Orthotic Treatment Management of Scoliosis

Definition
an abnormal lateral curve to the vertebral column

Causes
Idiopathic
Secondary to shortening, cerebral palsy, spina bifida, etc

Signs & Symptoms
• Uneven musculature on one side of the spine
• A rib “hump” and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
• Uneven hip, rib cage, and shoulder levels
• Asymmetric size or location of breast in females
• Unequal distance between arms and body
• Slow nerve action (in some cases)

Complications
• Leg length Discrepancy
• Problem with respiration
• Kyphoscoliosis

Orthotic Treatment
Treatment of scoliosis is depending on the age of patient, type of the scoliosis, level of apical vertebrae and the magnitude of the Cobb’s angle. For the apical vertebrae below T8, TLSO can be used, but above that, high profile CTLSO is required for the correction.
Types of TLSO for Scoliosis treatment:
• Boston
• New York Orthopedic Hospital Orthosis
• Wilmington
• Miami
• Charleston, etc

Most common CTLSO, which proved success, is Milwaukee Orthosis.
The Biomechanical principle of application of forces are used in the Orthosis, those are 3 Point pressures:

One corrective force toward the apical vertebra
Two counter forces located proximal and distal to the corrective force, to stabilize the proximal and distal segment of the curve, so that the correction can be achieved.
For the scoliosis double curve (S shape), six point pressures are needed, but the force can be combine in the form of four point pressures.

Orthotic Treatment post complication
When Leg length Discrepancy is occur due to untreated scoliosis, treatment of scoliosis should be considered first, with the successful treatment of Scoliosis, the shortening will be diminished.
In fixed deformity equinus or knee Flexion contracture, the Orthotic treatment to reduce / correct the deformity should be considered.
If the KyphoScoliosis occurred, the application of pressures will be both in Sagital plane and frontal plane, each curve required 3 point pressures application.

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