An Introduction to Cheneau-Rigo Bracing Principles
Thermoplastic braces such as the TLSO Boston brace places pressure pads over the convexities of the thoracic and lumbar curves in attempt to correct lateral deviation and rotation. However, Dr. Chêneau of France in 1979 found these general correction principles insufficient, and as a result, he designed a Chêneau brace that endeavors to treat every aspect of the complex 3D deformity. The Chêneau brace is defined as a thermoplastic brace modelled on a hyper-corrected positive plaster-cast of the patient. The general correction principle is that of detorsion and sagittal plane normalization, which would correct the coronal and transverse planes, resulting in some elongation of the spine, without any significant distraction force. During the past few years, Dr. Rigo of Barcelona has furthered the development of the original Chêneau brace by combining his new classification of scoliosis Rigo et al., (2010), Wood, G.I., ISPO, Leipzig, Germany (2010) and Chen, R., Wood, G, (2010).
The Wood-Cheneau Rigo (WCR) spinal orthosis is a thermoplastic brace uniquely constructed to bring the trunk and spine into the optimal postural alignment. The pressure points and expansion areas are located, shaped and oriented to apply pressure to selected regions of the trunk, bringing the patient into the best possible 3-dimensional correction while maximizing comfort. The WCR brace concept employs regional derotation, using an unique pressure-system to guide frontal plane alignment and sagittal plane profile balance. Through this design, the WCR prevents lordotization of the spine while treating the patient’s scoliosis.
The Wood-Cheneau Rigo (WCR) spinal orthosis is a thermoplastic brace uniquely constructed to bring the trunk and spine into the optimal postural alignment. The pressure points and expansion areas are located, shaped and oriented to apply pressure to selected regions of the trunk, bringing the patient into the best possible 3-dimensional correction while maximizing comfort. The WCR brace concept employs regional derotation, using an unique pressure-system to guide frontal plane alignment and sagittal plane profile balance. Through this design, the WCR prevents lordotization of the spine while treating the patient’s scoliosis.
Posterior view of a WCR brace.
Here the breathomechanics of the brace is demonstrated during breathing. Every time the patient breathes, the scoliosis is corrected three dimensionally:
1) Correction of the Cobb angle.
2) Reduction of rotation.
3) Sagittal plane normalization by allowing the spine to move from ventral to dorsal.
This prevents the increase of the flatback syndrome which is commonly associated with scoliosis in the thoracic region. Other brace designs usually promote flatback. You cannot have three-dimensional correction that lasts (i.e. after the brace is removed) by simply having a window cut out in the brace. You must have a large space in the dorsal and ventral thoracic regions of the brace to allow for migration of tissues from convex prominences to fill concave areas.
Here the breathomechanics of the brace is demonstrated during breathing. Every time the patient breathes, the scoliosis is corrected three dimensionally:
1) Correction of the Cobb angle.
2) Reduction of rotation.
3) Sagittal plane normalization by allowing the spine to move from ventral to dorsal.
This prevents the increase of the flatback syndrome which is commonly associated with scoliosis in the thoracic region. Other brace designs usually promote flatback. You cannot have three-dimensional correction that lasts (i.e. after the brace is removed) by simply having a window cut out in the brace. You must have a large space in the dorsal and ventral thoracic regions of the brace to allow for migration of tissues from convex prominences to fill concave areas.
Ventral view of a WCR brace while the patient is lying down on his back.
This ventral expansion area allows for the correction of the thoracic rotation and improves comfort of the brace. Other brace designs do not have this large ventral expansion area. When a brace does not have this expansion area, it treats the curves by squishing the body together (i.e. the sandwich affect). This can lead to discomfort, especially in scoliotic curves with large magnitudes.
This ventral expansion area allows for the correction of the thoracic rotation and improves comfort of the brace. Other brace designs do not have this large ventral expansion area. When a brace does not have this expansion area, it treats the curves by squishing the body together (i.e. the sandwich affect). This can lead to discomfort, especially in scoliotic curves with large magnitudes.
Case PresentationsThe WCR BraceThe Wood Cheneau Rigo (WCR) brace is a thermoplastic brace designed to treat scoliosis conservatively while taking into consideration that scoliosis is a three-dimensional deformity.
|
What you get with the WCR Brace.
The WCR brace involves a team of scoliosis professionals from around the world working on the patient’s classification of curve. The patient curve type is individually classified from the Classification of Rigo using the x-rays and clinical photos of each patient. Based on this classification, an individual brace design from the Classification of Rigo brace designs is selected for each patient. Dr. Manuel Rigo is personally consulted on WCR brace cases for verification of the patient's curve type and scoliosis brace design when necessary. This is a multi-disciplinary approach using feedback from the patients prescribing MD and Schroth or Barcelona Scoliosis Physical Therapy School (BSPTS) physical therapist in combination with the orthotist’s skills. Subsequently, the measurements, x-rays, and clinical photos are used to design and fabricate a custom-made Wood Cheneau Rigo brace.
All stages of treatment (clinical photos in and out of brace, X-rays and team notes) are posted on a secure orthotic and prosthetic database (OPIE). We discuss the fittings, follow-up photos, and in-brace x-rays between the MD, Schroth Therapist (PT) and orthotist, which optimizes the treatment and results.
The WCR brace involves a team of scoliosis professionals from around the world working on the patient’s classification of curve. The patient curve type is individually classified from the Classification of Rigo using the x-rays and clinical photos of each patient. Based on this classification, an individual brace design from the Classification of Rigo brace designs is selected for each patient. Dr. Manuel Rigo is personally consulted on WCR brace cases for verification of the patient's curve type and scoliosis brace design when necessary. This is a multi-disciplinary approach using feedback from the patients prescribing MD and Schroth or Barcelona Scoliosis Physical Therapy School (BSPTS) physical therapist in combination with the orthotist’s skills. Subsequently, the measurements, x-rays, and clinical photos are used to design and fabricate a custom-made Wood Cheneau Rigo brace.
All stages of treatment (clinical photos in and out of brace, X-rays and team notes) are posted on a secure orthotic and prosthetic database (OPIE). We discuss the fittings, follow-up photos, and in-brace x-rays between the MD, Schroth Therapist (PT) and orthotist, which optimizes the treatment and results.
Grant’s top 5 critical points for parents to improve brace correction
- Monitor growth/height in standing and sitting positions.
- Report growth of 1” to orthotist for possible adjustment.
- Don’t get complacent with good in-brace correction and subsequently not follow up with the orthotist for 6 to 9 months.
- Critical to follow up on brace fit at 9, 12, and 15 months.
- Report any significant changes in clinical presentation.
Grant’s top 5 important scoliosis criteria for start, finish or change of scoliosis brace treatment as well as for considering full-time brace use, part-time brace use or night-time brace use (please note: the final decision is determined by your MD). Also, please note that the type of brace does not determine the scoliosis patients’ wearing time/schedule or Schroth therapy schedule. The scoliosis brace wearing time and Schroth therapy is determined by each patient’s individual scoliosis.
- Cobb angle and curve history
- Onset of menses- girls ,change in voice-boys
- Age
- Risser sign
- Previous treatments
Frequently Asked Questions
What is a WCR brace?
The WCR brace is a thermoplastic scoliosis brace modeled on a hyper-corrected positive plaster cast of the patient. This is a 3-dimensional correctional brace which has significant pressure and expansion areas built into the brace, which provides correction in all three anatomical planes. It should follow the general correction principle as was written by Dubousset: “detorsion and sagittal plane normalization, which would affect correction of the coronal and transversal planes, resulting in some elongation of the spine, without any significant distraction force,” (Rigo, 2001, Wood 2003). The WCR brace utilizes both X-rays and clinical photos of the patient to determine curve type and brace design.
The WCR brace is a thermoplastic scoliosis brace modeled on a hyper-corrected positive plaster cast of the patient. This is a 3-dimensional correctional brace which has significant pressure and expansion areas built into the brace, which provides correction in all three anatomical planes. It should follow the general correction principle as was written by Dubousset: “detorsion and sagittal plane normalization, which would affect correction of the coronal and transversal planes, resulting in some elongation of the spine, without any significant distraction force,” (Rigo, 2001, Wood 2003). The WCR brace utilizes both X-rays and clinical photos of the patient to determine curve type and brace design.
Do you need a prescription for scoliosis braces (WCR brace and other TLSO braces)?
Yes, a prescription by an MD is required to have a brace fit and delivered to a scoliosis patient.
Yes, a prescription by an MD is required to have a brace fit and delivered to a scoliosis patient.
Is the scoliosis brace (WCR) uncomfortable?
Once the patient has completed the 7-day break in period, the brace is normally comfortable for the patient. Most patients do well and tolerate the brace. My experience has been that these braces are more comfortable compared with other braces. This is because the pressures points are located in such a way that it places the body where it should be. As a result, the patient is usually more comfortable in the brace, compared with not wearing the brace.
Once the patient has completed the 7-day break in period, the brace is normally comfortable for the patient. Most patients do well and tolerate the brace. My experience has been that these braces are more comfortable compared with other braces. This is because the pressures points are located in such a way that it places the body where it should be. As a result, the patient is usually more comfortable in the brace, compared with not wearing the brace.
Is the WCR brace heavy?
No, it is fabricated with a thermoplastic called polypropylene, which is thin and light.
No, it is fabricated with a thermoplastic called polypropylene, which is thin and light.
Can you notice the brace under the patient's clothes?
This depends on how tight or loose the patient's clothes fit. Normally, the brace is unnoticeable from the front, but it may be noticeable from the back. Some curve types require different expansion areas and locations that could be more or less noticeable depending on their size and location.
This depends on how tight or loose the patient's clothes fit. Normally, the brace is unnoticeable from the front, but it may be noticeable from the back. Some curve types require different expansion areas and locations that could be more or less noticeable depending on their size and location.
Why does the WCR function well with Schroth Therapy?
These braces have very large expansion chambers and windows built into the brace which allows a dynamic correction of the scoliotic deformities. Furthermore, the therapy teaches the patient how to optimize breathing and body movements to function with this expansion and pressure areas.
These braces have very large expansion chambers and windows built into the brace which allows a dynamic correction of the scoliotic deformities. Furthermore, the therapy teaches the patient how to optimize breathing and body movements to function with this expansion and pressure areas.
How long will the WCR brace last prior to needing a new brace?
These scoliosis braces normally last 12 to 16 months prior to needing a new one. This depends on how quickly the patient grows, primarily in height, and secondarily in weight.
These scoliosis braces normally last 12 to 16 months prior to needing a new one. This depends on how quickly the patient grows, primarily in height, and secondarily in weight.
Does the Cheneau brace correct scoliosis?
There are studies completed that have demonstrated that the Rigo brace and Cheneau brace both improve and stabilize the deformity. You can view some of the studies here.
There are studies completed that have demonstrated that the Rigo brace and Cheneau brace both improve and stabilize the deformity. You can view some of the studies here.
The WCR (Wood Cheneau Rigo) Brace is a registered trademark of Align Clinic of San Mateo, CA
