Blueprinting to Sobernheim Classification

• 1. rays


  • In-brace x-rays to check function of the orthosis (2-3 weeks)
  • Out of brace x-rays to check overall correction/progression (6-12 months)
  • Minimize exposure to x-rays
• "It is recommended that quality of the brace is checked through an in-brace X-ray"
• "It is recommended that out of brace X-rays are regularly performed to check the effectiveness of bracing treatment: the number of hours out of brace before x-ray taking should correspond to the daily weaning time"
• Common adjustments


  • Increase thickness of the corrective pads
  • Adjust position of the corrective pads
  • Minor trimline adjustments (axilla, distal edge)
  • Additional padding for comfort (axilla, ASIS, distal edge of the window)
  • Widening of the posterior opening
• Monitoring compliance


  • Wearing schedule compliance (Patient-reported, Parent-reported, Heat/pressure sensors)
  • Correct Donning (Check tightness, Pressure sensors)
• "It is recommended that compliance to bracing is regularly checked through compliance monitor devices"
• Signs that a new brace is needed

  • Anterior distal trimlines >1.5cm above thighs in sitting
  • Pain and excessive pressure on pelvis that cannot be resolved
  • Gaps at waist on both sides
  • Posterior opening is wider than lumbar vertebrae
  • X-ray shows progression of curve
• Surgery may be indicated if X-ray shows progression of curve
• End of treatment and weaning

  • Braces are worn until the end of vertebral bone growth and then the wearing time is gradually reduced
  • Typically 6-12 months of night-wear after skeletal maturity (Risser IV)
  • Limited research into benefits of gradual weaning
• Indications for Milwaukee Brace (SO), Boston Brace (SO), Cheneau Scoliosis Brace (a.k.a. Gensinger / Rigo-Cheneau)

  • Age below bone maturity (Risser sign) or menarche for female (~ 18 years old)
  • Cobbs Angle below 40 degrees
  • Allows for some correction or prevention of progression
  • Symptomatic scoliosis (i.e., pain, difficulty breathing, etc.)
  • Single major curve
• Wearing Schedule


  23 hrs. daily
• Cheneau Scoliosis Brace


  a.k.a. Gensinger / Rigo-Cheneau
• Importance of Custom Foot Orthosis in Scoliosis Treatment
• Custom Foot Orthosis (FO) / Insoles

  • Influences address leg length discrepancies (LLDs)
  • Prevent development of joint pain and osteoarthritis in the spine, hips, knees and ankles
  • Improve gait and posture
• Research shows similar baseline characteristics in curve improvement
• Cheneau shows greater results with single major scoliosis curves
• Boston shows better results for double major curves
• Both can be effective in prevention of surgery
• Effectiveness of each design varies greatly on the case, curve classification, age, menarche, wear time and physical therapy
• Double check references, spot bias or small sample groups
• Insole


  • Mix of 4 materials
  • Correction of Varus Deformity
• Final Checks - Shoe Modifications

  Insole must fit in footwear
• Proper footwear


  • Influences insole effectiveness by GRF manipulation
  • Can cause discomfort if ill fitting
  • Can aggravate foot deformities if improper
  • Allow modifications if insole is insufficient or more space is needed
  • Address leg length discrepancies
  • Improve ease in forward Progression
  • Help in joint pain and OA in the spine, hip, knees, ankle
• Role of Physical Therapists (OT) in Spinal Orthotics

  • Schroth method (Katherin Schroth)
  • Breathing techniques
  • Flexibility
  • Core and Back muscle strengthening
• Pectus Carinatum


  • a.k.a. Pigeon Chest
  • is a condition in which the breastbone and ribs are pushed outward. Pectus carinatum occurs more often in males than females (4:1 ratio) and develops somewhat later in males than it does in females.
• 3D Scan Progress Monitoring

  • Provides accurate and evidence-based comparison of deformity correction
• Standing Frame


  For patients who need supported standing
• Walking Frame (with wheels)


  For supported ambulation training
• 3D Printed Orthosis


  • Pros: Custom designs, Perforations can be incorporated, Inexpensive materials

  Cons: Can be time consuming, Requires special training, Expensive equipment, Can lead to poor or loose fit if inexperienced
• 3D Printed Foot Insoles


  • Pros: Can be a mixture of materials, Less waste, No need for POP Cast, Inexpensive

  Cons: Can be time consuming, Requires special training and equipment, Can lead to poor or loose fit if inexperienced