The Dynamic Effects of Custom-Made Spinal Orthoses on Females with Adolescent Idiopathic Scoliosis

• Main Authors: Yen-Yi Tsai, 蔡燕怡
• Other Authors: Liang-Wey Chang
• Format: Others
• Language: en_US
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/82457570771207969409

碩士 === 國立臺灣大學 === 醫學工程學研究所 === 99 === Background. Few studies have discussed the dynamic effects of spinal orthotic intervention on patients with adolescent idiopathic scoliosis (AIS), nor have they investigated the motion adaptation on them. Objectives. The objectives of this study is three-fold: 1) To evaluate dynamic and static balance between AIS patients and normal subjects; 2) to investigate the dynamic and static balance effects of spinal orthotic intervention in the AIS patients during investigative periods of immediate in-brace wearing and after four-month in-brace treatment; 3) to evaluate the motion adaptation after four-month brace treatment in the AIS patients. Design. A prospective cohort study was performed for this investigation. Participants. Fifteen adolescent females with AIS with Cobb angle of 20 to 50 degrees and fifteen age-matched healthy females participated in this study. Interventions. The intervention treatment for the females with AIS was a custom-made total contact thoracolumbar spinal orthosis. Methods. The gait kinematic data and the standing centre of pressure (COP) data were collected. For each AIS patient, data were collected for the following four conditions—pre-brace, immediate in-brace, after four-month of brace treatment data without the brace, and after four-month of brace treatment data in the brace. Normal iv subjects acted as the control and participated in gait analysis just one time. Main outcome measures. The dynamic variables of temporal-distance parameters, walking smoothness with harmonic ratios, and torsional offset of central segments during gait were calculated. The static variables included COP sway, postural orientation and head decompensation in static standing were also calculated for all subjects and conditions. Results. The walking smoothness measured by harmonic ratios was reduced in AIS patients compared with healthy teenagers, especially in the vertical direction on the head (p=.001), trunk (p=.001) and pelvis (p=.005) as well as the antero-posterior direction on the segments of the head on pelvis (p=.025) and the trunk on pelvis (p=.01). For the four-month effect of bracing, bracing negatively affected the smoothness in the medio-lateral direction on the head (p=.001), in the global reference, but the smoothness was not changed on the body reference in AIS patients. Moreover, the effect of bracing restricted the pelvis motion during gait in the frontal plane causing the limited motion on the trunk on pelvis. For the four-month motion adaptation, brace treatment promoted the walking rhythm and smoothness in the vertical direction on the segment of the head on pelvis (p=.026), but decreased in the medio-lateral direction on the head (p=.018). Conclusion. AIS patients before the brace treatment exhibited significantly poor v walking symmetry compared with age-matched girls. AIS patients had abnormal segmental offset during gait and abnormal segmental orientation in standing posture. Bracing stiffened the range of motion on the body but did not disturb walking rhythm in on the body reference in the four-month brace intervention. Brace treatment yielded motion adaptation for walking rhythm in the body reference in the four-month brace intervention.