Professionalfitting instructions

DESIGNED BY: THE SPINECORPORATION LIMITED www.cmpbrace.com

night

IntroductionThe CMP Night Brace is a scoliosis brace designed for part-time (P/T) wear, 10-12 hours per day.

It utilises the same corrective movement principle in its design, but in common with other nocturnal P/T braces is designed specifically for recumbent wear only.

The CMP Night Brace, in common with other P/T nocturnal scoliosis braces, is designed to achieve far greater in-brace curve corrections than full-time (F/T) rigid braces. In order to achieve greater in-brace corrections, the CMP Night brace provokes extreme postural over-correction. The asymmetrical brace design can create unbalanced postural overcorrection necessitating the brace only be used in a recumbent position.

Similar to F/T CMP bracing, the CMP Night Brace shares some of the design features utilised by the many Chêneau based derivatives in this class, however, curve classification and the correction principles differ by offering more focused correction.

Corrective Movement PrincipleBoth CMP Night & Day Braces utilise Dr Coillard’s SpineCor curve classification which defined the Corrective Movement Principle. Both the Curve Classification and Corrective Movement Principle developed in the mid 90’s have been clinically proven to be effective in more than 25 independent clinical brace trials.

The Corrective Movement Principle produces a curve specific, optimally focused, 3-D Global Postural Over correction promoting;

i. Normalisation of Sagittal Spinal Balance

ii. Optimization of Coronal Spinal Balance – In some cases this will be unbalanced

iii. Maximum De-Rotation

iv. Maximum Curve Opening- Much greater curve opening than with day braces, due to recumbent use, longer lever arms and more extreme, unbalanced, postural over correction.

CMP Night Brace Design1. Brace Construct

a. Monocot Rigid Envelope/Shell

b. Envelope high surface contact area controlling global postural correction/over-correction

c. Envelope incorporating pressure control areas with corresponding void areas and windows

d. Supplemental pads allowing additional incremental corrective force overtime

e. Anterior opening

f. Central Locking bar to increase rigidity preventing twist

g. Coccyx extension for optimal sagittal control

h. Trochanter extension for optimal pelvic control, longer than day-time braces allowing greater correction

CMP Night Brace - Corrective Movement Principle

Central Locking Bar

Anterior Opening

High Axilla Roll

Pressure Area/Pad

Trochanter Extension

night

2. Tri-Planar 3-D Corrections/Over-Correction

a. Sagittal i. Pelvic Version – Normalisation ii. Pelvic Tilt – Correction iii. Lumbar Lordosis - Normalisation iv. Kyphosis – Normalisation

b. Transverse i. Thorax ii. Shoulders iii. Lumbar

c. Coronal i. Translate ii. Tilt

CMP Braces classify curves according to apical level, number and direction of curves, differentiating between primary structural, secondary structural and non-structural compensatory curves. The classification is based on both radiological and clinical features. Postural adaption to the spinal deformity being most relevant to defining the specific Corrective Movement Strategy for each curve classification.

The CMP Brace Classification and the specific Corrective Movement Strategy associated with each Classification have been extensively proven over the past 25 years use with dynamic braces. Utilisation of the same Corrective Movement Principles in Rigid bracing is perhaps an obvious evolution but has taken many years to perfect.

CMP Night Brace offers some of the greatest possible in-brace curve reductions, together with optimal coronal and sagittal balance. Greater spinal elongation is possible in the CMP Night Brace in part because it is intended for use in a recumbent position only. Maximal curve opening during the night offers the greatest opportunity for positive vertebral growth modulation when HGH levels peak.

Professional Fitting Instructions1. Check the brace name and order number correspond to your patient.

2. Inspect the brace to confirm there are no sharp edges.

3. Before attempting to fit the brace explain to your patient to expect the following;

a. The degree of postural over-correction necessary to achieve optimal spinal alignment will be extreme, taking up to 14 days to gradually become accustomed to.

b. The brace will initially feel very tight and restrictive, this feeling will diminish over time.

c. On first fitting the brace may be too long or apply excessive pressure to the body in one or more areas. This is normal and will be adjusted as part of the fitting process.

d. The opening of the brace is unlikely to fully close when first fitted, again this is normal as it takes time for the body to adapt to the corrective position. As the body adapts to the brace over the first week the opening should close further.

e. The brace will appear to fit tightly in some areas and appear to have excessive space in others. This is normal, the brace is designed with corrective pressure areas and expansion areas allowing progressive correction over time.

f. A protective undergarment (body suit, vest or t-shirt) must always be worn underneath the brace.

g. Assure your patient that they will gradually get used to the brace and the tension will feel less with time.

h. Explain weaning-in procedure; Remind your patient that the brace is designed for nocturnal use and should be worn only when lying down at night. Ideally 10-12 hours once the brace is broken in.

We recommend a break-in period of up to 14 days to gradually adjust to wearing your CMP Night Brace.

1st Night: Tighten your brace to the minimum tension marked on the brace, wear the brace to bed and try to go to sleep. If after an hour you are unable to sleep, remove the brace and sleep the rest of the night without it.

2nd – 4th Nights: Wear the brace again to bed, fastened to the minimum tension and try to sleep. Wearing the brace should get easier each night and not prevent sleep. If you wake during the night, r emove the brace and sleep the rest of the night without your brace.

5th – 14th Nights: Once you are able to sleep comfortably through the night at the minimum t ension you should begin to gradually increase the tension towards the maximum marked on the brace.

PAGE 3

5. With the patient laying supine on a couch elongate and manipulate the patient into their brace ensuring brace waist rolls where present and over the iliac crests. Once positioned as described apply mild traction, pulling the brace down whilst engaged over the iliac crests. The patient may assist by holding onto the couch. If the patient is unable to assist in this process the parent/carer may hold the patient under the arms to prevent them from moving down the couch.

6. Once the brace is positioned correctly around the patient’s body with their spine elongated, begin fastening the brace.

a. Firstly, engaging the central stabilizing bar into the slot opposite.

c. Progressively fasten and tighten the upper strap.

d. Mark the brace with a Sharpie or similar indelible marker at two points on the central stabilising bar.

i. Indicate the minimum initial brace tension.

ii. Indicate the maximum brace tensing goal.

b. Pass the lower Velcro strap through the loop and pull back to tighten.

CMP Night Brace - Corrective Movement Principle

Maximum Tension

Minimum Tension

4. Apply the brace loosely to the patient without fastening either standing or laying, whichever is most appropriate for the individual. Ensure the short side of the brace lower edge sits on the waist just above the iliac crest.

6c

6a

6b

7. Axilla Length – Braces will frequently be longer on one side than the other with the proximal trimline high under the axilla on one side. The proximal trim on the long side has two functions, tilt the shoulders and flexion of the upper thoracic spine. This trim line must not be too low compromising it’s primary functions, applying lateral pressure to the upper torso and elevating the shoulder. Pressure directly under the axilla should not be so much that the patient is not able to move their body away from the distal edge of the brace into a comfortable position. Frequently, additional padding (an axilla roll) will be added to the brace providing a soft edge. The brace may be trimmed if necessary, however, this will necessitate re-padding of the final distal brace edge under the axilla.

8. Anterior Upper Thoracic Extension – This will not feature on all braces but is useful to control shoulder rotation in thoracic curves. The position of this extension on your patient may vary from its intended ideal position since it is hugely dependent upon how each patient responds to the inbuilt rotational shape of the brace envelope. The rounder end of the extension is intended to fit high towards or onto the clavicle. The extension piece itself should scoop under the arm without undue impingement. This extension piece may be trimmed and / or heat moulded to establish a comfortable and functional position. In some cases, this may not be possible to achieve, and the extension may need to be removed altogether.

PAGE 5

7

9. Posterior Upper Thoracic Extension – This will not feature on all braces but is useful to control shoulder rotation in thoracic curves. Similar to the Anterior Upper Thoracic Extension it may not always be in the optimal position, however, it is much easier to trim or alter the angle of push by heat moulding.

8

9

Pressure Relief Areas & Windows – These facilitate movement of the patient’s body away from the pressure / pad areas. Initially these pressure relief areas may look too big, however, over time this space will be needed to accommodate further improvement in the Corrective Movement Position.

10. Thoracic & Lumbar Pressure/Pad Areas – these pressure areas are intrinsic to the brace envelope. Pressure may be increased by the addition of further padding to the inside of the brace. The need to increase pressure/ pad areas at initial fitting is very unlikely unless a mild correction was requested, or the patient is significantly more flexible than anticipated.

Additional padding to supplement these pressure areas may well be necessary after the brace has been worn for some time and the patient is able to tolerate further correction.

CMP Night Brace - Corrective Movement Principle

Brace Review and X-ray Imaging Recommendations1. First brace fitting radiological review may be made on the day of brace fitting to check useful Cobb reductions are achieved prior to your patients commencing brace wear. Whist useful, this will not demonstrate full correction potential of the brace since it can take several weeks for the spine to mobilise and the patient to fully accept optimal brace tensioning. First radiological review at the first clinical review is advised 4-6 weeks after initial fitting and is more likely to demonstrate better Cobb correction.

2. First clinical brace fitting review is advised 4-6 weeks after initial fitting. Radiological review is advised if not carried out on the day of brace fitting.

3. Subsequent clinical brace reviews are advised every 4-6 months, depending on Initial curve reduction and growth potential.

4. Subsequent in-brace radiological reviews should be carried out after every pad adjustment or brace replacement.

5. Out of brace radiological reviews should be carried out every 6-12 months.

Window/Relief Area

Window/ReliefArea

Pressure Pad Area

PressurePad Area

Axilla Pressure

Pad Area

Trochanter Pressure

Pad Area

PAGE 7

Notes:

night

www.cmpbrace.com

Designed by:

The SpineCorporation LimitedMillennium House • Foxwood RoadChesterfield • Derbyshire • S41 9RFUnited Kingdom

For more information contact your local CMP Night Brace provider:

night