On this episode of The O&P Check-in: an SPS Podcast, we chatted with Bryan Malas, MHPR, CO, about increasing scoliosis patient confidence and bracing compliance. Bryan is the Director of the Orthotics and Prosthetics Department at the Ann & Robert H. Lurie Children’s Hospital of Chicago and an Associate Professor of Physical Medicine and Rehabilitation at Northwestern Feinberg School of Medicine.
The following includes an excerpt from our conversation, edited for length and clarity. Click here to listen to the full interview.
The O&P Check-in: an SPS Podcast unpacks trends and stories from the tight-knit community of O&P professionals. From patient care to technology, best practices, and regulations, this podcast features topics that help you stay current.
Could you share what treatment options there are for pediatric patients presenting with Adolescent Idiopathic Scoliosis (AIS)?
There are three broad categories. There's observation, orthotic management, and then finally surgery. But we need to qualify that and unpack it a bit.
Observation is typically associated with smaller curve angles, usually under 20 degrees. Observation might imply that this is passive, like a passive weighting gain. Sometimes, that's true, but increasingly, we see patients receiving physical therapy in the form of the Schroth Method.
The second category would be more for our moderate curves, so 20-25 to 40-45 degrees. That really falls in the window of orthotic management, where we can be fairly successful in impacting the natural history of the curve. Increasingly, we're seeing a combination of orthotic management being used with therapy, and the therapy is certainly complementary to what we are doing. With things like the Schroth Method, we see that there's increased flexibility of the curve. What is beneficial about that is that we may not need to apply as much force with the orthosis, which makes tolerating the system much better for the patient.
The last treatment option is for the larger curves over 45 degrees. At that magnitude, AIS becomes too difficult to stabilize orthotically, and surgery is required.
How can clinicians overcome objections to wearing a brace?
It starts with context before considering the compliance challenge. It's important to recognize where many of our kids are in terms of their age and development. Compliance is often less of an issue with younger kids. I notice that, if we put a spinal orthosis on a child who is eight or nine years of old, many times, they're fine with it.
That is not the case when we talk about the adolescent age group. We have to consider what they’re grappling with at that age - body awareness, self-image. They're trying to find themselves. We have to recognize that before even starting treatment. I try to always think back to when I was this age. What were the things that caused me consternation, stress, and worry? Now add an orthosis to that equation. Despite the fact that we can make it inconspicuous, the patient has to put it on every day. Try to imagine this: They can feel it, they can touch it. It's always there, front and center. So, really, that's the most important piece because if we can always remember how they're walking in to see us, we can always be mindful of that going into the treatment. And we can remain sensitive and offer solutions and appropriate counseling.
How can collaborative care strategies help?
It starts with a medical team that will communicate beyond just the patient or the case at hand, knowing each other's philosophies and the script for the family. For example, when I see an order from a physician I've worked with, I have a good sense of what already has been said. Instead of providing information that's going to be contrary, I can provide information that will be complimentary. It's not just continuity of care, but it's continuity of the message. That creates a clear and consistent expectation for the family. One frustration of families is when they go from one area to the next, and they're just not getting the same message. But really, it goes a long way. It assuages many concerns for the families, and they will be more receptive to the treatment we're laying out for their child.
To hear the entire conversation, click here: