After the doctor diagnoses scoliosis and confirm it on the X-ray of the spine, he needs to make a decision does the child needs the application of the brace. Depending on the skeletal maturity according to the Risser scale (iliac apophysis), it is determined whether the patient is in the phase of rapid growth and development. If so, this information tells us that the child is in a period when the curve can progress rapidly. Based on the size of the scoliotic curvature and skeletal maturity, the doctor decides whether the treatment should also include wearing the brace. When the curvature is greater than 20-25 degrees according to Cobb and Risser 0-3, the patient is sent to an orthotic who makes the brace.
The orthotic needs to have a specific and deep knowledge of the 3D nature of idiopathic scoliosis and have extensive experience in correcting scoliotic curvature. At the first placement of the brace, the child is assisted by an orthotic, who closes the brace in a supine position, after which he gives detailed instructions for wearing and getting used to it. After applying the brace, what the patient can feel is more or less pressure at the places of contact with the pads (on the convex sides), depending on the flexibility of the curve. Pressure produces physical discomfort, depending on the patient's sensitivity. Changing the posture of the body creates neurological problems by changing the body scheme abruptly without adjustment. The orthotic gives instructions on how much the brace should be tightened and therefore marks the strips that are on the front. Every day, the child wears the brace a little longer than the previous day, where after two weeks the full time (20-23 hours) of wearing the brace should be reached. In order to fulfill the hours of wearing, brace needs to be worn during the day and during the night. The efficiency of wearing the brace is higher during the day, especially at school while the child is sitting. During the night, the body is relieved and therefore the possibility of progression can be considered less.
It is obligatory to follow the instructions for setting up and wearing the brace, which are given exclusively by the orthotic. After a month of "full time" wearing the brace, an X-ray should be taken in the brace to determine its effectiveness. Controls of the brace are mandatory and agreed, in order to adapted it according to the changes caused by growth and development. When the brace becomes small due to growth and development, the doctor prescribes making a new one.
In order to achieve the best results, it is necessary to engage a multidisciplinary team (doctors, physiotherapists and orthotics) who work together to achieve the same goal.