The management and treatment of children diagnosed with adolescent idiopathic scoliosis has historically been and continues to be dictated (or at minimum heavily influenced) by the orthopedic surgeons not just in the US, but worldwide. The orthopedic actual treatment scope and specialty focuses almost exclusively on the advancement of surgical techniques and outcomes in the United States but treatment focus can vary greatly in other countries within the orthopedic specialist communities where there is specific focus on the advancement and outcomes of rigid spinal orthotics, otherwise known as scoliosis braces.
There are two distinct categories of orthopedic braces for the treatment of AIS, daytime and nighttime. Daytime braces are prescribed more often, consisting primarily of the TLSO (thoracic lumbar sacral orthosis) variety or “Boston type” brace. Daytime or full-time braces generally require a minimum application time of 16 hours per day with a minimum corrective value of 50%. Some studies have indicated that wearing a daytime brace less than 23 hours per day may increase the risk of brace failure, whereby the patient’s condition continues to worsen to the point that surgical intervention was recommended.
Nighttime or a sleeping brace is prescribed infrequently for AIS and is often referred to as an option solely for JIS (juvenile idiopathic scoliosis) under the age of 10. The two main types of nocturnal spinal orthotics are the Providence and Charleston braces, as with most scoliosis braces, named after the city in which they were first created. Night wear generally involves a 12-hour timeframe so usually there will be some hours where patients have it on prior to bedtime which are added to the time spent sleeping while braced. The Providence brace is sometimes referred to as a bending brace and represents most braces used for a nighttime recommendation from an orthopedic surgeon.
The Providence Nocturnal Scoliosis® Orthosis is exclusively manufactured by Spinal Technology INC located in West Yarmouth, MA. The brace is termed a hypercorrective brace for scoliosis and dominates, when it comes to the actual in brace correction numbers, boasting a 98% corrective value compared to the 56% average for the Boston daytime brace. Keep in mind that all rigid spinal orthotics are typically tested on younger patients, under the age of 13, that have a significant amount of growth remaining to allow for adaptation from the external forces applied to the body. These forces are somewhat aggressive and can only altera patient’s spinal alignment early on when there is little resistance from more mature tissue that often opposes the braces forces and limits alignment changes.
The official position of ScoliSMART doctors is a supportive one for the Providence Nocturnal Scoliosis Brace with each case being a unique one, nighttime brace wear may be recommended or supported as an adjunct to a patients ScoliSMART care program. The primary reason for this is based on several factors which support the theoretical neuro-hormonal etiology. The nighttime brace also will not interfere with the patients ScoliSMART home care like a fulltime rigid brace worn during upright hours, where gravity is sensed and part of the spine’s alignment program. Keep in mind that the ScoliSMART activity suit is not a rigid spinal orthosis and therefore not comparable from a biomechanical perspective. A rigid brace application should have a high corrective ability, be applied when growth rates are at their peak in a 24-hour cycle (10pm to 5am), and not interfere with the body’s gravitational righting mechanisms that control and regulate upright alignment of our bodies. Therefore, under these guidelines, a Providence brace can assist in improving outcomes when combined with the ScoliSMART approach, especially in younger idiopathic cases.
The ScoliSMART suit is constructed of a highly flexible material and does not trap the body with rigid opposing forces designed to force alignment change. The suit works like a resistance band and when worn during movement the resistance is specific to trunk rotation which stimulates isometric (muscle length doesn’t change) contraction of deep spinal musculature that is responsible for the vertebrae twisting near the apex or peak of the scoliotic curves. The Providence brace places the spine in a straighter position while lying down and the body is at its peak growth which when combined with the ScoliSMART triad approach becomes a good compliment.
In summary, the Providence brace is a friend when applied correctly and with the right patient age group. It is a superior brace option when looking for maximum in brace corrective rates during peak growth for children diagnosed with idiopathic scoliosis.