Milwaukee brace

The Milwaukee brace had been a standard of nonsurgical treatment for scoliosis since 1954. Milwaukee brace 23-hours wearing protocol was most effective for the treatment of adolescent idiopathic scoliosis. However, Milwaukee brace 23-hours wearing showed an impact on psychosocial functioning of the patients. Moreover, even with thoraco-lumbo-sacral orthosis, 23-hours wearing protocol affects patients' psychosocial function. To maintain the effectiveness of the Milwaukee brace and at the same time to reduce physical and psychological burden of the patients, we adopted part-time wearing of Milwaukee brace. Our part-time wearing treatment was effective and did not affect the quality of life of the patients with idiopathic scoliosis.     

Dysphagia

Dysphagia indicates an abnormality of pharyngeal or esophageal function due either to a motor abnormality or to organic narrowing of the lumen. As therapy differs for these two types of disorders, the physician's first responsibility is to establish the nature of the abnormality producing dysphagia. If the prognosis of cancer of the esophagus is to be improved, careful attention must be given to early symptoms of dysphagia.     

Dysphagia

Difficulty in swallowing may result from a motor disorder of the esophagus or an obstructing lesion. Dysphagia for liquids is characteristic of motor disorders, while symptoms on swallowing solid food point to mechanical obstruction. Difficulty initiating a swallow indicates oropharyngeal dysphagia, an abnormality of striated muscle. The major mechanical causes of dysphagia are peptic stricture, esophageal carcinoma and a mucosal ring.     

进食体位对脑卒中后吞咽障碍患者相关并发症影响的Meta分析

目的评价不同进食体位对脑卒中后吞咽障碍患者相关并发症发生率的影响。方法计算机检索Cochrane Library、PubMed、Nature、Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFang Data)和维普数据库(VIP)中关于进食体位干预对脑卒中后吞咽障碍患者相关影响的随机对照试验,并追溯纳入文献的参考文献。由2名研究者根据纳入和排除标准筛选文献,根据Cochrane手册质量评价标准进行严格评价和资料提取,使用RevMan 5.3软件进行Meta分析。结果共纳入6项随机对照试验、1 070例患者。Meta分析结果显示:进食时抬高床头30°~90°与抬高床头30°相比,脑卒中后吞咽障碍患者误吸、肺部感染、返流、腹胀的发生率差异均具有统计学意义。结论进食时,抬高床头30°~90°可降低脑卒中后吞咽障碍患者误吸、肺部感染、返流、腹胀的发生率,是脑卒中后吞咽障碍患者安全有效的护理措施。     

Dysphagia in the elderly

The capacity to swallow or eat is a basic human need and can be a great pleasure. Older adults look forward to sharing mealtimes and participating in social interactions. The loss of capacity to swallow and dine can have far-reaching implications. With age, the ability to swallow undergoes changes that increase the risk for disordered swallowing, with devastating health implications for older adults. With the growth in the aging population, dysphagia is becoming a national health care burden and concern. Upward of 40% of people in institutionalized settings are dysphagic. There is a need to address dysphagia in ambulatory, acute care, and long-term care settings.     

Milwaukee brace today

Purpose. The purpose of this paper is to investigate the efficacy of the Milwaukee brace and its psychological impact and to define whether its use is still acceptable today by a review of literature.

Method. A bibliographic search on PubMed and Medline database using keywords, ‘scoliosis and brace’ was performed.

Results. Milwaukee brace 23-hours wearing protocol was most effective for the treatment of adolescent idiopathic scoliosis. However, 23-hours wearing protocol has some drawbacks, and even the patients using thoraco-lumbo-sacral orthosis wore their brace only for around 60% of the time prescribed as their wearing protocol. Our Milwaukee brace part-time wearing treatment was effective, and by its use combined with physical therapy, better results than the natural history were obtained.

Conclusion. With part-time wearing protocol, the Milwaukee brace can survive today as a treatment option for idiopathic scoliosis with thoracic curve or double curve.     

The Lyon brace

The Lyon Brace or adjustable multi-shells brace has been used for more than 60 years. Three types of braces have been developed: Lyon thoracic brace, Lyon thoraco lumbar brace and Lyon lumbar brace. Considering the conservative orthopaedic treatment of scoliosis we outline the results of this orthosis. The management of the Lyon Brace includes: (i) The use of one or two reductive plastered brace which enable a flow of the concavity ligaments; (ii) a moulding either hand-oriented or electronic after the resection of the plastered brace; (iii) a blueprint adapted to Lenke's classification; and (iv) a specific physiotherapy. The protocol of the wearing of the orthosis depends on the initial angulation of the scoliosis. The effectivity index of 1338 scoliosis checked at least two years after the weaning of the brace, is 0.95. The effectivity index is 0.80 when the Lyon brace is put in place at Risser 0. If the angulation is globally stabilized, the rib hump is, on average, half reduced. We get the best results for lumbar scoliosis and double major. The technological progresses allow a precise use. The adjustment becomes easy during puberty growth.