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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
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'''Original Editors ''' - [[User:Leen Meylmans|Leen Meylmans]]
'''Original Editors ''' - [[User:Leen Meylmans|Leen Meylmans]]
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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
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== Search Strategy ==
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Used following search engines:<br>
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- PubMed
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- Google
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Used following sources:
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- Articles
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- Books
== Definition/Description ==
== Definition/Description ==
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A Milwaukee brace consists of a neck ring with a throat mould and two occipital pads to avoid a high pressure in the neck. Other elements are a plastic pelvic girdle, aluminum uprights, leather L-shaped thoracic pads and metal bars in the front and in the back.<ref name="Agnes Chow">Milwaukee brace non-operative treatment for scoliosis; Agnes Chow; Journal of the Hong-Kong physiotherapy association; 1978; Volume 2; p26-32 (A1)</ref><ref name="T. Maruyama">Milwaukee brace today. T. Maruyama, K. Takeshita, T. Kitagawa. Disability and Rehabilitation: Assistive Technology, May 2008; 3(3): 136 – 138. (A1)</ref><br>
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A Milwaukee brace consists of a neck ring with a throat mould and two occipital pads to avoid a high pressure in the neck. Other elements are a plastic pelvic girdle, aluminum uprights, leather L-shaped thoracic pads and metal bars in the front and in the back.<ref name="Agnes Chow">Milwaukee brace non-operative treatment for scoliosis; Agnes Chow; Journal of the Hong-Kong physiotherapy association; 1978; Volume 2; p26-32 (A1)</ref><ref name="T. Maruyama">Milwaukee brace today. T. Maruyama, K. Takeshita, T. Kitagawa. Disability and Rehabilitation: Assistive Technology, May 2008; 3(3): 136 – 138. (A1)</ref><br>
== Indication for use ==
== Indication for use ==
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A Milwaukee brace is used in treatment of postural disorders like idiopathic scoliosis or Scheurman disease. Especially in case where there is fear of deterioration during the growth spurt of adolescents. If the curve has a Cobb angle between 20° and 40°, it is an indication to use a brace.<ref name="Agnes Chow" /> Under this interval the curve the patient stays under observation and above the interval doctors tend to operate rather than wear a brace.<br>It is a brace that normally is prescribed for children with a postural disorder who have not reached their growth spurt or who are in their fast growing period. It is not used for adults or adolescents already beyond their growth spurt, because no effect has been proved. <ref name="Gill Solberg">Postural Disorders and Musculoskeletal Dysfunction. Gill Solberg; Vardita Gur; Eli Adar. Churchill Livingstone Elsevier; 2005. (book)</ref><br>
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A Milwaukee brace is used in treatment of postural disorders like idiopathic scoliosis or Scheurman disease. Especially in case where there is fear of deterioration during the growth spurt of adolescents. If the curve has a Cobb angle between 20° and 40°, it is an indication to use a brace.<ref name="Agnes Chow" /> Under this interval the curve the patient stays under observation and above the interval doctors tend to operate rather than wear a brace.<br>It is a brace that normally is prescribed for children with a postural disorder who have not reached their growth spurt or who are in their fast growing period. It is not used for adults or adolescents already beyond their growth spurt, because no effect has been proved. <ref name="Gill Solberg">Postural Disorders and Musculoskeletal Dysfunction. Gill Solberg; Vardita Gur; Eli Adar. Churchill Livingstone Elsevier; 2005. (book)</ref><br>
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== Principle and technique of the brace ==
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== Principle and technique of the brace
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The thoracic pad, neck ring and the pelvic girdle comprise the three point holding principle of the brace<br>The pelvic girdle stabilizes the pelvis, that’s why the girdle must fit perfectly. It also keeps the pelvis in a posterior tilt position, decreasing the lumbar lordosis (an excess in lumbar lordosis is often seen in an scoliosis patient).<br>The throat mould is placed just under the chin. If it fits well, it doesn’t touch the mandible. It’s aim is to remind the patient to retract the chin and to keep the head posteriorly against the occipital pads. The action of the pelvic girdle and the throat mould together keeps the head centered over the pelvis.<br>The metal bars extend the torso.<br>The L-shaped pads are precisely placed on the rib hump, which varies between every patient. The lower part of the pads applies a holding force in medial direction. The upper part and the posterior metal bar tent to correct the rib hump.<br>Source: <ref name="Agnes Chow" />
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The thoracic pad, neck ring and the pelvic girdle comprise the three point holding principle of the brace<br>The pelvic girdle stabilizes the pelvis, that’s why the girdle must fit perfectly. It also keeps the pelvis in a posterior tilt position, decreasing the lumbar lordosis (an excess in lumbar lordosis is often seen in an scoliosis patient).<br>The throat mould is placed just under the chin. If it fits well, it doesn’t touch the mandible. It’s aim is to remind the patient to retract the chin and to keep the head posteriorly against the occipital pads. The action of the pelvic girdle and the throat mould together keeps the head centered over the pelvis.<br>The metal bars extend the torso.<br>The L-shaped pads are precisely placed on the rib hump, which varies between every patient. The lower part of the pads applies a holding force in medial direction. The upper part and the posterior metal bar tent to correct the rib hump.<br>Source: <ref name="Agnes Chow" />
== Aims of the use of a brace ==
== Aims of the use of a brace ==
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Everything works together to keep the body straight and to prevent progression of the curve while the patient is growing.<br>The Milwaukee brace is used for a conservative treatment of postural disorders. Its aim is to prevent the curve to progress while the child is growing and also the need for operative intervention.<br>Important note is that not everyone achieves a permanent correction. It can be possible that the brace is effective when the patient is braced. But when the patient stops wearing the brace the curve can go back to its original shape.
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Everything works together to keep the body straight and to prevent progression of the curve while the patient is growing.<br>The Milwaukee brace is used for a conservative treatment of postural disorders. Its aim is to prevent the curve to progress while the child is growing and also the need for operative intervention.<br>Important note is that not everyone achieves a permanent correction. It can be possible that the brace is effective when the patient is braced. But when the patient stops wearing the brace the curve can go back to its original shape.
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Source: <ref name="T. Maruyama" /><br><br>
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Source: <ref name="T. Maruyama" /><br><br>
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== Brace Programma ==
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== Brace Programma
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It is recommended to wear the Milwaukee brace 23 hours a day. The one-hour that the child spends out of the brace should be spent in doing exercises. Studies have proven that this protocol is effective for the treatment of adolescent idiopathic scoliosis.<ref name="T. Maruyama" /><ref name="Agnes Chow" /><br>However this protocol has some psychological gevolgen. Patients have to spend their childhood in a brace. It is proven that patients wear their brace a lot less then is recommended. Instead of 23 hours a day they wear it 15 hours.<ref name="Andersen MO">Outcome at 10 years after treatment for adolescent idiopathic scoliosis. Andersen MO, Christensen SB, Thomsen K. Spine 2006;31(3):350 – 354. (B)</ref><ref name="T. Maruyama" /><br>
It is recommended to wear the Milwaukee brace 23 hours a day. The one-hour that the child spends out of the brace should be spent in doing exercises. Studies have proven that this protocol is effective for the treatment of adolescent idiopathic scoliosis.<ref name="T. Maruyama" /><ref name="Agnes Chow" /><br>However this protocol has some psychological gevolgen. Patients have to spend their childhood in a brace. It is proven that patients wear their brace a lot less then is recommended. Instead of 23 hours a day they wear it 15 hours.<ref name="Andersen MO">Outcome at 10 years after treatment for adolescent idiopathic scoliosis. Andersen MO, Christensen SB, Thomsen K. Spine 2006;31(3):350 – 354. (B)</ref><ref name="T. Maruyama" /><br>
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It is important that the brace is checked and adjusted regularly while the child is growing and the curve correction progresses. The program stops when skeletal maturity is achieved and if the curve is under control. The process of stopping the brace program should be done gradually and followed very carefully. If there is any sign the curve deteriorates the patient should wear the brace again as before. Otherwise every effort has been wasted.<ref name="Agnes Chow" />
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It is important that the brace is checked and adjusted regularly while the child is growing and the curve correction progresses. The program stops when skeletal maturity is achieved and if the curve is under control. The process of stopping the brace program should be done gradually and followed very carefully. If there is any sign the curve deteriorates the patient should wear the brace again as before. Otherwise every effort has been wasted.<ref name="Agnes Chow" />
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Activities and exercises are recommended and possible in the brace. Sports are also recommended, but the patient should avoid contact sports, where the brace can be harmful for the opponents.
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Activities and exercises are recommended and possible in the brace. Sports are also recommended, but the patient should avoid contact sports, where the brace can be harmful for the opponents.
== Physical Therapy Management <br> ==
== Physical Therapy Management <br> ==