**1. Introduction**

There are different presentations of scoliosis, including genetic spinal deformities, neuropathic and idiopathic onset scoliosis, that develop in two to three percent of the population (depending on the research report) during skeletal development. Sometime this can cause complex management issues which can present at any age and continue well into adulthood and throughout the geriatric years. These presentations at times require differing orthopaedic, physical therapy and orthotic interventions to improve symmetry and pain management.

Rigid and semi-rigid bracing has been in existence for thousands of years. One of the earliest examples being an orthopaedic corset of a tree bark that was discovered painted in cliff dwellings of pre- Columbian Indians circa 900 AD (**Figure 1**) [1].

Furthermore, a number of interesting historical, almost medieval (by today's standards) devices have been designed to counter the deformities utilising complex metal designs to force the spine into a required position. A number of researchers have incorporated thigh fixation as described by German orthopaedists in the 19th and early 20th centuries (**Figure 2**) [1].

### **Figure 1.**

*Drawing of an orthopaedic corset of tree bark from the pre-Columbian Indians cliff dwellings Circa 900 AD. Colorado State Historical Museum (Denver).*

### **Figure 2.**

*Scoliosis brace with thigh attachment (Redrawn from an early print).*

In 1971, the Boston modular rigid (**Figure 3**) and semi-rigid plastic spinal brace system was developed and has been used (and evolved) for over 40 years [2], becoming the stalwart of scoliosis management of both neurological onset and idiopathic scoliosis around the world.

Rigid bracing has been proven to be effective in preventing curves from progressing to the point of needing surgery and in some cases, have helped to reduce the curve magnitude [3]. The "Dose", the amount of time the patient wears the brace, has proven to be vital to bracing success. An international, partially randomized control trial (BRaist study) showed that if patients wore their full time brace an average of 12.9 hours per day or more, they had a 90–93% chance of not having

*The Use of a Dynamic Elastomeric Fabric Orthotic Intervention in Adolescents and Adults… DOI: http://dx.doi.org/10.5772/intechopen.96391*

### **Figure 3.**

*Original Boston Brace made with 15 degrees of lumbar lordosis, fitted with compression pads and cut out to provide spinal asymmetry.*

their curve progress to the point of requiring surgical intervention [4]. Wearing the brace for less than 6 hours per day, equated to a 42% chance of surgery requirement.

The opposite is true for neurological onset scoliosis, where a child with cerebral palsy (for instance), would wear similar corrective cast bracing. Spinal bracing would require "anniversary" casting (annual corrective brace casting) to ensure the brace was fit for purpose. The curve, however in neurological cases generally continues to worsen until the child reaches maturity in late adolescence and requires surgery to correct the spine. This happens even, with self-reported compliance. When compared to the natural history of neuromuscular scoliosis, bracing does not prevent the rate of curve progression [5], however there are reports that bracing improves seating [6], standing and walking postures as well as other benefits for people with neurological disorders.

Both idiopathic and neuropathic onset scoliosis presentations use the basic brace concept of marking up an x-ray to show the left/right lean and rotation of the vertebra at each level to inform the positioning of pads or pressure required to provide

**Figure 4.** *Bston Brace 3D-custom fabricated from scan, built in asymmetry.*

the corrective force on the body, known as "blue printing". Blue printing also informs the position of the cutaway areas of the brace. **Figure 4** illustrates the result, using computer aided design and manufacturing (CADCAM) to carry out this role.
