Effect of a Soft Boston Orthosis on pulmonary mechanics in severe cerebralpalsy

Spinal braces such as the Soft Boston Orthosis (SBO) help stabilize scolios is and improve sitting, positioning, and head control in individuals with c erebral palsy. However, their impact on pulmonary mechanics in this populat ion has not been studied. We examined the effect of a Soft Boston Orthosis on the pulmonary mechanics and gas exchange in 12 children and young adults (5-23 years of age) with severe cerebral palsy. Pulmonary resistance, comp liance, tidal volume, minute ventilation, work of breathing, oxygen saturat ion, and end-tidal CO, tension were measured with the subjects seated both with and without the orthosis and in the supine position without the orthos is. There were no significant differences in the measured parameters when compa ring subjects with and without their orthoses in the sitting or in the supi ne position. As would be expected in individuals with severe cerebral palsy , pulmonary resistance was increased (7.33 cm H2O/L/s) and compliance was d ecreased (0.12 L/cm H2O) compared to reported normal values. Work of breath ing was greatest in the sitting position without the orthosis (1.2 dynes/cm ), suggesting that the improved positioning achieved with the orthosis may decrease the work of breathing. We conclude that the application of a Soft Boston Orthosis does not impact negatively on pulmonary mechanics and gas exchange in young people with sev ere cerebral palsy. (C) 1999 Wiley-Liss, Inc.