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ACADEMY TODAY Advancing Orthotic and Prosthetic Care Through Knowledge Summer 2020 Vol 16 No 3 THEACADEMY TODAY Advancing Orthotic and Prosthetic Care Through Knowledge ACADEMY SPINAL ORTHOTICS SOCIETY How the Use of a Scoliosis Compliance Monitor Improved Patient Care for Patients with AIS The Role of Physical Therapy in the Treatment of AIS Indications for Psychological Intervention with Patients Receiving Spinal Bracing Sponsor’s Editorial The BOSTON BRACE 3D Read the articles and visit THE ACADEMY ONLINE LEARNING CENTER at www.oandp.org/olc Two continuing education opportunities in this issue! American Academy of Orthotists and Prosthetists Supplement of The O&P EDGE • Published by Western Media LLC How the Use of a Scoliosis Compliance Monitor Improved Patient Care for Patients with AIS Clinical Scenario can be determined. The patient will A twelve-year-old girl who is in be responsible for choosing her grade sixth grade presents for her first visit for brace treatment of scoliosis. after starting a brace program to treat I am a predictable and easy grader. idiopathic thoracic scoliosis of 31 My typical brace wear prescrip- Figure 1. The iButton thermal sensor. degrees. tion for AIS treatment with a curve In the past, I had found adolescent magnitude of 25–40 degrees is 18 idiopathic scoliosis (AIS) treatment hours per day. The patient will earn to be one of my most challenging an A with 16–18 hours of brace patient encounters. The first visit wear per day, a B with 14–16 hours, establishes the tone of the bracing and a C for 12–14 hours. I base the program, which will persist over the grades on the data from the Bracing next twenty-four months of brace in Adolescent Idiopathic Scoliosis wear. Will our team approach of care Trial (BrAIST), which showed the be acceptable to the family with the dose-response aspect of effective patient-centered treatment being the orthosis wear.1 In this randomized focus of care? clinical trial with a patient preference The emotions vary with each arm, brace treatment and observation patient. Will there be tears or with- were compared for patients with drawal? Will the patient refuse to an AIS curve magnitude of 20–40 wear the brace or deny there is a degrees, with the primary outcome problem? Or will there be strain being curve progression to a surgi- between the parent and child? I have cal level of 50 degrees. The study seen all these emotions, but I have confirmed the importance of brace also seen patients who show pride wear time, as the results improved in Figure 2. A Boston Brace 3D® with iButton in their ability to adapt to the brace accordance with hours in-brace. My installed. wear schedule, achieving an A grade grading based on the brace monitor on their brace monitor “report cards.” data is rarely a surprise to the patient, I like to equate the reading of the although it is a surprise to some par- patient. Involving the family in the brace monitor to the quarterly report ents. I no longer hear the patient and solution will strengthen the plan of card teens are familiar with in mid- parents argue about brace wear time, care and the family’s commitment dle school. Students often receive but I often hear parents acknowledge to supporting the patient in the brace a rubric from their teacher at the the challenges the teen faces in brace wear program. Often, there is a plea start of a term. The rubric outlines wear. I think of this as a teaching from the patient to alter the brace in the course requirements that must moment to discuss the obstacles that a manner that does not impact the be met for the students to receive a are preventing the patient from earn- efficiency of the brace, and these certain grade for the term, so there ing an A and an opportunity to ask requests should be honored. There are no surprises at report card time. the patient to generate her own ideas are other requests that should not be With a temperature sensitivity brace for improvement. honored. However, I always want monitor embedded in the orthosis, The patient-generated solutions to keep the patient engaged with the exact amount of brace wear time keep the center of care with the maximizing the hours of brace wear, THE ACADEMY TODAY Summer 2020 | 7 Use of a Scoliosis Compliance Monitor Figure 3. A Boston Brace 3D® adherence report. Patient name: HOURLY TEMPERATURE PROFILE Patient ID: 110 Patient DOB: 100 Average hrs/day: 17.8 90 Prescribed hrs/day: 18 80 Start date: 70 Avg. temp. Low line End date: 60 High line Days worn: 126 FAHRENHEIT DEGREES 50 Brace type: Boston Thoracic Brace 2:00 AM 4:00 AM 6:00 AM 8:00 AM 2:00 PM 4:00 PM 6:00 PM 8:00 PM 12:00 PM 10:00 PM Excellent reports, very compliant. — Dr. Hresko 12:00 AM 10:00 AM WEEKLY WEAR PROFILE % Weekday 24 HOURLY WEAR PROFILE % Weekend 20 1 16 0.8 12 0.6 8 0.4 HOURS WORN HOURS 4 0.2 % OF DAYS WORN DAYS OF % 0 0 Fri Sat Sun Mon Tues Wed Thurs 2:00 AM 4:00 AM 6:00 AM 8:00 AM 2:00 PM 4:00 PM 6:00 PM 8:00 PM 12:00 AM 10:00 AM 12:00 PM 10:00 PM Averagehours Worn HOURS WORN PER DAY Prescribed 24 20 16 12 8 HOURS WORN HOURS 4 0 DATE as brace wear time is the single most- expectations can achieve superior documented factor that improves brace wear compliance, while set- brace results. In-brace correction, ting low expectations will guarantee M. Timothy Hresko, MD strap tightness, and skin-contact area mediocre results. timothy.hresko@ are all important secondary factors childrens.harvard.edu Department of but are inconsequential if the brace is References are available at www.oandp.org/page/ATcurrent. Orthopaedic Surgery not being worn. Boston Children’s Hospital I have learned from treating teens Associate Professor of with scoliosis and from my col- Orthopaedic Surgery leagues in Milan2 that setting high Harvard Medical School 8 | Summer 2020 THE ACADEMY TODAY The Role of PHYSICAL THERAPY in the Treatment of AIS Physical therapists are members of the multidisciplinary team who treat patients with adolescent idiopathic scoliosis (AIS), including patients P 1,2 who are treated with an orthosis. Scoliosis-specific exercises (SSEs) have recently become more popular in the United States. A goal of physical therapy is to align the patient’s head over the pelvis. This goal can be achieved by improving aesthetics of the trunk through postural awareness, muscle stabilization, and decreasing asymmetry due to muscle tightness. An additional goal of SSE is Photographee.eu/stock.adobe.com reduction of the Cobb angle. Practicing activities like picking up an Providing exercises for the patient A physical therapy evaluation object from the floor in the orthosis to complete both in and out of the includes a thorough postural and using a squatting technique rather orthosis addresses impairments and assessment of the patient from the than forward bending can decrease improves functional limitations frontal and sagittal planes both in barriers to wear adherence during the while also demonstrating how to and out of the orthosis. From this weaning-in period. integrate use of the orthosis into the 7 assessment, the physical therapist An individualized home program patient’s life. Patients who are not can start to hypothesize muscle is determined based on the findings able to access SSEs can still benefit imbalances and asymmetries for of the evaluation. The home program from physical therapy and should further examination. Screenings is meant to be an adjunct to orthosis be encouraged to participate to for pain, skin integrity, leg length wear. Some patients initiate an SSE address their impairments. Treatment discrepancy, and respiratory pattern program with a physical therapist should focus on core strengthening are also conducted. A manual muscle who has completed certification and and postural awareness. The ability exam focused on the scapulae, hip, training. The decision to initiate an to achieve upright posture during and abdominal muscles, as well as an SSE program is based on the patient functional tasks is required to advance assessment of muscle length focused and family’s needs and wants. The strengthening exercises. on pectoral and hip musculature, is exercise program is customized to the individual patient. References are available at also required. These muscle groups www.oandp.org/page/ATcurrent. can impact a patient’s posture and Studies have shown that SSEs should therefore be evaluated and decrease the angle of trunk rotation 3,4 addressed. and Cobb angle. Schreiber et al. In addition, the angle of trunk showed that after three months of rotation during a spinal range of SSEs, back muscle endurance and motion assessment is helpful to pain scores improved. After six Rachel Tombeno, PT, DPT Boston Children’s Hospital track curve stability over time. months of treatment, self-image 5 [email protected] Evaluating functional movements scores also improved with SSEs. A while the patient is wearing the long-term study showed that the Cobb orthosis and educating the patient on angle remained stable and, in some how to complete activities of daily cases, decreased at skeletal maturity Danielle Barnack, PT, DPT living while wearing the orthosis when SSEs were used in conjunction Boston Children’s Hospital 6 [email protected] are essential to ensure proper fit. with orthoses. THE ACADEMY TODAY Summer 2020 | 9 SPONSOR ‘S EDITORIAL THE BOSTON BRACE 3D The Boston Brace 3D® orthosis is the improving the in-brace reduction of met.
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