T1 is the topmost Thoracic vertebra and supports the top 2 pairs of ribs. Ribs are important in many ways – they provide a protective shell to the lungs and other vital organs, they assist respiration and for us Orthotists, they provide a surface onto which we strap a brace. As the ribs are attached to the spine, they give us a useful point of force for the brace to act upon the spine to produce the corrective forces needed to combat a spinal deformity such as scoliosis. The beauty of such a mechanism is that we can use the way the ribcage expands and contracts during normal breathing to load the spine in very specific directions. Take a look at the video here: – watch the animation where the red line is the ribcage and spine, and the black line shows the action of the brace against the ribs, so even when you’re at rest, the brace is still working to correct the curve. This is a unique property of Cheneau braces – one that isn’t a feature of Boston Braces
I’m often asked about the process of weaning the brace off patients. Intuitively, I have always thought that the longer a brace is worn, the more established the effect will be, thus reducing the likelyhood of regression of any improvement or stabilisation that we have achieved. In an article article recently published in the Scoliosis Journal it appears that even amongst experienced Orthopaedic Surgeons, there is little consensus for the protocol to wean off a brace. Some base it upon radiographic evidence, and others ‘upon the patients convenience’. Others recommend night-time use only, but there is no indication as to how long this regime should continue.
The way I approach this conundrum is to look at the spine as a dynamic and flexible part of your anatomy which is not functioning in a ‘normal’ way, so its behaviour will differ from what we would normally expect, even after the end of growth and completion of skeletal maturity. As such, treatment needs to be seen as an ongoing project, which requires maintenance and monitoring, so the weaning-off process can last a long time without any significant inconvenience to the wearer.
As most of my clients are of school age, I suggest that initially they stop wearing it to school, and then reduce it to night-time only use, which can be extended for as long as they want. I feel that it is good practice to make final adjustments to the brace for this regime, as it is easier to tolerate higher pressures when you’re lying down and we can get better correction as we’re not acting against the effect of gravity, so it’s almost like that ‘final push’ to get the most out of the brace.
For smaller curves, and very young children, we have the nBrace, which is specifically designed for use at night – essentially, they are longer which means that we can use longer levers, thus increasing the corrective forces without over-stressing the skin. However, as they are long, they are not practical to use during the day (you’d struggle to sit in a normal chair comfortably), but at night, this isn’t a problem. It means that the same (or better) corrective effect can be achieved with lower forces to the skin, and hopefully, this means a more comfortable brace with the same outcome.
If you want to find out more about RSC braces then send me a message via the website contact form and we can have an informal chat without any obligation – I look forward to hearing from you