To brace or not to brace?

Ma, Edgar

doi:10.1302/0301-620x.67b2.3980519

Cited by 25 publications

(10 citation statements)

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“…In the six subjects whose oesophageal and gastric pressures were measured application of the brace caused at least a twofold increase in end inspiratory and end expiratory gastric pressure in both the sitting erect and the supine posture (p < 0 001); Poes was unaltered (table 4 and figure). Transdiaphragmatic pressures during tidal breathing were considerably raised with the brace on at both end inspiration and end expiration.…”

Section: Discussionmentioning

confidence: 95%

Effect of bracing on respiratory mechanics in mild idiopathic scoliosis.

Kennedy

Robertson

Hudson

et al. 1989

Thorax

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The use of a corrective orthopaedic brace is an established form of management for patients with progressive idiopathic scoliosis. Thirteen patients with mild idiopathic scoliosis were studied with and without the corrective brace applied. Lung volumes and the pattern ofchest wall and abdominal movement were measured during quiet breathing. Transdiaphragmatic pressures were measured in six of the patients and upper ribcage movement in seven patients. Application of the brace resulted in a significant reduction in vital capacity (14%), functional residual capacity (22%), and total lung capacity (12%). There was no effect on respiratory rate or minute volume. In the erect position the pattern of chest wall movement was altered with a reduction in lower ribcage movement of 46% and abdominal wall of 39% and an increase in upper ribcage movement of 43%. These changes were greater in the supine position. There was at least a twofold increase in end inspiratory and end expiratory gastric pressures during tidal breathing, but oesophageal pressures were not affected by the brace. Transdiaphragmatic pressures showed a similar twofold increase, which implies a substantial increase in the work of breathing. In view of the doubts concerning the influence of bracing on the natural history of idiopathic scoliosis and the substantial functional effect of bracing on the respiratory system, it is suggested that the current practice ofbracing in this condition needs to be reviewed.

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Section: Discussionmentioning

confidence: 95%

Effect of bracing on respiratory mechanics in mild idiopathic scoliosis.

Kennedy

Robertson

Hudson

et al. 1989

Thorax

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“…During the 1970s the Boston brace was introduced.2 There is continuing debate in orthopaedic publications about the indications and effectiveness of bracing programmes.3 4 Although braces have been used extensively in the past 30 years, their effect on underlying lung function and chest wall mechanics is largely unknown. We report the effect of bracing on lung volumes in 33 adolescents with idiopathic scoliosis.…”

mentioning

confidence: 99%

Pulmonary restrictive effect of bracing in mild idiopathic scoliosis.

Kennedy

Robertson

Olinsky

et al. 1987

Thorax

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The use ofbracing in the treatment ofmild idiopathic scoliosis is controversial. A study of 33 adolescents showed that bracing significantly decreased lung volumes. Functional residual capacity was reduced by a mean of 26%, 18% of children showing a reduction of greater than 40%. The mean reduction in total lung capacity was 16% and in forced vital capacity 18%. This restriction of lung function by bracing might have a deleterious effect on lung growth or might impose an additional risk factor in the presence ofother disorders, such as asthma and diaphragmatic weakness. The use of bracing in individuals with mild scoliosis should be judiciously reassessed. age was 13-3 years and the mean thoracic Cobb angle 290. In five children the thoracic curve had improved with bracing and at the time of testing was less than 20 degrees. The mean age of onset was 11 7 years (range 6-16 years) and the mean duration ofbracing 1 4 years (range I month-5 years). None of the patients had cardiopulmonary symptoms at the time of testing. Functional residual capacity (FRC) and total lung capacity (TLC) were measured in the sitting position by means of body plethysmography (Jaeger Bodyscreen 2) both with and without the brace. The order of testing-that is, whether the brace was on or offfor the first measurements was randomly selected to allow for a learning effect. All spirometric volumes were corrected to BTPS. The non-deformed height was taken as equal to arm span. In our laboratory the armspan:height ratio estimated from 2368 measurements of 8-18 year old subjects is close to unity (0999 (SD 0 023) for girls and 1 006 (0 022) for boys).The Milwaukee brace reduces lumbar lordosis with a polypropylene pelvic girdle and attempts to correct the thoracic curve with a metal vertical suprastructure on which are mounted pressure pads. The Boston bracing system also uses a polypropylene girdle, which, unlike the former, extends to enclose the lower thorax, again attempting to correct the spinal curve by means of pressure pads mounted on the inner surface, acting on the apices of the curve.Six children with a brace induced reduction in FRC of over 30% were further studied to assess the effect of bracing on oxygen saturation during sleep. Oxygen saturation was monitored overnight with a Nelcor pulse oximeter; studies were performed on two nights, one with and the other without the brace. 959

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“…Rather, we stated that "providing it is effective"ear1y diagnosis of scoliosis is desirable; this important reservation has been discussed by one of us (Edgar 1985).…”

Section: Eugene E Bleckmentioning

confidence: 97%

Correspondence

Bleck

1989

Acta Orthopaedica Scandinavica

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To brace or not to brace?

Cited by 25 publications

References 0 publications

Effect of bracing on respiratory mechanics in mild idiopathic scoliosis.

Effect of bracing on respiratory mechanics in mild idiopathic scoliosis.

Pulmonary restrictive effect of bracing in mild idiopathic scoliosis.

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