Effect Of Bracing For Scoliosis In Improving Gait Mechanics

Abstract

Patients with scoliosis demonstrate altered gait due to changes in global postural control strategies caused by pain and the spinal deformity. Bracing has been found to reduce pain and increase trunk support in adult degenerative scoliosis (ADS) patients.However, only anecdotal evidence of their efficacy is available in improving gait and posture control mechanics. PURPOSE: Investigate the impact of scoliosis bracing on lower extremity kinematics and effectiveness in gait rehabilitation. METHODS: 15 patients with ADS (cobb angle >25°; age:73.9±2.9yr; weight:66.6±16.2kg) were recruited using the adult deformity SRS-Schwab system. Oswestry Disability Index (ODI) scores were recorded and patients performed 3m timed up & go, 6 minute walk tests and over-ground 10m walk trials at a self-selected speed at initial evaluation (pre), 45min post fitting (post45) with Peak™ scoliosis brace and after 8 weeks of bracing (post8w). Gait variables were calculated for 5 walking trials and compared between the 3 time points (pre, post45 and post8w) using RM-MANOVA (p< .05). RESULTS: Patients walked faster on 3m timed test (pre: 12.5s; post8w: 10.0s) and covered greater distances in the 6 min walk test (p= .01; 61.2m). For kinematic variables, significant differences were observed for swing time of left leg (p =.013; pre:0.40s; post45:0.42s; post8w:0.39s), step length on right (p=.019; pre:0.52m; post45:0.57m; post8w:0.56m), right ankle peak dorsiflexion (p =.049; pre:8.7°; post45:7.9°; post8w:11.7°), both knee peak flexion and extension angles (p <.001- .048), and right hip (p =.002; pre:37.2°; post45:39.2°; post8w:31.6°) and knee ROM (p =.018; pre:29.8° ; post45:31.6°; post8w:37.7°). ODI pain scores (p=.06) showed tendency for statistical significance. CONCLUSIONS: Patients with scoliosis demonstrated few immediate and long-term benefits for improving pain and altered gait mechanics. Faster walking speeds, greater walking distances, longer step lengths and greater ROM as observed are indicators of improved gait and dynamic balance. Bracing has immediate effects on improving ambulation and for any neuromuscular adaptation, brace might need to be worn for at least 8 weeks.