Library Type: Treatment

Scoliosis Bracing

The Goal of Scoliosis Bracing: Stop Progression of the Curve

The primary goal of the brace is to stop the progression of the curve. For example, if your child starts with a 27-degree curve, the goal is to keep the curve at 27 degrees and for it not to get worse over the course of treatment.

Types of Bracing

There are many different types and manufacturers of scoliosis braces available. The type of brace will be determined by the spine doctor and your child’s orthotist (the clinician who fits the brace).

Typically, the braces are plastic on the outside, and the majority are lined on the inside with foam (although the foam lining is optional to allow for a thinner aesthetic). Different color patterns are available for children who want to personalize their brace.

Treatment Timeline

Typical treatment timelines range from 1-3 years, with the most common timeframe being about 2 years. Since the timeline is usually quite long, brace compliance is key.

In this case, compliance means wearing the brace for the number of hours indicated by your spine doctor and orthotist. The orthotist will work with your family to determine what is realistic in terms of wear time (taking into account sports, dance, activities, after-school commitments, etc.), so they can build a plan accordingly.

Full-time vs. Nighttime Bracing

The referring physician will make the decision as to whether your child needs to be in a full-time brace or a nighttime brace based on several different factors (bone age, chronological age, onset of menstrual cycle [in females], and curve magnitude).

The recommendation for full-time bracing is to wear the brace 16-20 hours a day, and the recommendation for nighttime bracing is to wear the brace 8-10 hours every night.

Studies show that full-time bracing worn for greater than 17 hours had a much higher success rate of preventing the progression of the curve than in patients who wore their braces for less than 17 hours. This reinforces the importance of brace compliance and ensuring the brace is being worn as prescribed.1

It is also important to note that the nighttime brace will maximize the in-brace correction for fewer hours each day. The decision between full-time bracing and nighttime bracing is often discussed with the spine doctor, orthotist, patient, and family.

Depending on the child’s growth, full-time braces last about 12 months and nighttime braces last anywhere from 18-20 months. Some children may require more than one brace over the course of treatment.

The Hanger Clinic Difference

Our team of expert clinicians established Clinical Practice Guidelines for treating adolescent idiopathic scoliosis based upon 2016 SOSORT International Society on Scoliosis Orthopedic and Rehab Treatment consensus findings.

These guidelines serve as the standard of care at Hanger Clinic and include five different areas that help ensure Hanger Clinic clinicians treating scoliosis patients have the necessary experience and education to provide the best possible care and outcomes.

The Clinical Practice Guidelines include seven different biomechanical design considerations to ensure all braces provided through Hanger Clinic are fabricated to a specific, high-quality standard.

Our Approach to Care

Our approach centers on communicating with families, partnering with broader healthcare teams, incorporating age-appropriate treatment plans, and applying new, innovative technologies throughout each child’s journey to ensure the best possible care today and into the future.

What to Expect on the Scoliosis Treatment Journey

The diagnosis is usually made by your child’s pediatrician or spine doctor, and the appropriate course of treatment is recommended.

If your child’s curve is between 25-50 degrees, bracing will likely be prescribed and the referring physician will decide whether he or she needs a full-time brace or a nighttime brace. Your family will receive a prescription for the brace and will be referred to an orthotic provider, such as Hanger Clinic.

At the first appointment (which typically takes 60-90 minutes), your orthotist will evaluate and measure your child for the brace indicated on the prescription. The evaluation consists of a clinical postural assessment looking at the shoulders, scapula, waist, and hips, as well as taking measurements and looking at your child’s X-rays.

Measurements are typically taken either standing or laying down, and sometimes a scan is taken, so the orthotist can capture the shape of your child. At the same time measurements are being completed or within 48 hours of the appointment, the office staff will work to verify insurance coverage, with the goal of providing families with an understanding of their out-of-pocket costs (due to their deductible and coinsurance).

Your orthotist will send the measurements and scans (if applicable) to a design center where the brace will be fabricated.

Within 2-4 weeks of the initial evaluation, your family will return to the clinic for fit and delivery (this appointment typically lasts 45-90 minutes). At that time, your orthotist will evaluate and adjust the brace to ensure a comfortable fit and the proper function. They will review the break-in schedule and cleaning instructions, show the parent and patient how to take the brace on and off, and will schedule necessary follow-up appointments.

It usually takes 1-2 weeks for children to get used to wearing the brace, which is why orthotists allow for a gradual break-in schedule. While there may be areas of redness that correspond with areas of pressure from the brace, there shouldn’t be areas of skin irritation associated with the bracing. The orthotist will advise on how to best address red pressure areas based on your child’s individual case.

Your family will return 2-10 weeks following delivery for a follow up appointment, which could be with your spine doctor and / or orthotist. The timing and who is at this appointment depends on your spine doctor’s protocols. At this appointment, an in -brace X-ray may be taken. If necessary adjustments are required, an additional appointment with your orthotist may be scheduled.

Your orthotist will also take the time to answer questions, discuss concerns, and review wear time compliance. Compliance monitors may be installed in the brace, allowing the orthotist to print and review wear time reports with families, and celebrate your child’s accomplishments.

The next follow-up appointment will be with your referring physician 4-6 months after the initial prescription was written. Your child will continue to see their physician for follow-up appointments every 4-6 months throughout the course of treatment or as determined by your spine doctor.

Intermittently between the visits with your referring physician, you will see the orthotist for adjustments to accommodate for growth (typically every 3-6 months, depending on the type of brace and upon the discretion of the orthotist). Patient and families are encouraged to call if adjustments are necessary before the next scheduled appointment.

The referring spine doctor will determine when bracing is discontinued. This is typically at skeletal maturity.


Insurance Coverage for Scoliosis Bracing

Scoliosis braces (TLSOs) are a covered benefit under many insurance plans. Hanger Clinic is in-network with more than 2,500 insurance providers, helping you receive your covered benefit under your insurance plan.

Our experienced office staff will verify your benefits with your insurance carrier to determine the amount of coverage available and will provide you with an estimate of your portion of the costs prior to you moving forward with treatment.

Please note–a prescription is required.

Scoliosis Wear & Care Guide

If you’ve been prescribed a scoliosis brace, these instructions will help you correctly use and care for your device. If you have any specific questions about your care plan, please contact your clinician.

Lower Limb Bracing

The Orthotist’s Role in Your Child’s Care

The orthotist (the clinician who designs and fits the brace) will work closely with your child’s physician and other key members of the healthcare team (therapists) to recommend the best solution for your child based on their individual needs and specific condition. The role of your orthotist is to provide your child with the necessary care, tools, and support to empower their potential.

Bracing Options

Bracing options range in level of support and will be determined by your child’s orthotist in conjunction with their broader care team (therapists, physicians, etc.). Some prevalent conditions treated with lower limb orthoses include toe walking, clubfoot, cerebral palsy, muscular dystrophy, Down syndrome, spina bifida, Charcot Marie Tooth (CMT) disease, foot drop, and more.

Foot Orthoses (FO) /
Shoe Inserts

Designed to support the foot under arch to reduce collapse.

Sumpramalleolar Orthoses (SMO)

Designed to support the foot just above the ankle bone. Controls alignment of the foot while allowing free ankle motion.

Ankle-Foot Orthoses (AFO)

Designed to provide support and proper joint alignment of the foot and ankle, assisting in instances of muscle weakness and helping protect the foot and leg.

Knee Orthoses (KO)

Designed to off-load painful areas or aid in the stability of the knee joint secondary to injury, postoperative reconstruction, meniscus damage, or for preventative protection.

Knee Ankle-Foot Orthoses (KAFO)

Designed to provide support and proper joint alignment of the knee, foot and ankle, assist or substitute for muscle weakness and joint instability, and protect the lower limb.

Hip Knee Ankle-Foot Orthoses (HKAFO)

Designed with the same components as a KAFO with the addition of a lockable hip joint and a pelvic band.

What to Expect on the Lower Limb Bracing Journey

Upon receiving a prescription for the brace from your child’s healthcare provider (pediatrician, neurologist, orthopedic surgeon, etc.), you will schedule a free evaluation with your nearest Hanger Clinic Pediatric Specialist.

The orthotist will provide you with education and information on the process for obtaining bracing for your child. The initial evaluation will include an analysis of your child’s movement abilities, and where appropriate, their walking patterns. Next, we will take an impression and gather the appropriate measurements for your child’s brace. During this appointment, you will likely have the opportunity to help design the appearance of the orthosis. Your clinician will send the impression(s), measurements, and scans (if applicable) to a design center where the brace will be fabricated.

At the same time, the office staff will work to verify insurance coverage, with the goal of providing you with an understanding of your out-of-pocket costs (due to your deductible and coinsurance).

Your family will return to the clinic in 3-6 weeks for fitting and delivery of the orthosis. At that time, the orthotist will evaluate and adjust the brace(s) to ensure a comfortable fit and proper function. They will review the break-in schedule and cleaning instructions, show you and your child how to put them on and take them off, and schedule necessary follow-up appointments. Some more complicated cases may require more than one fitting appointment.

Your family will return to assess the brace fit and address any concerns you may have. Your clinician will also take the time to answer questions and recommend a schedule for follow-up appointments.

Every 9-15 months, your child will need to be seen to assess the fit and function of their braces and to determine if they need replacements due to growth or other factors.


Insurance Coverage for Lower Limb Bracing

Lower limb braces are a covered benefit under many insurance plans. Hanger Clinic is in-network with more than 2,500 insurance providers, and we will take great care in checking your insurance coverage plan for your child’s prescribed lower limb braces. If we are not in-network with your provider, we are still happy to provide your child with bracing and will work closely with you to find alternative financial solutions.

Once you provide us with your insurance information, our experienced office staff will verify your benefits with your insurance carrier to determine the amount of coverage available. If needed, our staff will also obtain prior authorization from your insurance company. Our office staff will then provide you with an estimate of your portion of the costs prior to providing orthotic devices to your child.

Please note–a prescription is required.

Cranial Remolding Orthosis

Treating Your Baby at Hanger Clinic

Specialists in Hanger Clinic’s network of Cranial Asymmetry Remolding Experts, known as the CARE Network, are leading orthotists who have experience treating a full spectrum of musculoskeletal conditions. They will apply their deep, holistic understanding of pediatric anatomy and take into account natural developmental milestones when treating your baby.

Our Approach to Care

With over 200 clinicians at more than 260 locations nationwide, the highly-specialized CARE Network helps ensure patients and families receive access to unparalleled expertise. We embrace transparent, evidence-based care utilizing clinically-appropriate technology designed to fit each baby’s unique needs and help them achieve the best possible outcomes.

High Standard of Care

We follow a set of validated, research-based Clinical Practice Guidelines, so you can rest assured your child is benefitting from the best possible clinical techniques that are backed by science.1

Clinical Experience

In consultation with referring physicians, our specialists follow a defined treatment algorithm that informs our recommendation on whether a family should move forward with treatment.1

Commitment to Outcomes

Our clinicians are committed to collecting outcome measurements throughout your baby’s course of care, allowing you and the broader healthcare team to track improvements and monitor progress.

Advanced, Patient-Centered Technologies

As an early adopter of 3-D scanning technologies, we have embraced numerous techniques and systems that help us create a more precise fit. Utilizing FDA-regulated cranial band designs based on patient and physician needs, our cranial helmets are designed to grow with each child, so most baby’s will only need one device for their treatment.

1. Lin RS, Stevens PM, Wininger M, Castiglione CL. Orthotic Management of Deformational Plagiocephaly: Consensus Clinical Standards of Care. The Cleft Palate-Craniofacial Journal. 2016;53(4):394-403. doi:10.1597/15-007

Our care at Hanger Clinic has been exceptional. The team worked with two of my daughters and held our hand throughout the entire process. I can’t say enough good things about them!

Natalie A.Mom to Hanger Clinic Patient Colette

What to Expect on the Cranial Helmet Treatment Journey

What to Expect on the Lower Limb Bracing Journey

Upon receiving a prescription for the brace from your child’s healthcare provider (pediatrician, neurologist, orthopedic surgeon, etc.), you will schedule a free evaluation with your nearest Hanger Clinic Pediatric Specialist.

The orthotist will provide you with education and information on the process for obtaining bracing for your child. The initial evaluation will include an analysis of your child’s movement abilities, and where appropriate, their walking patterns. Next, we will take an impression and gather the appropriate measurements for your child’s brace. During this appointment, you will likely have the opportunity to help design the appearance of the orthosis. Your clinician will send the impression(s), measurements, and scans (if applicable) to a design center where the brace will be fabricated.

At the same time, the office staff will work to verify insurance coverage, with the goal of providing you with an understanding of your out-of-pocket costs (due to your deductible and coinsurance).

Your family will return to the clinic in 3-6 weeks for fitting and delivery of the orthosis. At that time, the orthotist will evaluate and adjust the brace(s) to ensure a comfortable fit and proper function. They will review the break-in schedule and cleaning instructions, show you and your child how to put them on and take them off, and schedule necessary follow-up appointments. Some more complicated cases may require more than one fitting appointment.

Your family will return to assess the brace fit and address any concerns you may have. Your clinician will also take the time to answer questions and recommend a schedule for follow-up appointments.

Every 9-15 months, your child will need to be seen to assess the fit and function of their braces and to determine if they need replacements due to growth or other factors.

Insurance Coverage for Cranial Helmets

Cranial helmets are a covered benefit under many insurance plans. Hanger Clinic is in-network with more than 2,500 insurance providers, helping you get the highest coverage possible under your plan. If we are not in-network with your provider, we are still happy to provide your baby with a cranial helmet, but you may be responsible for a larger percentage of the cost, subject to the out-of-network rate set by your insurance plan. 

Once you provide us with your insurance information, our experienced office staff will verify your benefits with your insurance carrier to determine the amount of coverage available. If needed, our staff will also obtain prior authorization from your insurance company. Our office staff will then provide you with an estimate of your portion of the costs prior to helmet therapy being provided. 

Please note–a prescription is required.

Tummy Time

Learn How to Postion, Carry, Hold, and Play with Your Baby

Children’s Healthcare of Atlanta developed helpful tools to help ensure your baby gets enough time on their tummy each day.

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