​The most commonly used scoliosis brace globally is the Boston brace, also called a thoracolumbar sacral orthosis (TLSO). It works on a straightforward principle: apply lateral (sideways) pressure to the spine, pushing the curve toward midline. The brace is fitted snugly around the torso, with corrective pads positioned to push inward on the rib hump or lateral curve, aiming to hold the spine in a more vertical position.
This lateral pressure approach has a track record spanning several decades. It is well-studied, effective for many patients, relatively simple to manufacture, and affordable. For many children with adolescent idiopathic scoliosis, the most common type. A well-fitted TLSO provides good curve management and can successfully halt progression during the growing years.
However, lateral pressure has a limitation: scoliosis is not purely a sideways problem. It is fundamentally a three-dimensional deformity. The spine does not just curve left or right; it also rotates. In many scoliosis cases, the rotation component is substantial, and a brace that only applies lateral pressure cannot address this.

The Rigo Concept (Rigo Chêneau) approaches scoliosis correction as a three-dimensional problem. Rather than applying one-directional lateral pressure, a Rigo Concept brace is designed with both corrective zones and expansion zones — areas of the brace that are deliberately open or soft.

Here is how it works:

• Corrective zones: areas where the brace applies targeted pressure to address the specific curve pattern, taking into account the rotational component of the deformity as well as the lateral curve
• Expansion zones: intentional gaps in the brace where the patient actively breathes and moves. As the patient breathes in, the thorax expands into these zones, encouraging the spine to de-rotate and move back toward midline.

 
This is a fundamentally different mechanism from lateral pressure alone. The Rigo Concept relies on active patient participation. The patient is not passively held in position, but actively engages in de-rotation through breathing and movement. This approach is grounded in the observation that scoliosis involves rotational displacement that cannot be corrected by force alone but can be addressed through guided, active correction.
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The biomechanical basis for the Rigo Concept is supported by the SOSORT guidelines (Society on Scoliosis Orthopaedic and Rehabilitation Treatment), published in 2016. SOSORT reviewed the global evidence on scoliosis bracing and identified the Rigo Concept (along with a small number of other 3D systems) as an evidence-supported conservative management option for idiopathic and low-grade neuromuscular scoliosis.

The Rigo Concept is most appropriate for the following presentations:

• Idiopathic scoliosis (the most common type) with a Cobb angle between 20° and 45°
• Skeletal immaturity bracing is most effective before skeletal maturity, ideally initiated before a Risser grade of 4
• Curves with a significant rotational component — particularly Lenke Type 1 or Type 2 curves
• Good compliance potential — the patient and family must be willing to wear the brace as prescribed (typically 18–23 hours per day)

 
The Rigo Concept can be adapted for selected neuromuscular presentations, particularly low-tone patients with good cognition who can engage actively with the bracing system. However, for children with significant spasticity or high-tone conditions, the brace design must be substantially modified, and the clinical benefit may be different from idiopathic cases.

The Rigo Concept is generally NOT appropriate for:

• Skeletally mature patients with curves greater than 45° Cobb — at this point, surgical options are typically considered
• Very young children (under 6–7 years) with small, progressive curves — in this age group, frequent bracing adjustments and the challenge of compliance make alternatives more practical
• Patients with severe spasticity or contractures — the brace may not be tolerated and cannot achieve the intended de-rotation mechanism

The Rigo Concept certification structure includes basic training and brace fitting, Level 1 and Level 2 advanced clinical assessment, complex case management, and individual brace design optimization.
Gibson Orthotics holds Level 2 certification, which means our practice meets advanced clinical standards for Rigo Concept case selection, assessment, fabrication, and follow-up.

Level 2 providers are expected to maintain ongoing clinical audit of outcomes, engage with the international Rigo Concept community for continuing education, and manage complex presentations requiring customized brace designs.

There are only a small number of Level 2 certified Rigo Concept providers in South Africa. This does not mean other practitioners cannot provide Rigo Concept bracing, it simply means they operate at a different level of certification. For cases requiring specialist assessment of scoliosis severity, individualized brace design optimization, or management of children with neuromuscular components, a Level 2 provider is the appropriate choice.

​Cerebral palsy affects muscle tone, posture, and movement in ways that place the developing spine under asymmetric forces over time. The underlying mechanisms vary by CP subtype, but the common contributors include:

• Muscle tone imbalance — spastic or hypotonic muscle groups on one side create unequal forces across the spinal segments
• Asymmetric posture — habitual positioning of the head, trunk, and pelvis reinforces lateral deviation of the spine
• Hip displacement or subluxation — pelvic obliquity caused by hip problems transmits directly to the lower spine, creating or exacerbating curvature
• Prolonged seated positioning — children who use wheelchairs or supportive seating spend extended time in postures that can drive spinal deviation if not properly managed
• Limited trunk muscle control — inability to actively self-correct posture means the spine is not counteracting lateral forces throughout the day

 
The prevalence of scoliosis in cerebral palsy is directly related to functional level. Research consistently shows that children with higher GMFCS levels — those with more significant motor impairment — carry a substantially greater risk. Published estimates suggest scoliosis affects up to 25% of children with CP at GMFCS levels I–II, rising to over 60–70% in children at GMFCS level V. Scoliosis in this group is not inevitable, but for children with moderate to severe CP, it is a known and predictable risk that warrants proactive monitoring.

What is the ideal age for cranial remoulding orthosis treatment?

​The best age for treatment is between 4 and 7 months when the skull is growing at the fastest rate. However, cranial remoulding orthoses can be used successfully between 3 and 18 months of age. Caregivers should try to reposition the baby for at least two months prior to initiating treatment with a cranial remoulding orthosis unless the infant is older than 7 months. At this point, infants can reposition themselves, and caregiver efforts to reposition are often futile.

What if my paediatrician tells me that my infant’s head shape will correct on its own?

​Historically, many head shape deformities present at birth disappeared within about 6 weeks because babies were placed in several different positions during the day and slept on their tummies at night. Since the Back to Sleep program was initiated in 1992, these head shape deformities often persist because babies sleep on their back all night and spend extended time on their backs during the day in infant carriers/ prams, swings, car seats, etc. Parents must be vigilant about changing the infant’s position more than in any other period of child rearing. Babies that spend most of their time on their backs in the early months roll and crawl later than usual, which results in even more time before the infant can actively reposition themselves. The best way to help your infant’s head correct “on its own” is to place your infant in a variety of positions during the time your infant is awake and supervised. This will encourage your infant to actively move their head through a full range of motion, strengthen their neck, shoulder and trunk muscles, and minimize pressure on the back of the head. More suggested repositioning activities are available in “Tummy Time Tools”, a document that can be downloaded from Orthomerica’s website. It is possible that your efforts to reposition your infant will be rewarded with a more symmetrical head shape that does not require further intervention. However, if your infant’s head does not change after two months of alternate positioning, make sure your paediatrician understands that you have tried prone and other positions to help make the infant’s head more symmetrical, and the skull has not corrected. Then ask your paediatrician if your infant would benefit from a cranial remoulding orthosis, and/or request a referral to a craniofacial specialist.

Why is treatment more effective between 4 – 7 months
​than at other ages?

​Even though the head grows fastest during the first 3 months of life, this time period is best spent actively repositioning your infant to encourage more symmetry. Between 4 and 7 months of age, the head grows about 1 cm per month*, and this rapid growth can be harnessed within the orthosis to produce rapid change in the desired direction of growth. At this point, the infant is starting to develop more head control and can tolerate the additional 6-8 ounces of weight from the helmet. It is actually the infant’s own growth that is the most active part of any CRM orthotic treatment program. The orthosis is specially designed to make total contact in the areas of the skull where growth needs to be curbed and allow space in the areas where growth is desirable. Between 8-12 months, the skull still grows quickly, but the rate is reduced to 0.5 cm per month*. Between 13-18 months, the rate drops below 0.5 cm per month*, and the skull begins to get thicker. Change is still possible in these older babies, but change is slower and generally requires longer treatment programs.

Once a scan is taken, how long will it take to get my child’s cranial remoulding orthosis?

​Ideally, your child will be fitted with a cranial remoulding orthosis within 14 days of the scanning date to assure proper fit and function. 

How often will my infant need to see the orthotist for follow-up and/or adjustments?

Frequency of follow-up visits usually depends on the severity of the initial head shape, age of the infant, and individual treatment protocols. 
Typically, the infant is seen a week after the initial fitting and approximately every 2 to 3 weeks thereafter, throughout the course of the treatment program. Younger infants may require more frequent follow up appointments since their heads are growing so rapidly.

​Founder, Clinical Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Chair of The South African Orthotic Prosthetic Association.

Deformational Brachycephaly
Deformational brachycephaly refers to full flattening across the back of the head or flattening at the occipital bone. The anterior-posterior measurement (front to back) appears smaller than the medial-lateral measurement (side to side).
The baby’s head appears wider and facial asymmetry is also involved. The area at the top of the head or the cranial vault appears higher. This occurs due to the growth of the baby’s brain accommodating growth in limited space. You may notice that the ears of the baby stick out as well.

Deformational Scaphocephaly
Deformational scaphocephaly refers to the long, narrow shape caused by the consistent side-lying positioning of the baby.  The cranial vault appears high and bossing or prominent areas of growth of the anterior (top) and posterior (back) aspects of the head occur.

​Founder, Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Vice Chair of The South African Orthotic Prosthetic Association.

We aim for an early initiation to achieve the best outcomes. The ideal age of treatment is 4 to 6 months; however, we can provide a helmet for a baby till the age of 18 months depending on the severity and causative factor.
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The duration of treatment varies due to the different severities and asymmetries present. The orthotic treatment is often used in conjunction with paediatric physiotherapy, osteopathy, chiropractic’s etc.

​Founder, Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Vice Chair of The South African Orthotic Prosthetic Association.

​Founder, Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Vice Chair of The South African Orthotic Prosthetic Association.

​A partial amputation foot can be challenging to manufacture & fit properly. Taking into consideration functional and cosmetic goals, along with patient expectations, wants and needs. 

The goals when working with our partial foot amputees are to restore stability and function that have been lost due to an amputation, facilitate energy-efficient gait, maintain support, and prevent further complications. 
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At Gibson Orthotics we use modern orthotic and prosthetic techniques and strive to manufacture low profile and aesthetically pleasing devices. Our partial foot amputees are often able to return to a fully functional lifestyle comfortably.

Founder, Clinical Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Chair of The South African Orthotic Prosthetic Association.

Founder, Clinical Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Chair of The South African Orthotic Prosthetic Association.

Founder, Clinical Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Chair of The South African Orthotic Prosthetic Association.

Founder, Clinical Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Chair of The South African Orthotic Prosthetic Association.​