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منتدى Rehabilitation Team

    Differentiation betwn Milwaukee and Boston braces regarding treatment of scoliosis

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    Abdulla Abubaker
    نائب المدير
    نائب المدير

    ذكر عدد الرسائل : 94
    العمر : 35
    تاريخ التسجيل : 07/10/2008

    Differentiation betwn Milwaukee and Boston braces regarding treatment of scoliosis

    مُساهمة من طرف Abdulla Abubaker في الثلاثاء ديسمبر 08, 2009 9:37 pm

    The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace used in the treatment of spinal curvatures (such as scoliosis or kyphosis ) in children. It is a full-torso brace that extends from the pelvis to the base of the skull. It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of immobilization.
    Milwaukee braces are often custom-made over a mold of the patient's torso, but in some cases, it can be made from prefabricated parts. Three bars—two posterior and one anterior—are attached to a pelvic girdle made of leather or plastic, as well as a neck ring. The ring has an anterior throat mold and two posterior occipital pads, which fit behind the patient's head. Lateral pads are strapped to the bars; adjustment of these straps holds the spine in alignment.
    This brace is normally used with growing adolescents to hold a 25° to 40° advancing curve. The brace is intended to minimize the progression to an acceptable level, not to correct the curvature. For corrective measures, special exercises or physical activities are used. If the curvature continues despite the brace, surgery may be required.
    The Milwaukee brace is often prescribed to be worn 23 hours a day for several years.






    The Boston Brace
    This is the most commonly-used brace in the United States. It is a symmetrical brace. It corrects curvature by pushing with small pads placed against the ribs, which are also used for rotational correction (here it tends to be slightly less successful, however). These pads are usually places in the back corners of the brace so that the body is thrust forward against the brace's front, which acts to hold the body upright. The brace opens to the back, and usually runs from just above a chair's seat (when a person is seated) to around shoulder-blade height. Therefore, it is not particularly useful in correcting very high curves. It also does not correct hip misalignments, using the hips instead as a base point. This brace is typically worn 20–23 hours a day.

    Advantages and Disadvantages for both kinds of braces:
    First: The Milwaukee brace or (CTLSO):
    Advantages:
    • It may remove for activities of daily living.
    • Because its open design, there is minimal restriction of respiration.
    • It allows good air circulation to minimize skin problems.
    • It is adjustable to growth and curve changes.
    • Because it has cervical ring we could use it for high level curve deformity.
    Disadvantages:
    • It must be worn for most of the day and night (typically over 20 hours) until the patient is mature. Time out of orthosis is allowed for swimming, bathing, and sporting activity.
    • It is noncosmetic, since the occipital and chin pads extend above the clothing.
    • Fabrication is more difficult and time consuming than that of Boston brace.
    • Little correction can be expected if the curves are major. However, use of the Milwaukee CTLSO does prevent further progression of the curve.

    Second: The Boston brace or (TLSO):
    Advantages:
    • The Boston brace, in contrast to the Milwaukee brace are low profile (underarm) an can be worn under clothing.
    • The Boston brace fabrication is quicker than Milwaukee brace.
    • Three-point pressure application in The Boston brace.

    Disadvantages:
    • The solid design of THE BOSTON BRACE limits adjustment for vertical growth and requires new THE BOSTON BRACE fabricating when the patient out-growth the THE BOSTON BRACE.
    • Heat retention can lead to possible skin problems because of the closed design of Boston brace.
    • Respiration is restricted because of thoracic compression of the Boston brace.
    • Because of its low profile, thoracic curves with an apex above T8 cannot be treated.

    see the pictures plz
    http://img704.imageshack.us/img704/9003/bbthoracic.jpg
    http://img189.imageshack.us/img189/9586/ahs19.jpg
    (From prosthetics and orthotics of lower limb and spine, RON SEYMOUR)

      الوقت/التاريخ الآن هو السبت نوفمبر 25, 2017 2:08 am