The Providence brace is a nighttime spinal orthosis for the treatment of adolescent

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent wikt:spontaneous, spontaneous origin. From Ancient Greek, Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approxi ...

scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not t ...

(AIS). The brace is used to curb the natural progression of the disease and prevent further curvature of the AIS patient's spine. The Providence brace was developed by Charles d'Amato and Barry McCoy, and is manufactured by Spinal Technology, Inc.

Medical use

The Providence brace is among the treatments prescribed to slow or stop further curvature of the spine as

patients naturally age and grow. While in use, the brace brings the spine closer to the midline or even further by applying both lateral and rotational pressure on the patient's body. The brace applies pressure at three points on the body while the patient is in the

supine position The supine position ( or ) means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; ...

, which itself plays a significant part in correcting the

coronal plane The coronal plane (also known as the frontal plane) is an anatomical plane that divides the body into dorsal and ventral sections. It is perpendicular to the sagittal and transverse planes. Details The coronal plane is an example of a longitud ...

curvature of the spine. The brace is worn for at least eight hours at night and during sleep as it significantly limits mobility while in use. The brace is indicated for adolescent patients with curves of less 35°. A recent study indicates that the brace is also effective for curvatures up to 45°. When used on appropriate patients, Providence brace has been shown to have a comparable efficacy as traditional scoliosis orthoses (such as the

Boston brace The Boston brace, a type of thoraco-lumbo-sacral-orthosis (TLSO), is a back brace used primarily for the treatment of idiopathic scoliosis in children. It was developed in 1972 by M.E "Bill" Miller and John Hall at the Boston Children's Hospital i ...

) that require full-time use. Studies report that 50% to 75% of patients show further curve progression of only 5° or less, including when examined two years after stopping use of the brace. A 2019 study also reported that, if an in-brace correction of more than 70% is achieved, the Providence brace was successful in preventing curve progression in 89% of compliant patients.

History

In 1992, Charles d'Amato and Barry McCoy created a board on which scoliosis patients can be positioned in a way that corrected the curvature of their spine. Developed at

Hasbro Children's Hospital Rhode Island Hospital is a private, not-for-profit hospital located in the Upper South Providence neighborhood in Providence, Rhode Island. It is the largest academic medical center in the region, affiliated with Brown University since 1959. As ...

Providence, Rhode Island Providence is the capital and most populous city of the U.S. state of Rhode Island. One of the oldest cities in New England, it was founded in 1636 by Roger Williams, a Reformed Baptist theologian and religious exile from the Massachusetts Bay ...

, the device allowed patients to lie on their back with little discomfort during

medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to rev ...

. D'Amato and McCoy applied the same principles to create a wearable brace for nocturnal use by adolescent patients at home. The Providence brace gets its name from the city where it was developed like its predecessors such as the

Milwaukee brace {{no footnotes, date=August 2013 The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace most often used in the treatment of spinal curvatures (such as scoliosis or kyphosis) in children but also, more ra ...

, the Boston brace, the Wilmington brace, and Charleston brace. The Providence brace is designed and custom fitted using a specialized measuring board and a digital model of the patient's body, accompanied by

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

s of the patient's spinal deformity. A

CAD/CAM CAD/CAM refers to the integration of Computer-aided design (CAD) and Computer-aided manufacturing (CAM). Both of these require powerful computers. ''CAD'' software helps designers and draftsmen; ''CAM'' "reduces manpower costs" in the manufactur ...

model is used to make the brace out of

polypropylene Polypropylene (PP), also known as polypropene, is a thermoplastic polymer used in a wide variety of applications. It is produced via chain-growth polymerization from the monomer propylene. Polypropylene belongs to the group of polyolefins and ...

plastic which is then modified to ensure optimal correction of the spinal curvature. The brace is manufactured by Spinal Technology, Inc., based in West Yarmouth,

Massachusetts Massachusetts (Massachusett language, Massachusett: ''Muhsachuweesut assachusett writing systems, məhswatʃəwiːsət'' English: , ), officially the Commonwealth of Massachusetts, is the most populous U.S. state, state in the New England ...

, and marketed under the name Providence Nocturnal Scoliosis System.

References

{{Reflist, 30em 1992 introductions Orthopedic braces