CHICAGO — A speaker here at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium developed a survey to poll spinal orthotists and to identify areas of agreement or disagreement regarding orthotic biomechanical correction theory of adolescent idiopathic scoliosis.
Sun Hae Jang, MSc, CO, FAAOP, a PhD candidate at Eastern Michigan University, and colleagues polled 46 certified orthotists and certified prosthetist-orthotists with at least 2 years of experience in scoliosis-orthotic treatment. Overall, 21 multiple-choice questions were developed that focused on general concepts and case examples in the orthotic-biomechanical field. Researchers calculated the number of participants who picked each multiple-choice option and identified the ratio of agreement vs. disagreement.
Researchers found agreement on 11 biomechanical-orthotic correction topics. There were seven topics on which participants did not find clear agreement, and the most disagreement occurred on questions regarding the sagittal plane.
Using the collected data, researchers conducted a review of literature on each area of disagreement. Jang said most studies supported that the superior edge of a thoracic pad should be placed on the rib attached at the apex of the thoracic curve or on the levels caudal to the apex.
“We found that abdominal compression has the function of superimposing a longitudinal stretch on the lumbar and thoracic spines by increasing intra-abdominal pressure,” Jang said. “Abdominal pressure is also related to reducing lumbar lordosis. However, most articles proposed that if someone has a thoracic scoliosis curve, unnecessary reduction of lumbar lordosis, including abdominal compression, could be contraindicated.”
Jang said evidence shows that cervical-thoracic-lumbar-sacral orthoses are the best option for T2-T6 curvatures. “However, patient compliance issues have been noted,” she said. “A shoulder ring is recommended to control cervico-thoracic scoliotic curves, and a trapezius pad is recommended to control high thoracic curves.”
According to Jang, more quantitative research is needed to understand biomechanical correction concepts and orthotists should treat patients based on generally defined concepts – by Shawn M. Carter
Jang SH. Current Practice in Orthotic Treatment of Adolescent Idiopathic Scoliosis. Presented at: American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium; March 1-4, 2017; Chicago.
Disclosure: Jang reports no relevant financial disclosers.