How to ensure orthotic effect of scoliosis brace

Conservative treatment of scoliosis mainly relies on orthopedic braces and orthoticgymnastics, other methods are adjuvant. Meanwhile there are many factors ofaffecting the orthopedic effect.There are five most important points as the following:

First, the qualified and effective brace does not affect the child development possible with concealment and comfort.

Second, to ensure the wearing time of brace, even the best brace works vain if children are not well wore. It must guarantee the wearing time of 23 hours each day in the peak of child development.Therefore,the child's ideological problems must be resolved, the brace must be worn to the optimum position at all times according to orthotist’s requirements.

Third, co-operate with the right training methods, such as Russian orthoticgymnastics, do not do any traction, such as hanging horizontal bar and so on.

Fourth, orthopedic timing, the younger the child is, the smaller the degree is, the better orthopedic effect is. Therefore, we must seize the best time, the faster the child development is day by day, the harder t the orthotic progress is day by day.

Fifth, periodic review, MEDI-REHATEK orthopedic brace is dynamic, that must be reviewed once every three months.In order to ensure the best effect of orthopedic brace, orthotist needsconstantly to adjust brace according to the child’s condition.

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What is neurofibromatosis scoliosis

Today,MEDI-REHATEK will introduce what is neurofibromatosis scoliosis.

Neurofibromatosis is a major cause of scoliosis. Neurofibromatosis is caused bygenetic defects that lead to abnormalities of neural crest cell and multi-system damage. Neurofibromatosis is divided into type I and type II based on clinical manifestations and gene mapping.

Cafe-au-lait spots and multiple neurofibromatosis of peripheral nerves are visible on surface of the skin after we exam the body of patient with Type I,which are more in non-exposed parts of the trunk. Also Lisch nodule is visible on eyes, that is upper eyelid  fibroma or plexiform neurofibroma. The mass is palpable on orbit and moves when eyes goggle.  Orange circular miliary nodules are visible on iris  nodulessthrough lit lamp. It is hamartoma  and specific performance of type I , can increase with age. Diagnostic criteria is more than 6 nodules with a diameter greater than 5mm (diameter is greater than 15mm after puberty ) with high diagnostic valuebefore puberty as well as the features of freckles on the body armpit.

Type I of neurofibromatosis easily lead to scoliosis. Patient will have early onset of the disease (usually before puberty) with rapid development of scoliosis and obviousdeformity. The curvature is stiff, and bone strength is decreased by itself etc.Orthopedic brace is difficult to deal with it.

Relative blog: The Application of Spinal Orthosis VI

Scoliosis Brace

C, Using Notes of Scoliosis Brace

MEDI-REHATEK Scoliosis brace is designed based on human anatomy, biomechanics, kinesiology, combined with the patient's condition, according to the requirements of doctor's treatment. Whether treatment effect is good or bad that closely related with the accuracy of force point, the magnitude of the pressure, proper way of use by patients, as well as the active cooperation of parents. Therefore,I'm asking parents to closely cooperate with treatment, push their children to adhere to wearing and exercise, and note the following:

1, The prescribing doctor has to examine whether the orthotic meet the therapeutic requirements after wearing initially.If it meets the requirements, the patient should be reviewed once a month during the first three months. If pressure is not enough, it should be adjusted timely. If abnormal changes of spine presents during wearing, patient should go to hospital to identify the cause in time. Then it needs periodically reviewing once every 3-6 months.

2, Orthosis should be adjusted or replaced every six months to a year according to the speed of human growth and development, or it fails to meet treatment requirements.

3, It will take a long course of treatment as it is corrected by external fixation.So patient should insist on long-term wearing,usually the wearing time should 22 hours a day. The remaining time is to deal with personal hygiene, do training exercises.

4,Main pressure pad of orthosis should maintain sufficient pressure while the patient can take the initiative to correct by "off-pad" action (to let the body leave away from the pressure pad) .

5, Orthosis can be taken off after the full development of bone. Gradually patient should reduce the wearing time according to the doctor’s requirements every day before stop wearing, then transition to take off orthosis. It will come to naught if taking-off time is inappropriate time.

6,If the patients feel too loose too tight during wearing, should be adjusted by themselves under doctor's orders,can have telephone consultation. If there is severe discomfort presenting (such as excessive pressure, redness, swelling, etc.),they can always come to our center to be inspected.

Relative blog: The Application of Spinal Orthosis V

What is spinal orthosis

A, What is orthotic?

Orthotic is external device used for changing performance characteristics or structures of the nerves, muscles and skeletal system. Why can it play a role in correcting? Here we can recall, it has been known that a tree grew in the direction of bending, people tied a straight stick on the part of bending in order to make it grow up to be useful, on which an external force straightened the bending part of tree little by little in the progress of growth.People gradually apply the way of external force to biological correction for human beings,that is how orthotic exists.

B, How can spinal orthosis play a role in correcting?

MEDI-REHATEK Spinal scoliosis orthosis corrects the children in the progress of growth based on principle of three-point force. Since the site of scoliosis, degree of curvature and contour of the body are different, so the spinal scoliosis orthosis is customized based on the degree of scoliosis taken from X-rays  in conjunction with the body shape.The urging direction and site must meet human biomechanics and the requirements of correction.

We hope that parents often observe the growth of child's spine in order to detect early and treat timely. That will avoid future deformities. 

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What is Scoliosis

MEDI-REHATEK will take about the scoliosis today.

Normal spine is without any curve in the back as a straight line, if the certain part ofspine bends sideways, it is called scoliosis. Scoliosis is divided into idiopathic, congenital and neuromuscular paralytic type according to etiology .The idiopathic scoliosis is the most common disease among them,that occurs in children in 10-14 year-old.Girls are more than boys.Scoliosis will be exacerbated without treatment on time as their age increases. Much worse it cause thoracic deformity and affect the function of heart and lung function. Medical experts find out that patients wear orthosis for correction on time and do rehabilitation exercises. We can control the development of deformities and correction of scoliosis angle in order to prevent thedisability in future.

In the past children with scoliosis generally have to wait to have corrective spine surgery until around the age of 14. The development of scoliosis develops rapidly and deformity exacerbates in growth and development stage when they wait for surgery.If we don’t control the development of scoliosis, it increases the difficulty of surgical correction even until the age for surgery. Nowadays with the development of science and technology, synthetic polymer materials are used widely, people combine medicine with engineering people bye the use of orthosis technology of modern rehabilitation engineering for treatment of mild scoliosis, correction or control of abnormal development. 

Curve of scoliosis is usually accessed by scientific method of Cobb angle . When Cobb angle is less than 15-20 degrees, patient may persist in rehabilitation exercises under the guide from rehabilitation doctors. Usually the scoliosis can be under control and in the way of recovery, but the patient must be regularly reviewed. 

When Cobb angle is greater than 20 degrees, less than 45-50 degrees,patient must wear orthotics to prevent scoliosis from getting worse. When Cobb angle is greater than 50 degrees,it should consider the implementation of orthopedic spine surgery to correct.

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Orthosis for children with congenital tibia pseudarthrosis III

Third, Results

Patient can stand and walk freely after wearing orthosis.Bilateral pelvis maintains in the horizontal plane and pseudarthrosis is effectively protected.Patient can operate the device of knee joint locking freely through the training. The work staff needs to adjust the height of orthosis according to their height of growth with follow-up once every six months, and replace surrounding part of the thigh and portion part of shank according to the situation of adaptation. So far, the patient have worn orthotics for seven years, as the underneath pseudoarthrosis of  tibia and fibula stops growing, bilateral unequal length changes from 5cm to 16cm. Bilateral pelvis maintains in the horizontal plane and the growth of spine is normal through compensating the unequal length by orthosis. The patient can live a normal life and learn although the figuration is non-aestheic.

Fourth, Discussion

We will see the following benefits by wearing the MEDI-REHATEK orthosis:tibia and fibula are effectively protected, no need to worry about the new damage caused by the collision force; shank bearing free load, no need to worry about the deformation of the tibia and fibula due to bearing load; bilateral pelvis maintains balance, no fear for deformation of the spine and other complications; no need of amputation.

We understand that the process of formation of congenital pseudarthrosis of the tibia by reviewing documents - the lower part of shin bone bending forward - post-traumatic nonunion - formation of pseudarthrosis. We can assume that: in the early period pediatric patient should wear suitable orthosis designed by us, have the tibia and fibula with reasonable protection.Shouldn’t we have to worry about pseudarthrosis due to post-traumatic fracture and failure of operations in multiple times? With the extensive communication between medical and orthotics circle along with the close relationship between medical rehabilitation and rehabilitation engineering, we will be able to find a better way of the treatment for many diseases. The patient will be able to receive better therapeutic effect, return to society faster and better.

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Orthosis for children with congenital tibia pseudarthrosis II

Second, Design of Orthosis

1) Design Ideas

MEDI-REHATEK Orthosis is designed for compensating unequal length of lower extremities,maintaining pelvis in the horizontal plane and avoiding the occurrence of spinal scoliosis; pseudarthrosis bears free of load and is protected ; realizing walking function.

The pseudarthrosis in the proximal tibia.The fabrication of orthosis of free-load on shank and patellar tendon bearing load,which has a small stress area with greater pressure in part that would exceed the tolerance of the skin. We will design an orthosis with free load on ischial tuberosity and soft tissue of thigh according to the specific circumstance (Fig. 2), although the orthosis has more weight than orthosis of free-load on shank and patellar tendon bearing load, it greatly improves the stress condition as well as offers significantly more comfort.

Taking into account that soft tissues of thigh change as age increases, we use opening type at the front of plastic plate with the fasteners in order to adjust the tightness;Orthosis has bilateral metal bars which increases its intensity. It also has a locking device of mechanical knee joint so that knee joint is stabilized when standing and the joint can be opened and bent down naturally when sitting down; There is a shank protection part put on the proximal leg protection for increasing the protection for lesion;The height can be adjustable between knee joint and stirrup as the growth of patient’s height.

2) Material Selection

Polyethylene plate on thigh part is suitable for the skin, which increases comfort and stability; bilateral bars and joint are made of metal that increase the intensity; The bottom of orthosis is connected with metal stirrup under which has rubber in order to increase the comfort level and the slip coefficient during walking.

3)Fabrication Process

The first step: Take the plaster cast from patient(guarantee of wearing comfort); The second step: modification of the positive plaster cast; The third step: the high temperature polyethylene sheet needs heating to be transparent and spreading on the surface of positive plaster cast.Then  get a vacuum molding; The forth step: cut the ideal shape of orthosis and edge polishing after the material is cooled; The fifth step: installation of metal bars, joints, stirrup, and determine the height of the orthosis according to the length of patient’s limb; The sixth step:The patient tries to wear the sample; The seventh step: install velcro straps and complete.

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