Bracing plays the role of holding the spine in the correct posture. The brace corrects the curve without the patient needing to think about it.
Dr. Hey was trained on the Boston brace; which, generally maintains the curve. One day, Dr. Hey went to a conference and heard about the Rigo Cheneau brace.
The Rigo Cheneau opens in the front, unlike the Boston brace that opens in the back which is difficult for younger patients.
The Rigo Cheneau can reduce the curve rather than only maintain it. The dynamic nature of the brace causes the patient’s back to shift into the correct position every time. The brace constantly applies force addressing the rotation all day long.
KC Wheeler, Hey Clinic orthotist, said patients preferred the Rigo Cheneau because of its lighter weight, lower profile and less padding for heat retention. Patients also get to pick the pattern of their brace.
“[The brace will] help keep my spine stable, [but] it wont straighten it by itself,” Michael Steenbergh, a current bracing patient, said.
When Bracing Becomes an Option
Once an adolescent’s curve is over 20 degrees, bracing becomes a consideration.
Generally, bracing patients are pre-adolescent from 8-12 years-old when they start bracing. The Hey Clinic does brace patients with significant curves as young as 5, but only so the child could hold off on surgery and do one operation rather than multiple when they are fully grown.
Usually bracing last for 2-4 years, but a patient could need a new brace each year.
Considering how rapidly scoliosis curves can progress, early screening is important for earlier intervention.
“[We want to] reduce the curve rather than just maintain it,” KC said.
The Importance of Brace Compliance
Bracing’s effectiveness depends on patient compliance. According to the Weinstein study, there is a direct relationship between correction after 18 hours of bracing a day. 18-23 hours is the recommended number of hours patients should spend in their brace each day.
“I wear it to school at night as much as I can,” Daisy, bracing patient, said. “The only time I take it off is to shower, for sports and for PT.”
KC said that patients think they are wearing it more or less than they actually are. If the patient prefers, KC puts a sensor into the brace that connects to an app so that they can see the patient’s wear time. By knowing the exact amount of hours, it makes it easier for KC to make adjustments to create better results.
KC suggests bringing the brace on trips to the beach as well, even if it’s only worn in the afternoon or evening because once a patient gets used to being out of the brace it becomes more difficult to get back into it again.
“You really stop thinking of it and forget it’s there [which] makes it easier,” Daisy said.
At a patient’s 3, 6 and 9 month appointment they go without the brace for 24 hours to track the curve. KC said many comment on missing or feeling weird without the brace.
“[We are] trying to straighten [my curve] as much as we can so we can avoid surgery,” Michael said. “Either way I’m going to be a lot stronger.”
The Process of Bracing
The process of bracing starts with the patient coming in for measurements. KC takes pictures, a scan with her iPad and uses the x-rays that were taken at the Hey Clinic.
After a couple of weeks, the patient returns for a 3-hour fitting. The patient takes home their brace after that day and start the process of weaning into the brace until they are up to 18-23 hours of wear time. The stability of their curve is monitored and the patient can come out of the brace when they are fully skeletally grown.
KC wore the brace for two weeks in order to experience the weaning in process. KC felt surprised at how few people noticed her wearing the brace. She said the biggest challenge is going to the bathroom. She decided to take off the brace, but said she could also loosen the straps.
“[I suggest to] do a practice run at home,” KC said. “It eliminates the stress of not knowing what to do.”
The Goal of Bracing
The goal is for patient’s curves to be under 30 degrees because that is the number the Weinstein study reports that if a patient is below that then they are less likely to progress as an adult.
“Even though my body is fighting for it, I have to do some stuff with it,” Michael said.
Schroth physical therapy can prime and pre-correct the curve as it builds strength. After physical therapy, patients can keep their elongated position by putting their brace on as they lay in the corrected position on the ground.
“It made me feel like we’re actually doing something to stop [the progression],” Daisy said.
KC emphasises using the window of opportunity to reduce the curve and make life better in the future.
“People wear braces on their teeth,” KC said. “Everyone has their own challenges.”
