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  • initial correction by brace

    The initial correction achieved by bracing my 11 year old daughter was 25 % (from 29 > 21 degree, whilst wearing the brace)

    I have been made to believe that one should aim for at least 50% reduction to have a reasonable chance of eventual succes.

    Is that the common practice in the USA (or elsewhere) or is this generally seen as unrealistic.

    What really does my head in, is that apparantly in Germany it is common practice to try to even overcorrect, i.e. bend in the opposite direction.

    still not sure whether I should ask for more effort from my treating consultant

    thanks

    gerbo

  • #2
    Hi Gerbo...

    I've always heard that 50% is the goal. Even with the perfect brace, some kids can't get that much correction. It doesn't mean that your child won't be successful in the brace, it just means that she has less of a chance of being successful.

    I'm not sure, but what you may be talking about in terms of Germany is a bending brace (e.g., Charleston bending brace). These night-time only braces are used by some specialists all over the world.

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

    Comment


    • #3
      from a german forum I got the impression that a "Cheneau" brace is used a lot, which, as far as I understand, works with pressure pads on one side and expansion space on the other side of the brace, which seems similar to the Boston. Generally they aim for 50% as well, but they will, if possible try to push it even further (literally). How realistic this is in practice, I really do not know.

      So would the Boston be the most commonly used brace in the usa. I understand this is a "prefabricated" brace available in different sizes. Is that correct.?

      My daughter is using an entirely custummade TSLO, which fits very smugly, but doesn't use any additional pads for additional correction.

      Any idea what a us physician would do if the initial correction would only be 25%, would they leave it, or would they have another go trying to improve?

      thanks

      gerbo

      Comment


      • #4
        Hi...

        Some doctors use off the shelf braces, but most of them use custom made. I've never seen statistics, but I'm guessing that the Boston brace, or braces that are very similar, are the most common.

        While a correction of at least 50% is the goal, some kids get much better correction.

        Regards,
        Linda
        Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
        ---------------------------------------------------------------------------------------------------------------------------------------------------
        Surgery 2/10/93 A/P fusion T4-L3
        Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

        Comment


        • #5
          thanks, so these custom made ones, do they fit exactly to the body (as "ours" does) or does it still leave room for additional pressure pads (is that how you would call them?) With other words, is the correction determined by the shape of the original brace, or is additional correction achieved by adding bits to the inside of the brace as required.

          I know I am getting a bit technical here, but thanks for answering

          gerbo

          Comment


          • #6
            Hi...

            I think that initially, they fit perfectly to the body. Then, over time, pressure pads can be added. Hopefully, someone whose child has had one of the braces can answer the question better.

            --Linda
            Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
            ---------------------------------------------------------------------------------------------------------------------------------------------------
            Surgery 2/10/93 A/P fusion T4-L3
            Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

            Comment


            • #7
              Hi gerbo,

              You are exactly right in what you said to Linda.


              My daughter wore two different types of braces and each one was custom made for her. When she was fitted for each brace, they took a lot of measurements to make sure the brace fit perfectly. Whenever we picked up her brace, they spent a lot of time making sure it fit perfectly. After about two weeks of wearing the brace, they would x-ray her in the brace to be sure it was doing what they wanted it to do and if it wasn't, they added pads to give that extra push.

              I hope this helps.

              Mary Lou

              Comment


              • #8
                Gerbo, my daughter stood in a machine that took electronic measurements of her body for fitting her brace. I don't know if they always use that machine. After the brace came in, we went between the person who fits the brace and the surgeon, as they decided how to be most effective with any padding needed to correct the curvature comfortably. They took x-rays in the brace, and decided to add some padding, so we returned to the brace person and then went back to have the surgeon look again. This time he did not take x-rays, but approved or the added padding and the tightness of the brace. Her curve was around 45 degrees to start with, so the brace was not recommended as highly as surgery, but they of course did as we decided and hoped it would help and prevent the need for surgery. It did seem to help control some of the increase, which is what became our personal family goal and the goal with the physician. We were all willing to use the brace until adulthood to at least control the curvature and avoid surgery, until a year later her curve started increasing at a faster rate, and it became obvious the brace was not preventing curvature enough for her adulthood health. In our case, we were just happy to have the brace control the curve to some extent, so we did not look at a requirement of a certain percentage of improvement. Good luck with your situation. Kris

                Comment


                • #9
                  This goal of a 50% correction - how long do you need to wear a brace before you begin to see a correction this size?

                  Comment


                  • #10
                    this is the initial correction achieved with the brace on, which isn't the same as the eventual correction without a brace. As I understand it, usually the best you can hope for is "no worsening" in the longterm (although there are always exeptions to this) and the best chance of achievibg this would be with a brace which straighten you out as much as possible.

                    gerbo

                    Comment


                    • #11
                      i have been posting a similar question on a german site (www.skoliose.net) and the response i got from there was that the best brace makers in Germany (Rahmouni) often achieve 100% initial correction, specially in younger patients. By all standards this is pretty impressive. I have posted further questions aboout experience of patients havin g worn these braces longer, as that is the most important issue to look at.

                      just thought you might be interested........

                      gerbo

                      Comment


                      • #12
                        gerbo initial correction

                        Initial correction:

                        Hi Gerbo, posting here per your request. Initial correction - why is emphasis placed on it. Well, there is some correlation in the literature linking good initial correction with a successful outcome (no surgery) (Upadhay et al.). However, keep in mind it is just one variable.

                        50% has been preached for years, probably derived from outcome studies with Milwaukee, Boston, and the like. I have had patients with initial corrections (initial correction typically is measured 3-5 weeks post initial brace fitting) who do not correct 50% "initally" , yet who have avoided surgery.

                        As mentioned in an earlier post forces within the brace can be altered to enhance correction after initial correction. Followup is crucial. Initial correction can occur immediately or over longer periods of time as the soft tissues respond to the forces applied by the brace. For exactly what period of time would be interesting to see.

                        100% correction doesn't just occur in Germany - it can occur anywhere, and We have experienced it here in the US. In my opinion, the Germans might have a better chance of achieving good correction given their aggressive approach to scoliosis in that country and given their health care system - the Schroth method is quite popular there - they even have a hospital there exclusively for scoliosis patients where the kids reside there for months and train in this scoliosis therapy and their orthosis. Their health care system enables this type of intensive treatment. This may even affect cultural/psychological variables (brace acceptance e.g.).
                        The best 'bracemakers' are only as good as their patient, family and medical team. A good culture, adjunct therapy, and involved patients like the above can only help outcomes.

                        Comment


                        • #13
                          Thanks for your helpful comments, would you be able to respond/ comment to the following
                          ????
                          1) Lisanna's brace was made from a plastercast which was fitted whilst some correction was being attempted through traction (upwards, collar round the neck) and by pressure on the trunk by hand. The resulting TSLO type brace sits entirely snug to the body, i.e, there is no expansionspace or space to apply corrective pads. This means in practice that the correction achieved initially is the correction we have to live with. Saying that, now she is used to it, she is very comfortable in it.The only variable we have is that we can thighten the brace till some extend, which lisanna tolerates to a varying extend, although we do not know whether the actual tightening achieves anything, or only tortures her.

                          2) Our correction achieved in this way was from 29 degree (without brace) to 21 degree(with), follow up is 6 months (april >>oktober)

                          3) My own sense is that "they" are not trying hard enough and that a miserable 25 % initial correction doesn't give us a good chance to achieve anything significant, and that if you believe in bracing you have to go for the maximum achievable correction. It is great to have a comfortable brace, but if it has little chance of succes, it is still a burden for little purpose.

                          On the other side, i am still kind of happy to wait till the review in oktober to see what has been achieved, however a deterioration then would make me consider alternatives, which could include to go over to Germany, get a brace fitted there and attend the Schroth clinic (which you do mention as well)

                          I think what creates mosty anxiety for me is the awareness that at age 11 and no first period yet, lisanna is at high risk of deteriorating, whilst at the same time still having the biggest scope for improvement as few irreversible structural changes will have occured.

                          I know she hates all the fuss which is being made of her condition, however in the long term she is bound to hate it even more if she ends up with a big curve, requiring major surgery and i will hate myself (kind of) for not having made all reasonble effort to influence the eventual outcome.

                          I am well aware that it will be impossible for you to comment comprehensively "from a distance" but any pointers would be welcome.

                          gerbo

                          Comment


                          • #14
                            lisanna

                            I take it that lisanna was measured for her TLSO on a Risser table or some variation, and that is quite common and effective for taking a mold with correction. I am pleased that you are so concerned about her, sometimes I wish some of my patients' parents were as concerned as you She is young and she is higher risk - good news though is that there is still time to address treatment.

                            Of course, there is not enough information about the case to express a solid opinion, but consider the following:

                            First, the "miserable" result is not totally miserable. She did achieve some correction! Miserable is no change or even an increase in brace imo - it happens. Doctors typically will take an xray Out of brace to determine if curve is progressing beyond original magnitude despite bracing. If it is <= 29 degrees still, there's hope.

                            Second, more of a question, how many hours a day does she wear it? More = better.

                            Third, you can request or demand a change in the brace. I have remade them if I cannot adjust brace any further. The forces applied in the plaster process can be made more aggressive in the modification process (hand making) of brace.

                            Fourth, depending on the child, some curves are just plain tough to correct and are more rigid than others e.g. recent studies showing heavier/kids with more soft tissue do not respond as well to brace treatment versus more slender children.

                            Fifth, besides Germany, there is a good clinic in Barcelona where they specialize in Scoliosis bracing and exercise - know them. Good people. another alternative.

                            Finally, continue to do all u can and seek the best outcomes - you're on the right path.

                            Hope this helps.

                            Comment


                            • #15
                              sometimes I wish some of my patients' parents were as concerned as you "Sometimes I wished that all orthotists were as considerate and helpfull as you are"

                              some responses to your comments

                              1) i will make sure that on her follow up in oktober the xray will be taken out of brace, as you sensibly suggest
                              2) average of 20-22hours/day
                              3) will ask for that depending on correction achieved in next brace
                              (which reminds me of a question; how often do you tend to remake a brace in a young and growing child, also, how concerned do we need to be re repeated x rays to check if we are doing ok??)
                              4) Lisanna can only be described as very slender and very flexible (she is a (damned good) balletdancer after all)
                              5) I've indeed also heared about this Spanish clinic, were they also apply the Schroth method

                              Just as a thought, if little children with infantile scoliosis are being treated by frequently changed casts, applied under GA (which i assume ensures maximum correction), would a similar approach in adolescent scoliosis not give similarly good results??

                              once again, thanks for being helpful

                              gerbo

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