FW: Rigo-Cheneau brace [1 Attachment]

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Hi ,Thanks for the info. I have a couple of questions. Is your doc the only one making this brace? Can the brace be worn only at night for some children? Or is the brace designed only for full-time wear? Thanks!~Noah 4 1/2 years old9 months of casting in SLC; Currently on 2 years of bracing at 6* in braceAnd Mariella 12 months old - resolved Infantile Scoliosis

To: infantile_scoliosis From: dew.writes@...Date: Mon, 15 Mar 2010 16:22:25 -0400Subject: Rigo-Cheneau brace [1 Attachment]

[Attachment(s) from D included below] Hi Everyone,

We are back from our trip to DC and have Todd's new Rigo-Cheneau system brace, so I want to give a little update here in case anyone is interested.

Todd was casted using EDF/Mehta method for just over a year, and had a series of 7 casts, most of which had shoulder straps. The last three casts gave no lasting correction, so he was transitioned to a Providence brace (night only). That was in November, 2008--his curves measured 29 and 22. A year later, December 2009, his curves had progressed to 39 and 24.

We had a consult with a doctor about VBS (vertebral body stapling) when Todd came out of casts, but learned that his curves then were too great for vbs to work. It is an internal brace, essentially, that is meant to hold very mild curves. Also, his bones are still too soft to be a candidate.

So we stayed the course with the Providence brace until we learned it was not holding him.

We learned about the Rigo-Cheneau system brace from a Schroth physical therapist. This type of brace addresses the three dimensions of scoliosis--I don't know for certain, but I read that this is the only type of brace to do that. Our casting doctor grew quite excited about this type of brace after calling and talking with the orthotist to makes it, and encouraged us to go for it--writing letters for our insurance company and a prescription for the new brace also.

We were scheduled to go get this brace made last month, but Snowmageddon cancelled our flight, so we went last week. (We still had to climb hills of dirty slush and snow that blocked the sidewalks, but at least the weather was balmy and clear!)

The process was amazing.

The orthotist carefully examined all Todd's xrays, from the first to the most recent, and looked at photos of Todd before casting, between casts, in casts, and after casting. We also gave him a chart of Todd's measurements throughtout his journey so far. (If you do not yet have a notebook with all this stuff, I highly recommend making one now!) He examined Todd clinically also, observing his posture while sitting, standing, walking, and just being Todd. He also looked at both of Todd's Providence braces.

To make the R-C brace, the orthotist uses a special camera to take a 3-D image of the patient's body. That image is then transferred to a software application that allows him to manipulate the image and apply some correction to the shape of the body. Then, the data is transferred to a lathe which cuts a block of foam into the shape that will become the mold for the brace. After the lathe, the orthotist makes further refinements to the form by hand, which takes a couple of hours more. Finally, he molds the plastic for the brace around it.

The the process of fitting begins. At first, there is no padding on the brace at all. The orthotist makes marks on it to begin cutting it down to size little by little, top and bottom. He flares it in places and trims in places, adds padding, and gets a good, comfortable fit.

Then we took it home for Todd to wear that night. In the morning, we checked for pressure points (red marks) and returned to his office for further adjustments. Todd had been complaining that it hurt his tummy, so the orthotist cut a tummy hole. He also put in some ventilation holes all around the brace. He added some straps inside to push against the curves, and a strap over Todd's right shoulder to help balance his shoulders. (His right shoulder is higher than his left due to his scoli.) The brace pushes up under the left shoulder. In the brace, he looks very good. (By the way, this is exactly opposite what the Prov does--it pushes way up under his right shoulder--they said that is has to do that to push in against his curve, but we feel a lot more optimistic about this different configuration, which manages to both push in against the curves, and up on the left/down on the right.)

The brace itself is quite lightweight. Whereas the Prov seems to be mostly a thick layer of padding and is heavier than the R-C brace, the R-C brace has very little padding. It does not need it. It is barely noticeable under Todd's clothing! the shoulder strap is a type of elasticized velcro, and barely peeks out from under the neckline of his shirt. It is cut high enough in front to allow him to bend his legs up 90 degrees, but still it acheives purchase against his hips to gain the needed vertical correction--it does that by having fairly deep indentations just above his hips and going down lower in the rear/sides.

I will try to post some pics, too.

Todd is not happy about having to wear this brace night AND day, but it is not an uncomfortable brace. Just being in a brace is not fun, but I think if a child has to be in one, this would be a pretty good one to be in.

We did not get an in-brace xray. Their method is to allow the child's body to adjust to the brace for about a month before getting the in-brace xray. This seems to make very good sense to me, especially after seeing the brace-making process, and how organic and body-patient-specific it is. If the in-brace xray looks good, we will then wait about 5 or 6 months and get an out-of-brace xray. The expectation is that this brace will last until he gains about 8 pounds, or about 9 months.

I cannot say enough good things about our orthotist. He was absolutely wonderful to work with, and is a very compassionate, devoted professional. If anyone wants to talk with me about it, I would be happy to answer any questions.

All for now,

, Mommy to Todd

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