The efficiency of brace treatment for adolescent idiopathic scoliosis is correlated to how the brace has been worn. A smart orthosis was developed to maintain the interface pressure between the brace and the body within the prescribed range during daily activity. Six patients with scoliosis, with Cobb angles of 31 +/− 5 degrees, who were new brace candidates were recruited. They used the system for four weeks: two weeks with monitoring only and two weeks with an automatic feedback activated. The time that the pressure level was in target level range during the study period was increased from 53 +/− 9% to 68 +/− 14% with the feedback activated. This work helps brace candidates wear their braces more effectively and receive the most benefit from the brace treatment. As a result, all subjects who participated in the study maintained their Cobb angles within + two degrees during the study period.

Brace correction based upon mechanical action requires appropriate interface pressure between the body and the brace. A smart orthosis was developed to record how much time (quantity) a brace was worn, how well (quality) it was used and how well the interface pressure was maintained to the prescribed level. Six subjects were recruited and they all were fitted with Boston style braces. Each subject wore the brace for 2 weeks without the force maintenance system activated to serve as the control period, and the remaining 2 weeks with the force maintenance system activated. During the automatic feedback mode, the pressure maintenance system was activated only during the daytime hours (8:00–22:00hrs) to avoid disturbing the patients during sleep. The subject could either return the system to us after 1 month or continue to use the system until the next clinic.

The time that the pressure level was in the target level range during the study period was increased from 53 +/− 9% to 68 +/− 14% with the feedback activated. The average brace wear time for the study period was 72 +/− 15% (12.6hr/day) of the prescribed time (17.5 +/− 3.8 hours). The curve severity of all subjects on the following clinical visit was the same (within measurement error) as the first visit (32 +/− 5 vs 31 +/− 5 degrees). Compliance was not affected when wearing the monitor.

The smart orthosis was able to improve the efficiency of a conventional brace by maintaining the prescribed interface pressure automatically. This project helps brace candidates wear their braces more effectively and gets the most benefit from the brace treatment. As a result, all participating subjects maintained their Cobb angle within +/− 2 degrees during the study period.

Objectives: To determine the correlation between brace treatment and the brace tightness and treatment compliance

Design: A monitoring device [1] was designed to measure and record the time and temporal profile of the loads on the pressure pad imposed on the trunk during daily activity. The device consists of a programmable digital data acquisition system and a force transducer. Three light emitted diodes (LEDs) were used to indicate the tightness level below 80%, between 80 to 120%, and above 120% of the load level prescribed. Each subject used the indicator on the device to adjust the tightness of the brace so as to achieve the prescribed pad load. The prescribed pad load had been set by his/her physician after the transducer was installed.

Subjects: Eighteen brace candidates, 3 males and 15 females age 13.6 ± 1.8 years, who had worn their braces from 6 months up to 1 year were recruited. All subjects gave their informed consent to participate in this study. The selection criteria were 1) diagnosis of idiopathic scoliosis, 2) ages between 9 – 15 years and 3) prescribed brace treatment. The exclusion criteria were anyone who 1) had other musculoskeletal or neurological disorders, 2) refused to wear the brace, 3) was being weaned from treatment, or 4) was a surgical candidate. Twelve of eighteen subjects have completed their brace treatment. Loads were measured one sample per minute. These twelve subjects used the systems from 3 to 14 days (9.4 ± 4.9 days). All subjects reported that the time they wore their braces was not influenced by wearing the monitor.

Outcome measures: The quality of the brace wear was assessed by how often the brace was worn with zero force (i.e., not worn), below 80%, between 80 to 120%, and above 120% of the load level prescribed in the clinic. The quantity of brace wear was determined by how many hours per day they wore their braces. Three treatment outcomes were defined: improvement, no change, and deterioration. Improvement was defined as a reduction of the Cobb angle, compared to the pre-brace measurement, by more than 5 degrees after weaning; no change was defined as a Cobb angle change of ± 5 degrees after weaning, and deterioration was defined as a Cobb increase greater than 5 degrees after weaning.

Results: One subject had curve improvement, 7 subjects had no change and 4 subjects had curve deterioration. The improvement subject was 84% compliant and wore her brace above or in the target load range 62% of prescribed time. No change subjects were 70 ± 12.5% compliant and wore their braces above or in the target load range 40 ± 24% of prescribed time. Deterioration subjects were 64 ± 10% compliant and wore their braces above or in the target load range only 26 ± 9% of prescribed time.

Conclusions: It appears that tightening the straps to the prescribed level and wearing the brace as much as the prescribed time is important for successful brace treatment. Simply wearing a brace is not enough; it has to be worn tightly and often.

Introduction: Braces are the most generally accepted form of non surgical treatment for adolescent idiopathic scoliosis (AIS). Despite decades of usage controversy still exists regarding the efficacy of this treatment. We believe this controversy continues in part because there are few studies describing the mechanical effect of bracing and linking mechanically effective bracing to changes in the natural history of AIS. If braces are effective, is it because they apply significant mechanical support to a collapsing spine or are they effective for other reasons? A first step towards answering this question is to document the mechanical action of braces during activities of daily living. This would enable researchers to examine the effect of mechanical support on progression of the scoliosis. The objective of this study was to determine the temporal pattern of forces exerted by the pressure pad in Boston braces prescribed for the treatment of AIS.

Methods and results: A force transducer and a programmable data logger were designed to measure loads exerted by the pressure pad over extended periods of time. The loads were recorded at one minute intervals. Braces were adjusted to a prescribed load level and the patients were asked to set the brace tightness to match this target any time the brace was donned. Brace wear data were stratified into: not worn, worn at less than 80% of target, 80–120% of target and greater than 120% of target. Bracing was considered mechanically effective if the load was at least 80% of the prescribed level. Patients were aware of the study and consented to participate.

Thirteen patients were followed from 1 to 16 days, average was 9±5 days. Nine patients were asked to wear their braces 23 hours per day, two for 20 and two for 16 hours per day. Braces were not worn 34±27% of the time logged. When they were worn, patients adjusted the tightness of the brace such that it was < 80% of the target 29±20% of the time, within 20% of target 19±19% and over 120% of target 18±13% of the time. Patients wore their braces at or above the target levels 33% of the time logged or 8 hours in a typical day. Subjects had no difficulties using the data logger and none complained that it interfered with brace wear. Reviewing individual histories suggested that subjects did not alter their brace wear pattern because of the data logger.

Conclusion: The mechanical effectiveness of the brace varies considerably over the normal course of wear but seldom does it provide the support intended. While patients wear their braces for about 16 hours per day, it is mechanically effective for 8 hours only.

Introduction: Trunk asymmetry has been acknowledged as an important aspect of scoliosis that is difficult to treat. Recent innovations in the surgical management of idiopathic scoliosis have attempted to improve trunk symmetry as well as spine curvature. But there have been few reports in the literature describing the effectiveness of these procedures on trunk alignment. The objective of this study was to determine the long-term changes in spine and trunk alignment after surgery for scoliosis.

Methods and Results: 38 subjects were identified as candidates for this study. Fifteen were lost to follow-up. Of the remaining 23 subjects, 20 (15 female, 5 male; age at surgery 16±5 years) agreed to participate and had posterior-anterior radiographs and surface topography prior to derotational surgery, within six months of surgery, at two years post-operatively and 5-10 years after surgery. Three subjects had anterior instrumentation and 17 had posterior instrumentation. Cobb angles, surface trunk rotations, and cosmetic scores were measured at each visit. A questionnaire assessed back appearance and pain at the 5–10 year follow-up and the results compared to a group who had recently undergone surgery. A paired two tailed Student’s t-test with p=0.01 was used to compare the deformity between visits.

The Cobb angle and cosmetic score improved after surgery; the initial Cobb angle improved to 35±11° (42%). Trunk rotation change was insignificant (p=0.25).

Between the two and seven year reviews, the Cobb angle had significantly increased while the cosmetic score (p=0.07) and surface trunk rotation (p=0.10) were unchanged. The mean back appearance and pain scores were 4.3 for both compared to 4.2 and 4.0 for the control group where 1 is worst and 6 is best.

Imperfect surgical correction of spinal curvature leads to continued changes to spine alignment as well as to cosmesis and trunk alignment, although the increases were not all statistically significant. Responses to the patient questionnaire suggest that these changes are not clinically significant.

Conclusion: Surgery significantly improves trunk symmetry but not trunk rotation. There is mild deterioration of the deformities associated with scoliosis after surgery but these changes do not appear to be clinically significant.