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 an 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 modeled 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 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.
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:
- Correction of the Cobb angle.
- Reduction of rotation.
- Sagittal plane normalization by allowing the spine to move from ventral to dorsal.
This prevents the increase of flatback syndrome which is commonly associated with scoliosis in the thoracic region. Other brace designs usually promote flatback. You cannot have a 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 the 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 the 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 effect). This can lead to discomfort, especially in scoliotic curves with large magnitudes.
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
- The onset of menses- girls, change in voice-boys
- Risser sign
- Previous treatments