Very short-term effect of brace wearing on gait in adolescent idiopathic scoliosis girls

Abstract

Adolescent idiopathic scoliotic (AIS) deformity induces excessive oxygen consumption correlated to a bilateral increase of lumbo-pelvic muscles timing activity (EMG) during gait. Wearing a brace, the usual treatment for AIS, by supporting the spine and the pelvis, would generate lumbo-pelvic muscular relaxation and consequently reduce excessive oxygen consumption. The purpose of this study was to evaluate the short-term effect of bracing on gait biomechanics in scoliotic spine when compared with normal braced spine. Thirteen healthy volunteers were compared to 13 AIS girls. In both samples, gait analysis was assessed using a three-dimensional motion analysis, including synchronous kinematic, electromyographic, mechanical and energy measurements, first without brace, then wearing a brace. For scoliotic patients, comparison of in-brace and out-brace situations revealed a significant decrease of frontal pelvis (p < 0.001), hip (p < 0.001) and shoulder (p = 0.004) motion in brace associated with a significant reduction of pelvis rotation (p = 0.003). However, the brace did not change significantly the lumbo-pelvic muscle activity duration (EMG) or the mechanical and energetic parameters. Transversal pelvis motion was reduced by 39% (p = 0.04), frontal hip and shoulder motions by 23% (p = 0.004) and 30% (p = 0.01) respectively, and energy cost of walking remained increased by 37% in braced AIS girls relatively to braced healthy subjects. Mechanical and electromyographic variables were not significantly different between the two braced populations during gait except for the gluteus medius muscle that showed bilaterally an increase of duration of electrical activity in healthy subjects and contrarily a decrease in AIS patients (healthy: -3.5 ± 9.6% of gait cycle vs. scoliotic: 3.7 ± 7.7% of gait cycle; p = 0.04). Bracing changed neither the oxygen consumption nor the timing of the lumbo-pelvic muscles activity in both groups during gait. However, in brace the timing activity of bilateral gluteus medius muscles tended to decrease in AIS patients and increase in healthy subjects. Moreover, braced AIS patients had more restricted frontal hips and shoulder motion as well as pelvis rotation than braced healthy subjects.