Orthotic Management of Adolescent Idiopathic Scoliosis (AIS)
Section 7

The Providence Nocturnal Scoliosis® system’s objective is to move the apices of scoliotic curves to midline or beyond, through the application of controlled, direct, lateral and de-rotational forces to the spine. In contrast to daytime brace wear, bracing in the recumbent position eliminates the conflicting forces of gravity, allowing for natural elongation of the spine and horizontal rib alignment. This creates a wider space between the floating ribs and the iliac crest, providing greater access to the lumbar vertebrae, enabling effective lateral and de-rotational forces. When thoracic ribs are aligned horizontally, thoracic pads may be applied more precisely. Locating the correct apices to apply the appropriate push towards midline and appropriate de-rotational forces is vital to successful correction. The natural elongation of the spine helps provide access, control, and correction of higher thoracic curves.

Natural elongation of the spine in the recumbent position

The Providence® orthosis utilizes overlapping 3-point pressure systems with opposing voids and segmental de-rotation at selected points.

The objective of the Providence is to move the curve apices to mid-line, identified as a straight line between C7 and S1.
Without the need to support under the forces of gravity, the most efficient application of force involves directly targeting the apex of the curve with a vector that is perpendicular to midline, while incorporating elements of de-rotation.
Forces applied at the apex are countered by stabilizing pads, located at the upper and lower ends of the curve on the opposing side, allowing for effective and unobstructed migration.
Single curves use a single 3 point system, while thoracic and double curves utilize an overlapping 3 point pressure system.