Andreas Donauer

Ultrasound-assisted brace casting for adolescent idiopathic scoliosis, IRSSD Best research paper 2014

BackgroundBrace treatment is the most effective non-surgical treatment for AIS. High initial in-brace correction increases successful brace treatment outcomes. The objective of this study was to investigate if real-time ultrasound (US) can aid orthotists in selecting the pad pressure level and location resulting in optimal in-brace correction of the spine.MethodsTwenty six AIS subjects participated in this pilot study with 17 (2 M, 15 F) in the control group and 9 (2 M, 7 F) in the intervention group. For the control group, the standard method was used to design their braces. In addition to the standard of care, a medical 3D ultrasound (US) system, a custom pressure measurement system and in-house software were used to select pad placement and pressure levels for the intervention group. The orthotist used a custom standing Providence brace design system to apply pressures against the patient’s torso. The applied pad pressures were recorded. A real-time US spinal image was displayed. Cobb angle measurements from the baseline and the assessment scan were performed. The orthotist then decided if an adjustment was needed in terms of altering the pad locations and pressure levels. The procedures may be repeated until the orthotist attained the best simulated in-brace correction configuration to cast the brace.ResultsIn the control group, 8 of 17 (47%) subjects needed a total of 16 brace adjustments after initial fabrication requiring a total of 33 in-brace radiographs. For the intervention group, the orthotist tried additional configurations in 7 out of 9 cases (78%). Among these 7 revised cases, 5 showed better stimulated in-brace corrections and were subsequently used to cast the brace. As a result, only 1 subject required a minor adjustment after initial fabrication. The total number of in-brace radiographs in the intervention group was 10.ConclusionsThe use of the 3D ultrasound system provided a radiation-free method to determine the optimum pressure level and location to obtain the best stimulated in-brace correction during brace casting. The average number of radiographs per subject taken prior to final brace implementation with the interventional group was significantly lower than the control group.

A Smart Orthosis for the Treatment of Scoliosis

The tightness of an orthosis for the treatment of scoliosis varies greatly during daily activities. To be effective the orthosis should be maintained at the prescribed tightness to optimize the active component of objective treatment. Subjective feeling is the most commonly used method to evaluate how patients tighten their orthoses. To provide an objective measure, a battery-powered microcomputer system was developed to monitor loads exerted by orthoses during daily living. The system not only records how well the orthosis has been used, but also helps patients wear the orthoses as prescribed. Four subjects have used the system for one month. The proportion of the time that the subject wore the orthosis at the prescribed level increased from 53plusmn10% to 69plusmn16%. The effectiveness of the smart orthosis is still under evaluation

Results of ultrasound-assisted brace casting for adolescent idiopathic scoliosis

BackgroundFour factors have been reported to affect brace treatment outcome: (1) growth or curve based risk, (2) the in-brace correction, (3) the brace wear quantity, and (4) the brace wear quality. The quality of brace design affects the in-brace correction and comfort which indirectly affects the brace wear quantity and quality. This paper reported the immediate benefits and results on using ultrasound (US) to aid orthotists to design braces for the treatment of scoliosis.MethodsThirty-four AIS subjects participated in this study with 17 (2 males, 15 females) in the control group and 17 (2 males, 15 females) in the intervention (US) group. All participants were prescribed full time TLSO, constructed by either of the 2 orthotists in fabrication of spinal braces. For the control group, the Providence brace design system was adopted to design full time braces. For the intervention group, the custom standing Providence brace design system, plus a medical ultrasound system, a custom pressure measurement system and an in-house software were used to assist brace casting.ResultsIn the control group, 8 of 17 (47%) subjects needed a total of 11 brace adjustments after initial fabrication requiring a total of 28 in-brace radiographs. Three subjects (18%) required a second adjustment. For the US group, only 1 subject (6%) required adjustment. The total number of in-brace radiographs was 18. The p value of the chi-square for requiring brace adjustment was 0.006 which was a statistically significant difference between the two groups. In the intervention group, the immediate in-brace correction as measured from radiographs was 48 ± 17%, and in the control group the first and second in-brace correction was 33 ± 19% and 40 ± 20%, respectively. The unpaired 2 sided Student’s t test of the in-brace correction was significantly different between the US and the first follow-up of the control group (p = 0.02), but was not significant after the second brace adjustment (p = 0.22).ConclusionsThe use of the 3D ultrasound system provided a radiation-free method to determine the optimum pressure level and location to assist brace design, resulting in decreased radiation exposure during follow-up brace evaluation, increased the in-brace correction, reduced the patients’ visits to both brace adjustment and scoliosis clinics. However, the final outcomes could not be reported yet as some of patients are still under brace treatment.Trial registrationNCT02996643, retrospectively registered in 16 December 2016

How does pressure configuration affect Cobb angle during AIS brace casting

Methods Nine AIS patients undergoing casting for new braces participated in this pilot study (2 males, 7 females, aged 11-16, Cobb angles 16-44 degrees). An ultrasound scan was used to measure the patient’s (baseline) Cobb angle. The orthotist then used a custom standing Providence system to apply corrective pressures simulating a brace. A second ultrasound scan measured the new (corrected) Cobb angle. The orthotist could then try to achieve additional correction by adjusting the pressure magnitude/location. The process of adjusting pressures and ultrasound scanning repeated two or three times; the orthotist then chose the most satisfactory pressure configuration and performed the actual casting. The procedure produced 26 individual scans (including baseline scans) from the 9 patients. The magnitude of applied pressures was measured using inflatable air bladders fixed to the Providence pads. The air pressure was measured during the ultrasound scan. The distance between pads was measured and multiplied by the total pressure to create a torque-like measurement. Robust linear regression was used to relate pressure with Cobb angle correction, and torque with correction. Outlier points were removed if they fell more than 1.5 standard deviations from the regression line. Correlations between pressure/torque and correction were then measured. Results Two outlier points were removed both belonging to a single patient. Pressures ranged from 16-113 mmHg. The major curves’ correction ranged from 0-39%. Significant correlations existed between average pressure and Cobb angle correction (r = 0.86, p < 0.01), and average torque and Cobb angle correction (r = 0.82, p < 0.01).

Validation of smartphone inclinometer tools for measuring rib hump in scoliosis patients

Material and methods Inclinometer tools in smartphones can be used to measure angles. Spinologics (Montreal, Canada), designed an iPhone application called Scolioscreen along with a rubber sleeve that can be placed on the iPhone to take rib hump measurements. To ensure the new device’s ability to measure angles, measurements were taken on a flat granite block which was accurately leveled in the Department of Mechanical Engineering Metrology Lab. Highly accurate angle gage blocks were used (0.0003 degrees). Angles from -30 to 30 degrees were measured by two observers, with two different iPhones (iPhone4 and iPhone5), on two occasions. Angles blocks were arranged by one observer at a random angle between -30 and 30 while the other blindly measured (Figure 1). Additionally, four plaster casts from brace patients were measured with one iPhone.