Orthotic Treatment Did Not Worsen Walking in Girls With AIS

After 6 months, orthotic treatment of girls with adolescent idiopathic scoliosis did not significantly stiffen the body or deteriorate functional daily walking observed before treatment, according to study results recently published in The Spine Journal.

“So far, long-term follow-ups of orthotic treated adolescent idiopathic scoliosis (AIS) patients have been limited to the assessment of the effectiveness of brace treatment in terms of radiographic curve progression, pain, quality of life and psychological effects. Many AIS patients reported that this long-term daily restricting orthotic treatment forces them to greatly limit social activities or habitual relations with others because of early fatigability and mobility restrictions. However, no study, to our knowledge, has assessed the long term effects of strictly worn braces on walking and its spatiotemporal, kinematic, mechanical, electromyographic and energetic parameters in AIS,” the researchers wrote. “The objective of this study was therefore to assess the effect of orthotic treatment on gait variables in thoracolumbar/lumbar AIS females after wearing a brace for 6 months. We hypothesized that the long-term effect of bracing treatment could induce a stiffening of the body, affecting functional daily walking.”

Orthotic treatment for AIS

Researchers enrolled 13 girls diagnosed with progressive AIS with left thoracolumbar/lumbar curves and instructed them to wear a custom-made rigid underarm thoracolumbo-sacral orthosis for 22 hours daily. Participants with AIS underwent a radiographic and 3-D gait analysis, including assessment of kinematics, mechanics, electromyography and energetics of walking, both before treatment and 6 months later without the orthosis. Gait parameters were compared with those of 13 matched healthy girls. AIS participants also underwent a t-paired test to evaluate the effect of 6 months of orthotic treatment, and a Student’s t-test to identify if the observed changes in gait parameters meant improved or worsening of gait when compared with the healthy group.

Study results showed after 6 months of orthotic treatment, thoracolumbar/lumbar curves remained reduced by 25% and apical rotation remained reduced by 61% in patients with AIS. Frontal pelvis and hip motions were significantly increased during gait, according to study results. Before orthotic treatment, researchers found bilateral lumbo-pelvic muscles were almost 40% more active in girls with AIS compared to healthy patients. Step length and stance phase significantly increased after treatment, while cadence showed a significant decrease.

In patients with untreated AIS, the electromyographic activity duration of the erector spinae muscles was significantly increased compared with healthy participants, but after 6 months of orthotic treatment, the EMG activity duration of both groups was similar.

Compared with healthy participants, untreated patients with AIS consumed 30% more oxygen and that energy expenditure did not change at 6 months follow-up, according to study results.

“The take home message is that long-term bracing treatment — more than 6 months — that is prescribed for almost 2 years (22h/24 daily), aggravates the restriction of trunk and hips motions with the risk of pain symptoms, but this treatment has no affect on the excessive oxygen consumption linked to the gait,” Philippe Mahaudens, PT, PhD, of the Institute of NeuroScience and Orthopaedic Research Laboratory and Rehabilitation and Physical Medicine Unit at the Universite Catholique de Louvain, told O&P Business News. “The second message is that adolescent scoliosis girls would limit their physical activities and social participation because of their excessive oxygen consumption already present for light efforts such as walking.”

Future studies

According to the researchers, future studies evaluating the effect of the amount and the duration of physical activity on gait parameters in patients receiving orthotic treatment for AIS would be helpful in determining whether hours spent in the orthosis without any activities would have any effect on gait parameters.

The researchers plan to conduct studies on specific overall body reconditioning and training regimen to determine if the excessive energy cost of walking is due to either poor physical condition or muscular disease in patients with AIS.

“Further studies would be necessary to better understand the excessive electromyographic activities of back muscles surrounding the scoliosis curves and oxygen consumption occurring in untreated adolescent girls with idiopathic scoliosis whatever the severity of the curve,” Mahaudens said. — by Casey Tingle

For more information:
Mahaudens P. Spine J. 2013;doi:10.1016/j.spinee.2013.08.050.

Disclosure: Mahaudens has no relevant financial disclosures.

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