ATLANTIC CITY, N.J. — Working with patients who have scoliosis is a specialty that requires self-critique and careful orthotic management, according to Tom Gavin, CO, national orthotic specialist for Hanger Clinic. Gavin offered a presentation on scoliosis management at the New Jersey branch of the American Academy of Orthotists and Prosthetists’ Annual Meeting.
The larger the patient’s spinal curve, the more instability. Gavin said the three mechanisms of action open to orthotists are to restore and maintain balance; to reduce the spinal curve maximally while the patient is in orthosis; and to maintain reduction of the curve throughout wear.
Gavin said most physicians working with scoliosis patients do not have a working knowledge of O&P practices and are trained to correct a spinal curve with surgery; therefore, it is up to the orthotist to make sure the scoliosis patient and the patient’s family understand the advantages of orthotic care.
The ultimate goal for orthotists should be 2 years post-orthosis with a stable spine and no surgery. “That is the hard part, because you have some gunslingers that pull the trigger a little too soon,” Gavin said.
Scoliosis management should go beyond choosing a good brace, Gavin noted: “Just because the physician did not complain, does not mean I did a good job.”
He added, “The type of orthosis is not as important … Force is force no matter how it is applied.” Similarly, “Nocturnal orthoses have a place, but they should not be thought of as a replacement for full-time orthotic management.” Rather than focusing on the orthosis itself, he said, orthotists should focus on prescribing the best time frame for patients to wear the device.
“Wearing hours as dosage of orthotic treatment is probably the singular most important variable outcome,” he said.
Orthotists should carefully monitor patients with scoliosis and be sure to correct the orthosis as needed.
“The more you correct the orthosis, and the more you maintain it to the termination of orthosis, that will predict where you will be 5 years later,” Gavin said. “And I have seen this. I have seen 38° curves come back 25 years later at 10°. But if you do not correct it well, and you do not adjust it enough to maintain your correction, that too will predict where you are going to be later.”
Gavin’s tips for O&P practitioners who would like to improve their knowledge of scoliosis treatment include: viewing a spinal fusion from start to finish; documenting and publishing results; spending extra time listening to the patient and the patient’s family; being kind and reassuring toward the patient, especially on his or her first visit; and communicating with the physician.
“You are the teacher,” he said. ¾by Amanda Alexander
For more information:
Gavin T. Scoliosis management. Presented at: New Jersey chapter of American Academy of Orthotics and Prosthetics Annual Meeting; Nov. 5-7, 2014; Atlantic City, N.J.
Disclosure: Gavin has no relevant financial disclosures.