Prophylactic bracing in pseudohypertrophic muscular dystrophy (preliminary report). Part II: The brace.
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Sensor-based measures of knee brace adherence have low agreement with self-report methods: A multi-measure study among knee osteoarthritis patients.
OBJECTIVE: To explore agreement between self-report and objectively measured adherence to brace wearing by patients with knee osteoarthritis. METHOD: A single-arm observational analysis nested within the PROP OA randomised controlled trial (ISRCTN28555470). Of 237 adults with symptomatic knee osteoarthritis randomised to brace treatment, 60 were included in this sub-study investigating three different methods of assessing knee brace wear time over 26 weeks: 1. Self-report questionnaires (SRQ) at 12 weeks and 26 weeks; 2. Short message service (SMS) questions (days worn in past week, typical hours per day when worn) administered from week 1 to week 24; 3. A skin temperature sensor embedded in the brace, sampling every 10 min for 26 weeks. The presence and reason for the sensor were concealed from participants. The estimated proportion of participants meeting "minimum brace use", defined a priori as ≥1 h on ≥2 days in past week, was described for each measurement method, overall and by brace type (unloader, neutral). For temperature sensor measurements, time spent above 24°C and time spent above 25°C were used. Agreement between the measures was summarised by percentage agreement and kappa (ĸ). RESULTS: The estimated proportions of participants meeting "minimum brace use" at 12 weeks were 83% (SRQ), 83% (SMS), 60% and 58% (temperature sensor, 24°C and 25°C thresholds, respectively). At 26 weeks, the corresponding estimates reduced to 72%, 71% (SMS at 24 weeks), 43% and 37%. Sensor data suggested the sharpest decline in brace use occurred within the first 12 weeks. Agreement between self-report measures was higher than between self-report measures and sensor (SRQ vs SMS at 12 weeks: 92% agreement, ĸ=0.67 (95%CI: 0.34, 1.00); SRQ vs Sensor at 12 weeks: 74%, 0.35 (0.10, 0.60); SMS vs Sens at 12 weeks: 76%, 0.36 (0.05, 0.66). Agreement between all measurement methods reduced at 26 weeks. CONCLUSIONS: This novel use of a temperature sensor to monitor brace adherence in knee osteoarthritis indicates that self-report adherence substantially overestimates knee brace wearing time, with implications for clinical trials and practice.
Humans↗
[Investigation of gait of patients with idiopathic scoliosis and the influence of the Milwaukee brace on gait (author's transl)].
We investigated 42 juvenile patients with idiopathic scoliosist, 37 of them were provided with a Milwaukee brace and treated physically. The electromyographic activity of the musculi erectores trunci and the musculi glutaei medii were recorded during walking and standing on one leg. Simultaneously the motions of the trunc and the pelvis in the frontal plane were registered and calculated. Results without the brace: During walking the activity of the erectors trunci predominates on the convex side of the curvature of the spine. This applies as to the functional curve. The M. glutaeus medius shows an increased activity on the contralateral side of the overhang of the trunc. The priodical shifts of the trunc to the right and to the left during walking decrease with increasing activity of the M. glutaeus medius. In this way, we show the stabilizing influence of this muscle upon the statics of the spine. This should be especially considered with regard to the physical treatment of the patients. Results with the brace put on: There is only little influence of the brace upon the electrical activity of the musculi erectores trunci: we could not detect any activating ore inactivating effect of the brace. The amplitude of the periodical shifts of the trunc and the perlvis during walking is reduced by the brace. At the same time we found a greater activity of the musculi glutaei medii than with the brace taken off. We suppose that the reduced shifts of the trunc and the pelvis involved by the brace force a greater activity of the glutaeus medius.
Adolescent↗
Energy expenditure during walking in patients with scoliosis. The effect of the Milwaukee brace.
Oxygen uptake during treadmill walking was measured in 8 scoliotic patients with idiopathic curves ranging from 25 to 60 degrees. The patients were fitted with a Milwaukee brace and the test was repeated within 2 or 3 days to study the effect of the brace on energy expenditure, mechanical work, and ventilatory function. The total oxygen uptake was not systematically affected by wearing the brace. When the weight of the brace was included, the oxygen uptake/kg body weight decreased in most of the patients at low walking speed in spite of an increased lift work. The positive influence on energy expenditure was interpreted as a stabilizing effect of the brace on the spine. This effect was not consistent at moderate and high speeds of locomotion, where both a decrease and an increase in oxygen uptake/kg were observed. Heart rate increased significantly during walking at high speed with the brace, while a slight but significant reduction of the tidal volume was found during walking at low speed.
Adolescent↗
Cylinder or mobile cast brace after knee ligament surgery. A clinical analysis and morphologic and enzymatic studies of changes in the quadriceps muscle.
Sixteen patients participated in a prospective randomized trial in which a standard cylinder cast was compared with a mobile cast brace. Both were worn for 4 weeks, beginning at 1 week after reconstruction of the anterior cruciate ligament. The athletes that had used a cast brace could return to sports activities in about one-half the time it took for the athletes with a standard cast. The patients with a standard cast showed a significant atrophy of Type I (slow twitch) muscle fibers in the vastus lateralis. The cast brace patients did not show any significant changes in cross-sectional areas of Type I or Type II (fast twitch) muscle fibers. The standard cast patients had a significant reduction of succinate dehydrogenase (SDH) activity in the vastus lateralis whereas the patients with the cast brace did not show any significant changes. No difference in surgical end result was found. A cast brace with a limited range of motion between 20 and 60 degrees of flexion is recommended as the standard postoperative treatment after knee ligament surgery.
Adult↗
[The use of an articulated brace in the treatment of juvenile kyphosis (author's transl)].
The authors have attempted to assess the efficiency of an articulated brace in the treatment of juvenile kyphosis (Scheuermann's disease and idiopathic kyphosis). Two series of patients were compared. Patients in both series were treated in a first stage by a plaster cast and in a second stage by a bivalve brace in the first series and an articulated brace in the second series. The technique of treatment by a plaster cast and by the brace is fully described. It is concluded that control of the lumbar lordosis is of great importance. The results were better with an articulated brace. The indications for treatment are given depending on the age at the onset of treatment, the type of spine deformity and its severity. In some cases of severe dorsolumbar kyphosis, surgery may be indicated.
Adolescent↗
The Boston brace system for the treatment of low thoracic and lumbar scoliosis by the use of a girdle without superstructure.
A brace for the non-operative treatment of scoliosis constructed without a metal superstructure is preferred by teenage patients. Preliminary results show that a 50-60% correction can be achieved as measured on standing X-rays in the brace. Three quarters of these patients have no skin problems associated with brace wearing. In several years when these patients have reached skeletal maturity and have spent 1 year out of their braces, it will be possible to determine whether the short term results are comparable to the standard set by the Milwaukee Brace.
Activities of Daily Living↗
Cast-bracing for fractures of the femur. A preliminary report of a modified device.
The second-generation cast-brace system offers some advantages over previous systems of cast-brace treatment for fractures of the femur. Because the thigh section is adjustable, loosening of the cast-brace is not a problem. The device can be applied earlier and need not be reapplied when the girth of the thigh is reduced. Using a roller traction system, the cast-brace can also be used initially for traction and suspension without the complexity of traditional systems. With the use of commercially available plastic knee joints, special skills in alignment of the joints are not necessary, and no specially trained personnel need be on hand. The lightweight thigh section coupled to custom-fit plaster leg section, with the foot and ankle free, are less bulky than a totally plaster cast-brace with metal side joints. Walking may be begun earlier with the device, and in-patient hospital time is reduced. However, this system requires a high level of patient cooperation in that the patient is free to adjust the system himself and, therefore, the system may not be safe for application in all settings.
Adult↗
Milwaukee brace correction of idiopathic scoliosis. A biomechanical analysis and a restrospective study.
We analyzed the biomechanics of Milwaukee brace treatment of idiopathic scoliotic patients through simulation in five computer-constructed model spines. The contributions to correction of each component of the brace were examined in these model spines, and some of the mechanical principles that determine the outcome of brace treatment were studied. The validity of the stimulation findings was then tested by a retrospective analysis. Simulation was used to predict the outcome of milwaukee brace treatment in sixty-eight patients. In 81 per cent of these patients, the actual outcome agreed with the prediction. The study suggests that careful adherence to mechanical principles in the use of a Milwaukee brace will result in successful treatment of more patients.
Adolescent↗
The cast-brace treatment of femoral shaft fractures.
Ninety-eight fractures of the shaft of the femur were seen in one unit over the two years 1974 and 1975, and the results have been assessed in sixty-nine. Of these, thirty-eight were treated by skeletal traction in a Thomas's splint followed by skin traction, and thirty-one by skeletal traction followed by a cast-brace. The technique of application is described in some detail. The average time for application of the cast-brace was six weeks after the injury, the time in hospital eight weeks and the time till removal fifteen weeks. The patients selected for a cast-brace were in hospital for just over half the time of the others and their fractures on average united more quickly, though with some trouble from angulation of fractures of the uppermost third of the shaft. It is concluded that when used with all the judgment and skill it demands, the cast-brace method is a great advance in conservative treatment.
Braces↗
Clinical assessment of a new weight-relieving brace.
A new cosmetic weight-relieving brace which utilises stainless steel and light alloy in its structure is described. A clinical assessment of thirty-six patients (four bilateral cases) has shown the Salford Cosmetic brace to be suitable for over 80 per cent of patients attending for assessment. Five patients rejected the brace, and the reasons are discussed. Contra-indications which emerged during the assessment included limb shortening of more than 5 centimetres; fixed equinus of more than 10 degrees; and fixed deformity of the knee of more than 10 degrees. The safety and durability of the brace, first demonstrated in laboratory tests, are confirmed. Further possible development is outlined.
Biomedical Engineering↗
Nursing care of the patient in a cast brace.
To establish realistic outcomes and formulate workable nursing care plans for the patient in a cast brace, the nurse must understand the concept of cast bracing, the patient's response to the injury and previous treatee is often the most persistent problem, and vigilant observations along with supportive care may prevent the skin from breaking down and the patient from becoming discouraged. Since the purpose of cast brace treatment is to hasten healing, maintain knee and hip joint function, and shorten the rehabilitation period, the smooth progression of activity and prevention of problems due to the cast brace are priorities.
Braces↗
Follow-up study of Milwaukee brace treatment in patients with idiopathic scoliosis.
Milwaukee brace treatment for patients with idiopathic scoliosis very rarely accomplishes improvement approaching that of successful surgery. Prpgression of small and medium-sized curves (60 degrees or less) has been routinely halted. Few curves progress with adequate brace treatment. Occasionally, improvement in deformity and curve measurement is significant, but loss of improvement seems to be gradual and almost uniformly present to some degree after cessation of treatment. A much longer follow-up period will be necessary if the improvement seen with Milwaukee brace treatment can be considered "permanent." Milwaukee brace treatment is effective in skeletally immature patients with small, flexible and nondeforming curves. Corrective surgery is recommended for deforming curves in all patients for whom permanent improvement is the goal.
Adolescent↗
A modified brace (Prenyl) for scoliosis.
Sixty-six skeletally immature patients with idiopathic scoliosis were treated with a Prenyl brace and their results were analyzed. Fifty-three patients (80%) showed a satisfactory response. The best results were obtained in patients with lumbar curves and thoracolumbar curves less than 40 degrees. Advantages of this brace are simplicity of fabrication and fitting, patient comfort, patient acceptance and relatively low cost. The disadvantages of this brace are that it is less effective in thoracic curves in the upper thoracic spine, double major curves and kyphosis. It probably causes more significant chest restriction than the Milwaukee brace.
Adolescent↗
Cast brace for the upper extremity.
Management of a traumatized elbow or intra-articular fracture with concomitant upper extremity long bone fracture is tedious, especially when early elbow motion is desirable. An adaptation of the lower extremity hinged cast brace to the elbow provides controlled flexion while protecting against varus/valgus stress and translation forces. A cast brace is constructed from readily-available materials, and can be applied in an out-patiet clinic. The functional results obtainable in a variety of upper extremity injuries are excellent, and the patients generally accept the elbow cast brace very well.
Adult↗
The treatment of femoral fractures by cast-brace and early walking: a review of seventy-nine patients.
Seventy-nine cases of fracture of the femoral shaft treated by cast-brace and early walking have been reviewed. Discrepancy in femoral length was assessed by scanogram. The cases were analysed to relate the incidence of shortening greater than 2 centimetres to the type and site of the fracture, and the time which elapsed from injury until the cast-brace was applied. Such shortening was encountered most frequently when the cast-brace was applied within the first two weeks from injury or after six weeks and in those patients with comminuted fractures of the middle third of the femoral shaft.
Adult↗
Effect of the Milwaukee brace on vital and ventilatory capacity of scoliotic patients.
The vital capacity (VC) and the maximal voluntary ventilation (MVV) were studied in 29 patients with scoliosis (predominantly idiopathic). The results obtained confirmed earlier observations that scoliotic patients have decreased VC and MVV. The immediate effect of the application of the Milwaukee brace was a slight though statistically significant decrease in MV, whereas there was no significant effect on VC. Treatment with the Milwaukee brace for a mean period of 15 months did not appreciably influence the VC or MVV, as a percentage of the predicted normal values of the patients, when measured without the brace applied.
Adolescent↗
[The Erlangen hip brace, a principle of rehabilitative treatment (author's transl)].
Painful, loosened total hip prostheses and instability following their removal require up to now occasionally support by means of a brace. The paper deals with design, way of action and indication of a new, light-weight, dynamic brace to controle the motion of hip joint. It is evident that this brace can be used not only to manage the loosening of a total hip prosthesis or conditions following the resection of the head of femur, but also in osteoarthrosis of hip joint.
Braces↗