Rethinking Rigidity: Development of a 3D-Printed Scoliosis Brace With Varying Flexibility

Scoliosis bracing is an effective treatment method for idiopathic scoliosis, but only if worn consistently for many hours a day. Unsurprisingly, brace discomfort is a significant deterrent against treatment adherence. For decades, custom braces for idiopathic scoliosis have been fabricated using one of three materials - copolymer, polypropylene, or polyethylene. The application of the biomechanical principles behind bracing have improved over the years, but the materials have not. The investigators' goal is to expand fabrication options by testing a 3D-printed scoliosis brace with variable flexibility. The aim is to improve patients' perceived brace comfort.

After optimizing the brace design, the investigators will collect patient feedback about the design from currently braced participants. These participants understand what a standard brace feels like and will provide impactful feedback.

After optimizing the brace design, the investigators will collect patient feedback about the design from currently braced participants. Once a participant enrolls in the study, the 3D printed brace will be made using the exact same shape as their current brace. The standard fabrication process includes the following:

1. Certified orthotist completes a full evaluation
2. Taking a scan of the patient's body
3. Modifying, or editing, the patient's body shape using Computer-Aided-Design and applying corrective pressures against the apex of the scoliotic curve
4. Carving a positive foam model of the modified shape and thermoforming the polypropylene plastic over the positive foam model

These steps were already completed to make the participant's current brace, which has been deemed acceptable by their medical team, including the PI and Dr. Timothy Borden. To reduce the number of variables present, the 3D printed brace will be made using the exact same shape as their current brace. The only difference is the fabrication technique (step 4). Instead of carving a foam mode and thermoforming, the exact brace shape will be directly 3D printed. Therefore, no additional x-rays, scans, or measurements are required from the participants. The standard fabrication process and research activities are outlined in attachment titled "Fabrication Process Outline."

Once the 3D printed brace has been fabricated, the participant will come in to be fit with the brace. A standard fitting involves trimming the brace, adding straps, heating and flaring to improve comfort, and potentially adding padding. The PI is a scoliosis bracing specialist and will be the lead orthotist during the fitting process to ensure that best practices are followed.

Following the fitting, the participant will provide test out the 3D printed brace for comfort by performing a series of tasks. The activities will include the following: sitting in a chair, picking an item up from the floor while standing, picking an item up from the floor while sitting, stepping onto a stool, jogging in place for 10s, performing the hula hoop Wii-fit game, lying down on an exam table, and donning shoes. All data collection will take place via the survey platform Qualtrics.

If the participants feel comfortable in the brace and pass a skin check, the participants will then take the brace home and wear it for 1 week. They will return for the 1-week follow-up appointment and complete the study at this time. They will provide feedback about the 3D printed brace through a semi-structured interview (recorded using BCM Zoom Platform) and complete a survey (Qualtrics). They will return the brace, marking the end of the study.

Total duration of study participation ranges from 2 weeks - 6 weeks. The time commitment required from the participant is no more than 8 hours. The timelines are outlined below:

1. Participant enrollment during appointment at Align Clinic (complete consent forms, demographic survey, baseline testing). Study-related activities will take approximately 30-60 minutes
2. 3D printed brace fabrication. Nothing required of participants. Fabrication will take roughly 1-4 weeks
3. Brace fitting. Participant will come to the office to be fit with the 3D-printed brace. Fitting will take roughly 1-4 hours
4. Activity series in 3D printed brace. Will occur on the same day as the fitting. Testing will take approximately 30 minutes
5. Follow-up appointment one week after the fitting. 3D printed brace is returned, marking the end of the study. Study activities (semi-structured interview, survey) will take 30-60 minutes.

Standard of care will be maintained throughout the study. The only activities outside of the standard of care are the semi-structured interview, study surveys, and performance of tasks. While the goal of the study is to elevate the 3D printed materials, the investigators will still be following the standard of care for 3D printing.

Eligibility Criteria:
Inclusion Criteria:

1. Have a diagnosis of juvenile idiopathic scoliosis or adolescent idiopathic scoliosis
2. Have a Cobb angle between 20-40 degrees
3. Are between ages 8-18
4. Present as Risser 2+ on x-ray
5. Currently wear a traditionally fabricated scoliosis brace
6. Have good brace adherence in current brace (self-reported to be 75% of prescribed time)
7. Be an established patient of Align Clinic and Dr. Timothy Borden
8. Speak English (survey and semi-structured interview will only be available in English)
9. Assent and receive parental consent

Exclusion Criteria:

1. Have a diagnosis other than juvenile idiopathic scoliosis or adolescent idiopathic scoliosis
2. Have a Cobb angle outside the range of 20-40 degrees
3. Present as Risser 0 or 1
4. Do not currently wear a traditionally fabricated scoliosis brace
5. Have poor adherence in their current brace
6. Do not speak English
7. Are not willing participate in the study