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Thread: Night braces

  1. #1
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    Dec 2008
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    Night braces

    I dont suppose anyone has references about the effectivness of night braces. Sharon, I know you said your daughter is using one. The reason I ask is because, well, after careful thought we have decided to abandon the SpineCor. I am not ready to get into details but I have lost faith in the brace and the claims made by the inventors in the technical literature.

  2. #2
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    I was told by my Daughters Dr. they work best on single curves. My daughter has an S curve and we tried it anyway. It didn't work, and a year later she wore a Boston. I wish you the best of luck.
    Becky

  3. #3
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    i wore the charelston night time bending brace as a teenager about 20 years ago. it was fairly new then. i think there have been some questions raised about their effectiveness. i can tell you that at that time i had 32/28 degree curves. now 20 years later i am 62/45. i was not as diligent as i should have been in wearing it, i starting wearing it a little later than ideal, and i was lazy and in denial and did not follow up with xrays annually as i should have. so, i cant say if i continued to progress during the time i was in the brace or after i stopped wearing it... it was extremely uncomfortable and actual somewhat painful at times. mostly when removing it when everything inside me kind of shifted back into place it knocked the wind out of me... but, i think many kids with parents help may be more likely to wear this in lieu of wearing other braces they would have to wear to school etc... but again, i would investigate its effectiveness. i cant say either way... hope this helps!

    daniel

  4. #4
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    Oct 2008
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    Hi CD, sorry things are not working out as you hoped. I'm sure you've already done this as you seem very adept at research but I recall from when I researched the Providence brace (my daughter wore one for 5 months) that there were a 2-3 studies found through a simple net search that were helpful. They all involved AIS and seemed clear on what their parameters were.

    Just FYI, my daughter had no problem wearing the Providence. My 14 year old niece also has one and has done fine with it, no compliance problems.

    Good luck,
    mamandcrm

    G diagnosed 6/08 at almost 7 with 25*
    Providence night brace, increased to 35*
    Rigo-Cheneau brace full-time 12/08-4/10
    14* at 10/09 OOB x-ray
    11* at 4/10 OOB x-ray
    Wearing R-C part-time since 4/10
    latest OOB xray 5/14 13*
    currently going on 13 yrs old

    I no longer participate in this forum though I will update signature from time to time with status

  5. #5
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    CD, hang in there.

    I don't have the literature at hand but here is what I was told, what I understand to be the case, and what our experience has been...

    1. Our surgeon specifically told me that before the recent literature on the Charleston, he never (or rarely) braced. So as I understand it, this is the only brace he uses and has used it only recently. Essentially, it pulled him out of watching and waiting camp as I understand his comments to me.

    2. As I understand it, it seems to be more promising for the lumbar curves. My daughter has a thoracic curve so I think it was not expected to be as effective. (Moreover, there is evidence in hand that no brace can hold certain curves associated with connective tissue disorders like I think my daughters have. So there's that in looking at her experience.)

    3. I found one article on its use in the JIS crowd but I didn't critique the analysis.

    4. As I have written, my daughter's curve movement does not appear to be a function of brace wear; it was stable for periods without it and the curve increased ~8* with it though was stable in the next 6 months in the brace. But again, I don't think her case applies to the AIS cases.

    5. About half the kids find it very comfortable and are uncomfortable not wearing it for a night. My daughter is in this group.

    Good luck.
    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. #6
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    Dec 2008
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    Charleston vs Providence?

    I think we will only (easily) have access to the Providence Brace. I dont really see yet what the difference is.

  7. #7
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    Quote Originally Posted by concerned dad View Post
    Charleston vs Providence?

    I think we will only (easily) have access to the Providence Brace. I dont really see yet what the difference is.
    I know you've seen this literature before, CD, but I've included the links for anyone who hasn't and would care to review.

    It seems the main difference between the Providence and the Charleston is that the Charleston uses applies opposite bending force to overcorrect the curve.

    The Providence seems to take more of 3 dimensional approach, and does not attempt to mimic opposite bending. Instead, it relies on counter forces applied against the lateral and rotational aspects of the curvature. I find it interesting the thoracic and lumbar sections are modeled separately and then rejoined to form the brace vs. a one piece construction like the Charleston and TLSO's like the Boston. Conceptually, that makes sense to me.

    I've made my views on bracing fairly clear, but I've also said if bracing is destined to work it is a LOT more likely to work if the patient wears it. Anything that achieves effective compliance is better than nothing, and I really wish either option for night time bracing had been available for me. I suspect it could have changed how I view the concept of bracing trauma as a whole.

    Best of luck to you, CD. I can only imagine how tough it is to head one direction and switch midstream. No matter what the eventual outcome, you've done the best you can to find the best solution for your daughter. That's a tough task in a scenario without absolutes - and riddled with anomalies.

    Hang in there.

    Regards,
    Pam
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op ±53°, Post-op < 20°
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
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  8. #8
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    Oct 2008
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    It was my understanding from our ortho that the Providence "overcorrects" as well...and I could see that in my daughter when she was upright in it, walking to the bathroom or something before bed. Definitely tilted, much different than a "standing" brace. But from the pictures I've seen of the Charleston, which looks very bending (much moreso than the Providence), it is not as obvious in the Providence I think because the Providence has a straighter look to it from the outside...the foam padding on the inside is fairly thick in places and more molded...
    Last edited by mamandcrm; 03-21-2009 at 02:14 PM.
    mamandcrm

    G diagnosed 6/08 at almost 7 with 25*
    Providence night brace, increased to 35*
    Rigo-Cheneau brace full-time 12/08-4/10
    14* at 10/09 OOB x-ray
    11* at 4/10 OOB x-ray
    Wearing R-C part-time since 4/10
    latest OOB xray 5/14 13*
    currently going on 13 yrs old

    I no longer participate in this forum though I will update signature from time to time with status

  9. #9
    Join Date
    Oct 2008
    Posts
    299
    Hi CD,

    I was reading over another post of yours and noticed that your daughter's curve is 38 (not sure where it's located). If I recall correctly, I think the success of night-time bracing goes down significantly where the curve is over 35 degrees...and that lumbar curves fare better than thoracic...just some things to think about...
    mamandcrm

    G diagnosed 6/08 at almost 7 with 25*
    Providence night brace, increased to 35*
    Rigo-Cheneau brace full-time 12/08-4/10
    14* at 10/09 OOB x-ray
    11* at 4/10 OOB x-ray
    Wearing R-C part-time since 4/10
    latest OOB xray 5/14 13*
    currently going on 13 yrs old

    I no longer participate in this forum though I will update signature from time to time with status

  10. #10
    Join Date
    Aug 2004
    Location
    ny
    Posts
    1,809
    Hi CD,

    I'm not sure where you live, but just this morning I came across this post on the VBS site and thought you might be interested:

    Someone posted the following:

    "I have seen a few comments about the Providence brace being uncomfortable for some children to wear. Dr. Betz was so impressed by my daughter's orthotist that he asked for his card. She has curves of T2-T-10 35degrees and T-11 - L2 25 degrees. She corrected to ZERO in brace. Brace fits really well and there is some discomfort, but minimal. Here is the name and info. of the orthotist. He is in Spring Valley, NY which is about 45 minutes from New York City in Rockland County.

    Kenneth Lynch Co.
    Phone: 845-356-9357
    AMKEN Orthopedics
    9A Perlman Drive
    Spring Valley, NY 10977"

    Good luck to you and your daughter.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

    https://www.facebook.com/groups/ScoliosisTethering/

    http://pediatricspinefoundation.org/

  11. #11
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    Jul 2007
    Location
    Amarillo Texas
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    It looks like the Providence works with double curves. Does it depend what part of the country you live in to get the Providence? If my younger daughter ever develops scoli that looks very promising. Compliance is a big issue and nighttime braces are easier to tolerate. For the life of me, I couldn't keep my daughter in her Boston except at night! She wore the Charleston faithfully every night, it just didn't work on her curve types.
    Becky

  12. #12
    Join Date
    Dec 2008
    Posts
    494
    Quote Originally Posted by mamandcrm View Post
    Hi CD,

    I was reading over another post of yours and noticed that your daughter's curve is 38 (not sure where it's located). If I recall correctly, I think the success of night-time bracing goes down significantly where the curve is over 35 degrees...and that lumbar curves fare better than thoracic...just some things to think about...
    Yes, the 35 degree cut off looks pretty troubling.

    This is from the 2007 Janecki Paper we discussed before (the paper that came out simultaneous with Coillard). This is what they observed for a subset of patients between 35 and 40 degrees. Emphasis added is mine.

    There was no difference in the progression of curve magnitude or the rate of surgery between the 14 patients in the TLSO group and the 11 patients in the Providence group whose initial curves were between 36 and 40 degrees. Only 2 patients in the TLSO group (14%) and 1 patient in the Providence group (9%) did not progress. The curves of all 12 remaining patients in the TLSO group progressed beyond 45 degrees and required surgery. In the Providence group, the curves of 8 of 10 patients progressed beyond 45 degrees, but all 10 required surgery.

    Granted it seems they pull the trigger on surgery pretty quick (even below 45 in some cases) but wow, this is a bummer.

  13. #13
    Join Date
    Oct 2008
    Posts
    299
    It is a bummer. I am so sorry you got the rug pulled out from under you on the spinecor. It's hard to start over from scratch again.
    mamandcrm

    G diagnosed 6/08 at almost 7 with 25*
    Providence night brace, increased to 35*
    Rigo-Cheneau brace full-time 12/08-4/10
    14* at 10/09 OOB x-ray
    11* at 4/10 OOB x-ray
    Wearing R-C part-time since 4/10
    latest OOB xray 5/14 13*
    currently going on 13 yrs old

    I no longer participate in this forum though I will update signature from time to time with status

  14. #14
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    Quote Originally Posted by concerned dad View Post
    Granted it seems they pull the trigger on surgery pretty quick (even below 45 in some cases) but wow, this is a bummer.
    It's a bummer, CD. Sorry.

    In re pulling the trigger, my daughter was at 48* when we scheduled surgery. She was 58* on the table.

    Maybe they schedule the cases that they know are moving fast because the fast moving ones are known not to stop. Who knows. My daughter's curve averaged about 5*/month in the two months before her surgery but even the slower progression just prior to scheduling her was enough to trigger the call. And it was a perfect call on the surgeon's part I might add. These guys are amazing.
    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."

  15. #15
    Join Date
    Dec 2008
    Posts
    494
    Any idea just exactly what they are trying to say here?

    We wish to again emphasize the differences between the Charleston Bending Brace and the Providence brace, both of which are recommended for nighttime use. The Charleston brace works by bending the spine. When a double curve is treated, the forces unbending one of the curves in a double curve pattern can worsen a curve with an apex in the opposite direction. Indeed, this was observed in 11 of 24 double curves in the first report published on the Charleston Bending Brace. The Providence brace works by the application of opposing forces and does not bend the spine; rather, it pushes the curve apexes to the midline. We did not experience permanent worsening of secondary curves at the final follow-up.

    Not bend the spine? Push the apex? How can you push the apex without bending the spine?

    This is from:
    Nighttime Bracing With the Providence Brace in Adolescent Girls With Idiopathic Scoliosis
    Charles Roland d’Amato, MD, FRCS(C), Sean Griggs, MD, and Barry McCoy, MEd, CPO
    SPINE 2001 Volume 26, Number 18, pp 2006–2012

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