fitting Instructions - CMP Brace

nightProfessionalfitting instructionsDESIGNED BY: THE SPINECORPORATION LIMITEDwww.cmpbrace.com

nightIntroductionHigh Axilla RollThe CMP Night Brace is a scoliosis brace designedfor part-time (P/T) wear, 10-12 hours per day.It utilises the same corrective movement principle in itsdesign, but in common with other nocturnal P/T bracesis designed specifically for recumbent wear only.The CMP Night Brace, in common with other P/Tnocturnal scoliosis braces, is designed to achievefar greater in-brace curve corrections than full-time(F/T) rigid braces. In order to achieve greater in-bracecorrections, the CMP Night brace provokes extremepostural over-correction. The asymmetrical bracedesign can create unbalanced postural overcorrectionnecessitating the brace only be used in a entralLocking BarSimilar to F/T CMP bracing, the CMP Night Braceshares some of the design features utilised by the manyChêneau based derivatives in this class, however, curveclassification and the correction principles differ byoffering more focused correction.TrochanterExtensionCorrective Movement PrincipleBoth CMP Night & Day Braces utilise Dr Coillard’sSpineCor curve classification which defined theCorrective Movement Principle. Both the CurveClassification and Corrective Movement Principledeveloped in the mid 90’s have been clinically provento be effective in more than 25 independent clinicalbrace trials.The Corrective Movement Principle produces a curvespecific, optimally focused, 3-D Global Postural Overcorrection promoting;i. Normalisation of Sagittal Spinal Balanceii. Optimization of Coronal Spinal Balance –In some cases this will be unbalancedCMP Night Brace Design1. Brace Constructa. Monocot Rigid Envelope/Shellb. Envelope high surface contact area controllingglobal postural correction/over-correctionc. Envelope incorporating pressure control areas withcorresponding void areas and windowsd. Supplemental pads allowing additional incrementalcorrective force overtimee. Anterior openingiii. Maximum De-Rotationf. Central Locking bar to increase rigiditypreventing twistiv. Maximum Curve Opening- Much greater curveopening than with day braces, due to recumbentg. Coccyx extension for optimal sagittal controluse, longer lever arms and more extreme,h. Trochanter extension for optimal pelvic control,unbalanced, postural over correction.longer than day-time braces allowinggreater correctionCMP Night Brace - Corrective Movement Principle

2. Tri-Planar 3-D Corrections/Over-Correctiona. Sagittali. Pelvic Version – Normalisationii. Pelvic Tilt – Correctioniii. Lumbar Lordosis - Normalisationiv. Kyphosis – Normalisationb. Transversei. Thoraxii. Shouldersiii. Lumbarc. Coronali. Translateii. TiltCMP Braces classify curves according to apical level,number and direction of curves, differentiating betweenprimary structural, secondary structural and nonstructural compensatory curves. The classification isbased on both radiological and clinical features. Posturaladaption to the spinal deformity being most relevant todefining the specific Corrective Movement Strategy foreach curve classification.The CMP Brace Classification and the specific CorrectiveMovement Strategy associated with each Classificationhave been extensively proven over the past 25 years usewith dynamic braces. Utilisation of the same CorrectiveMovement Principles in Rigid bracing is perhaps anobvious evolution but has taken many years to perfect.CMP Night Brace offers some of the greatest possiblein-brace curve reductions, together with optimalcoronal and sagittal balance. Greater spinal elongationis possible in the CMP Night Brace in part because it isintended for use in a recumbent position only. Maximalcurve opening during the night offers the greatestopportunity for positive vertebral growth modulationwhen HGH levels peak.Professional Fitting Instructions1. Check the brace name and order number correspondto your patient.2. Inspect the brace to confirm there are nosharp edges.3. Before attempting to fit the brace explain to yourpatient to expect the following;b. The brace will initially feel very tight and restrictive,this feeling will diminish over time.c. On first fitting the brace may be too long or applyexcessive pressure to the body in one or moreareas. This is normal and will be adjusted as part ofthe fitting process.d. The opening of the brace is unlikely to fully closewhen first fitted, again this is normal as it takestime for the body to adapt to the correctiveposition. As the body adapts to the brace over thefirst week the opening should close further.e. The brace will appear to fit tightly in some areasand appear to have excessive space in others.This is normal, the brace is designed with correctivepressure areas and expansion areas allowingprogressive correction over time.f. A protective undergarment (body suit, vest ort-shirt) must always be worn underneath the brace.g. Assure your patient that they will gradually getused to the brace and the tension will feel lesswith time.h. Explain weaning-in procedure; Remind your patientthat the brace is designed for nocturnal use andshould be worn only when lying down at night.Ideally 10-12 hours once the brace is broken in.We recommend a break-in period of up to 14 days togradually adjust to wearing your CMP Night Brace.1st Night: Tighten your brace to the minimum tensionmarked on the brace, wear the brace to bed and tryto go to sleep. If after an hour you are unable tosleep, remove the brace and sleep the rest of thenight without it.2nd – 4th Nights: Wear the brace again to bed,fastened to the minimum tension and try to sleep.Wearing the brace should get easier each night andnot prevent sleep. If you wake during the night, remove the brace and sleep the rest of the nightwithout your brace.5th – 14th Nights: Once you are able to sleepcomfortably through the night at the minimum tension you should begin to gradually increase thetension towards the maximum marked on the brace.a. The degree of postural over-correction necessaryto achieve optimal spinal alignment will be extreme,taking up to 14 days to gradually becomeaccustomed to.PAGE 3

4. Apply the brace loosely to the patient withoutfastening either standing or laying, whichever is mostappropriate for the individual. Ensure the short sideof the brace lower edge sits on the waist just abovethe iliac crest.b. Pass the lower Velcro strap through the loop andpull back to tighten.6c6b5. With the patient laying supine on a couch elongateand manipulate the patient into their brace ensuringbrace waist rolls where present and over the iliaccrests. Once positioned as described apply mildtraction, pulling the brace down whilst engaged overthe iliac crests. The patient may assist by holdingonto the couch. If the patient is unable to assist in thisprocess the parent/carer may hold the patient underthe arms to prevent them from moving down thecouch.c. Progressively fasten and tighten the upper strap.d. Mark the brace with a Sharpie or similar indeliblemarker at two points on the central stabilising bar.i. Indicate the minimum initial brace tension.ii. Indicate the maximum brace tensing goal.6. Once the brace is positioned correctly aroundthe patient’s body with their spine elongated, beginfastening the brace.a. Firstly, engaging the central stabilizing bar into theslot opposite.MaximumTension6aMinimumTensionCMP Night Brace - Corrective Movement Principle

7. Axilla Length – Braces will frequently be longer onone side than the other with the proximal trimlinehigh under the axilla on one side. The proximal trimon the long side has two functions, tilt the shouldersand flexion of the upper thoracic spine. This trimline must not be too low compromising it’s primaryfunctions, applying lateral pressure to the uppertorso and elevating the shoulder. Pressure directlyunder the axilla should not be so much that thepatient is not able to move their body away fromthe distal edge of the brace into a comfortableposition. Frequently, additional padding (an axillaroll) will be added to the brace providing a soft edge.The brace may be trimmed if necessary, however, thiswill necessitate re-padding of the final distal braceedge under the axilla.879. Posterior Upper Thoracic Extension – This will notfeature on all braces but is useful to controlshoulder rotation in thoracic curves. Similar to theAnterior Upper Thoracic Extension it may not alwaysbe in the optimal position, however, it is much easierto trim or alter the angle of push by heat moulding.8. Anterior Upper Thoracic Extension – This will notfeature on all braces but is useful to controlshoulder rotation in thoracic curves. The positionof this extension on your patient may vary from itsintended ideal position since it is hugely dependentupon how each patient responds to the inbuiltrotational shape of the brace envelope. The rounderend of the extension is intended to fit high towardsor onto the clavicle. The extension piece itself shouldscoop under the arm without undue impingement.This extension piece may be trimmed and / or heatmoulded to establish a comfortable and functionalposition. In some cases, this may not be possible toachieve, and the extension may need to be removedaltogether.9PAGE 5

10. Thoracic & Lumbar Pressure/Pad Areas – thesepressure areas are intrinsic to the brace envelope.Pressure may be increased by the addition of furtherpadding to the inside of the brace. The need toincrease pressure/ pad areas at initial fitting is veryunlikely unless a mild correction was requested,or the patient is significantly more flexible thananticipated.AxillaPressurePad AreaAdditional padding to supplement these pressureareas may well be necessary after the brace has beenworn for some time and the patient is able to toleratefurther correction.PressurePad AreaWindow/ReliefAreaTrochanterPressurePad AreaWindow/ReliefAreaPressurePad AreaBrace Review and X-ray ImagingRecommendations1.Pressure Relief Areas & Windows – These facilitatemovement of the patient’s body away from thepressure / pad areas. Initially these pressure reliefareas may look too big, however, over time thisspace will be needed to accommodate furtherimprovement in the Corrective Movement Position.First brace fitting radiological review may be made onthe day of brace fitting to check useful Cobbreductions are achieved prior to your patientscommencing brace wear. Whist useful, this will notdemonstrate full correction potential of the brace sinceit can take several weeks for the spine to mobilise andthe patient to fully accept optimal brace tensioning.First radiological review at the first clinical review isadvised 4-6 weeks after initial fitting and is more likelyto demonstrate better Cobb correction.2. First clinical brace fitting review is advised 4-6 weeksafter initial fitting. Radiological review is advised if notcarried out on the day of brace fitting.3. Subsequent clinical brace reviews are advised every4-6 months, depending on Initial curve reduction andgrowth potential.4. Subsequent in-brace radiological reviews should becarried out after every pad adjustment or bracereplacement.5. Out of brace radiological reviews should be carried outevery 6-12 months.CMP Night Brace - Corrective Movement Principle

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nightFor more information contact yourlocal CMP Night Brace provider:Designed by:The SpineCorporation LimitedMillennium House Foxwood RoadChesterfield Derbyshire S41 9RFUnited Kingdomwww.cmpbrace.com

3. Subsequent clinical brace reviews are advised every 4-6 months, depending on Initial curve reduction and growth potential. 4. Subsequent in-brace radiological reviews should be carried out after every pad adjustment or brace replacement. 5. Out of brace radiological reviews should be car