IntroductionAs brace treatment of idiopathic scoliosis has proven effective and has become accepted as a realistic treatment alternative [11], the psychological impact of its use on children has become a major concern. The psychosocial effect of bracing has been discussed in many reports. The studies have focused on children's ability to cope with the stress of chronic disability [5,10,14,17,19], on the longterm effect of scoliosis treatment, either by brace or operation [1,2,4,6,12], and on identifying factors contributing to non-compliance [15,18]. Most of these studies have included patients treated with the Milwaukee brace, and adequate age-matched control groups have not been used. Brace wear has been found to be related to a negative body-image, lower level of self-esteem, and increased stress [6,9]. Factors such as an intellectual understanding of scoliosis and bracing, optimistic view of outcome, active decision to wear the brace, and support of family and Abstract To evaluate the effect of brace treatment on self-image in patients with adolescent idiopathic scoliosis, 54 consecutive patients admitted for brace treatment were interviewed before bracing. A prevalidated questionnaire including the following five aspects of self-image was used: (1) body-image, (2) selfperception of skills and talents, (3) emotional well-being, (4) relations with family, and (5) relations with others. As a control group, the answers of 3465 normal school children were used. Forty-six patients participated in a follow-up interview 1.7 (range 0.8-3.0) years later. In addition, during the first interview, the scoliosis patients answered selected questions about their social circumstances and attitudes towards their forthcoming brace treatment. Grossly, the patient group lived in stable family conditions with a high percentage (40%) of fathers and/or mothers with an academic education or with a high employee status. The patients' relations with families were generally good. Nearly all believed that the brace would affect their posture, but only a few thought that wearing the brace would influence their growth. Two-thirds believed that it would be difficult to wear the brace, and often reflected on the use of it. There were no statistically significant differences between the scoliosis patients and the age-matched controls at the pre-bracing nor at the follow-up interviews. Neither were there any statistically significant differences between the answers of the scoliosis patients in the pre-bracing and follow-up interviews. This was valid for the total score as well as for each subscale item score. It is concluded that wearing the brace does not affect the self-image of adolescents with idiopathic scoliosis negatively.
We reviewed 90 consecutive patients with various neuromuscular diseases and a progressive spine deformity treated with a prefabricated Boston-type underarm corrective brace. Of these, 38 patients had spastic tetraplegia; seven, syndrome-related muscular hypertonia; 24, muscular hypotonia; and 21, myelomeningocele. The mean age at the treatment start was 9.2 years (range, 1.4-17.7 years). Twenty-four were ambulating and 66 wheelchair-bound. Hypotonia was the dominant type of muscle involvement in 49, spasticity in 28, and athetosis in 13 patients. The mean pretreatment Cobb angle was 47 degrees, with a range from 23 to 95 degrees. The mean brace-induced Cobb-angle correction was 60%, thus well comparable to that in idiopathic scoliosis. However, this did not predict favorable treatment results. At the follow-up, on average 3.1 years (range, 1-5.5 years) after weaning from the brace, the brace treatment was successful in 23 patients. Successful was defined as<10 degrees curve progression during the observation time and a good brace compliance. Forty-one patients discontinued the brace treatment, and 19 progressed despite adequate brace wear. Five patients are still in treatment, and two have died. Successful treatment was seen in ambulating patients with muscle hypotonia and short thoracolumbar/lumbar curves measuring <40 degrees as well as in nonambulating patients with spastic short lumbar curves. These types of neuromuscular scoliosis may be the only ones to respond to brace treatment. In other cases, the brace treatment cannot be expected to have a lasting corrective effect although it can be used as sitting support.
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