{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T01:47:09Z","timestamp":1790560029107,"version":"4.1.0"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Scientific and Technological Research Council of Turkey (TUBITAK) under the 1002-A Short-Term R&D Funding Program","award":["323S007"],"award-info":[{"award-number":["323S007"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Type 1 spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by severe muscle weakness, which results in progressive spinal and chest deformities. This study aims to evaluate the effect of thoracolumbosacral orthosis (TLSO) use along with pulmonary care (PC), individualized pulmonary rehabilitation (IPR), and individualized trunk exercises (ITE) in children with Type 1 SMA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study enrolled 24 children with Type 1 SMA aged 2\u20136 years, with a scoliosis angle of 20\u00b0\u201340\u00b0. Participants were randomly assigned into two groups using a stratified randomization method: Group 1 (PC, IPR, ITE) and Group 2 (PC, IPR, ITE &amp; TLSO). All participants underwent an 8-week treatment program. Pre- and post-treatment assessments included scoliosis progression measured by the Cobb angle, chest deformity evaluated through the basal upper-lower chest wall ratio and the Supine Angle of Trunk Rotation Test (SATR), and motor function levels assessed using the Children\u2019s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Significant improvements were observed in Cobb angle, bell-shaped chest deformity, and motor function in both groups (p\u2009&lt;\u20090.05). Group 2 demonstrated greater improvements in effect size (ES) across all evaluation parameters. Compared to Group 1, Group 2 showed superior improvement in Cobb angle (ES\u2009=\u20093.98), basal upper-lower chest wall ratio (ES\u2009=\u20095.00), SATRL (lower) (ES\u2009=\u20092.55), SATRU (upper) (ES\u2009=\u20091.64), and CHOP INTEND (ES\u2009=\u20091.23) (p\u2009&lt;\u20090.05).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study is the first to demonstrate that the combination of PC, IPR, ITE, and TLSO yields superior clinical outcomes in children with Type 1 SMA. The findings support current recommendations for TLSO use in patients with a Cobb angle &gt;20\u00b0, and emphasize the potential benefits of early, proactive orthotic intervention when integrated with mobilization, trunk, and pulmonary exercise programs in managing scoliosis in this population. However, limitations such as the small sample size and short follow-up period underscore the need for larger and longer-term studies to confirm these findings. <jats:bold>Trial Registiration:<\/jats:bold> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05878418\" xlink:type=\"simple\">NCT<\/jats:ext-link><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05878418\" xlink:type=\"simple\">05878418<\/jats:ext-link><\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323341","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T17:22:52Z","timestamp":1757956972000},"page":"e0323341","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The effect of thoracolumbosacral orthosis on scoliosis 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