Evaluation of Effectiveness of Brace Treatment in Scoliosis Patients

Scoliosis is a medical condition which occurs in adolescents, where an individual's spine develops curvature. Monitoring the effectiveness of brace treatment of scoliosis is an ongoing challenge that many physicians face today. A Thoracolumbosacral orthosis (TLSO) is a type of brace used to control the lateral curvature of the spine in scoliosis. It is a non-surgical treatment with the goal of preventing curve progression in patients with idiopathic scoliosis. To successfully monitor compliance with brace treatment, a wearable multi-modal sensor solution is embedded into the patient's brace. The custom-designed hardware consists of a sensor board, a force sensor, an accelerometer and a gyroscope. The force sensor collects the force being exerted on the patient's back, while the accelerometer and gyroscope generate cues to determine the patient's activities and lifestyle. In this dissertation, a novel data-mining method is proposed, to identify patient activities and evaluate the effectiveness of the brace treatment pervasively based on fusion of continuous force and inertial motion recordings. The proposed method evaluates three main factors: 1) The compliance to the brace treatment or duration of brace wear through the process of segmentation, 2) The level of tightness of brace by estimating the baseline force per segment and 3) The quality of brace fit in the presence of different activities including sitting, standing, climbing, walking, running and lying. The aim is to design a context-aware remote monitoring system for ubiquitous evaluation and enhancement of brace treatment compliance of adolescent idiopathic scoliosis patients. Two experimental scenarios have been investigated: 1) Semi-supervised scenario in which, the patient performs a series of pre-defined activities at home during day long segments of brace wear, and 2) Unsupervised scenario in which, there is no knowledge of the patient's activities and other circumstances during pervasive sensor data recordings. The experimental results demonstrated that we achieved an overall accuracy of a 100% for activity detection. The level of tightness of brace-fit reduced gradually over a period of 4 weeks by 33%. Initially, at the beginning of the treatment, patients were instructed to wear the brace for 2 hours, and the compliance with the brace treatment was 7.8%. The duration of the brace wear increased gradually during the period of 4 weeks. At the end of week 4, the compliance reached 80%.Master of Science in EngineeringElectrical Engineering, College of Engineering & Computer ScienceUniversity of Michigan-Dearbornhttps://deepblue.lib.umich.edu/bitstream/2027.42/145482/1/bhavaniThesisWordFormat25Aug.pdfDescription of bhavaniThesisWordFormat25Aug.pdf : Thesi

Designing an Automated System using Wearable Devices for Compliance Monitoring and Activity Detection in Scoliosis Patients

The use of wearable devices in healthcare and rehabilitation programs is growing exponentially. This thesis focuses on wearable sensors and technology used to monitor treatment compliance in patients with a medical condition known as Adolescent Idiopathic Scoliosis (AIS). Patients with AIS are prescribed to wear a thoracolumbosacral orthosis (TLSO) – a type of back brace, to help prevent worsening of their condition. Scoliosis is a medical condition which occurs in adolescents, where an individual's spine develops curvature. Adolescent Idiopathic Scoliosis (AIS) occurs in children aged 16 years or younger. Brace treatment with TLSO is known as one of the most effective non-surgical treatment for scoliosis. The brace is designed to be worn continuously for long periods of time without any supervision. Therefore, it is vital to carry out the proper procedures for measuring the effectiveness of the treatment, and to accurately evaluate the amount of time of the brace being worn. To successfully monitor compliance with brace treatment, a wearable multi-modal sensor solution is to be embedded into the patient's brace. This thesis proposes an end-to-end system to help improve monitoring brace treatment by continuously observing the amount of force inside the brace. In addition to compliance monitoring, my research is extended to detecting the patient’s daily activities by implementing a novel data-mining method to identify different trends and patterns associated with the activities performed by the patient. This thesis attempts to implement wearables in such an application, and anticipates realizing a successful relationship between monitoring and improving compliance.Master of ScienceComputer and Information Science, College of Engineering & Computer ScienceUniversity of Michigan-Dearbornhttps://deepblue.lib.umich.edu/bitstream/2027.42/143517/1/Thesis_final (2).pdfDescription of Thesis_final (2).pdf : Thesi

Bracing for Idiopathic Scoliosis: Improving Adherence through Psychological Intervention

Poor treatment adherence is increasingly being recognized as a significant problem in pediatric medicine. For the condition Adolescent Idiopathic Scoliosis, poor adherence rates to the most non-surgical intervention, orthotic bracing, have become a well-established fact. This treatment modality has been correlated with multiple psychosocial areas of difficulty, including low self image, suicidal ideation, feelings of isolation, social discomfort, depression, an external locus of control, increasing risk taking behavior, high levels of stress, anger, fear, shame, and eating disorders. Since the orthotic bracing has been linked to both poor adherence and to psychosocial problems, an intervention is created to increase adherence through the use of psychosocial techniques. Cognitive behavioral therapy has been used successfully to increase treatment adherence in both adult and pediatric patients. Thus, a comprehensive program is put forth that aims to increase bracing adherence by means of a cognitive behavioral intervention. Additionally, methods for studying the psychometric properties of this intervention are proposed

Bracing for Idiopathic Scoliosis: Improving Adherence through Psychological Intervention

Poor treatment adherence is increasingly being recognized as a significant problem in pediatric medicine. For the condition Adolescent Idiopathic Scoliosis, poor adherence rates to the most non-surgical intervention, orthotic bracing, have become a well-established fact. This treatment modality has been correlated with multiple psychosocial areas of difficulty, including low self image, suicidal ideation, feelings of isolation, social discomfort, depression, an external locus of control, increasing risk taking behavior, high levels of stress, anger, fear, shame, and eating disorders. Since the orthotic bracing has been linked to both poor adherence and to psychosocial problems, an intervention is created to increase adherence through the use of psychosocial techniques. Cognitive behavioral therapy has been used successfully to increase treatment adherence in both adult and pediatric patients. Thus, a comprehensive program is put forth that aims to increase bracing adherence by means of a cognitive behavioral intervention. Additionally, methods for studying the psychometric properties of this intervention are proposed

Recommendations for research studies on treatment of idiopathic scoliosis: Consensus 2014 between SOSORT and SRS non–operative management committee

The two main societies clinically dealing with idiopathic scoliosis are the Scoliosis Research Society (SRS), founded in 1966, and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT), started in 2004. Inside the SRS, the Non-Operative Management Committee (SRS-NOC) has the same clinical interest of SOSORT, that is the Orthopaedic and Rehabilitation (or Non-Operative, or conservative) Management of idiopathic scoliosis patients. The aim of this paper is to present the results of a Consensus among the best experts of non-operative treatment of Idiopathic Scoliosis, as represented by SOSORT and SRS, on the recommendation for research studies on treatment of Idiopathic Scoliosis. The goal of the consensus statement is to establish a framework for research with clearly delineated inclusion criteria, methodologies, and outcome measures so that future meta- analysis or comparative studies could occur. A Delphi method was used to generate a consensus to develop a set of recommendations for clinical studies on treatment of Idiopathic Scoliosis. It included the development of a reference scheme, which was judged during two Delphi Rounds; after this first phase, it was decided to develop the recommendations and 4 other Delphi Rounds followed. The process finished with a Consensus Meeting, that was held during the SOSORT Meeting in Wiesbaden, 8-10 May 2014, moderated by the Presidents of SOSORT (JP O'Brien) and SRS (SD Glassman) and by the Chairs of the involved Committees (SOSORT Consensus Committee: S Negrini; SRS Non-Operative Committee: MT Hresko). The Boards of the SRS and SOSORT formally accepted the final recommendations. The 18 Recommendations focused: Research needs (3), Clinically significant outcomes (4), Radiographic outcomes (3), Other key outcomes (Quality of Life, adherence to treatment) (2), Standardization of methods of non-operative research (6). © 2015 Negrini et al.; licensee BioMed Central

mHealth for the Monitoring of Brace Compliance and Wellbeing in Adolescents with Idiopathic Scoliosis: Study Protocol for a Feasibility Study

Attempts to optimize monitoring of brace adherence prescribed to adolescents with idiopathic scoliosis (IS) have generally relied on sensors. Sensors, however, are intrusive and do not allow the assessment of psychological and physical consequences of brace use that might underlie poor adherence. Mobile applications have emerged as alternatives to monitor brace compliance. However, the feasibility and utility of these app-based systems to assess key psychological and physical domains associated with non-adherence remain unexplored. This feasibility study aims to test the usability, acceptability, and clinical utility of an app-based system that monitors brace use and related psychological and physical factors. Forty adolescents with IS daily respond to the app for 90 days. The patient responses may generate clinical alarms (e.g., brace non-adherence, discomfort, or distress) that will be sent daily to the medical team. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will include brace adherence, the number of side effects reported, number and type of clinical alarms, stress, quality of life, perceived health status, and mood. If accepted by patients and clinicians, apps may allow rapid detection and response to undesired events in adolescents undergoing brace treatment

Inheritance and genetics in idiopathic scoliosis

Idiopathic scoliosis is the most common spine deformity, affecting approximately 3% of children and adolescents. Its aetiology is still unknown. However, relatives of individuals with idiopathic scoliosis have a higher risk of developing scoliosis compared to the general population. The aim of this thesis was to improve our understanding of the hereditary and genetic background of idiopathic scoliosis. Self - reported data on scoliosis in twins (n=64,578) in the population - based Swedish Twin Registry were an alysed to estimate the relative importance of genetic effects on the phenotypic variance – that is, the heritability of scoliosis. Using structural equation model ing, we estimated that 38% of the phenotypic variance of scoliosis is due to additive genetic effects and 62% to unique environmental effects. In ScoliGeneS, an ongoing multi - centre study, we included individuals with idiopathic scoliosis and controls. The importance of a family history of scoliosis wa s investigated in 1,463 individuals with idiop athic scoliosis . Among those treated with a brace or surgery for scoliosis, 53% reported one or more relatives with scoliosis compared to 46% of the untreated, indicating a higher risk of treatment in the presence of a family history of scoliosis (odds rat io 1.32; 95% confidence interval 1.06 – 1.64). The prevalence of back problems was investigated in 1,069 adults with idiopathic scoliosis and in 1 58 controls. B ack problems were reported in 64% of the individuals with scoliosis compared to 29% of the control s (p<0.001, adjusted for sex, age and smoking). No differences betwee n untreated and treated individuals with idiopathic scoliosis regarding the prevalence of back problems in adulthood were seen. Four common single - nucleotide variants, previously shown to be associated with idiopathic scoliosis, were genotyped in 1,739 individuals with idiopathic scoliosis from the ScoliGeneS cohort and in 1,812 controls. In addition, the protein - coding regions of the genome – the exome – was sequenced in pooled samples (10x10) from 100 surgically treated patients in the ScoliGeneS cohort. We found a strong associ ation of idiopathic scoliosis with a common previously known variant downstream of the LBX1 gene (OR=1.5 3; p=7.0x 10 - 18 ). We identified twenty novel variants by exome sequencing after filtering and an initial genotyping validation. No significant association was f ound with idiopathic scoliosis in the large cohort of 1,739 cases and 1,812 controls. In summary, inherited factors are of importance in the development and progression of idiopathic scoliosis. A genetic variant downstream of the LBX1 gene is strongly associated with idiopathic scoliosis. We were unable to find genes of similar or stronger effect

Fusionless Correction of Moderate Adolescent Idiopathic Scoliosis with a New Minimally Invasive Dynamic Implant (ApiFix®) and Postoperative Schroth Scoliosis Specific Exercises-Case Series

The standard surgical management of AIS is spinal fusion. Nonfusion solutions for addressing moderate AIS curves are desirable. ApiFix® is a new posterior dynamic device consisting of an expandable ratcheting rod anchored by two pedicle screws to the concave side of the scoliotic spine. It was designed to address single, moderate Lenke type 1 or 5 curves. Surgery is performed without the addition of spine fusion of the instrumented segments. The surgical procedure is short with negligible blood loss and rapid recovery. Deformity correction is achieved by distraction leading to rod elongation. Curve correction is achieved not only during surgery but also after the surgical procedure by performing scoliosis specific exercises. These exercises activate the ratchet with further rod expansion and curve reduction. The reported cases demonstrate the efficacy of the combined approach of surgery and exercises in controlling moderate AIS. This clinical experience with the ratchet device shows consistent curve improvement and stabilization. It lends support to the concept that surgery with this new posterior dynamic device may be a viable alternative to fusion and or as an internal brace in non-compliant brace users for managing moderate AIS curves

Guidelines on "Standards of management of idiopathic scoliosis with corrective braces in everyday clinics and in clinical research": SOSORT Consensus 2008

<p>Abstract</p> <p>Background</p> <p>Reported failure rates,(defined based on percentage of cases progressing to surgery) of corrective bracing for idiopathic scoliosis are highly variable. This may be due to the quality of the brace itself, but also of the patient care during treatment. The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT. The aim of this paper was to develop and verify the Consensus on management of scoliosis patients treated with braces</p> <p>Methods</p> <p>We followed a Delphi process in four steps, distributing and gradually changing according to the results a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Athens Meeting with a Meeting Questionnaire (MQ). We set a 90% agreement as the minimum to be reached.</p> <p>Results</p> <p>We had a 71% response rate to PMQ, and 66.7% to MQ. Since the PMQ we had a good agreement (no answers below 72% – 70.2% over 90%). With the MQ the agreement consistently increased for all the answers previously below 90% (no answers below 83%, 75% over 90%). With increasing experience in bracing all numerical criteria tended to become more strict. We finally produced a set of 14 recommendations, grouped in 6 Domains (Experience/competence, Behaviours, Prescription, Construction, Brace Check, Follow-up).</p> <p>Conclusion</p> <p>The Consensus permits establishment of recommendations concerning the standards of management of idiopathic scoliosis with bracing, with the aim to increase efficacy and compliance to treatment. The SOSORT recommends to professionals engaged in patient care to follow the guidelines of this Consensus in their clinical practice. The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care. If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies.</p

Advances on Scoliogeny, Diagnosis and Management of Scoliosis and Spinal Disorders

This book contains research articles on the advances in the aetiology of idiopathic scoliosis (IS), the spinal growth related to the implementation of growth modulation for the surgical treatment of early-onset IS, the non-surgical treatment of IS using Physiotheraputic Scoliosis Specific Exercises, and braces. Additionally, it focuses on issues related to surgical treatment, issues related to body posture and the quality of life of this sensitive group of people. The high quality of published papers in this Special Issue of the JCM serve these objectives