Greetings and a Reminder:
I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. Please share our story. For more information please check out http://www.infantilescoliosis.org/
Hoping that this information answers any questions that may be bubbling. :-) Olivia's cast is under the shoulder and made of fiber glass, but the rest holds true....
Early Treatment Defined:
Facts gleaned from the article, “Growth as a corrective force in the early treatment of progressive infantile scoliosis” and personal time spent with Dr. Min Mehta, FRCS.
Why materials, proper windows, and the correct frame are non-negotiable in the treatment of progressive infantile scoliosis.
Why act Early?
First and foremost Early Treatment with serial corrective plaster jackets is simply a preventive treatment that is provided as soon as an infants curve is considered progressive. We now know that the infants curve will keep pace at the rate in which the child is growing, and that is very fast the first two years of life. If the child is diagnosed with progressive infantile scoliosis under 2 years of age, and treated with a series of specialized plaster jackets, the jackets have the ability to harness that vigorous rate of growth and train the young spine to grow straight gently, and permanently. The time it takes for the curve to grow into the corrected position is about equal to the time from initial curve detection, to its first proper corrective treatment by POP jackets.
Parents are most often the first to detect their child’s scoliosis. Medical professionals typically advise parents to wait 3-6 months to determine whether or not the scoliosis will progress. However, there is a measuring technique that will help determine if the scoliosis is of the progressive nature, or self - resolving. The RVAD (Rib Vertebral Angle Degree) can be measured with a pencil and ruler, and will be able to give the surgeon an indication of what type of curve is present. There is a window of time that children benefit from Early Treatment. “The earlier treatment is begun, the greater will be the chance of success.” Time is critical for maximum correction and/or resolution of infantile scoliosis.
Why Plaster?
“Plaster-of-Paris” (POP) is the most comfortable and effective material in the application of jackets. Plaster of Paris is easier to mold to the child’s unique body shape than newer synthetic materials. The surgeons applying the jackets only have a certain amount of time to mold the jacket properly to the child’s torso, and since plaster doesn’t dry as fast as fiberglass, it allows them the time required to apply the best jacket possible. Other synthetic materials may not give the surgeons the time they need. Not to mention, overall comfort for the child, and time spent under anesthesia. Fiberglass is a very rigid material that dries fast and does not breathe with the child’s body at all.
Why Windows?
Properly placed windows are crucial in the proper application of plaster jackets. Each child’s curve(s) is individual and unique. Consequently, the windows in the jacket must address the child’s specific needs. Dr. Mehta has found that a large mushroom shape window in the front will give the child a lot of breathing room, while also providing rib flaps to support the rib cage. We call this a chest expansion window. The window in the back should start at the midline, and should be placed on the concavity side of the curve. This window allows the flattened ribs on the concave side of the curve to grow out, and the prominent ribs on the convex side to grow flat. This cut out will also be unique to your child, because every curve is different. This window will not only help to improve over all body shape, but will also address rotation.
With over 30 years of research and treatment, Dr. Mehta has found that these windows are absolutely essential in preventing chest wall deformities and that they allow ample room for normal breathing. In fact, proper lung growth is the primary reason for treating scoliosis other than cosmetic deformity.
Why use the correct frame?
Scoliosis occurs three dimensionally. The spine not only curves, but will eventually rotate also. A proper frame should be child size appropriate, and incorporate a series of devices and mechanisms that facilitate controlled traction and assist the surgeon with derotation and lateral pressure of the spine while a POP jacket is being applied. The frame is essential to this process because it assists the surgeon in obtaining gentle correction. A great example of this is how the child’s spine loosens up while on the frame during jacket application preparation. While the team is preparing to assist the surgeon the child is on the frame and you can clearly see the spine become straighter. By the time the surgeon is ready to apply the plaster, the spine has had time to loosen a little via traction, and derotation. This “loosening” of the curve(s) helps the surgeon tremendously in overall gentle correction on all three planes. These are critical components in the Early Treatment Method of addressing progressive infantile scoliosis.
Over the Shoulder –vs- Under the Arm Jacket?
This depends on the child’s individual presentation of scoliosis. My understanding of this is that the over the shoulder type of jacket provides extra support to the spine and the jacket, itself. Over time, plaster jackets loosen up and if the jacket is an under arm style, the jacket will begin to ride up under the arms and is no longer supportive. To prevent this from happening, surgeons using the under arm jackets must apply them tighter around the chest cavity, and in some cases must tightly reinforce the top section of the jacket with an extra roll of plaster in effort to prevent the jacket from eventually riding up and loosing all support.
The over the shoulder type of jacket has shoulder straps, which help prevent the jacket from riding up. The surgeon doesn’t have to reinforce the jacket tighter around the chest or use extra plaster, because the shoulder straps assist in holding the jacket down through the life of the jacket.
Children’s bones are soft, so less pressure around the chest cavity is best. There are many factors that contribute to chest wall deformities. The length of time your child wears the jacket, the location of the child’s curve(s), the proper application of the jacket, and the equipment used to apply the jacket should all be taken into account. A surgeon that has been trained to use the Early Treatment Method developed by Dr. Mehta will know what type of jacket is best for your child.
Why go to a trained Dr.?
If the treatment of progressive infantile scoliosis were non-specific there would not be the prevalence of cases nor the need for organizations like ISOP. Again, if progressive infantile scoliosis was so non-specific, any cast technician with basic skills could apply any kind of cast and get consistent results without detrimental side effects. We know, and must remember, that the early treatment of infantile scoliosis is very specific to the individual child. As Miss Mehta would say, “Treat the child, not the x-ray.” There are many individual factors which define each child’s own presentation of scoliosis. Dr. Mehta has devoted over 30 years of her medical career to the development and perfection of the Early Treatment Method. Her findings are not based on one child or even a handful of children. The Early Treatment Method is substantiated by over 136 cases, of differing scoliosis presentations, whose treatment was documented over several years. These cases highlight the consistent and lasting results gained through the Early Treatment Method.
Conclusion
In the last few years I have been able to witness at least 25 POP jacket applications by Dr. Mehta. On each occasion I learn something new, and these experiences have been invaluable to me in understanding that there is a very specific formula to applying serial corrective plaster jackets early and properly to our young children. My goal in sharing what I have learned is to help you make the best decisions possible for your child. Early Treatment is still very new in the orthopaedic world and ALL of us familiar with it, are on a learning curve. Please take this into account when pursuing this option for your child. Children have a short window of rapid growth in which to benefit from Early Treatment. The best plan is to have the jacket applied properly, so the window of time for your child to benefit is not lost.
