Posts Tagged "Boy"

Case – Bracing and Exercise Rehabilitation

Posted on October 23rd, 2015 by admin

Male patient aged 14 years with a right thoracic curve measured at 49 degrees.

Background 

This patient was diagnosed with Scoliosis by his Physiotherapist at the age of 13 years old with a curve of 39 degrees. They first consulted a surgeon about the case who suggested surgery or bracing.

A year later they presented to the Sydney Scoliosis Clinic for bracing and the curve had progressed a further 10 degrees. The patient was not experiencing any pain from the scoliosis, but did notice the asymmetrical shape of his torso. This patient is a National medallist in Athletics and also previously played representative Australian Rules Football. Due to his regular training, this patient had a good general strength and flexibility.

1- Background

Treatment

This patient’s treatment involved wearing a customised rigid brace for 23 hrs per day, ongoing scoliosis specific exercise sessions and tractioning exercises with a scoliosis treatment aid. His brace wear started at 2 hrs per day, which was built up gradually over the following weeks to 23 hours each day. The patient does not compete in the brace but is very diligent in putting it back on straight after an event.

The scoliosis specific exercises require him to position his body in an active self-correction, which is the mirror image of his scoliosis, and to also work on strengthening his core and lower back muscles with exercises specifically prescribed for his case. He regularly sees the exercise physiologist to assess his progress and increase the difficulty of the exercises to ensure he keeps improving.

The patient does quite advanced  exercises and we have now started incorporating his active self-correction to warm-up movements he does at training to help keep his spine in good alignment when he is out of the brace. The home exercises are done every day and take approximately 40mins to complete.

Results

From examining xrays and posture photos, there has been an improvement in this patient’s posture in the first 12 months of treatment. The intial curve of 49 degrees, has now decreased to 35 degrees.

3a - Results

Due to his age and currently being Risser 4, it is essential for the brace treatment to continue while he is still growing. If left untreated, the scoliosis can progress further with growth.

At the beginning of the treatment, the patient was not competing at his best, but after a period of adaptation and the inclusion of specific exercises, he is now excelling and is back to the optimal form he was in prior to starting his scoliosis treatment.

The patient and his family are very committed to his treatment and to helping him succeed.

3b - Results

 

Conclusion

This  case demonstrates the reduction of a large curve that was at a surgical level to a moderate curve no longer at risk of needing surgery. The combination of a rigid custom designed 3D scoliosis brace, with scoliosis specific exercise, may achieve reduction in curve and cosmetic improvement in similar cases.

The patient was also able to continue competing at an elite level without compromising his ability.

NB: All cases are different and results may vary case to case. Our commitment is to recommend the most appropriate treatment based on the patient’s type and severity of scoliosis.

© ScoliCare 2015

Case – Kyphosis Bracing

Posted on September 29th, 2015 by admin

Patient aged 16 years with Kyphosis measured at 61 degrees.

Background 

Patient presented to the Melbourne Scoliosis Clinic aged 16 years at the time of initial examination complaining of a sore back and poor posture. He was diagnosed with a Scheuermann’s kyphosis measuring 61 degrees.

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Treatment

A custom 3D designed kyphosis brace was recommended to help reduce and stabilize the kyphosis. This brace was created specifically for this patient through a specialised 3D scanning and manufacturing process.

It was recommended that this Kyphosis brace be worn for 20 hours per day for a 24 month period. The brace was very low profile and with clothes over the top was nearly impossible to see.

Results

At the 3 month mark, an in-brace x-ray was taken. The in-brace kyphosis had reduced to 47 degrees.The patient’s posture was also improved.

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After 4 months of treatment, an out of brace x-ray was taken. The Kyphosis had reduced from 61 to 48 degrees.

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Discussion

Scheuermann’s kyphosis is a progressive spinal deformity that can worsen with growth and if it gets too severe requires surgery. Bracing is recommended when a Kyphosis progresses beyond 60 degrees as there is a tendency for the curve to continue to worsen even after growth has finished. Surgery is often recommended if the curve is greater than 70 degrees.

Old fashion braces used to be the only way to non-surgically treat kyphosis. The development of specialised kyphosis braces however, means there is now another bracing treatment option for kyphosis in teens and young adults that aims to not only hold but also reduce the kyphosis and is low profile and hardly visible under clothing.

Conclusion

In this case, xrays showed both improvements in the patient’s postural appearance, and the degree of the curve. A rigid custom designed 3D kyphosis brace may achieve reduction in kyphosis curve in similar cases of  Scheuermann’s kyphosis.

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NB: All cases are different and results may vary case to case. Our commitment is to recommend the most appropriate treatment based on the patient’s severity of kyphosis

© 2015 Scolicare

Case – Bracing

Posted on September 9th, 2015 by admin

Patient aged 7 years with scoliosis thoracic curve measured at 32 degrees and lumbar curve measured at 27 degrees.

Background

Patient presented to the Sydney Scoliosis Clinic, aged 7 years at the time on initial examination. This patient had been recommended and fitted with a traditional 3 point pressure hospital made TLSO.

This brace had achieved minimal in-brace correction – the thoracic curve had been reduced from 32 to 21 degrees. The lumbar curve remained the same in brace.

Alternative background images

 

Treatment

The patient was recommended a customised 3D designed rigid brace. New in-brace x-rays show an improved in-brace correction in this brace compared to the hospital TLSO.
 

Results

Thoracic curve reduced to 13 degrees which was a correction of 19 degrees and 8 degrees better than the hospital brace. The lumbar curve reduced to 3 degrees which was a correction of 24 degrees. The hospital brace made NO improvement in the lumbar curve.

 

Alternative results images

 

Discussion

The customised rigid brace created for this patient was not a traditional 3 point pressure brace. Instead the brace used a concept of spinal repositioning by over correcting the body posture and using specific 3D moulding to main the correction in the brace. As highlighted in Stokes review on bracing published in Bone Joint Journal. 2013 titled “The current status of bracing for patients with adolescent idiopathic scoliosis”. Stokes states that; “In conclusion…The Hueter–Volkmann principle holds true for bracing in AIS. If a brace does not correct a curve onapplication, then either the brace has not been designed, manufactured or fitted correctly, or the curve cannot be braced.”

This case demonstrates a clear difference in corrective effect on the same patient by two different braces.  One of the braces had poor correction and most likely would have not stopped progression of the curve. The other had good correction and has a much high chance of stopping progression or improving the curve.

Conclusion

Not all braces are the same. In this case the 3D designed, customised rigid brace clearly showed a superior in-brace correction to the hospital manufactured brace for the same patient. Although this case has not reached its end point and treatment is ongoing,  this case shows a rigid custom designed 3D scoliosis brace may achieve reduction in Cobb angle in similar cases.

NB: All cases are different and results may vary case to case. Our commitment is to recommend the most appropriate treatment based on the patient’s type and severity of scoliosis.

© ScoliCare 2015