Thoracolumbosacral Orthosis Research Articles

150P Patient, caregiver and healthcare professionals’ perspective on spinal bracing in early onset spinal muscular atrophy in the UK: a national survey

150P Patient, caregiver and healthcare professionals’ perspective on spinal bracing in early onset spinal muscular atrophy in the UK: a national survey

Efficacy of a Modified Thoracolumbosacral Orthosis in Adult Idiopathic Scoliosis: A Case Study

Background and Objectives: Adult patients with late-onset idiopathic scoliosis (LIS) presents with cosmetic concerns, back pain, muscle fatigue and the psychological effects of living with a visible deformity. The purpose of this study was to evaluate the effectiveness of modified thoracolumbosacral orthosis on adult female patient with LIS who had been suffering from chronic back pain still refusing for spinal surgery. Case Report: A 27-year-old female patient clinically diagnosed with late onset left LIS with apex at T8 level reported to our institute for spinal rehabilitation with orthotic management. She was completely examined for radiographic findings and treated with physiotherapy and modified thoracolumbosacral orthosis with anterior corset and turn buckle device for gradual correction of deformity and spinal alignment. At a 12-month follow-up, the patient no longer suffered from daily low back pain (LBP) (with heavy lifting only) and was fully active. Additionally, her post intervention radiographs showed an improvement in left thoracic scoliosis and coronal balance. Conclusion: This study suggests that the new modified custom-made design of spinal orthosis may be effective in the management of adult LIS and it represents an acceptable alternative to surgery for patients who refused for surgery.

Real-world multidisciplinary outcomes of onasemnogene abeparvovec monotherapy in patients with spinal muscular atrophy type 1: experience of the French cohort in the first three years of treatment

BackgroundSpinal muscular atrophy type 1 (SMA1) is the most severe and early form of SMA, a genetic disease with motor neuron degeneration. Onasemnogene abeparvovec gene transfer therapy (GT) has changed the natural history of SMA1, but real-world data are scarce.MethodsA French national expert committee identified 95 newly diagnosed treatment-naive SMA1 patients between June 2019 and June 2022. We prospectively report on children treated with GT as the first and only therapy who had more than one-year of follow-up.ResultsForty-six SMA1 patients received GT. Twelve patients received other treatments. Patients with respiratory insufficiency were oriented toward palliative care after discussion with families. Twenty-nine of the treated patients with more than 12 months of follow-up were included in the follow-up analysis. Among them, 17 had 24 months of follow-up. The mean age at treatment was 7.5 (2.1–12.5) months. Twenty-two patients had two SMN2 copies, and seven had three copies. One infant died in the month following GT due to severe thrombotic microangiopathy, and another died due to respiratory distress. Among the 17 patients with 24 months of follow-up, 90% required spinal bracing (15/17), three patients required nocturnal noninvasive ventilation, and two needed gastrostomy. Concerning motor milestones at the 24-month follow-up, all patients held their head, 15/17 sat for 30 s unassisted, and 12/17 stood with aid. Motor scores (CHOPINTEND and HINE-2) and thoracic circumference significantly improved in all patients.ConclusionsOur study shows favorable motor outcomes and preserved respiratory and feeding functions in treatment-naive SMA1 infants treated by GT as the first and only therapy before respiratory and bulbar dysfunctions occurred. Nevertheless, almost all patients developed spinal deformities.

Reliability of the Biomechanical Assessment of the Sagittal Lumbar Spine and Pelvis on Radiographs Used in Clinical Practice: A Systematic Review of the Literature.

Background: Biomechanical analysis of the sagittal alignment of the lumbar spine and pelvis on radiographs is common in clinical practices including chiropractic, physical therapy, scoliosis-related thoraco-lumbo-sacral orthosis (TLSO) management, orthopedics, and neurosurgery. Of specific interest is the assessment of pelvic morphology and the relationship between angle of pelvic incidence, sacral slope, and lumbar lordosis to pain, disability, and clinical treatment of spine conditions. The current state of the literature on the reliability of common methods quantifying these parameters on radiographs is limited. Methods: The objective of this systematic review is to identify and review the available studies on the reliability of different methods of biomechanical analysis of sagittal lumbo-pelvic parameters used in clinical practice. Our review followed the recommendations of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The design of this systematic review was registered with PROSPERO (CRD42023379873). Results: The search strategy yielded a total of 2387 articles. A total of 1539 articles were screened after deduplication and exclusion by automation tools, leaving 473 full-text articles that were retrieved. After exclusion, 64 articles met the inclusion criteria. The preponderance of the evidence showed good to excellent reliability for biomechanical assessment of sagittal lumbo-pelvic spine alignment. Conclusions: The results of this systematic review of the literature show that sagittal radiographic analysis of spinal biomechanics and alignment of the human lumbo-pelvic spine is a reliable tool for aiding diagnosis and management in clinical settings.

A4 Thoracolumbar Fracture Class Is Associated With a Greater Degree of Vertebral Height Loss in Conservatively Managed Patients.

Thoracolumbar (TL) junction fractures are common, often resulting from high-energy trauma or osteoporosis, and may lead to neurological deficits, deformities, or chronic pain. Treatment decisions for neurologically intact patients remain controversial, with nonsurgical management often favored. The AO classification system has been used to characterize thoracolumbar fractures using fracture morphology and clinical factors affecting clinical decision-making for fracture management. This study aims to assess the radiographic outcomes of utilizing a thoracolumbosacral orthosis (TLSO) brace in neurologically intact patients with TL fractures based on the AO classification system. A retrospective analysis of 43 patients was conducted using data from the VCU Spine Database on patients with TL fractures managed conservatively with a TLSO brace from 2010 to 2019. Demographic variables and radiographic measurements of anterior height loss were analyzed and stratified by AO fracture class. Significant differences were observed in anterior height loss between AO fracture classes, with A4 fractures showing significantly greater anterior height loss at initial presentation (27.6 + 4.8%) compared to A1/A2 (16.1 + 2.2%; p=0.049). At follow up, A4 fractures had a significantly greater anterior height loss (40.2 + 6.6%) than both the A1/A2 (22.4 + 2.9%; p=0.029) and A3 fracture classes (20.5 + 3.6; p=0.020). The study highlights significant differences in anterior height loss among AO fracture classes, suggesting varying degrees of severity and potential implications for clinical management. While conservative treatment with TLSO braces may provide pain relief, surgical intervention may offer better structural recovery, especially in more severe fractures. Conservative management of TL fractures with TLSO braces may result in greater anterior height loss, particularly in A4 fractures, emphasizing the need for individualized treatment decisions. Further research, including prospective studies, is warranted to validate these findings and guide clinical practice effectively.

Rehabilitation Strategies for Patients With Spinal Muscular Atrophy in the Era of Disease-Modifying Therapy.

The impact of disease-modifying therapy ranges from cure to no impact with a wide range of intermediates. In cases where the intermediate group reaches a plateau after the acquisition of some muscle strength, it is necessary to set a functional level appropriate for increased motor power and establish a long-term exercise plan to maintain it. As the disease status stabilizes and the life span increases, early nonsurgical interventions are required, such as using a standing frame to prevent joint contracture, applying a spinal brace at the early stage of scoliosis, and maintaining sitting postures that exaggerate lumbar lordosis. In cases where scoliosis and hip displacement occur and progress even after conservative managements are implemented, early referral to surgery should be considered. Oromotor activity and swallowing function are influenced not only by the effects of disease-modifying drugs, but also by post-birth experience and training. Therefore, although the feeding tube cannot be removed, it is necessary to make efforts to simulate the infant feeding development while maintaining partial oral feeding. Since the application period of non-invasive ventilators has increased, it has become more important to prevent long-term complications such as facial abrasion, skin allergy, orthodontic deformities, and maxillary flattening caused by the interface. Dual ventilator mode or interface can also be utilized.

The effect of thoraco-lumbo-sacral orthosis wear time and clinical risk factors on curve progression for individuals with adolescent idiopathic scoliosis

BACKGROUND CONTEXTThe effectiveness of bracing with a thoraco-lumbo-sacral orthosis (TLSO) for adolescent idiopathic scoliosis (AIS) has been studied extensively, with a growing body of evidence supporting TLSO use. In this study we examine the effect of wear time and other important causal factors affecting curve progression and develop a risk model that can be applied to individual patients and is based on important casual factors. PURPOSEUnderstand the impact of TLSO wear time and other risk factors in order to guide optimal treatment. STUDY DESIGN/SETTINGProspective, multi-center, cohort study Patient SampleIndividuals with a diagnosis of AIS, age of 10 to 16 years, primary Cobb angle of 20 to 45 degrees, Risser 0 to 2, <1 year post menarche if female, who were to be treated with a TLSO OUTCOME MEASURES(1) Rate of primary curve progression, (2) surgery recommendation during TLSO treatment METHODSWear time was monitored with thermochrons. Participants were followed until the end of growth. We examined the causal effects of wear time and baseline skeletal maturity as measured by triradiate cartilage (TRC) status, Cobb angle, and age. We then fit an outcome prediction model (logistic regression) based on important casual factors. RESULTSOur final cohort consisted of 145 individuals (baseline age 12.1–13.4 years). Wear time was an important cause of response to treatment, including an interaction with TRC status. Baseline Cobb angle and age were also meaningful causes of response. The prediction model was accurate (79%) and had good specificity (81%) and moderate sensitivity (68%) and an area under the receiver operating characteristic curve (AUC) of 0.81. Additionally, we were able to independently confirm previous estimates of treatment efficacy, with an odds ratio around 2.0. CONCLUSIONSOur study showed the explicit causal effects of wear time, and baseline skeletal maturity, Cobb angle and age. The risk model we developed can be used for counseling patients and their families regarding TLSO wear and expectations for outcome.

IMMEDIATE EFFECT OF CUSTOM-MADE BOSTON-TYPE THORACO-LUMBO-SACRAL ORTHOSIS ON BALANCE AND POSTURAL STABILITY IN ADOLESCENT IDIOPATHIC SCOLIOSIS

Adolescent idiopathic scoliosis (AIS) can impair postural stability and balance functions. Boston brace systems with varying external corrective force strategies are used as one of the common conservative treatments in AIS. Although multiple studies have found that various orthotic therapies enhance curve advancement, the effects of spinal bracing on postural equilibrium and stability remain unknown. The primary objective of this study was to examine the effect of the immediate use of custom-made Boston-type thoraco-lumbo-sacral orthosis (TLSO) on balance and postural stability in AIS. Postural balance using the center of pressure (CoP) measures was measured by the HUMACⓇ Balance &amp; Tilt System (CSMi, Stoughton, MA). The line laser tool (Bosch, GLL 3 X P, Stuttgart, Germany) was used for measuring the decompensation distance for postural evaluation. The balance parameters such as stability score (%), path length (cm), average velocity (cm/s), and compensation–decompensation for posture were evaluated and compared between brace-on and brace-off conditions. Improvement of standing posture indicates spinal symmetry and cosmesis whereas enhancement of static balance was statistically nonsignificant ([Formula: see text] &gt; 0.05). Although the mean stability score, path length and average velocity of CoP in braced condition (91.4 ± 4.57, 115.62 ± 22.34 cm and 1.05 ± 0.12 cm/s) was found to be improved than unbraced condition (90.5 ± 5.09, 121.46 ± 35.52 cm and 1.11 ± 0.24 cm/s), the results were nonsignificant ([Formula: see text] = 0.078, 0.425 and 0.263). The scoliotic compensation was improved in the braced condition (0.64 ± 0.60 cm) compared to brace-off condition (1.74 ± 0.61 cm) showing improved posture ([Formula: see text] = 0.00013). Wearing the custom-made Boston-type TLSO showed positive effects on static posture and mean balance parameters. In future studies, the long-term effectiveness of this brace should be examined in patients with different spinal curve patterns and degrees of scoliosis.

Patient-specific 3D-printed Brace for Adolescent Idiopathic Scoliosis: A Prospective Cohort Study

To evaluate the efficacy, safety of patient-tailored 3D printed brace in the treatment of adolescent idiopathic scoliosis (AIS), and to compare the health-related quality of life (HRQoL) of patients treated with two different types of brace. From September 2017 to August 2020, 103 AIS patients requiring non-operative management were prospectively recruited in this study. All patients were followed up every 6 months, clinical and radiological examination were assessed at each follow-up time. Full-length anteroposterior X-ray of the spine in the standing position was performed obtained. At the last follow-up, each patient completed a standardized HRQoL questionnaire. Compliance is defined as that the patient insists on wearing the brace for ≥ 23h every day (full-time wearing) and follow-up every 6 months until bone maturity.The rate of major curve Cobb progression was defined that maximum Cobb Angle of major curve greater than 6° compared with that at the initial diagnosis, or aggravated to more than 45° so that orthopedic surgery was recommended during treatment, which was defined as the rate of conversion to surgery. The effects of these two types of braces on the rate of major curve Cobb progression and HRQoL were analyzed by independent sample t-test ad Chi-square test. The thickness was 4 mm for thoracolumbosacral orthosis (TLSO) and 3 mm for 3D-printed brace (3DPB). In addition, compared with the material used in TLSO, the weight (600-800 grams) of the 3DPB materials with the same area is reduced by about 25-30%. 55 patients (49.1%) and 48 patients (33.1%) were respectively included in the 3DPB cohort and the TLSO cohort.The maximum Cobb angle of major curve in the 3DPB cohort was significantly lower than those in the TLSO cohort at 6 months, 12 months and the last follow-up (p < 0.01). The thoracic kyphosis (TK) and lumbar lordosis (LL) of the two cohorts at the last follow-up were lower than those before brace treatment, in addition, there was a significant difference in TK (p = 0.001) and LL (p = 0.004) between the two cohorts at the follow-up. The scores of physical function, pain, self-image, mental health and treatment satisfaction in the Chinese version of SRS-22 in the 3DPB cohort were higher than those in the TLSO cohort (p < 0.01 and p < 0.05, respectively). The scores of the 3DPB cohort were significantly higher than those of the TLSO group in the four dimensions (p = 0.008, 0.013, 0.015, and 0.002, respectively) of the EuroQol-5D health description system except for mobility, and the overall health status of EuroQol-5D was higher for the 3DPB cohort (p < 0.001). At the last follow-up, One patient in the 3DPB cohort and ten patients in the TLSO cohort had major curve Cobb progression of greater than 6°, and the rate of major curve Cobb progression in 3DPB cohort was significantly lower than that in the TLSO cohort (OR 14.2, 95% CI 1.7∼115.8, p < 0.01). One patient in the 3DPB and seven patients in the TLSO cohorts received subsequent surgery or was recommended for surgery, and the rate of conversion to surgery was significantly lower than in the 3DPB cohort (OR 9.2, 95% CI 1.1∼77.9, p < 0.05). Patient-tailored 3D-printed brace is lighter, thinner, and more comfortable than conventional braces in the treatment of AIS. It can substantially improve the HRQoL of patients and can significantly reduce the progression of major curve Cobb progression and rate of conversion of surgery.

Immediate vs Gradual Brace Weaning Protocols in Adolescent Idiopathic Scoliosis

Lack of evidence and consensus for brace weaning protocol in adolescent idiopathic scoliosis (AIS) results in clinicians prescribing gradual weaning in the hope of avoiding curve deterioration after weaning. However, gradual weaning contributes to prolonged brace wear, which can affect spinal stiffness and health-related quality of life (HRQoL). To determine whether gradual weaning results in better curve magnitude and truncal balance maintenance after brace weaning vs immediate brace removal for patients with AIS. This was an open-labeled randomized clinical trial commenced in April 2017 with 24-month follow-up completed in January 2023. Outcome assessors were masked to weaning protocol assigned. The study took place at a territory-wide tertiary scoliosis clinic serving the largest number of referrals in the local population. Patients with AIS ready to wean off of brace wear were eligible (402 were screened; 33 were excluded [15 for <18 hours/day of brace-wear compliance before weaning, 11 were treated with Milwaukee brace, and 7 declined to participate]; and 369 were included), and those who were treated with a custom molded thoracolumbosacral orthosis and had reached skeletal maturity were consecutively recruited. Patients were randomized to gradual weaning protocol (n = 176) with an additional 6 months of nighttime wear before completely stopping or immediate weaning protocol (n = 193) with immediate brace removal at recruitment. Changes in major curve Cobb angle and truncal balance from the time of weaning to 6-month, 12-month, and 24-month follow-up. HRQoL was also assessed using the refined Scoliosis Research Society 22-item and EuroQol 5-dimension questionnaires. A total of 369 patients (mean [SD] age, 14.9 [1.1] years; 304 [83.4%] girls) were randomized with 284 (77.0%) completing 24-month longitudinal follow-up. Immediate and gradual weaning groups had no significant differences in change of major Cobb angle at postweaning 6-month (difference, -0.6°; 95% CI, -1.4 to 0.2; P = .17), 12-month (difference, -0.3°; 95% CI, -1.2 to 0.6; P = .47), and 24-month (difference, -0.3°; 95% CI, -1.2 to 0.7; P = .60) follow-up. The number of curve progression, nonprogression, and rebound cases were comparable (χ22 = 2.123; P = .35). Postweaning changes in truncal balance and HRQoL demonstrated no significant differences between groups. Gradual weaning did not demonstrate superiority to immediate weaning with predefined criteria of Cobb angle and truncal balance maintenance and HRQoL after brace weaning. Gradual and immediate weaning achieved very similar maintenance of brace outcomes in AIS. We therefore recommend the consideration of immediate brace weaning, which aims to benefit patients with earlier time for increased exercises and activity level. ClinicalTrials.gov Identifier: NCT03329716.

Evaluation of In-Brace Coronal and Sagittal Plane Measurements Between CAD/Chêneau-Style and Traditionally Fabricated Wilmington Braces in Adolescent Idiopathic Scoliosis

ABSTRACT Introduction Traditional thoracolumbosacral orthosis fabrication involves truncal casting (traditionally fabricated [TF] Wilmington brace [WB]), whereas the newer Chêneau-style brace (computer-aided design [CAD]) involves three-dimensional truncal scanning technology. We sought to evaluate how these two brace styles affect the position of the spine in the coronal and sagittal plane. Materials and Methods Inclusion criteria included adolescent idiopathic scoliosis treated with WB or CAD Chêneau-style brace, major curve Cobb angle 20°–45°, age 10–15 years, Risser 0–3, and radiographs (prebrace and in-brace posteroanterior and lateral). Analysis included 28 CAD Chêneau-style braces and 56 WB patients. Results There was no difference between groups regarding age, sex, body mass index, major curve location, major curve degree, sagittal plane curvature, and pelvic parameters. In-brace analysis demonstrated decreased sagittal plane curvatures and increased T1 pelvic angle in both groups; both had significantly reduced major curve correction. Coronal plane major curve correction ratio of the two groups was similar (P = 0.236). In the CAD Chêneau-style brace group, the thoracolumbar junction became more kyphotic (P = 0.03). In the WB group, both coronal balance and thoracic trunk shift were leftward (P = 0.001). Both groups had a significant increase in T1 pelvic angle, but this increase was higher in the CAD Chêneau-style brace group (P = 0.045). Conclusions Both braces exert a flattening effect on the spine and positive global sagittal balance. Coronal plane major curve correction was similar for both groups. Coronal plane trunk shift and C7 coronal balance were significantly changed leftward after WB application. Kyphotic thoracolumbar transition and forward tilt of the spine (T1 pelvic angle) were significantly greater in CAD Chêneau-style brace than WB. Clinical Relevance A Chêneau-style brace fabricated with CAD/computer-aided manufacturing technology can produce a brace comparable to one fabricated by traditional methods using cast molding.

Design and development of an intelligent wearing system for adolescent spinal orthotics.

Adolescent idiopathic scoliosis is the deformity of the human spine in three-dimensional space. It is a disease with a long course and difficult to recover in a short time. Currently, spinal orthotic braces are an effective non-surgical treatment for this condition. However, existing spinal orthotic braces are still deficient. For example, existing spinal orthotics braces have no way of knowing how correct, effective, and comfortable a patient is wearing the orthotics. Based on distributed pressure monitoring technology, this paper conducts pressure acquisition and compensation research on spinal orthotics used by adolescent patients. After analyzing the principles of orthopedics and selecting monitoring points, this paper selects appropriate sensors and calibrates them. An intelligent wearable system for adolescent spinal orthotics was developed based on these findings. The experimental results show that the system can effectively monitor the process of patients wearing spinal orthotic braces. In addition, the system can compensate and visualize the pressure in real-time, so that doctors and patients can know the process and make judgments and adjustments.

Evaluating the Efficacy of Orthoses in the Conservative Treatment of Thoracolumbar Fractures: A Systematic Review.

Thoracolumbar fractures are common traumatic injuries that can be treated conservatively or by surgery, depending on the type and severity of the injury. This study aimed to determine the efficiency of various orthoses used for these fractures based on the available literature. Between 1950 and 2023, a search was conducted in some databases, including PubMed Central and MEDLINE, ISI Web of Knowledge, Cochrane-centered Register of Controlled Trial (CCTR), Embase, and Scopus. Some keywords-such as conservative treatment, orthoses, brace, and cast-were used in combination with thoracolumbar fracture, burst fracture, and compressive fracture. The quality of the studies was evaluated using the PEDro scale. Two researchers independently reviewed the studies. Based on the results of the included studies, orthosis is not necessary for stable burst and compression fractures. Based on the inclusion criteria, 20 papers were selected for the final analysis, 12 of which were on the use of spinal braces and casting (with quality between 1 and 6), 2 on the no-treatment approach, and 6 on comparing the outputs of treatment with spinal braces with no braces. Although the use of orthosis and cast is one of the conservative treatments recommended for patients with thoracolumbar fractures, it seems that for stable burst fractures and compression fractures, the use of a brace does not provide any benefits. However, the use of a brace or cast is recommended for burst fractures with more than 1 column fracture.

Comparison of the efficacy of thoracolumbosacral and lumbosacral orthosis for adolescent idiopathic scoliosis in patients with major thoracolumbar or lumbar curves: a prospective controlled study.

Thoracolumbosacral orthosis (TLSO) is the most commonly used type of brace for the conservative treatment of adolescent idiopathic scoliosis (AIS). Although lumbosacral orthosis (LSO) is designed to correct single thoracolumbar or lumbar (TL/L) curves, its effectiveness remains underexplored. This novel article aims to compare the effectiveness of LSO with TLSO in treating AIS with main TL/L curves. This prospective controlled cohort study enrolled patients with AIS with main TL/L curves and minor thoracic curves who were treated with either TLSO or LSO. Demographic and radiographic data were compared between the two groups. Treatment outcomes were also assessed. Risk factors for minor curve progression were identified, and a cut-off value was determined within the LSO group. Overall, 82 patients were recruited, including 44 in the TLSO group and 38 in the LSO group. The initial TL/L curves showed no difference between both groups. However, the baseline thoracic curves were significantly larger in the TLSO group compared to the LSO group (25.98° ± 7.47° vs. 18.71° ± 5.95°, P < 0.001). At the last follow-up, LSO demonstrated similar effectiveness to TLSO in treating TL/L curves but was less effective for thoracic curves. The initial magnitude of thoracic curves was identified as a risk factor for minor curve outcomes in the LSO group. The ROC curve analysis determined a cut-off value of 21° for thoracic curves to predict treatment outcomes. In contrast to TLSO, LSO exhibits comparable effectiveness in treating main TL/L curves, making it a viable clinical option; however, it is less effective for thoracic minor curves. The initial magnitude of the minor thoracic curves may guide the selection of the appropriate brace type for patients with AIS with main TL/L curves.

Rehabilitation for lumbar pain: A comprehensive review on addressing pain and enhancing function in both acute and chronic situations

Lower back pain (LBP) is a prevalent problem that may progress to chronic LBP, resulting in a deterioration of life quality, heightened pain levels, and diminished functionality. Given the diverse demographic affected by LBP, it is crucial to tailor rehabilitation strategies to address the distinct requirements of different patient groups and individuals. This analysis explores various methods of LBP rehabilitation, including categorized treatments and specific rehabilitation techniques, spanning from exercise and physical therapy to spinal manipulation and bracing.

Effect of traditional rehabilitation programme versus telerehabilitation in adolescents with idiopathic scoliosis during the COVID-19 pandemic: a cohort study.

Telerehabilitation has become increasingly popular since the SARS-CoV-2 (COVID-19) outbreak. However, studies are needed to understand the effects of remote delivery of spine treatment approaches. To verify and compare the effects of traditional rehabilitation programmes (in-person) and telerehabilitation (online) on the progression of scoliotic curvature in adolescents with idiopathic scoliosis during the COVID-19 pandemic, and to verify the acceptability, appropriateness, and feasibility among patients and physiotherapists regarding both treatments. This is a cohort study (prospective analysis of 2 intervention groups: telerehabilitation (online) and traditional rehabilitation (in-person). A total of 66 adolescents with idiopathic scoliosis were included. Recruitment was conducted through the Clinical Center in Scoliosis Care (January-December 2020). Participants were divided into 2 intervention groups: telerehabilitation (online) (n=33) and traditional rehabilitation programme (in-person) (n=33). Both groups also were supplied with a spinal orthopaedic brace. Scoliosis was confirmed by a spine X-ray examination (Cobb angle). Radiographic parameters measured were: Cobb angles (thoracic and lumbar). The method of Nash and Moe (thoracic and lumbar) was also evaluated based on the relationship between the vertebral pedicles and the centre of the vertebral body in the X-rays. Assessments were performed at baseline (T0) and after 6 months of the intervention protocol (T6). Patient and physiotherapist reports were evaluated on the acceptability, appropriateness, and feasibility of the interventions. Adolescents with idiopathic scoliosis showed a significant decrease in the Cobb angle (main scoliotic curvature), with a 4.9° for the traditional rehabilitation programme and 2.4° for the telerehabilitation. Thoracic and lumbar Cobb angles did not show significant changes after the intervention in both groups or between groups. Thoracic and lumbar Nash and Moe scores scores also did not show significant differences after 6 months of in-person or telerehabilitation intervention, or between groups. The intervention by telerehabilitation was acceptable, appropriate, and feasible for patients and physiotherapists. Use of the rehabilitation programme for adolescents with idiopathic scoliosis, delivered via telerehabilitation during the COVID-19 pandemic, was encouraging for future applications due to the improved effect on reducing the Cobb angle, preventing progression of scoliosis. In addition, telerehabilitation showed good acceptability among patients and physiotherapists. Traditional rehabilitation programmes (in-person) in adolescents with idiopathic scoliosis also showed a reduction in the Cobb angle.

Numerical Modeling and Nonlinear Finite Element Analysis of Conventional and 3D-Printed Spinal Braces

This study aims to describe the numerical modeling and nonlinear finite element analysis of typical spinal braces as a first step towards optimizing their topology for 3D printing. Numerical simulation was carried out in Abaqus CAE software Version 2021, utilizing a CAD (Meshmixer Version 3.5.474) scan of an actual spinal brace. Boundary conditions were defined by means of contact surfaces between the human body and the supporting pads located in the interior of the brace. The process of tightening the straps on the rear face of the brace was simulated via appropriate imposed displacements. The response is described through the deformations and developing stresses of the brace and the contact pressures in the areas of interaction with the human body. Parametric analysis indicated that increasing the cross-sectional thickness or elastic modulus of the brace material results in higher maximum von Mises stresses and lower displacements. The comparison between 3D-printed and conventional braces highlighted the potential of 3D-printing technology to achieve comparable performance with customized designs, leveraging the constitutive properties of 3D-printed material obtained from tension tests. The tension tests demonstrated that the 3D-printed material achieved higher values of modulus of elasticity compared to traditional brace materials. Finally, the topology optimization criteria to be applied for the design of spinal braces in the next step of this ongoing research are briefly described.

Rehabilitation for Marfan Syndrome

Abstract: Marfan syndrome is a spectrum of disorders caused by a heritable genetic defect of connective tissue that has an autosomal dominant mode of transmission. The defect itself has been isolated to the FBN1 gene on chromosome 15, which codes for the connective tissue protein fibrillin. Abnormalities in this protein cause a myriad of distinct clinical problems, of which the musculoskeletal, cardiac, and ocular system problems predominate. The skeleton of patients with Marfan syndrome typically displays multiple deformities. Mitral valve prolapses that requires valve replacement can occur as well. Given the variable expressivity of Marfan Syndrome, no single sign is pathognomonic; the diagnosis is made on clinical grounds on the basis of typical abnormalities. We reported a boy, 12 years old, referred from surgeon with diagnosis pectus carinatum pro brace. Chest protusion appeared since age 6, getting bigger without any complaint but cosmetic. Other complaints on feet which looked flat, sometimes ankle sore after long distance running or futsal. He was the first child and no family history had a condition like him. His hobby was playing futsal, and daily activities were independent without assistive devices. General appearance and vital signs were normal, cardiorespiratory assessment was normal, BMI on percentile 10-25, arm span to height ratio 1.09, lens subluxation of left eye, lens dislocation of right eye, poor standing balance, inadequate toe off, thoracic hyperkyphotic, positive wrist sign, true leg length discrepancy of 1 cm (left&gt;right), bilateral ankle ROM limitation, rigid flat feet suspected bilateral vertical talus, left hallux valgus, Marfan syndrome score 9, and normal echocardiography. In this patient, we gave semi rigid thoraco-lumbo-sacral orthosis (TLSO) with 3 points pressure system and rigid bar on protution area (custom molded). resistance exercise (F: 3x/week, I: moderate fatigue, Borg scale 13-15/20, T: 8-15 reps/ set, 2-3 set/ session, T: major muscle group upper and lower extremities aerobic exercise (F: 3x/week, I: moderate to vigorous, borg scale 13-15/20, T: ≥60 min/session, @5-10 min warming up and cooling down (stretching), T: sport (swimming, running, cycling). The patient was referred to a surgeon for a brace. In conclusion, this case report highlights the multidisciplinary management of patients with Marfan syndrome. Keywords: Marfan syndrome; typical abnormalities; multiple deformities

The Future is Flexible: The Impact of improved Comfort and Aesthetics on Patient Compliance in Spinal Bracing

The Future is Flexible: The Impact of improved Comfort and Aesthetics on Patient Compliance in Spinal Bracing

IoT-Based Solution for Detecting and Monitoring Upper Crossed Syndrome.

A sedentary lifestyle has caused adults to spend more than 6 h seated, which has led to inactivity and spinal issues. This context underscores the growing sedentary behavior, exemplified by extended sitting hours among adults and university students. Such inactivity triggers various health problems and spinal disorders, notably Upper Crossed Syndrome (UCS) and its association with thoracic kyphosis, which can cause severe spinal curvature and related complications. Traditional detection involves clinical assessments and corrective exercises; however, this work proposes a multi-layered system for a back brace to detect, monitor, and potentially prevent the main signs of UCS. Building and using a framework that detects and monitors signs of UCS has facilitated patient-doctor interaction, automated the detection process for improved patient-physician coordination, and helped improve patients' spines over time. The smart wearable brace includes inertial measurement unit (IMU) sensors targeting hunched-back postures. The IMU sensors capture postural readings, which are then used for classification. Multiple classifiers were used where the long short-term memory (LSTM) model had the highest accuracy of 99.3%. Using the classifier helped detect and monitor UCS over time. Integrating the wearable device with a mobile interface enables real-time data visualization and immediate feedback for users to correct and mitigate UCS-related issues.