Scoliosis Bracing for Spinal Muscular Atrophy (SMA) Patients
Scoliosis Bracing is now recognised as an effective and necessary means to manage patients’ posture and scoliosis progression.
If left unsupported, these patients will develop a scoliosis and hyperkyphosis which can progress quite quickly. The aim of bracing is to maintain as straight a spine as possible during growth to positively influence how the spine grows. Preventing progression while maintaining a balanced sagital profile gives the best potential to achieve maximum growth without the need for early surgical intervention.
SMA Braces
We utilise CAD-CAM scanning in the assessment and design of our SMA braces, performing a supine and prone scan, along with measures which can then be combined on screen. An accurate supine scan gives a better base line scan to work from, as we have removed most of the postural element of the deformity, while reducing the Cobb angle and achieving elongation which we would want to capture in the brace design.
When designing braces, we use corrective movement principles to reduce the scoliotic curve while providing space within the brace for the potential for further correction. This results in a slight asymmetric brace design, which is less aggressive than an idiopathic scoliosis hyper corrective brace design. This, combined with a good sagital profile to avoid a kyphotic collapse, should maintain as straight a spine as possible, while providing the optimal posture for upright seating. The patient is therefore able to focus on other activities, such as head control and upper limb positioning.
The Corrective Movement Principle (CMP)
The principle of corrective movement differs from more traditional rigid braces in which 3-point forces are applied.
Avoiding this 3-point force design reduces the risk of compression of the thorax, reducing risk to the respiratory system as much as possible.
Where possible, having some correction space within the brace can allow for micro movements, which can help to reduce the risk of weakening of the stabilising muscles of the spine, and positively influence the asymmetric growth of the vertebral bodies that would be seen as the structural element of the curve increases.
SMA Brace
Design
2Lumbar support appropriate to achieve optimal sagital alignment.
3No need for long posterior trims often seen in standard TLSOs that affect seating position.
4Asymmetric trim design to maximise postural correction while not over supporting unnecessarily.
5Soft lining over void spaces to maximise space to correct into.
6Trim design and height appropriate for level of kyphosis control required
7Soft inner liner helping to redistribute corrective force and give a comfortable soft edge
8Abdominal window allowing for typical lower abdominal breathing.
9Flexible hip extension when appropriate to stabilise pelvis but still allow required correction, maximizing corrective movement and comfort.
10Breathing mechanics accommodated into rigid brace design to maximise volume change and not impact respiratory system.
11Balance of pressure and space within the brace to avoid compression forces seen in typical TLSOs which can have a negative remodelling effect on rib cage.
12Angled hip extensions to allow for best fit/comfort in sitting in wheelchair.
| CMP Lite X Brace | |
| Trim Adjustment | Greatest Adjustment both EVA & HDPE Trimmable |
| Plastic Frame Moulding | Possible |
| Addition of Windows | Yes |
| Correction Adjustment | Increase with Pads + Increase/Decrease by Frame Adjustment |
| Heat Moulding | EVA & HDPE Frame Adjustments Possible |
As with all CMP braces, SMA Braces are designed for the needs of each individual patient. Curve type and magnitude define the overall design of the brace, however the patient’s condition, curve stiffness and tolerance to pressure determine the Corrective Movement Position applied. Our clinical team will determine the most appropriate degree of correction applied to each brace. Any input from the treating clinician is always taken into consideration.
SMA Brace Treatment Outcomes
Prevent curve progression:
- Stabilise the curve(s) at pre-treatment levels
Slow Progression:
- Avoid progression to a surgical level
- Delay surgery to an optimal age, allowing full growth potential
- Reduce the degree of surgical intervention, short fusion vs long fusion, maintaining maximum movement and flexibility
- Avoid the need for multiple surgeries
- Provide physical support
- Prevent postural collapse
SMA Brace Wear
SMA Braces are typically prescribed for wear during periods in upright posture.
This allows for effective control of the spine when gravity will have maximum impact on the postural control, when the curve will be greatest. However, the nature of the typical patient indicated for these braces may necessitate some compromise on wearing time for some patients.
Night-time Bracing for SMA Patients
The agreed aim/benefit of bracing in SMA patients is to control gravity and postural effect during the upright hours of the day, so wearing the brace anytime patients are upright is the ideal.
However, there are some occasions where night use may be considered. Night-time is when most growth happens so a good in-brace correction may see some positive influence on the patient’s growth.
The use of the brace during night-time is not recommended until the patient has become an established brace user and the brace’s influence on the respiratory system during sleep can first be monitored. If respiratory levels are low at night, or if the patient is on ventilation/assisted breathing, then bracing wouldn’t be considered appropriate.
Equally, if the patient has quite a small curve which is mainly postural, then it probably isn’t necessary to wear the brace when laying as gravity is removed.
Any decision on night-time bracing should be made along with the patient’s brace provider, together with input from the patient’s respiratory team at their local hospital to approve brace wear during night-time hours.
Interested in becoming a provider?
To find out how CMP Brace treatment could benefit your patients, please fill out the contact form below.