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Thread: How tight should a night time brace be?

  1. #61
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    Quote Originally Posted by hdugger View Post
    I'm genuinely confused about what it is that you're doing.
    This child is coping well with a night-time brace.

    The problem is your comments would be IDENTICAL if the kid was struggling in a 23 hour/day brace because you feel the research supports that. The numbers don't change depending on whether the child is in a night-time brace or a 23 hour/day brace, yes?

    It is easy to show you do not have a correct amount of skepticism towards the research literature.

    It remains rational to not brace given all the caveats. When more research comes down the pike, then maybe it will become irrational. But we aren't there yet. Ask yourself why some surgeons STILL don't treat bracing like chemo for cancer. That says it all.

    I am a scientist. My job is skepticism. You are trained in the scientific method. I am immensely perplexed why you are not more skeptical. Truly.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  2. #62
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    Quote Originally Posted by hdugger View Post
    Ok, I'm doing that Columbo thing again. I meant to back out of the discussion this morning, but this time I really do have to go or I won't get any work done this week.
    When you write these silly little asides it makes you seem not serious. Are you serious?
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  3. #63
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    Quote Originally Posted by hdugger View Post
    I really cannot make heads or tails of it.
    This is what I am doing...

    "The first principle is that you must not fool yourself and you are the easiest person to fool." -- Richard P. Feynman
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #64
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    WOW you two are really passionate about this subject.

    I really appreciate all the information but really all I wanted to know when I started this thread was just how tight a night time brace should be.
    But since I am new to this scoliosis thing, its good to hear about studies, and options for it.

    In my last post I stated that after the readjustment of the brace I could in the beginning get it to the marks but later could not.

    So now you can get a laugh out of this because it has been really really cold here and I didnt realized my daughter was wearing a second Tshirt under the brace.
    Dumb-ole-me for not paying attention.( She gets dressed, puts the brace on and I come in and cinch it up).

    Well today we had the Xray with the brace on and my daughter put on the Boston T with no other Tshirt on and low and behold I can get it to the marks Ok now......That'll teach me to think twice before I post wont it?

    Any Way, some of the information you two share, scares me and some of it is comforting but I know I have to see both sides of this issue.

    In the mean time, since Nalina is Ok with the brace I will continue to have wear it and still do the PT and just hope for the best.
    (One great side effect of this is that I do the exercises with her so its good for me too).

    And One other thing. Our little girl (Nattie 7 yrs) had a check up today and I made sure her pediatrician really looked carefully at her, as did I. The doctor saw no signs of Scoliosis(and neither did I, not that I am some kind of expert). So we agreed to wait for a year and look again. In the mean time we will keep checking it ourselves and if we see ANYTHING that looks slightly suspicious we will take her in for an X-ray.

    thanks again for all your info,
    Last edited by FAHSAI; 12-09-2013 at 10:32 PM.

  5. #65
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    Nobody is born knowing to check for a second shirt. :-)

    Your daughters' names are very beautiful!
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #66
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    Hi Fahsai,

    I wrote you a long post this AM with some direct answers to your specific questions about your daughter's brace. I am not sure you saw it in light of the volumes of spirited discourse here, so I want to make sure you saw it, as I think my experiences with bracing (myself and) my daughter could be helpful to your family. It is post #41.

    That's funny about the extra shirt, and great news especially about your younger girl. Hopefully the brace will continue to settle in to the family and all will be well.

    Thanks for posting. It is helpful to read everyone's experiences.
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  7. #67
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    Quote Originally Posted by hdugger View Post
    I don't believe so. It closes in the middle of the peak height velocity.
    I will have to find the relation between triradiate cartilage closer and iliac apophysis ossification which the BrAIST study used. But note that they were declaring victory at only 75% closure of the iliac apophysis (Risser 4) for girls. I don't know why they didn't use Risser 5. The other thing is given the comment about disagreement between readers, I would like to know how robust this stuff is and exactly how much disagreement there was about determining bone ages in these study patients. That sounds like yet another layer of potential noise throw in there.

    The original maturity outcome was based on the change in vertical height, with adjustment for the change in the Cobb angle.19 Owing to concerns regarding the accuracy and reliability of this measure, maturity was redefined as a Risser grade of 4 for girls (75 to 100% ossification of the iliac apophysis, corresponding to near-cessation of growth) or 5 for boys (100% ossification of the apophysis with fusion to the ilium) and a Sanders digital maturity stage of 7 (defined as closure of all physes of the phalanges).20 This change was made before any analysis of the data. In the case of disagreement between the two primary readers regarding the treatment outcome, a third reader who was unaware of the treatment assignment and the treatment received broke the tie.
    I found this which shows both growth indices on the same figure...

    http://books.google.com/books?id=2om...tilage&f=false

    Seems like triradiate cartilage is not too useful. Could be growth remaining so I am not clear on why this rules out tethering for that other girl.
    Last edited by Pooka1; 12-10-2013 at 07:12 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  8. #68
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    Quote Originally Posted by Pooka1 View Post
    Actually, what I'm trying to do is provide the background for why surgeons like Dr. Hey still do not treat bracing like chemo for cancer. If a parent were to just read your posts, we would have kids browbeaten into brace wear when more than half will not benefit for one reason or another. Maybe considerably less than half will benefit when the long term is accounted for including potential collateral damage to formerly non-structural areas of the spine.
    I gave you another chance to show that background, asking you to explain what you seemed to be wanting to say with those doubts about percentage of kids ‘apparently’ helped by braces and so on, but you didn’t reply. It not surprises me of course.
    Certainly, it was more ‘funny' when it seemed you were looking for strange arguments in order to deny the statistical fact about brace effectiveness until maturity as braist study did.

    If you would not be dishonest and believe that surgical range should to be moved to 40 or 30 (or less?), instead of doing such kind of confusing claims in order to convince parents that braist study didn’t prove nothing significant yet, you should to contact that Dr. Hey and try to change the current medical protocol. Surely he could not show the bad outcome of his cases in something so serious as this Braist Study because he has conflicting interest (surgeries are much more expensive than braces), but anyway he might find the way to convince the medical community to does that change, who knows?.
    Last edited by flerc; 12-10-2013 at 09:59 PM.

  9. #69
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    Quote Originally Posted by Pooka1 View Post
    I am a scientist.
    Yes, surely a Nobel prize too.

  10. #70
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    About night braces (certainly the topic of this thread), I’m not a health professional, so of course what I may believe or not, cannot be important for none here and I’m really very farrr to want to discourage nobody in any kind of solution selected, so it’s just only a comment..

    I believe braces were better understood centuries ago and I have read they were removed to sleep. A simple system (surely not so much comfortable) was used to contribute with the distraction in the absence of the gravity force.

    I believe braces are extremely useful (if they are used in the right way) to fight against the gravity force, so night braces would not be used when they are really useful.. I don’t see the point in using a brace just only to sleep.

  11. #71
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    Quote Originally Posted by hdugger View Post
    I simply cannot make sense of what you're trying to do here.
    Too much obvious really.

  12. #72
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    I'm about as confused about bracing as anyone can be but If I understand correctly the idea behind the night time(at least as it was explained to me) is to force the curve the opposite direction and by doing that the stronger muscles that are curving the spine atrophy(get weaker). And the reason for night time is because the back relaxes more during sleep so it is more susceptible to this bending the other direction.

    Also if I understand correctly, 23 hour braces don't push the curve the opposite way, they just hold it in place so it doesn't get worse.

    In ieither case the hope is to keep the curve from getting worse, not to straighten it.

    But as I say, this is only how it has been explained to me and may be incorrect information.

  13. #73
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    Quote Originally Posted by FAHSAI View Post
    I'm about as confused about bracing as anyone can be but If I understand correctly the idea behind the night time(at least as it was explained to me) is to force the curve the opposite direction and by doing that the stronger muscles that are curving the spine atrophy(get weaker). And the reason for night time is because the back relaxes more during sleep so it is more susceptible to this bending the other direction.
    Has that been shown? I haven't heard that.

    My lay GUESS is that it puts more pressure on the anterior part of the spine, albeit for less time, so as to check the overgrowth more than a non-bending brace. Idiopathic scoliosis curvature is due to the front of the spine growing faster/more than the back. The spine must curve in response in a space-saving way.

    Also if I understand correctly, 23 hour braces don't push the curve the opposite way, they just hold it in place so it doesn't get worse.
    No I think they also aim for a large correction in brace. A number they seem to aim for is 50% correction in brace. The night-time braces of course can correct close to 100% or maybe even over-correct (>100%).

    In either case the hope is to keep the curve from getting worse, not to straighten it.
    That's correct. Braces only claim to hold curves from getting worse.

    But as I say, this is only how it has been explained to me and may be incorrect information.
    Please consider it may be people "know" how braces work but they never "show" how braces work. In any case, muscles atrophy with brace wear as they must with restricted motion.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  14. #74
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    I believe an enough flexible spine may keep a reduction at least very close to 100%, sleeping on a hard mattress (specialy over the concave side of the curve) without the help of any brace, so I suppose night braces may be very useful in not very flexible spines and sleeping in a soft mattress.
    Anyway a good point for night braces is that it seems that growth occurs while sleeping.

  15. #75
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    Quote Originally Posted by Pooka1 View Post
    The problem is your comments would be IDENTICAL if the kid was struggling in a 23 hour/day brace because you feel the research supports that.
    No, my comments would not be the same. The research supports the idea of a dose response curve - more is better (up to about 13 hours when it seems to stop mattering.) For a theoretical child with a high-risk curve, 13 hours is better than 7 hours is better than 0 hours.

    But, on a support forum, I never see a theoretical child. If a child is struggling at 23, or 13, or 7 hours, then 0 hours is better, no matter what the research says. The idea is for kids to end up feeling OK. If bracing isn't a struggle, then the path to feeling OK runs through a brace, because it has the best chance of keeping a curve small and pain free. But, if the brace itself is causing pain, then that's not a reasonable path for a kid to be in pain for years, and you start looking at some path that doesn't involve bracing.

    I'm not wed to any of this stuff. It's not some victory for me to have a kid wearing a brace - I'm not actually all that pro-bracing. I think I just seem that way because the discussions on this forum lean so far into the anti-bracing direction that I'm forever arguing the other side of the issue just to try to present an unslanted picture. The only thing I'm in favor of is keeping small curves small, because those kids with curves that never progress do better then kids whose curves do progress. Surgery doesn't set those odds right, from anything that I've seen. Those kids whose curves go to 40 or 50 and have surgery are just not the same as those kids whose curves that never got above 15 or 25. Again, not from anything that I've read. So, if people can keep their curves small, then that's the best thing possible, IMO. But it's not the only thing that matters. The whole kid is the thing that matters.

    My "in-and-out" posts are serious. I want to note that I'm absent from the discussion because I'm not reading, and not because I'm in agreement.

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