Braces and spinal jackets – improving the patient experience

Developments in technology are helping to transform the ways in which orthotics can improve a child’s quality of life. Orthotist Alan Hews shares two of the most exciting advances taking place. Caring for children with brain injuries is a full-time job and a complex one at that. Alan Hews is an orthotist with the London Orthotic Consultancy and visits The Children’s Trust school clinic at Tadworth every Tuesday morning. Here he explains the technology developments in bracing and 3D scanning.


As many of you will know, children and young adults who have suffered a brain injury often have difficulty controlling certain limbs, or even their back. But developments in bracing are providing paediatric orthotics with new ways to help patients gain more independence and, in some cases, to maintain limb function. Braces work in two ways – either to support better functional position, or to slow down deterioration in muscle tone to prevent functional difficulties from getting worse. In orthotics, we want to prevent limb redundancy as much as possible, so for instance we might use an ankle-foot orthotic to stop foot positioning from deteriorating over time. But I think the spinal jackets are most interesting. They can be particularly useful for a child who is wheelchair-bound. Often the spine starts to weaken, causing it to start to collapse. Over time, that curvature can impede other functions, such as how well the lungs work. The more we can help to keep a child’s spine straight, the better their overall quality of daily life will be. When we work with our patients at The Children’s Trust, we prescribe one of two types of spinal brace – one that wraps right around the body and a bi-valve brace. The bi-valve brace is made in two pieces and it’s easier to put on someone who is severely disabled or has restricted movement. We also use lots of different types of lining and padding inside the brace to make it as comfortable as possible. Bracing is just one part of a child’s ongoing treatment and I work closely with the physiotherapy teams at The Children’s Trust’s specialist rehabilitation centre in Surrey. We take a holistic, tailored approach to every child, working together to create the best possible brace options to support the day-to-day physiotherapy to help keep each child’s functional ability as high as possible.

3D scanning

3D scanning is another promising area for orthotics. Historically, spinal jackets have been made by creating a plaster of Paris mould. This process can be really tricky if a child’s injury has left them on their back, or if they are easily agitated or find communication difficult. Most children struggle to sit still for long so this can be quite a stressful, uncomfortable experience for everyone, but mostly for the child, and often the final brace is not as accurate as we would like. A perfect fit is very hard to achieve but new technological advances are helping orthotists to reduce the variables. In particular, 3D scanning removes any need to use plaster of Paris. Instead, we can use an iPad with an attachment that clips over the tablet’s camera to allow us to take a series of three-dimensional photographs from multiple angles. The child doesn’t need to move into uncomfortable positions and doesn’t feel anything during the process. The photographs are stitched together to create a full scan. This is sent to our manufacturing unit where a specialist robotic manufacturing arm creates a lightweight, precise piece of carved foam. Unlike the heavy plaster of Paris mould, we can keep adjusting the foam mould until we’re ready to make the final bespoke brace. It’s a technology that’s starting to transform the way we work with The Children’s Trust and its patients. It’s increasing the accuracy of our work, raising the quality of the manufacturing process and, most importantly, improving the experience for the children that we treat.
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