.3). EAT-26 is recognized among the most valid questionnaires for eating disorders and has been widely applied in various countries. By applying this questionnaire, a lower incidence of eating disorders in female scoliosis patients was found than in the general population (using both our own controls and Italian reference values). This contrasts with some expert opinions and a recent study performed in Italy. The low BMI already reported in the literature as being typical of scoliosis participants is confirmed by our data.

Brace technology thematic series - The Sforzesco and Sibilla braces, and the SPoRT (Symmetric, Patient oriented, Rigid, Three-dimensional, active) concept

BACKGROUND

Bracing is an effective strategy for scoliosis treatment, but there is no consensus on the best type of brace, nor on the way in which it should act on the spine to achieve good correction. The aim of this paper is to present the family of SPoRT (Symmetric, Patient-oriented, Rigid, Three-dimensional, active) braces: Sforzesco (the first introduced), Sibilla and Lapadula.

METHODS

The Sforzesco brace was developed following specific principles of correction. Due to its overall symmetry, the brace provides space over pathological depressions and pushes over elevations. Correction is reached through construction of the envelope, pushes, escapes, stops, and drivers. The real novelty is the drivers, introduced for the first time with the Sforzesco brace; they allow to achieve the main action of the brace: a three-dimensional elongation pushing the spine in a down-up direction.Brace prescription is made plane by plane: frontal (on the "slopes", another novelty of this concept, i.e. the laterally flexed sections of the spine), horizontal, and sagittal. The brace is built modelling the trunk shape obtained either by a plaster cast mould or by CAD-CAM construction. Brace checking is essential, since SPoRT braces are adjustable and customisable according to each individual curve pattern.Treatment time and duration is individually tailored (18-23 hours per day until Risser 3, then gradual reduction). SEAS (Scientific Exercises Approach to Scoliosis) exercises are a key factor to achieve success.

RESULTS

The Sforzesco brace has shown to be more effective than the Lyon brace (matched case/control), equally effective as the Risser plaster cast (prospective cohort with retrospective controls), more effective than the Risser cast + Lyon brace in treating curves over 45 degrees Cobb (prospective cohort), and is able to improve aesthetic appearance (prospective cohort).

CONCLUSIONS

The SPoRT concept of bracing (three-dimensional elongation pushing in a down-up direction) is different from the other corrective systems: 3-point, traction, postural, and movement-based. The Sforzesco brace, being comparable to casting, may be the best brace for the worst cases.

Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements

BACKGROUND CONTEXT

It is a broad consensus today that scoliosis curves cannot be improved through bracing, and the Scoliosis Research Society (SRS) methodological criteria for bracing have the avoidance of progression as their only objective. Consequently, in curves more than 45°, fusion is considered as basically the only possible treatment.

PURPOSE

The purpose of the study was to verify in a series of patients who utterly refused surgery if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment (bracing and exercises).

STUDY DESIGN/SETTING

Retrospective cohort from a prospective database.

PATIENT SAMPLE

Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°-58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment.

OUTCOME MEASURES

Self-report measurement: SRS-22; physiological measures: Cobb degrees, Bunnell angle of trunk rotation (ATR), aesthetic index (AI), and sagittal plumb line distances.

METHODS

The methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed.

RESULTS

Reported compliance in the 4.10±1.2 treatment years was 94%, with satisfaction regarding treatment and excellent results at the SRS-22. Two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements have been found in 71% of patients and a 5° Cobb progression in one patient. Statistically, we found highly significant reductions of the main (-9.25°), average (-6.6°), thoracic (-7.8°), and lumbar (-15.9°) curves. Statistically significant improvements have been found for the AI and ATR, with a general decrease in plumb line distances.

CONCLUSIONS

Bracing can be successfully used in patients who do not want to undergo operations for IS with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance. Future studies could demonstrate the percentages at which this result can be achieved.