| Author: | Fung, Ho Yi |
| Title: | Ergonomic brace wear for adolescent idiopathic scoliosis (AIS) |
| Advisors: | Yip, Joanne (ITC) Yick, Kit-lun (ITC) |
| Degree: | M.Phil. |
| Year: | 2020 |
| Subject: | Hong Kong Polytechnic University -- Dissertations Orthopedic braces Scoliosis in children |
| Department: | Institute of Textiles and Clothing |
| Pages: | xxiii, 203 pages : color illustrations |
| Language: | English |
| Abstract: | Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of spine, thorax and trunk which occurs in adolescents during their period of growth spurt. To halt the progression of AIS and avoid surgery, bracing is the most common non-operative treatment option for patients with a Cobb angle between 25° to 40°. Through the external mechanical forces given by the brace, the alignment of spine and body can be restored. Scoliosis braces are usually divided into two categories as hard braces and soft braces. Hard braces are considered effective in preventing the progression of spinal curvature, but they are rigid, bulky, uncomfortable and aesthetically unappealing to wear. As a result, the brace compliance in patients is low, and the negative impacts of hard braces on the quality of life (QoL) and psychological well-being of patients are concerned. Furthermore, the lead time for fabricating a hard brace is long because it is customized individually based on the spinal curvature and torso shape of each individual patient, and therefore patients can only receive the brace and start the treatment a few weeks after the diagnosis of AIS. Soft braces, on the other hand, have been developed to remedy the shortcomings of hard braces; however, hard braces are still prevalent and can hardly be replaced because there are controversies within the literature concerning the treatment efficacy of soft braces. The aim of the project was therefore to address the deficiencies in the existing designs through developing a new scoliosis brace called the Ergonomic Brace. The Ergonomic Brace had considered the equal importance of treatment effectiveness with hard braces and patient compliance with soft braces; hence, it integrated both hard and soft components to form one single brace. At the same time, the concept of mass customization was applied to reduce the brace production lead-time from few-weeks of time to less than a day. In doing so, all of the brace components were prefabricated and specifically designed with the flexibility to cope with the different spinal curvatures and body sizes of patients. This had not only facilitated the initial process of brace customization and fabrication, but could also rapidly deal with the changes in spinal situations, pubertal growth spurt and brace impairments along the treatment period. As regards the biomechanical principles of spinal correction adopted by the Ergonomic Brace, the brace construction and fitting for different curve patterns followed the SOSORT consensus on brace action for the TLSO biomechanics of correction and also the Rigo classification to ensure a high level of validity. A clinical trial was carried out to assess the treatment efficacy of the Ergonomic Brace in comparson with the current hard brace. Hence, AIS patients who were undergoing hard brace treatment in The Duchess of Kent Children's Hospital (DKCH) were recruited. The clinical results showed that the Ergonomic Brace was able to address the patient compliance issue by lowering the bracing impacts on the QoL of subjects; however, its average effect upon correcting the major Cobb angle(s) of a spinal curvature was merely 10.85% of the hard brace. From the pressure results, it was recognized that the possible reason why the Ergonomic Brace could not exercise a similar corrective effect as the hard brace might due to its design and construction. The hard brace is entirely rigid and hence the shifting of trunk was limited to a certain extent by its wall like the form of a mold, whereas the construction of the semi-rigid Ergonomic Brace was not sturdy enough to hold and constrain the active truncal shifting as well as the realignment of spinal curvature. Even so, statistically, it was found that the sagittal balance and apical vertebral rotation were significantly, positively and strongly associated with the magnitude of Cobb angle, and thus important to the outcome of bracing. On top of that, the hard brace was incompetent in amending both of those. Based on these findings, the development of semi-rigid/soft scoliosis brace in the future should base its focus of spinal correction on the aspects of sagittal balance and apical vertebral rotation instead, bacause they are what the hard braces could not be accomplished and would likely be beneficial to the correction of Cobb angle. In addition, the brace design features relating to mass customization, which came up in this project for the Ergonomic Brace, can provide new insights to the future development of scoliosis braces or other medical orthoses as well. |
| Rights: | All rights reserved |
| Access: | open access |
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| File | Description | Size | Format | |
|---|---|---|---|---|
| 991022378658503411.pdf | For All Users | 6.65 MB | Adobe PDF | View/Open |
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