Milwaukee brace: Difference between revisions

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Aims: 1. Maintain flexibility<ref>Weiss HR, Negrini S, Hawes MC, Rigo M, Kotwicki T, Grivas TB, Maruyama T. [https://scoliosisjournal.biomedcentral.com/articles/10.1186/1748-7161-1-6 Physical exercises in the treatment of idiopathic scoliosis at risk of brace treatment–SOSORT consensus paper 2005]. Scoliosis. 2006 Dec;1(1):6.</ref>
Aims: 1. Maintain flexibility<ref>Weiss HR, Negrini S, Hawes MC, Rigo M, Kotwicki T, Grivas TB, Maruyama T. [https://scoliosisjournal.biomedcentral.com/articles/10.1186/1748-7161-1-6 Physical exercises in the treatment of idiopathic scoliosis at risk of brace treatment–SOSORT consensus paper 2005]. Scoliosis. 2006 Dec;1(1):6.</ref>


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== Key Research  ==
 
add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>  


== Resources    ==
== Resources    ==

Revision as of 10:32, 27 August 2018

Definition/Description[edit | edit source]

Milwaukee brace

The Milwaukee brace is an active corrective spinal orthosis. It 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, aluminium uprights, leather L-shaped thoracic pads and metal bars in the front and in the back.[1][2]

Indication for use[edit | edit source]

A Milwaukee brace is used in the treatment of postural disorders like idiopathic scoliosis or Scheuerman disease.

The brace is normally 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, as it will have no effect.[3]

Especially in cases where there is fear of deterioration during the growth spurt of adolescents. If the spinal curve has a Cobb angle between 20° and 40°, it is an indication to use a brace.[1]

Under this interval, the curve of the patient stays under observation. Above this interval surgeons will intervene rather than wear a brace.

Principle and technique of the brace[edit | edit source]

The thoracic pad, neck ring and the pelvic girdle comprise the three-point holding principle of the brace.

  • The pelvic corset fits snugly over the iliac crests, around the waist and curves upwards in front to support the abdomen. It is cut lower at the sides to avoid pressure on the costal margins. It also keeps the pelvis in a posterior tilt position, decreasing the lumbar lordosis (an excess in lumbar lordosis is often seen in a scoliosis patient).
  • The metal bars are attached to the leather pelvic corset to form a base from which one anterior and two posterior metal uprights pass upwards to a ring around the neck. The ring is inclined at 20 degrees to the horizontal. The uprights are adjustable to allow for growth.
  • 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.
  • Rib rotation is corrected by a pressure pad located over the rib prominences. The pressure pad is fixed to a single, heavy, broad leather strap which is attached to the uprights at the desired level by stud fastenings. The leather strap is passed over the posterior bar on the convex side so that the pressure is applied directly from the lateral side.[4][1]

Aims of the use of a brace[edit | edit source]


The Milwaukee brace is used for a conservative treatment of postural disorders.

Its aim is tokeep the body upright and to prevent progression of the curve while the patient is growing and awaiting possible need for operative intervention.[2]


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. [2]

Brace Program[edit | edit source]

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.[2][1]
However, this protocol has some psychological impact on the patients. 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 for 15 hours.[5][6][2]

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.[1]

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[edit | edit source]

Promotion of normal movement, activities and sports should be the focus of physiotherapy intervention. Holistic approach should be undertaken and not just focused on the scoliosis.[7]

Aims: 1. Maintain flexibility[8]

2.

Resources[edit | edit source]

2016 Scoliosis rehab guidelines

Clinical Bottom Line[edit | edit source]

In the long term versus surgical management quality of life is similar however, more pain is reported with brace wearers.[6]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 Milwaukee brace non-operative treatment for scoliosis; Agnes Chow; Journal of the Hong-Kong physiotherapy association; 1978; Volume 2; p26-32 (A1)
  2. 2.0 2.1 2.2 2.3 2.4 Maruyama T, Takeshita K, Kitagawa T. Milwaukee brace today. Disability and Rehabilitation: Assistive Technology. 2008 Jan 1;3(3):136-8.
  3. Postural Disorders and Musculoskeletal Dysfunction. Gill Solberg; Vardita Gur; Eli Adar. Churchill Livingstone Elsevier; 2005. (book)
  4. John D.M Stewart, Jeffrey P. Hallett, Traction and Orthopaedic Appliances; B.I.Churchill Livingstone New Delhi, Second Edition; Spinal Orthosis, Milwaukee brace; Page No.141.
  5. Maruyama T, Takesita K, Kitagawa T, Nakao Y. Milwaukee brace. Physiotherapy theory and practice. 2011 Jan 1;27(1):43-6.
  6. 6.0 6.1 Andersen MO, Christensen SB, Thomsen K. Outcome at 10 years after treatment for adolescent idiopathic scoliosis. Spine. 2006 Feb 1;31(3):350-4.
  7. de Mauroy JC, Lecante C, Barral F. " Brace Technology" Thematic Series-The Lyon approach to the conservative treatment of scoliosis. Scoliosis. 2011 Dec;6(1):4.
  8. Weiss HR, Negrini S, Hawes MC, Rigo M, Kotwicki T, Grivas TB, Maruyama T. Physical exercises in the treatment of idiopathic scoliosis at risk of brace treatment–SOSORT consensus paper 2005. Scoliosis. 2006 Dec;1(1):6.