BZebra!
Your English is marvelous.
you have explained such a complex matter as Skoliosis is in many details: congratulations.
To the Gerbo family:
Obviously you were a bit confused and - in some way rejected - by the fact that practically all the members of this forum recommend the braces made by Rahmouni.
This must have appeared to you like a kind of "local arrogance".
How come?
Nobody else should be able to do the proper thing?
Let me explain this in some detail.
There is no school in which an Orthpedic Technician can learn how to design the optimal brace.
Especially, since each patient has a different problem according to which the brace has to be designed and created.
When I visited Dr. Steffan a few weeks ago (he and Rahmouni are "working" on my daughters skoliosis) he explained me that only a close cooperation between a dedicated Orthopedic Doctor and a similarly dedicated Orthopedic Craftsman like Rahmouni can lead to such good results.
There is no obvious way and rule for Ortheophedic Technicians how to make a good and optimally correcting brace.
To get to this point you need instinct, experience and a solid knowledge of anatomie.
And Rahmouni obviously has this and Dr. Steffan is helping him.
Most of the orthopedic Technicians do not have this optimal constellation.
The question why such a brace helps at all, not only to keep the persons back bone upright as long as he/she carries it, but also why it keeps the back bone upright even after removing the brace, we call this "Ausschulen", is not so easy to understand.
The back bone is stabilized by a complicated system of several layers of many small muscles that keep the backbone together and - normally - keep it straight.
Most of the muscles of the back bone are static, i.e. they are always contracted and thus fix the vertebrae in place.
Others connect the ribs to the vertabrae and so forth.
You should hav a look on a poster with these muscles. It is fascinating how such an astonishingly complex system of several layers of muscles has evolved.
Look, for example, into this paper:
http://www.anatom.uni-tuebingen.de/docs ... ulatur.pdf
Now, when the back bone is not strait anymore but bent to one side, the back bone muscles on one side are overly strechted whereas on the other side they are overly contracted.
The brace forces the back bone into its normal position.
As a consequence those muscles that have been overly strechted will contract to their nomal length and those muscles that have been adapted to an overly contratcted state will recover and get strechted accordingly.
If this correcting force of the brace is acting long enough the different mussles wil take on the tonus they had bevor the change that occurred out of unknown reasons ("idiopathic").
This is the hope and the chance.
However, from the side of the technician who makes the brace, it is important to get an optimal correction.
And, depending of the angle that has to be corrected, that hurts.
An optimally correcting brace is a kind of torture instrument.
From the side of the patient, it is important that he/she wears the brace as often as possible.
The muscles that have been adapted to extension on one side and to contraction on the other side will only then re-adapt to the "normal" tonus and keep it, if the brace is used practically everyday, all day, many (23) hours a day.
It is a very difficuilt thing for a young girl, and it needs understandig the process and remembering the consequences.
But even older girls (like our 16 years old daughter) that have an understanding of the phsiological processes often just can't bare it, because the brace squeezes the whole thorax into the desired position and thereby stretches some muscles and pushes some ribs into the proper position.
That hurts!
A brace that does not hurt is not worth very much.
This is the worst part of the treatment
Although we have an Orthopedic Technician just around the corner (20 km) and a clinic with an orthopädic workshop at a distance of 100 km, we have decided to take the long trip to Stuttgart (440 km one way) to get the Rahmouni brace.
There is another fact that Dr. Steffan pointod out to me:
It appears that most of the German Orthopedic Doctors are not interested in Skoliosis.
It might be the similar in other countries.
But about 4 % of children and adolescents develop this condition in a more or less heavy way.
So you get either no advice at all or wrong advice.
The worst advice can be an operation which irreversibly changes you body and will cause you problems for the rest of your life.
Since your daughter is in the age in which changes occur very fast, you shuld - under no circumstances - wait until October.
Bring her to Dr. Steffan at a day in which Rahmouni is at the doctors Office. They then discuss the treatment plan for each patient.
The costs:
Dr. Steffan will take a special x ray that coverse the whole length of the back bone.
The Doctors bill will be around 60 - 100 € .
The brace will be between 2,500 and 3,000 €
After returning from the Doctor in Rahmounis Car he will prepare a Gypsum cast of your daughters thorax.
On this he will construct the brace.
About 10 days later you have to be in Stuttgart again.
At this date the brace will be fitted and you can then take it home.
After another few weeks, when your daughter has become used to use the brace as long as possible, you have to be in Stuttgart again.
Dr- Steffan will the take another ex ray, this time the girl has to weare the brace for the x ray.
From the comparison of the two x ray pictures you will get to know how good the brace corrects.
If nevecvessary, Rahmouni may change someting in the cushion-like bolsters in the brace (we call them "Pelotten"), that help to squeeze the thorax into the proper form.
I hope that I could give you some more information on why we think that this Technician makes the optimal braces.
Kindest reagrds1
Frank