Development of posture correction girdle for adolescents with early scoliosis

Abstract

Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine, which appears and sometimes progresses during periods of rapid growth in apparently healthy adolescents with a higher proportion of girls than boys. In Hong Kong, it was found that the prevalence of scoliosis has an increasing trend. Postural alterations and imbalance problems are commonly found in these adolescents. However, there is a lack of product selection and treatment choice for adolescents with early scoliosis, and many problems are found with the existing products in the market. Therefore, the aim of this study is to provide a tailor-made posture correction girdle for girls who are in the age group of 10-13 with early scoliosis, in order to improve their imbalanced postures by girdling and reduce the possibility of curvature progression in scoliosis. A systematic framework produced by using a three-stage design process, as well as the functional, expressive and aesthetic (FEA) consumer needs model are used during the design and development process of the girdle. A screening program has been carried out in 7 schools and 21.9% of the screened students possibly have early scoliosis. Nine are recruited in accordance with the inclusion criteria to participate in a 6 month wear trial. A posture correction girdle made of well-performing materials evaluated by physical tests is provided to each subject after two fitting sessions. Padding insertion is one of the key factors that contribute to posture correction by generating point-pressure forces in accordance with the needs in different cases. Acceptable compliance is found in the wear trial and no effects induced by girdling are found to influence heart and pulmonary functions, as well as the sensory levels according to the results of the health tests. Three dimensional body scanning, direct measuring of shoulder levelness by using the floor as a reference, and motion capturing are carried out to evaluate the possible effectiveness of the girdle on posture correction. The results of shoulder levelness measurement show that wearing the girdle with padding insertion have better effects than without wearing the girdle and wearing the girdle that without padding insertion in both of 0 and 3 months. The results of motion capturing show that the imbalanced postures of the subjects generally improve after 6-months of girdling. Significant immediate improvements including more even shoulder in frontal plane and horizontal plane during standing, as well as straighter upper back in sagittal plane during sitting; while significant improvements from time-to-time including more even shoulder in frontal plane during standing and walking. Moreover, statistically significant differences of interaction effects of girdling (without girdle, with girdle) and time (0, 3, 6 months) on posture changes including more even shoulder an pelvis in frontal plane during standing, straighter lower back in sagittal plane during sitting, as well as acceptable constrained anterior and lateral bending range. As well, a radiographic analysis has been carried out to evaluate the effectiveness of the girdle on spinal deformity control. Regarding the results of radiographic analysis (Cobb's angle), 1 subject has improvement, 4 subjects were within control and 2 subjects have further curve progression after 6 months of girdling. Moreover, there are immediate improvements in the spinal curve of the subjects when comparisons are made between wearing a girdle and when a girdle is not worn, i.e. one of the subjects has 83.33% and 75% reductions of the thoracic and lumbar curves respectively after she put on the girdle at 6 months. Additionally, for time-to-time improvements in the spinal curve of the subjects when comparisons are made between 0 month (pre) and 6 months (post) under condition of without girdle, one of the subjects has 26.32% and 20% reductions of the thoracic and lumbar curves respectively. The progression rate could be due to factors such as compliance, growth and curve type which influenced the curve progression of the subjects in this study. To sum up, the posture correction girdle aims to provide a non-invasive method to control the body posture in order to reduce the possibility of progression of the spinal curve. Patience is needed to see improvement as training of posture needs time. The important thing is that treatment or training should be provided as soon as possible at the right time, i.e. puberty period, as it is more difficult to reverse poor posture or spinal curve deformity if it has already reached a certain level of severity. Although scoliosis is a multi-factorial deformity of the spine that sometimes results due to heredity, waiting to address the issue until it is too advanced is detrimental.