The Dynamic Brace Continued from Page 26 THE NEED FOR A MODIFIED MODE OF ACTION The wide variety of traditional rigid braces – that are, unfortunately, still in wide use today – all work with a rigid three-point pressure to induce a static correction in spinal curvatures. These braces rob the patient of normal proprioceptive input to the brain and create muscle atrophy, resulting in poor long-term outcomes. Most often, in fact, the spinal curvature will return to its original abnormal mag- nitude, once the patient discontinues use of the brace. It was clear that a more flexible brace with an improved mechanism of action was required, in order to effect a ben- efi cial and permanent result in patients with spinal deformities. FLEXIBLE BRACING AND CORRECTIVE MOVEMENT Named “dynamic brace,” (DB), this inven- tion is composed of a pelvic base that looks like a rock-climbing harness and has four elastic bands hooked onto it, starting from the lower ribcage and shoulders, in order to induce its unique mechanism of action – corrective movement (CM). The CM created by the elastic bands acts through an active biofeedback mechanism, which will result in a neuromuscular integration by the central nervous system. This elegant and simple mechanism is what makes the DB completely revolu- tionary. Corrective Movement is created by the arrangement of brace around the spine, thereby inducing neuromuscular integration and, also, producing correc- tion over time. As well, although the brace must be worn for 20 hours a day for a minimum of 18 months, it is important to note that the psychological impact on teenagers is neg- ligible compared to that of rigid braces, as this one is concealed under clothing and, unlike with rigid braces, patients are actually encouraged to carry on with their sports activities while wearing it. The effi cacy of the brace in cases of AIS is best between Risser 0-2 – or roughly pre-menarche, or change in the voice, in the case of male patients – where most of the growth occurs in the trunk. In this age group, the DB has been proven not only to correct, or stabilize, the scoliotic curves 30 • CANADIAN CHIROPRACTOR | SEPTEMBER 2008 Scoliosis, and other major distortions in posture, benefi ted little from rehabilita- tion until just over a decade ago. in 59.7 per cent of cases, but is seeing a stable correction in 95.7 per cent or these cases even at two years out of the brace. 2 CLASSIFICATION OF CURVES FOR BRACING To guide clinicians – chiropractors and orthotists – in the use of the DB, its in- ventors have developed a unique clas- sifi cation system for pathological spinal curves. The system describes, step-by- step, the diagnostic process and brace- fi tting instructions for each group of curves. Based on where the initial wedging occurs in the spine, 11 different types of curves for AIS have been identified and characterized. Each is associated with a specifi c CM plan and unique brace- fi tting instructions to meet the plan. ALTERNATIVE APPLICATIONS Although the DB was intended for the treatment of AIS, it offers endless pos- sibilities for the treatment of vertebral subluxation stemming from spinal de- formities. Doctors of chiropractic, who understand spinal biomechanics better than anybody, can therefore also help a great number of patients with conditions other than scoliosis. Examples of these would be Sheuermann’s or senile hyperky- phosis, to name but a few. I have discovered, in my practice, that my list of “out of indication” uses for the brace is growing every day and that most of my brace patients are, in fact, adults. The therapeutic goal, of course, is very different in their cases, as the spine is permanently deformed after the growth plates have been fused. I must say, how- ever, that the results are quite astounding, at least as far as the reduction of posture displacements, and therefore, pain man- agement, are concerned. I have found that it is even possible, in some cases, mainly in younger and more flexible adult patients, to produce some degree of correction while in brace. As well, I am proud to have had the opportunity to present my results in the form of an abstract at a recent ortho- paedic conference regarding the conser- vative management of scoliosis (Athens, SOSORT, April 2008). CONTINUING EDUCATION FOR SCOLIOSIS MANAGEMENT For those chiropractors who are interested in learning more about this amazing spi- nal brace, we will have the privilege of hearing Drs. Coillard and Rivard pres- ent their fi ndings with the DB during the next instalment of “Les journées chiropra- tiques,” a continuing education initiative of the Quebec Board of Chiropractors, on September 14, 2008, in Montreal. Chiropractors are, and must remain, the spine experts! It is therefore, our responsibility to know that there now is something available, out there, for the conservative treatment of scoliosis and other spinal deformities.• References: 1. Dunn, Sharon. Amazing Brace: why aren’t Canadian parents told about a Montreal invention used around the world to treat scoliosis? Macleans Magazine, January 23, 2008. http://www.macleans. ca/article.jsp?content=20080123_55198_ 55198&page=1 2. Coillard C., Vachon V, et al. Effective- ness of the SpineCor brace based on the new standardized criteria proposed by the Scoliosis Research Society for Adolescent Idiopathic Scoliosis. J. of Pediatr Orthop 2007; 27: 375-379. www.canadianchiropractor.ca
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