Moe et al published first classic study on in- orthosis correction in CTLSO. Best was 55% for lumbar curves, 38% for Thoracic, and 17% for High Thoracic With patients that have apices above T10, a TLSO with superstructure is strongly recommended WATTS ET AL Clin Ortop Rel Res 1977. Biomechanically, there is no better three point pressure system than the Milwaukee, so why the change? Compliancy due to cosmesis Referral preference
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� Moe et al published first classic study on in-orthosis correction in CTLSO.
� Best was 55% for lumbar curves, 38% for Thoracic, and 17% for High Thoracic
� With patients that have apices above T10, a TLSO with superstructure is strongly recommended WATTS ET AL Clin Ortop Rel Res 1977.
� Biomechanically, there is no better three point pressure system than the Milwaukee, so why the change?
� Compliancy due to cosmesis
�Referral preference
ThoracicLumbar Thoracolumbar
� Lumbar pad is highest component
� For
� Lumbar Curves
� Thoraco-Lumbar curves where patient is decompensated to convex side
� Double curves with flexible thoracic curve
� Low thoracic pad is highest component
� For:
� Thoracolumbar curves where thoracic component flexible
� Lumbar curves where patient is decompensated to concave side
� Axillary extension is highest component
� For:
� Thoracic curves
� Double curves
� Thoracolumbar curves where thoracic component not flexible
� Increased comfort from total contact
� No ridges or sharp points of pressure
� Shifts with moderate three point pressure system
� Cast mold allows for shifting with total contact reducing pressure
� Allows for asymmetrical design.
� Use strap as central central sacral linesacral line
� Roll to allow time to shift mold while still wet
� Most patients balance well on table
� Identify waist grooves and pelvic girdle
� Help stabilize patient
� Use three point TOTAL CONTACT forces
� Or use SHIFTING SHIFTING techniques
� No pinpoint pressure on ribs or bony segments of hips
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� Key is that it is assymetrical vs the traditional symmetrical designs.
� Can be made from mold (risser table, Scanned from mold)
� Can be made from measurements.
� Can be made from CAD
� Gluteus Push extremely important with End Point Control
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� In past windows needed due to symmetrical designs.
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Anterior Posterior
The dynamic connection between
these forces mean that they move
with every movement made by
the patient.
In every body position an equal corrective
force is exerted on the same place in the
body
After adjustments
After adjustments
INDICATIONS FOR TREATMENT
� Idiopathic Scoliosis
� Boys and Girls 5 Years +
� Initial Cobb angle equal or above 20o or proven progression > 5o in last 6/12 or strong family history