‘Smart Brace’ Brightens Scoliosis Treatment Outlook

Young scoliosis patients can unintentionally compromise the effectiveness of their orthosis as their energetic lifestyles and daily activities can cause it to loosen. Now a solution is at hand-a "smart brace" which automatically tightens itself if it is loosened.

Photo by Edmond Lou of the University of Alberta. Courtesy of Glenrose Rehabilitation Hospital. The computerized orthosis is the result of research involving several disciplines and crossing national borders.

Located in the Scoliosis Clinic of Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada, the Orthopedic Engineering Research Group (OERG) of the University of Alberta works with experts from various disciplines to develop orthotic technology and diagnostic tools to enable better scoliosis diagnosis and treatment, decreasing the need for surgery.

The group is headed by Jim Raso, MASc, associate director of Glenrose Hospital and adjunct professor in the University of Alberta's Departments of Mechanical, Electrical, and Computer Engineering, and includes Edmond Lou, PhD, PEng, research associate and adjunct professor in the Departments of Electrical and Computer Engineering, Pediatric and Surgery; and Doug Hill, BSc, MBA, who focuses on implementing research at the clinic.

The OERG collaborates with an eclectic group of experts comprising surgeons from the university's Department of Surgery, researchers from the Faculty of Medicine, experts in anatomy, radiology, and diagnostic imaging, and a physicist, according to an article by Caitlin Crawshaw in the University's ExpressNews .

The "smart brace," one of several research projects being conducted by the group, is under the purview of Lou, who specializes in microcomputer and non-surgical treatment of scoliosis. "One of my systems is able to maintain the interface pressure between brace and body," Lou explained in the ExpressNews article. "So if the system senses it's too loose, it will pump air into the force pad area, and when it's too tight, it will release the air."

The research group is collaborating with Utah State University in Logan and the University of Hong Kong, China, where Lou's orthotic technology is being used. "The project is currently in clinical trial," Lou told The O&P EDGE . "We have six subjects so far who have used the system. All of their out-of-brace Cobb angles are the same as their initial visits, which means that the system is able to maintain the patients' Cobb angles. However, all the patients are still under the brace treatment, so a conclusive statement cannot be made.

"We are applying for more research funding to perform a large-scale clinical trial to validate the system," Lou said. The study will be collaborated with the University of Hong Kong and is planned to start October 1 and end in August 2009, he added.

Software Measuring Tool The OERG also has developed computer software to accurately measure the physical surface of the back. "Surface topography produces a map of the back and shows where the bumps and valleys are," Raso said in the ExpressNews article. The technology allows clinicians to track physical changes associated with scoliosis and determine if there have been changes to the spinal curve. "This offers some information that an x-ray can't provide," the article added. "While x-rays are low-dose, radiation exposure is still a health concern for clinicians and patients."

The software has been in use about four years, Lou told The EDGE . A study is currently under way to correlate the brace treatment outcome and the surface topography changes, he added.

The interdisciplinary and international cooperation has helped solve problems and speed up technological advances, the research team observed.

"It's been a real education for us to see how people from different areas approach problems differently and have different insights as to what's causing the problems and what the solutions may be," Raso said in the ExpressNews. "It's discussing these issues with people from different backgrounds that lead us to finding solutions more quickly."

Etiological Mystery Besides researching more effective diagnosis and treatment options, the group is studying the mystery of why patients develop idiopathic scoliosis. The Scoliosis Clinic will soon be recruiting molecular biologists to look at the etiology of the condition in children, according to ExpressNews .

Research to unlock the secrets of the etiology of adolescent idiopathic scoliosis (AIS) is progressing on several fronts.

One promising path may be the development of a diagnostic test to predict idiopathic scoliosis. Paradigm Spine LLC, New York, New York, is funding clinical trials of a blood test devised by Alain Moreau, PhD, director of Ste. Justine University Hospital Centre's Bone Molecular Genetics and Skeletal Malformations Laboratories, Montreal, Quebec, Canada.

According to Moreau, as quoted in a press statement from Paradigm Spine, the results of his research that began in 2001 made him optimistic that the progression of scoliosis would be predictable in infants using well-understood genetic markers. Trials are being conducted throughout 2008.

However, many experts consider the causes of idiopathic scoliosis to be multifactorial. Some factors playing a role could include melatonin, the effects of connective tissue, skeletal muscle abnormalities, thrombocyte abnormalities, neurological mechanisms, and growth and biomechanical factors, according to research articles.

Although much remains to be done, research efforts from several different sectors into the etiology, diagnosis, and treatment of scoliosis continue to paint a brighter picture for the millions of children, youths, and adults throughout the world who suffer from the condition.

Miki Fairley is contributing editor for The O&P EDGE and a freelance writer based in southwest Colorado. She can be contacted via e-mail atÂ miki.fairley@gmail.com

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