Posture training bracewear for older adults with degenerative scoliosis (ADS)

Abstract

Adult degenerative scoliosis (ADS) which is found in the ageing population is increasing in prevalence. This condition is a three-dimensional (3D) spinal deformity in which the coronal Cobb angle exceeds 10 degrees. Usually, ADS patients suffer from progressive lower back pain (LBP), progressive deformity and symptoms of sagittal imbalance. Research has also suggested that about 65% to 85% of older adults are affected by musculoskeletal pain, which is the most frequent problem, especially LBP which is reported by 36% to 70% of these adults. This seriously affects the daily activities and general health of ADS patients. Since the number of mature adults is increasing, there is now heightened concern around ADS and its health effects which could burden health systems. Current treatment for ADS is not yet well defined. The primary intervention for treating ADS is surgical in nature. However, surgery has a certain level of risk, especially when it comes to operating on the elderly. As a result, bracing is the most typical non-invasive treatment recommended for ADS patients. However, older patients who are subjected to a prolonged period of bracing could experience deterioration of their muscles due to long term inactivity and further worsening of the spinal deformity and symptoms. In response, this study aims to design and develop a posture training bracewear, which incorporates both passive and active corrective forces, in response to the drawbacks of bracing as well as address the special needs of ADS patients. The active corrective forces are produced through a vibrotactile feedback (VTF) system during posture training sessions. Meanwhile, passive forces are produced by the bracewear with spinal support which eliminates the adversities of conventional hard braces by offering increased flexibility and comfort. To the best of my knowledge, there are few studies that focus on designing braces specifically for ADS patients and developing braces with textile materials. Therefore, the proposed design and development of the posture training bracewear in this study would be very helpful for maintaining a certain level of physical function while minimizing the progression of the symptoms of ADS, as well as improving the current problems of brace-wear experiences. It is anticipated that this project will contribute as a new breakthrough in brace development especially for ADS patients and provide a more active lifestyle to them. There are four main objectives in this study which include: (1) to understand the background information of ADS well as ideal postural alignment of the human body, (2) to design and develop a posture training bracewear and provide a new option for treating ADS, (3) to select appropriate materials and accessories for constructing the bracewear through laboratory tests and (4) to evaluate the effectiveness of the proposed bracewear through a clinical wear trial to assess the spinal conditions, trunk appearance and quality of life (QoL). As the pain might bring negative effects on their quality of life in terms of physical functioning, emotional functioning as well as social functioning, the primary and secondary outcomes of this study are relieving pain and correcting spinal deformity respectively. It is hoped that the designed bracewear could alleviate their LBP and bring comfort after wearing the brace immediately. In order to investigate the effectiveness of the proposed bracewear, subjects are recruited to participate in a clinical wear trial and prescribed bracing and posture training sessions for 3 months. Monitoring is also done at the midterm (6 weeks) of the treatment. The collected data are analyzed respectively to understand the immediate and short-term effects of the proposed treatment. The measurements of garment pressure distribution, changes in spinal conditions, trunk appearance, the outcome of posture training in the laboratory and home as well as the rated QoL are all compared at different stages of the intervention. It is found that after participating in active training sessions with the posture training bracewear, no significant changes in spinal deformity can be found in terms of the Cobb angle, and coronal and sagittal alignments. However, the asymmetry of the trunk in the coronal plane is significantly reduced as shown by lower sub-scores of the height difference index- trunk (HDI-T) and height difference index- shoulder (HDI-S) in the anterior trunk symmetry index (ATSI), total score of the posterior trunk symmetry index (POTSI) and its sub-scores of the frontal asymmetry index- the 7th cervical vertebra (FAI-C7), height difference index- axilla (HDI-A) and height difference index- trunk (HDI-T). It is also found that the shoulder, spinal and pelvic obliquities are highly correlated with the QoL elements of mobility, mental health, self-esteem as well as vitality. The pain level is also positively corresponded to the sagittal vertical axis (SVA) and spinal curvature. Overall, the proposed posture training bracewear can statistically reduce the level of pain. Most of the QoL elements can be maintained and even enhanced after a 3-month bracing period. The laboratory training sessions also train the subjects to maintain a proper posture during sitting and standing and significant improvements in their posture are found. However, there is room for further improvement in terms of the garment design and the posture training programme so that the subjects can be motivated to comply with the treatment in order to fully determine the efficacy of the prescribed bracing treatment.