If your child has been diagnosed with adolescent idiopathic scoliosis, it is likely that your orthopedic specialist will, at some point, prescribe a brace for your child if the scoliosis reaches 20–25 degrees.
The most common scoliosis brace prescribed in the United States is the Boston Brace, which is but one of several braces commonly referred to as a TLSO (thoraco-lumbar-sacral-orthosis).
An Overview of the Boston Brace
The Boston Brace was invented in the 1970s and essentially replaced the Milwaukee Brace, often considered to be too aggressive, uncomfortable, and difficult for children to tolerate. The Boston Brace was the first orthosis made from hard plastic, a polypropylene high-density mold which also contained no metal. It was considered an improvement due to its light weight and improved comfort.
Despite the results of the TLSO version being controversial and potentially inferior to its predecessor (the Milwaukee Brace), the fact that kids were more likely to comply and attempt wearing it, the Milwaukee Brace took a backseat and is now considered obsolete.
The current version of this TLSO brace is now referred to as the Boston Brace 3D. Scoliosis is a three-dimensional deformity of the spine and therefore taking on a more three-dimensional approach seemingly makes sense.
The brace is custom fit using a laser scan of the patient’s body — along with x-rays — to optimize the corrective response when wearing it. Typically, an in-brace x-ray is taken to measure the performance and overall effect the patient has when the brace is fully secured at maximum tension. Research data suggests that a rigid spinal orthosis, when used to prevent growth-related curve progression, requires a minimum of 50% in-brace correction. Unfortunately, due to multiple factors — such as the orthotist’s scoliosis experience (clinician who makes the brace), or the orthopedic surgeon’s confidence in bracing — bracing outcomes have been mixed.
Boston Brace International, the company that makes the Boston Brace, also has adopted a common functional stance originally presented by European brace pioneers like Cheneau, who claimed that allowing open space zones for rotational correction delivers superior outcomes. Boston Brace 3D refers to this mechanism as shift/push.
There are multiple disadvantages to using bracing-only as a therapy option, including the high rate of noncompliance (primarily due to interference with school and sports-related activities), the potential impact on respiratory function, the psychological impact of brace wearing during social/school times, and the inability of the Boston Brace to treat certain curve patterns effectively. The Boston brace is chiefly recommended for scoliosis curve types that have an apical (center of curve) vertebra lower than T8, which is commonly referred to as a thoracolumbar or lumbar scoliosis type (see a list of scoliosis locations and curvature types). Unfortunately, only 20% of idiopathic scoliosis curvatures, especially in adolescent cases, fall into this category of curve type. More than 70% of kids diagnosed with idiopathic scoliosis have a thoracic type curve, as well as an additional thoracolumbar or lumbar curve (double or ‘S’ curve), for which the Boston Brace is not recommended. Therefore, a significant group of children wearing a Boston Brace may not see any benefit for their respective curve pattern, even if they are fully compliant with their prescribed wear time.
Finally, bracing itself does not address the underlying or associated non-spinal scoliosis symptoms, such as neurotransmitter imbalances, hormone metabolism and genetic variants, and bone density differences. Since it is possible that these compounding factors may be what trigger the curve to increase, failing to address them may invariably sabotage any physical intervention treatment. However, there are times, as you will read below, where combining appropriate bracing with a comprehensive management approach like ScoliSMART may create a positive synergistic effect in certain specific cases.
When Was ScoliSMART First Used to Treat Scoliosis?
Spinal rehabilitation techniques have been used extensively for postural awareness and postural rehabilitation training for over a century; however, many of the exercises were not originally developed for scoliosis specifically. ScoliSMART exercise methods and devices have been used in postural training and rehabilitation since the early 1990s. In 2011, the Scoliosis Activity Suit was developed. Shortly thereafter, information about neurotransmitter disruptions, hormone imbalances, and genetic variations were identified in scoliosis patients. The ScoliSMART management system immediately incorporated all of this new information about these non-spinal scoliosis symptoms — along with a “Scoliosis Activity Suit” — into a comprehensive management strategy.
ScoliSMART has continuously made efforts to advance its management strategies as new published evidence becomes available. Some of these advancements have been in their rehabilitative exercise methods, collectively referred to as “reflex response” re-training. Other areas include identifying genetic variants in idiopathic scoliosis, and taking proactive functional medical approaches to minimizing their impact on curve progression.
The ScoliSMART management system works primarily by training the areas of the brain that are responsible for spinal and postural muscle control. Posture control is essentially the same thing as muscle or postural memory. In the case of scoliosis, the posture memory is abnormal. Therefore, exercises need to be selected that can help to change the posture memory back to normal. Unfortunately, voluntary exercises, such as intentionally sitting up or standing up straighter, or pulling your shoulder blades back, do not impact posture memory. Posture memory has to be trained automatically, in a way that teaches the brain how to sit and stand straighter without consciously doing it.
Not all exercises can accomplish this task. This is why the ScoliSMART exercises are referred to as reflexive response training. Any exercise or task designed to change muscle memory must be performed a minimum of 400–500 repetitions in order to make a lasting muscle memory change (think of retraining a golf swing, or shooting a free throw, or any repetitive task). Changing the posture memory serves to either prevent growth-related worsening of the scoliosis, or improve scoliosis measurements when patients are not in a growth cycle.
What Types of Scoliosis Respond Best to ScoliSMART?
Published peer-reviewed literature has shown that nearly all types of idiopathic scoliosis respond positively to ScoliSMART treatment. Single primary curves tend to respond the best compared to cases that have two or more major curves. Unlike the Boston Brace, children with thoracic curves centered above T8 do respond well to this methodology, whereas they often get worse despite wearing the Boston Brace.
The ScoliSMART management approach can also help many cases of neuromuscular scoliosis and syndromic scoliosis. Although less information is known about these types of scoliosis, and fewer treatment options available overall, ScoliSMART works tirelessly to advance the treatment options available for these types of scoliosis. Whether it is a child with scoliosis due to cerebral palsy, or a child with Ehlers-Danlos syndrome, we can develop comprehensive management strategies to achieve the best non-surgical outcome possible.
Can You Combine a Boston Brace With ScoliSMART?
Yes, in specific cases the combination of the two is warranted.
In cases where there is distinct overlapping spinal abnormalities (e.g. spina bifida, hemivertebra, facet tropism, etc.), or in cases where there is demonstrable joint hyperflexibility (such as Ehlers-Danlos syndrome), combining these approaches is logical.
In idiopathic scoliosis, there are times when a young child (age 3–10) diagnosed with a curve above 30 degrees, known as juvenile idiopathic scoliosis, may need a combined approach to best decrease the risk of progression to surgical threshold (above 50 degrees).
Determining a Course of Treatment
Scoliosis takes many different forms, and understanding the differences is important for determining the proper course of treatment.
ScoliSMART Clinics provides the first scoliosis treatment approach that uses nutritional support principles in combination with both static and dynamic Auto Response Training equipment. Recent clinical studies have shown that certain neurotransmitter (brain chemical) imbalances are commonly found in scoliosis patients. These neurotransmitters are directly related to your spine’s reflex control mechanism which affects your spine’s alignment.
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