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Braces And Their Application

Creator: Frank D. Dickson (author)
Date: May 1933
Publication: The Polio Chronicle
Source: Roosevelt Warm Springs Institute for Rehabilitation Archives
Figures From This Artifact: Figure 2  Figure 3  Figure 4

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By Frank D. Dickson, M.D., Kansas City, Missouri

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EDITOR'S NOTE

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In illustrating this article by Dr. Dickson, we have used only three illustrations. We consider, however, that these are fairly representative, and serve their purpose in showing what can be done by an expert brace maker.

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It must be remembered, though, that no braces should be fitted except under the supervision of an orthopaedic doctor.

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MEDICALLY speaking, braces are supports used to prevent deformity and buttress weak and imperfectly functioning extremities so that they may perform at least a part of their work of support and locomotion. The history of braces used in this manner starts with the beginnings of medicine and follows down over a period of some twenty-five hundred years. Hippocrates advised the use of splints or braces for moulding and retention in the treatment of club foot. In 650 A.D., Paul of Aeginia suggested bandaging wooden strips to the trunk for the treatment of curvature of the spine. In 1510, Ambroise Paré advocated the use of a padded iron corset to correct deformities of the trunk. In 1691, we find Jungkin using whalebone corsets in a similar way. In the eighteenth century, the apparatus inventors were particularly active, and braces and corsets, infinitely complicated, were developed by the dozen. Most of these braces were designed as supports for deformities of the trunk, and it was only in the latter part of the nineteenth century that adequate braces, designed to immobilize and protect tuberculous joints and to correct club foot deformities, were produced. Infantile paralysis, first described in 1840 but not reaching serious dimensions in this country until 1907, has been largely responsible for the development of the elaborate and efficient braces used today. This development naturally took place because the grave interference with locomotion incident to infantile paralysis made it imperative that means be devised to enable those so handicapped to get about. Today braces are one-third of our armamentarium for combating deformity and disability, the result of disease or injury; aseptic surgery and physical therapy provide the other two-thirds.

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Fundamentally braces serve these purposes: (1) they protect weak or diseased joints; (2) they prevent deformity; (3) they enable weak or paralyzed limbs to function. Properly designed and properly fitted braces fulfill these purposes admirably and are indispensable in the treatment of many conditions which cause deformity and physical incapacity. At the same time, it should be appreciated that braces have limitations and if called upon to do more than that of which they are capable, disappointment will follow. Braces, while very efficient in preventing deformity and in maintaining the corrected position after deformity has been overcome, do not correct existing deformity unless it is of slight degree, and if applied for this purpose they will fail. Deformity then should be corrected before braces are used if we are to get the best results; applying braces to extremities so distorted that correct filling and proper joint action is impossible is a grave mistake and productive of ill rather than good. Too often braces are cast aside as failures because they have been expected to do the impossible and the dissatisfied sufferer is, in consequence, deprived of what might have been a very helpful aid if used under proper conditions.

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Although used in the treatment of many different conditions, it is in the treatment of the paralysis following Anterior Poliomyelitis that today braces find their greatest field of usefulness. With the light and mechanically ingenious braces which are obtainable, an amount of physical activity and usefulness, which is often truly astonishing, is possible and the upbuilding in morale which results is of inestimable benefit to those who, without this help, would be deprived of the privilege of leading active, useful lives. In infantile paralysis, braces are used in the convalescent stage to protect the weakened muscles struggling back spine to strength; they are used during the stage of recovery to prevent deformities from developing because of muscle imbalance, the result of paralysis; and finally, they are used to enable the otherwise helpless individual to become ambulatory. Braces are so important in the treatment of infantile paralysis that it may be said without fear of contradictions that the management of this disease would be disastrously handicapped.

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Perhaps a word should be said about a common fallacy, prevalent among the laity, which is that braces cause muscles to weaken and limbs to waste away. This idea is based upon the fact that disease or lack of use always causes wasting of muscles and this wasting will occur whether braces are worn or not. So far as braces are concerned, it may be truthfully said that no properly designed and properly fitted brace ever caused weakening and wasting of muscles and limb; on the contrary, braces, by protecting weak muscles and preventing the over-action of strong or un-paralyzed muscle groups, definitely promote muscle development and allow a maximum of usefulness to the part so protected.

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