Effectiveness of Bracing in Preventing Scoliosis in Children With Spinal Cord Injury

Study Overview
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Brief Summary
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The purpose of this study is to determine whether full-time high dose prophylactic bracing (23 hours or more per day) is more effective than low dose bracing (12 hours or less per day) in preventing or delaying spinal curve progression in children with scoliosis after spinal cord injury.

Detailed Description
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This is a randomized control trial to determine the effectiveness of high dose bracing (≥ 23 hours per day) and low dose bracing (≤ 12 hours per day) in skeletally immature children with Spinal Cord Injury. Subjects will be randomized into either a prophylactic high dose-bracing group (≥ 23 hours per day) or low dose-bracing group (≤ 12 hours per day). Subjects will be stratified by age (younger than age 10 and older than age 10), and curve severity (< 20 degrees and 20-40 degrees) using a matching random blocks design.

Official Title
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Effectiveness of Full-Time Prophylactic Bracing at Preventing or Delaying Curve Progression in Paralytic Scoliosis Secondary to Spinal Cord Injury in the Growing Child: Randomized Trial

Conditions
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Scoliosis

Intervention / Treatment
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* Device: Thoraco-Lumbar-Sacral-Orthoses (TLSO) / Flex-Foam


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children with C5 to L2 SCI. ASIA impairment levels A, B, or C. Age greater than 5 up to one year before end of growth (14 in girls, 16 in boys) A single structural curve <40 degrees or a double curve <40 degrees where the largest compensatory curve is <25 degrees on bending film. Children at risk for Paralytic Scoliosis Ability to follow simple instructions. Exclusion Criteria: Curve magnitude >40 degrees, pressure sores over the trunk. Inability to tolerate TLSO wears. Structural compensatory curves of 25 degrees or greater (double structural curves). Severe Traumatic Brain Injury, TBI (8 and below on Glasgow Coma Scale). Cognitive Impairment Less than 6 months from date of injury

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1<br>High-dose Thoraco-Lumbar-Sacral Orthoses wear (>23hrs/day) will be compared to low-dose Thoraco-Lumbar-Sacral Orthoses wear (12hrs/day) | Device: Thoraco-Lumbar-Sacral-Orthoses (TLSO) / Flex-Foam<br>* TLSO back brace, Flex-Foam (Posterior Opening)<br>|
| Active Comparator: 2<br>Low-dose Thoraco-Lumbar-Sacral-Orthoses wear (12hrs/day) | Device: Thoraco-Lumbar-Sacral-Orthoses (TLSO) / Flex-Foam<br>* TLSO back brace, Flex-Foam (Posterior Opening)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| X-rays (at the time of consent and every 6 months for 5 years) to determine degree of scoliosis. |  | 5 years | 
| Timed Motor Assessment (at the time of consent and once a year for 5 years) to measure functional ability in daily life activities including putting on sweat pants, T-Shirt, transferring from wheelchair to bed, etc. |  | 5 years | 
| Reachable Workspace Assessment (at the time of consent and once a year for 5 years): performing functional tasks including reaching for the floor, overhead, and every 20-degree radius in between. |  | 5 years | 
| Global Measures (at the time of consent and every 6 months for 5 years): Four different questionnaires to monitor function, satisfaction, and quality of life. |  | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Spinal Cord Injury, TLSO brace, Spine curvature, Child, Effectiveness of bracing