Scoliosis is a curvature of the spine that can occur in children and adolescents, and may have potential to worsen during growth spurts. Some growing children and adolescents may qualify for scoliosis bracing to keep the curves from getting larger. The goal of bracing is not make the spine more straight, but to prevent the curve from getting significantly larger during those growth spurts. Strong evidence exists to support that effective brace wear may decrease the chance of needing surgery. Unfortunately, brace wear can be difficult, and presents many obstacles for teens and families alike. Physical discomfort due to materials and design, the visual appearance, and negative effects on psychosocial well-being are common struggles of brace wear in teens. Empowering each patient to “own” their scoliosis brace is one key to successful treatment.
Scoliosis bracing historically carries an undesirable physical image, triggering reluctance to wear it. As self-expression flourishes in the adolescent years, involving teens in the creation of their brace is one simple way to promote autonomy. Modern technologies allow patients to “test out” different patterns and designs, tapping into their creativity. Establishing a positive relationship between patients their orthotist is crucial. The opportunity to co-design the outside surface of their brace increases the likelihood of a positive experience and may enhance willpower.
Accurate evaluation of brace wear has been a challenge for physicians, patients and families. As many teens are involved in numerous academic and extra-curricular activities, tracking brace wear is one more additional task that often falls by the way-side. Historically, medical providers have relied on verbal reports of the number of hours worn, leaving much room for error. Electronic brace sensors have become increasingly available, which allow for an objective way to measure brace wear. Some sensors can even be linked to a smart phone app. Empowering teens to track their brace wear with a sensor and app encourages ownership of the process, establish individual schedules, and provide a visual report to promote compliance.
Allowing teens to have a say in their bracing plan allows their values, circumstances, and goals to be incorporated into their treatment process. Customizing their schedule to incorporate brief breaks for sports and social events may help facilitate a more acceptable brace experience. Involving a psychologist familiar with developing brace-wear routines and coping skills can help to reframe peer pressures and body image concerns.
Recognition that teens can play an active role in their scoliosis treatment can be very important in optimizing outcomes, and can offer autonomy in the decisions affecting their lives.