It is periodically adjusted for growth. The brace needs to be worn 23 hours a day with relief only during bathing and exercise. Newer, molded braces, particularly the Boston brace, come up to beneath the underarms and can be fitted to be worn close to the skin so that they don't show under clothes. Patients are still urged to wear these braces 20 hours a day, but wearing them for 16 hours a day may still be beneficial. Some may only be needed at night.
Compliance is a major problem.
This brace is particularly difficult to endure. One woman who had worn it for seven years during adolescence remembered herself as being invisible at school, ignored and shunned by other children. Young people often refuse to wear even the newer braces, and emotional support from the family and professionals is extremely important to help a child accept the process and sustain compliance. A team approach, with several health professionals involved, is usually beneficial and often necessary to support the patient through the bracing process. An orthopedic surgeon interprets the x-rays, assesses the potential progression of the scoliosis, and plans the treatment with the patient and family.