Author: Soumaya Foughali, CPO, Master in Orthotics & Prosthetics, Annaba, Algeria
In conservative scoliosis treatment, the measurement and casting stage is one of the most important parts of the entire brace process. It is the moment when the orthotist captures the body, records the deformity, identifies the correction strategy and creates the foundation for every clinical and technical decision that follows.
For many years, plaster of Paris has remained the historical reference for scoliosis brace measurement. However, in hot and humid climates such as Algeria, plaster can create practical problems for both the patient and the certified prosthetist-orthotist.
A clinical experience from Annaba, Algeria, led by Soumaya Foughali, CPO, suggests that high-density synthetic resin bandages may offer an effective alternative. Based on 30 scoliosis brace cases, the approach showed improvements in precision, patient comfort and resource efficiency, without reducing the clinical role or craftsmanship of the CPO.
Plaster of Paris remains widely used because it is familiar, affordable and historically trusted. However, in daily practice, it can be difficult to manage in challenging climates and with anxious adolescent patients.
In the Annaba experience, three main limitations were identified.
First, plaster casting can take a long time. A patient may need to remain still for around 30 minutes. In scoliosis treatment, this is not a neutral waiting period. Fatigue, fear and muscle trembling can change posture. Instead of capturing the body’s best clinical presentation, the cast may begin to capture the patient’s anxiety.
Second, plaster may be unstable in heat and humidity. The author reports that at around 40°C and 70% humidity, a plaster mould can retract by approximately 1.2mm within 24 hours. In scoliosis brace treatment, small errors can matter. A loss of millimetres at the measurement stage can affect correction, symmetry and final brace quality.
Third, plaster can be uncomfortable for the patient. It is heavy, warm, dusty and often unpleasant. For some adolescents, the first experience of brace treatment begins with discomfort and fear. That early negative association can influence future compliance, particularly in a treatment pathway where long daily brace wear may be required.
The central message is clear: if the input data are wrong, every later step simply reproduces that error more precisely. Digital tools, rectification, milling, 3D printing or skilled manual modification cannot fully correct a poor initial capture.
In scoliosis orthotic management, the measurement stage can be understood as “minute zero”. It is the first irreversible moment in the brace journey.
Before fabrication, before foam correction, before CAD modification and before final fitting, the orthotist must capture the patient’s body as accurately as possible. This requires clinical judgement, anatomical knowledge, communication, patient trust and technical control.
The Annaba protocol argues that resin bandages help protect this critical moment. By reducing casting time and improving mould stability, the CPO can focus less on managing the weaknesses of plaster and more on clinical correction, patient positioning and communication.
Since 2022, high-density synthetic resin bandages have been used in Annaba for scoliosis brace measurement. According to the author, the protocol remains aligned with the principles of three-dimensional correction in conservative scoliosis treatment.
The technique does not remove the clinical role of the CPO. The orthotist still identifies anatomical landmarks, controls posture, applies corrective principles and prepares the mould for brace fabrication. The difference is that the material sets faster and holds its shape more reliably.
In the reported experience of 30 patients, several practical benefits were observed.
The most important benefit was improved precision. Resin polymerisation took approximately five minutes, compared with around 30 minutes for plaster.
This shorter casting time reduces the period during which the patient must remain still. It also reduces the chance that fatigue, fear, muscular contraction or posture drift will distort the capture.
The reported dimensional stability was also better. The resin mould showed approximately 0.3mm change after 24 hours, compared with the higher deformation described with plaster in hot and humid conditions.
For scoliosis bracing, this matters because the mould is not simply a shape. It is the clinical foundation for correction. A more stable mould gives the CPO a more reliable starting point for modification and brace design.
Patient comfort also improved. The author reports that resin bandages reduced mould weight by around 60% and that no cases of skin irritation were observed in the 30-patient series.
One of the most telling patient reactions was: “Is it already finished, Madam?”
That response matters. In adolescent scoliosis care, first impressions can influence acceptance. A shorter, lighter and less stressful measurement experience may reduce the psychological barrier between the patient and the brace.
This is particularly important because scoliosis bracing is not only a technical treatment. It is also a behavioural and emotional one. A brace only works when it is worn. Comfort, confidence and trust are therefore clinical factors, not secondary details.
The Annaba experience also suggests that resin bandages may improve service efficiency.
According to the author, one resin roll replaced approximately three plaster rolls to achieve the required rigidity. While the global cost was described as equivalent, the time saving was approximately 25 minutes per patient.
In a busy orthotic service, this can be significant. Time saved during measurement can be used for explanation, education, documentation, follow-up or additional patient appointments. In under-resourced systems, efficiency is not only an operational benefit. It can become a question of access.
If the same team can treat more patients without lowering quality, the material choice has a direct service-delivery impact.
A key message from the author is that resin bandages do not replace the clinical eye or the hands of the CPO. Instead, they may free the clinician to focus on what matters most.
The CPO still decides where correction is needed, how the body should be positioned, which landmarks must be marked and how the mould should be interpreted. The material does not make the clinical decision. It simply gives the orthotist a more stable and efficient way to capture the patient.
This is an important point for the wider orthotic profession. Technology and materials should not be framed as replacements for clinical skill. Their value lies in supporting better judgement, better communication and better reproducibility.
The Annaba experience also raises a wider question for the O&P sector: before discussing digital fabrication, are we doing enough to ensure faithful three-dimensional capture?
Across the IMEA region, clinics are increasingly exploring scanning, CAD/CAM, milling and 3D printing. These technologies have strong potential, particularly in spinal orthotics and paediatric care. However, digital precision is only valuable if the initial clinical capture is accurate.
A poor scan, poor cast or poorly controlled measurement will still produce a poor brace, even if the final fabrication method is advanced.
This is why the author’s message is relevant beyond Algeria. Before manufacturing a scoliosis brace, the CPO must first earn the trust of the body being treated. Measurement is the most human part of the process. It is where clinical skill, patient communication and technical accuracy meet.
To support reproducibility, the author has made a detailed technical protocol available through Zenodo. The protocol includes technical steps and anatomical landmarking for colleagues who wish to study or adapt the method in other clinical environments.
This open access approach is valuable for the global O&P community. It allows clinicians in other countries to review, test and compare the method, especially in regions where heat, humidity, patient throughput and material efficiency are daily challenges.
The experience from Annaba is particularly relevant for orthotic services in the Middle East, India and Africa. Many clinics in the region work in hot climates, with limited resources, high patient demand and a mix of manual and digital fabrication methods.
In these settings, practical innovation does not always mean expensive technology. Sometimes it means selecting a material that improves comfort, reduces deformation, saves time and supports better clinical work.
For scoliosis bracing services, resin bandages may be worth further evaluation in relation to:
Further research with larger sample sizes and outcome measures would help strengthen the evidence base. However, the reported clinical experience offers a useful professional insight: the quality of scoliosis brace treatment begins at the first bandage.
The use of synthetic resin bandages for scoliosis brace measurement in Annaba, Algeria, suggests a practical alternative to traditional plaster casting in hot and humid clinical environments.
The reported benefits include faster setting time, improved mould stability, lower weight, better patient comfort and more efficient use of clinical resources. Just as importantly, the method does not reduce the role of the CPO. It reinforces it.
In conservative scoliosis treatment, precision begins before fabrication. It begins at measurement, at the moment when the orthotist first captures the patient’s body and builds trust.
As Soumaya Foughali’s experience shows, improving that “minute zero” may improve not only the mould, but also the patient’s first relationship with the brace.