THE CHICAGO INSERT

Abstract

Scoliosis is a complication of wheelchair confinement in Duchenne muscular dystro­ phy. 4 Such curves are rapidly progressive and are convex toward the side of the domi­ nant hand because the patient usually leans toward the nondominant side to support the dominant arm. 3 A variety of external spinal containment systems have been described which retard the rate of scoliotic progression by maintaining the spine erect. Wilkins and Gibson, studying 62 wheelchair-confined Duchenne dystrophics, noted that al though many developed marked scoliosis and kypho­ sis, those with hyperextended spines and rig­ id paraspinal contractures had comparatively little lateral curvature. 5 Locking of vertebral facets in exaggerated lordosis apparently in­ hibits the development of scoliosis. Wilkins and Gibson recommend orthotic manage­ ment of wheelchair-confined patients to keep the pelvis level and the spine extended. This can be accomplished with a firm wheelchair seat and either circumferential or three-point torso support, preferably fabricated from orthoplast or Pelite-lined polypropylene or polyethylene. Alternatively, a spinal con­ tainment orthosis in the form of a modified wheelchair seat may be used. 2 This method features a fiberglass shell, lined with customcarved polyurethane foam upholstered with a modified urethane foam and a tricot double-knit covering. The patient's pelvis is snugly fitted and his thoracolumbar junction extended. The lumbar lordosis thus created is bolstered by the backrest, which also incor­ porates lateral flanges to support the sides of the chest. To further encourage lumbar ex­ tension, the backrest is inclined backward 15 degrees. Although offering a viable option in the prevention of scoliosis in wheelchairconfined Duchenne dystrophies, cost and availability of this system limit its wide ap­ plication.