Bracing for neuromuscular scoliosis: orthosis construction to improve the patient's function.
OBJECTIVE
To present technical particularities of construction and application of trunk orthosis in non-ambulatory patients with severe neuromuscular spinal deformity. Unlike in the idiopathic scoliosis, the aim of bracing was not morphological (decrease of Cobb angle) but functional.


METHODS
Specially designed orthosis, resting against the seat, not leaned against the pelvic, partially suspending the trunk, was applied to 45 children aged 2.0 - 15.0 years. The construction of the orthosis, based on the achievements of the Society of Scoliosis Orthopaedic and Rehabilitation Treatment SOSORT, is presented, and the technical details of manufacturing are discussed and illustrated with clinical cases.


RESULTS
The orthosis was able to partially correct the spinal curvature and pelvic obliquity, provide stable sitting position, balance the trunk, facilitate breathing, discharge the abdomen, unload soft tissues of the buttocks. Complications comprised skin intolerance in 36 patients, requiring modification of orthosis, and progression of the curve under orthotic management in 22 children, requiring surgical indication. None of the patients reported worsening of the subjective symptoms of the respiratory discomfort while sitting in the orthosis.


CONCLUSIONS
Correctly designed and fitted, the orthosis can markedly improve the function, prevent some of threatening complications and partially postpone the need for surgical treatment.
Kotwicki
Tomasz
T
Department of Paediatric Orthopaedics and Traumatology, University of Medical Sciences, Poznan. kotwicki@amp.edu.pl
Durmala
Jacek
J
Czubak
Jaroslaw
J
D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000534:rehabilitation / Q000628:therapy*; D010865:Pilot Projects; D011187:Posture; D011446:Prospective Studies; D012600:Scoliosis / Q000534:rehabilitation / Q000628:therapy*