title: Effect of long-term orthotic treatment on gait biomechanics in adolescent idiopathic scoliosis.
abstract: BACKGROUND
  A previous study showed subtle biomechanical changes in the gait of unbraced adolescent idiopathic scoliosis (AIS) patients such as a reduction of pelvic, hip, knee, and ankle displacements. However, lumbopelvic muscles' timing activity was bilaterally increased during gait and correlated to excessive oxygen consumption as compared with healthy subjects. Usually, a brace, when indicated, is worn strictly for 22 hours every day in skeletally immature idiopathic scoliotic girls. To our knowledge, no study has assessed the long-term brace effect (6 months) on functional activities such as level walking.
  
  
  OBJECTIVE
  To assess the stiffening effects of 6 months' brace wearing on instrumented gait analysis in girls with thoracolumbar/lumbar adolescent idiopathic scoliosis.
  
  
  METHODS
  Clinical prospective study.
  
  
  METHODS
  Thirteen girls diagnosed as progressive adolescent idiopathic scoliosis with left thoracolumbar/lumbar curves (curves ranging 25°-40°).
  
  
  METHODS
  All patients underwent a radiographic and instrumented gait analysis, including assessment of kinematics, mechanics, electromyography (EMG), and energetics of walking.
  
  
  METHODS
  The scoliotic girls were prospectively studied at S1 (before bracing) and 6 months later at S2 (out-brace: treatment effect). The gait parameters were compared with those of 13 matched healthy girls. A t paired test was conducted to evaluate the effect of the 6-month orthotic treatment in AIS girls. Student t test was performed to compare the scoliotic group at S2 and the healthy subjects to identify if the observed changes in gait parameters meant improvement or worsening of gait.
  
  
  RESULTS
  After 6 months of orthotic treatment in AIS, thoracolumbar/lumbar curves and apical rotation remained reduced by 25% and 61%, respectively. During gait, frontal pelvis and hip motions were significantly increased. Muscular mechanical work increased becoming closer but still different as compared with healthy subjects. Bilateral lumbopelvic muscles were almost 40% more active in AIS at S1 compared with healthy subjects and did not change at S2 except for the erector spinae muscles EMG activity, which decreased significantly. Energy cost exceeded by 30% in AIS at S1 compared with healthy subjects and did not change at 6 months' follow-up.
  
  
  CONCLUSIONS
  After 6 months of orthotic treatment, in an out-brace situation, the main structural thoracolumbar/lumbar curve remained partly corrected. Frontal pelvis and hip motion increased, contributing to an improvement of muscular mechanical work during walking. EMG activity duration of lumbopelvic muscles did not change except for the erector spinae muscles, which was decreased but without any beneficial change in the energy cost of walking. In summary, brace treatment, after 6 months, did not significantly influence the gait variables in AIS girls deleteriously, but did not reduce the excessive energy cost, which was 30% above the values of normal adolescents.
authors: Rehabilitation and Physical Medicine Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 12, Ave. Hippocrate, 1200 Brussels, Belgium; Institute of NeuroScience, Université Catholique de Louvain, 53, Ave. Mounier, Bte B1.53.04, 1200 Brussels, Belgium. Electronic address: Philippe.Mahaudens@uclouvain.be.
authors: Philippe
authors: P
authors: Mahaudens
authors: Institute Research Chair in Pediatric Rehabilitation Engineering, École Polytechnique and Centre de Réadaptation Marie Enfant (CRME) Bureau GR-123, 5200 rue Bélanger Est, H1T 1C9 Sainte-Justine, Montréal QC, Canada.
authors: Maxime
authors: M
authors: Raison
authors: Orthopaedic Research Laboratory, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 53, Ave. Mounier, Bte B1.53.04, 1200 Brussels, Belgium.
authors: Xavier
authors: X
authors: Banse
authors: Service d'Orthopédie et de Traumatologie de L'Appareil Locomoteur, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 12, Ave. Hippocrate, 1200 Brussels, Belgium.
authors: Maryline
authors: M
authors: Mousny
authors: Institute of NeuroScience, Université Catholique de Louvain, 53, Ave. Mounier, Bte B1.53.04, 1200 Brussels, Belgium.
authors: Christine
authors: C
authors: Detrembleur
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D001915:Braces; D016022:Case-Control Studies; D002648:Child; D004576:Electromyography; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D010388:Pelvis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation*; D013131:Spine / Q000000981:diagnostic imaging
keywords: Energy; Gait; Idiopathic scoliosis; Muscle; Orthotic treatment