Kalibus

Pictured here is the Kalibus Infantile Scoliosis brace. It is designed for infants as young as 8months old.

I have used this brace on several infants with good success. They usually progress to a standard custom Scoli brace as soon as they are physically large enough.

The spine is an elegant structure — from the side it takes the form of an elongated S, the upper back bowing outward and the lower back curving slightly inward. Viewed from behind though, the spine should appear as a straight line from the base of the neck to the tailbone. Scoliosis is an abnormal curvature of the spine.

Signs and symptoms of scoliosis may include:

• Uneven shoulders
• One shoulder blade that appears more prominent than the other
• Uneven waist
• One hip higher than the other
• Leaning to one side
• Fatigue

If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing.

Natural History

The Natural History of a Curvature of the Spine

The natural history of a curvature refers to the course of events in spinal maturation without any intervention.

Two factors are of paramount importance in the natural history of a curvature: the magnitude of the curvature and the degree of skeletal maturity. The angle of the curvature is measured from the X-ray. The degree of skeletal maturity is determined by looking at the top of the pelvis to examine the appearance of a small piece of bone called the apophysis. The appearance of the apophysis is divided into stages known as the Risser signs. Growth centers on the vertebral body can often be identified as well, indicating continuing spinal growth. Skeletal maturation is closely linked to the hormonal changes in puberty, which produce the more visible changes of adolescence. These changes also provide clues as to the state of skeletal maturity.

It is important to recognize that our information about the natural history of curves is incomplete. Nevertheless, we do know a great deal from studying large groups of patients. From such studies, for example, we know that in the patient who is relatively immature skeletally — that is, a Risser 0 or 1 — and who has a curve of less than 20 degrees, there is about a 25 percent chance that a curve will progress. However, in patients with a similar state of skeletal maturity with a curvature greater than 20 degrees, the chance of progression is about 70 percent. When the child gets older and reaches a greater level of maturity — that is, a Risser 2, 3, or 4 — the chance of the small curves (20 degrees or less) progressing is extremely small (about 2 percent). However, larger curves, at the same level of maturity, have about a 25 percent chance of progression. These studies point to a trend: the less mature the skeleton, and the larger the curve, the more likely the curve is to progress.

Other information and trends from natural history are also important in determining treatment.

Boys and girls have small curves in almost equal numbers, but girls are far more likely to progress than are boys. Therefore, more girls need treatment than boys. Curves progress most during periods of rapid growth. Most curves that progress do so at a little less than 1 degree per month, or about 10-12 degrees per year. Curves can progress after growth is finished. Although this is not common, it can happen and depends on how large the curvature is at the end of growth. While studies tell us what the probabilities are for large groups, they do not tell us what will happen for each particular patient. That is why observation is so important in the treatment of smaller curvatures.

Below is a skin care guide for Scoli Brace wearers.


SKIN CARE
For the first few days, watch closely for skin irritation or soreness. If redness or numbness occur on the skin during the day, leave the brace off for 30 minutes and recheck the area. If the redness disappears during that time, your child is OK.
If skin breakdown (soreness, red or raw skin) does not go away, leave the brace off and call your orthotist immediately. You may need to leave the brace off for a day to allow your child's skin to heal. Make an earlier follow-up appointment with your orthotist if your child's brace or skin problems keep happening.
Where to check skin for redness?
1. Watch the areas where the pads are located. These are the areas of highest pressure, a pressure needed to help manipulate the spine.
2. Watch the areas where the skin touches the edge of the brace.
3. Check the skin over bony areas such as the ribs and the hip bones.
4. Look for reddened areas, blisters, and/or rashes.
5. Talk to your child about how the brace feels; ask is there is any severe pain, etc.
How to protect your child's skin?
It is important to prevent skin breakdown. Everyone's skin is different. You will need to check the skin often. The skin under the brace also needs to be toughened up. These tips will help you with skin care.
1. Bathe daily (bath or shower).
2. Apply rubbing alcohol with your hands, rubbing vigorously at the areas of pressure applied by the pads. (Your orthotist will show you these areas of concern)
3. Wear a cotton undershirt, tubular knit without seams. The Orthotics Department provides you with one shirt, more may be purchased.
4. Do not use creams, lotions, or oil-based powders. They soften the skin too much and can cause it to break down. You can use a non oil-based powder (such as baby powder or Gold Bond medicated powder) if you would like something to help with perspiration and keeping the skin dry.
5. A loose brace moves around and will rub against your child's skin. This is another reason for your child to wear the brace as tightly as possible.
6. A dirty brace hurts your child's skin. Clean the brace daily.
Sometimes the skin over the waist and hips becomes darker. There is no reason to worry. This is common and is not a problem. When the orthotic treatment is over, this dark skin color will disappear.
Note : After the skin has become accustomed to wearing the brace and pressures being applied (usually after 2 months), lotion can then be used on dry skin when out of the brace. Be sure to allow time for the lotion to completely dry and be absorbed by the skin before putting the brace on.

Top left is a Boston Module type brace,in the middle is a Custom Charleston Bending Brace, And next is a Custom Modified Boston Brace.

There are a number of different types of bracing options. Some ,but not limited to, are:

The Boston Brace, which is a fitted brace from measurements, or a custom brace from a cast of the patients body.

The Charleston Bending Brace is made by taking specific measurements, and is a nocturnal brace worn for from 8 to 12 hours a night.

The Providence brace is also a nocturnal brace that is made from specific measurements, but it uses a special table that is labeled and has holes set in specific order so that push pads can be placed so that you can see the effect the brace will have before it is fabricated. The Providence is pictured below.

Bracemaker is a Blog dedicated to those who are interested in pediatric orthotics, especially with adolescent, pediatric, and infantile scoliosis.

I am a Certified and Licensed Orthotist with thirty four, 34, years of experience in the field.
I think I have been to every course that has been offered in the scoliosis bracing arena, except the Scopes tension based system. I will have to leave that to someone else.

I will be posting pictures and information on this blog as I have time.

My purpose is to pass on what I have learned over the years, if you are a parent, a teen with scoliosis, or an orthotist with a question, or information about scoliosis, just post the the comments section and I will reply for all to see.