Epidemiology of lateral curvature of the spine in children and adolescents

Michał Dziewulski, Waldemar Szymanik

Michał Dziewulski, Waldemar Szymanik – Epidemiology of lateral curvature of the spine in children and adolescents. Fizjoterapia Polska 2003; 3(2); 106-112

Abstract
Background. The primary purpose of this article is to draw attention to the problem of lateral scoliosis in children and adolescents, a serious issue in orthopedics. This subject should be of interest not only to orthopedists, but also to pediatricians, rehabilitation specialists, physiotherapists, family physicians, and even specialists in internal medicine. The authors’ goal is to focus on the basic facts concerning this disorder, its classification, and the epidemiology. Material and methods. In our clinical work over the last 30 years we have observed patients treated at the Rehabilitation Center in Konstancin, Poland. The rate of occurrence of scoliosis has been calculated, and the data broken down by sex, age, and residence (urban or rural). The goal was to point out any possible predisposition by gender, to discover whether the residence had any impact on the likelihood of diagnosis due to better facilities, and to specify the age at which there occurs the greatest risk of occurrence. Results. Despite a systematic increase in the number of patients admitted to our Center, there has not been a proportional increase in the number of patients with scoliosis, and in fact the number has diminished. A distinct tendency for scoliosis to appear in girls was noticed. Scoliosis is more often diagnosed in urban children and adolescents. Conclusions. More precise examination and diagnosis of children is required in respect to the possible occurrence of lateral scoliosis, especially in rural environments. Other aspects, such as gender-related trends and the most common type of scoliosis, do not differ from the data reported in the literature.

Key words:
body posture, scoliosis, gender, early diagnosis

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Some possibilities for using the Lehnert-Schroth concept during corrective exercises in stationary system

J. Nowotny, K. Czupryna, O. Nowotny-Czupryna

J. Nowotny, K. Czupryna, O. Nowotny-Czupryna – Some possibilities for using the Lehnert-Schroth concept during corrective exercises in stationary system. Fizjoterapia Polska 2003; 3(4); 412-419

Abstract

Corrective exercises constitute a basic element in the conservative treatment of lateral curvature of the spine. In recent years corrective breathing exercises based on the concepts of C. Lehnert-Schroth have proven to be especially valuable. It is a well-known fact that individual exercises are most effective, especially in advanced scoliosis: however, for epidemiological and organizational reasons it is not possible to extend such individual attention to all those who need it. As a result, group exercises are the dominant from of corrective procedure. It is important, however, for these types of exercises to be adapted to the individual needs of every participant. The only form that can meet this requirement is the so-called “stationary system”. The present authors have been advocating the use of this form for corrective exercises for many years. Given the value of corrective-breathing exercises and the need for these kinds of exercises to be conducted in a group system, the authors have presented here their own conception for rehabilitation, keeping both these elements in mind, including our own modifications of various exercises modeled on the Lehnert-Schroth method. These types of exercises have been woven into the entire system, supported by biofeedback, creating in turn circumstances conducive to shaping the habit of proper posture.

Key words:
Scoliosis, group exercises, stationary system
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Impact of musical performance on the frequency of postural abnormalities in children

Anna Kluszczyńska, Jolanta Kujawa, Mirosław Janiszewski, Ireneusz Pieszyński

Anna Kluszczyńska, Jolanta Kujawa, Mirosław Janiszewski, Ireneusz Pieszyński – Impact of musical performance on the frequency of postural abnormalities in children. Fizjoterapia Polska 2004; 4(2); 117-128

Abstract

Background. An increased load on components of the musculo-skeletal system caused by musical performance can lead to postural abnormalities and overstraining of the musculo-skeletal system in young performing artists. The aim of our research was to investigate the link over the long term between play on musical instruments by children, the type of musical performance, and disturbances of body posture. Material and methods. Our research involved a group of 113 primary music school pupils. The study was conducted in 1st, 2nd, and 3rd grade pupils, 7, 9 and 11 years of age respectively. The clinical examination consisted of a physical exam and an orthopedic evaluation of the musculo-skeletal system. A questionnaire indicating the type of instrument played and the body posture during play was also used. Results. The postural abnormalities found in this population included scoliotic posture, scoliosis, and thoracic muscle contraction. Many children showed several types of postural abnormalities coexisting. A statistically significant difference in the frequency of postural abnormalities was found, depending on how long the given musical instrument had been played after five years of attendance at the music school. Conclusions. Musical performance may increase the incidence and progression of some body posture disorders in music school pupils. The load imposed by the instrument being played leads to faster development of the clinical symptoms of scoliosis in girls than in boys. The appearance and progression of the body posture disorders may be contingent on how long the musical instrument is played. The progression of clinical symptoms in music school pupils depends on the type of music performance.

Key words:
scoliotic posture, scoliosis, thoracic muscle contracture
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Intraobserver and interobserver variability of the assessment of trunk rotation with Bunnell scoliometer in children with idiopathic scoliosis

Tomasz Kotwicki, Kamila Frydryk, Małgorzata Lorkowska, Aleksander Krawczyński, Andrzej Szulc

Tomasz Kotwicki, Kamila Frydryk, Małgorzata Lorkowska, Aleksander Krawczyński, Andrzej Szulc – Intraobserver and interobserver variability of the assessment of trunk rotation with Bunnell scoliometer in children with idiopathic scoliosis. Fizjoterapia Polska 2006; 6(2); 111-116

Abstract

Background. Idiopathic scoliosis is a three-dimensional deformity of the spine. The measurement of vertebral axial rotation is one of the most important parameters in the assessment of a scoliotic curve. Bunnell proposed a device — scoliometer in order to measure the angle of trunk rotation (ATR). Scoliometer has not been described in polish scientific literature. Material and methods. 50 patients (65 scoliotic curves) were examined with Bunnell scoliometer. In the forward bending test position the scoliometer was applied to the surface of the back in the region of maximum deformity, with its „zero” over spinous processes. The exam was made by four independent observers: three senior students of physiotherapy and one orthopaedic surgeon experienced in scoliosis management. One author performed the exam three times. lnterobserver and intraobserver agreement were checked with ANOVA. Rib hump height was measured in millimetres and the correlation with the angle of trunk rotation was calculated. Results. lnterobserver agreement revealed high concordance of measurements (ANOVA, p<0,01). Non-experienced observers demonstrated results parallel to those of an experienced specialist. lntraobserver agreement was also found very high (ANOVA, p<0,01). Strong positive correlation between the rib hump height measurement with a goniometer and the angle of trunk rotation measurement with a scoliometer was found (r=0,92, p<0,05) in thoracic curves (n=30). Conclusion. Scoliometer can be recommended for standard use in the checking of children and adolescents examined for scoliosis. Non-experienced paramedicals can correctly use the device.

Key words:
scoliosis, scoliometer, vertebral rotation
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The effect of vertebral rotation forces on the development of pathological spinal curvatures

Andrzej Mroczkowski, Ewaryst Jaskólski

Andrzej Mroczkowski, Ewaryst Jaskólski – The effect of vertebral rotation forces on the development of pathological spinal curvatures. Fizjoterapia Polska 2007; 7(1); 80-86

Abstract

The main aim of this article is to provide physiotherapists, physicians, corrective exercise instructors and all persons responsible for the prevention and treatment of scoliosis with factual arguments justifying the need to pay more attention to examining the position of the pelvis in children. Early detection of abnormalities in pelvic position is particularly important. An oblique position of the pelvis in the frontal plane may signal the onset of scoliosis of mechanical origin. A persisting pathological oblique position of the pelvis results in changes in the distribution of the force of gravity on individual spinal structures. Starting from the lumbar segment, those changes may give rise to vertebral rotation forces. We investigated S-shaped scolioses to demonstrate a correlation between the location of the costal and lumbar prominences and the direction of the vertebral rotation force. The development of a vertebral rotation force may cause further augmentation of pathological curvatures of the spine. We believe that exercises of pelvic musculature should be employed as a measure to prevent scoliosis, particularly in the lumbar segment. Exercise is indicated for low-grade functional scolioses to facilitate reestablishment of appropriate static equilibrium in pelvic position and, through the pelvis, in the position of the spine. Children who spend much of their time in sitting or standing positions, which leads to insufficient movement, particularly in the pelvis, are the most vulnerable to abnormalities in pelvic position. Insufficient movement within the pelvis can weaken the muscles keeping the pelvis in position. Contemporary programmes of corrective exercise in schools should include exercises to improve the position of the pelvis. Examples of such exercises should be developed since not all methods can be employed in the corrective exercise setting, while at the same time pelvic exercises should be used in a considerable population of children.

Key words:
scoliosis, vertebral rotation, pelvis
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Kinesiotaping application in children with scoliosis

Zbigniew Śliwiński, Wojciech Kufel, Bartłomiej Halat, Beata Michalak, Jan Szczegielniak, Wojciech Kiebzak, Tomasz Senderek

Zbigniew Śliwiński, Wojciech Kufel, Bartłomiej Halat, Beata Michalak, Jan Szczegielniak, Wojciech Kiebzak, Tomasz Senderek – Kinesiotaping application in children with scoliosis. Fizjoterapia Polska 2007; 7(3); 370-375

Abstract
Background. Scoliosis is still a serious problem, despite numerous therapeutic methods. Kinesiotapping (KT) is one of the methods, which can prove helpful in scoliosis treatment. Using proper applications, we can affect alteration of stability line and achieve balance of the spine. Material and methods. The studies were conducted in Zgorzelec Rehabilitation Centre. The participants were 18 children, who stayed there for rehabilitation, including 16 girls and 2 boys. The mean age was 12 years in this group. Changes in the waist angle were evaluated before and after KT application. Results. The obtained results indicate that application of KT in the examined group results in waist angle change, on average by 4 degrees. For left waist angle this mean value is 5.27 degrees, while for the right waist angle it is 2.58 degrees. The highest value for correction was 11.2 degrees. Conclusions. Selected KT techniques result in changes in stability line course, which is also manifested by waist angle change. Due to muscular and fascial tone normalization, the posture of a child with scoliosis changes in the frontal and sagittal plane. KT as a new method, using multiple forms and techniques, seems helpful in carrying out rehabilitation programme for children with scoliosis.
Key words:
scoliosis, KT application, angle of waist
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Standard of Radiological Scoliosis Assessment in Zgorzelec Rehabilitation Centre

Wojciech Kufel, Bartłomiej Halat, Beata Michalak, Zbigniew Śliwiński

Wojciech Kufel, Bartłomiej Halat, Beata Michalak, Zbigniew Śliwiński – Standard of Radiological Scoliosis Assessment in Zgorzelec Rehabilitation Centre. Fizjoterapia Polska 2008; 8(3); 344-350

Abstract
Present-day physiotherapeutic practice requires the therapist to be able to assess radiographs. University syllabuses in physiotherapy take this into account and students acquire this knowledge. However, there are a number of physiotherapy practitioners working at health care facilities who do not participate in post-graduate training but work with scoliotic children. Our aim is therefore to present a standard of functional and radiographic assessment of patients with scoliosis adopted in the Rehabilitation Centre in Zgorzelec. The radiograph is the fundamental tool of medical diagnostic imaging. A radiograph used for scoliosis assessment should show the entire spine, including the iliac ala and the femoral joints. It should be taken in the AP and lateral views, with the patient in a standing position. Radiographs complying with these requirements make it possible to determine scoliosis characteristics (type, Risser sign, Cobb angle, vertebral rotation angle, kypho-lordotic index, etc.), according to which appropriate physiotherapeutic management is chosen. Radiological work-up is essential for the assessment of scoliosis and for therapeutic management planning. It also allows an objective evaluation of the progress of rehabilitation. Moreover, radiographs can also be used to monitor the time course of scoliosis. Treating scoliosis without an obtaining x-ray images is like driving a car at night with the headlights switched off!
Słowa kluczowe
scoliosis, x-ray image
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King-Moe Scoliosis Classification, case study: Zgorzelec Rehabilitation Centre

Wojciech Kufel, Bartłomiej Halat, Beata Michalak, Zbigniew Śliwiński

Wojciech Kufel, Bartłomiej Halat, Beata Michalak, Zbigniew Śliwiński – King-Moe Scoliosis Classification, case study: Zgorzelec Rehabilitation Centre. Fizjoterapia Polska 2008; 8(3); 272-278

Abstract
Background. A large number of scoliosis classification systems are in use. The most popular and widely used classification, proposed by H. King and J. Moe in 1893, distinguishes 5 types of idiopathic scoliosis. Application of the classification facilitates assessment of the condition performed by multiple examiners and provides for homogeneity and comparability of the results. Material and methods. The investigation was conducted in the Child and Adult Rehabilitation Centre of the Independent Public Health Care Facility in Zgorzelec. The study involved 48 children: 37 girls aged 7-18 (mean age 12.3) and 11 boys aged 10-17 (mean age 12.7) with a mean age of the entire group of 12.4. The distribution of particular scoliosis types according to the King-Moe classification was assessed, and the results were compared with King’s and Sastre’s findings. Results. The most common was type I scoliosis – 41% (Sastre – 28%, King – 12.9 %), followed by type II -13% (Sastre -25%, King – 32.6 %). Less common are: type III – 21% (Sastre -16%, King – 32.8 %), type IV – 17% (Sastre – 29%, King – 9.2 %), type V- 8% (Sastre -2%, King – 11.6 %). Conclusions. The distribution of particular scoliosis types presented in the papers under comparison differs significantly. Classification facilitates the analysis and comparison of data presented by different centres. The use of the King-Moe system and x-ray image analysis allows a precise and standardised diagnosis of scoliosis.
Key words:
scoliosis, King-Moe classification
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POTSI, Hump Sum and Sum of Rotation – new surface topography parameters for evaluation of scoliotic deformity of the trunk

Tomasz Kotwicki, Edyta Kinel, Joanna Chowańska, Agnieszka Bodnar-Nanuś

Tomasz Kotwicki, Edyta Kinel, Joanna Chowańska, Agnieszka Bodnar-Nanuś – POTSI, Hump Sum and Sum of Rotation – new surface topography parameters for evaluation of scoliotic deformity of the trunk. Fizjoterapia Polska 2008; 8(3); 231-240

Abstract
Background. Surface topography in idiopathic scoliosis should take into account scoliosis-specific parameters (POTSI and Hump Sum). The aim of the study was to introduce these parameters, previously not described in Polish literature, and describe their use in the work-up of scoliotic children. Material and methods. A total 105 girls, aged 13.7 ± 1.9 years, including 54 treated with a Cheneau brace and 51 not braced, were examined in spontaneous standing. POTSI and Hump Sum were calculated according to the original description; Sum of Rotation, a new parameter, was defined as the sum of trunk rotation angles measured at twelve thoracic and five lumbar levels, adjusted for peMs rotation. Results. In girls with 25-40° scoliosis, POTSI was 25.5 ± 16.7 and the Hump Sum was 16.9° ± 6.8° in the group of brace-treated girls, compared to 24.5 ± 11.5 and 18.0° ± 4.8°, respectively in the non-braced group. In girls with scoliosis above 45°, POTSI was 33.4 ± 17.5 and the Hump Sum was 24.9° ± 3.6 in the brace-fitted group, and 41.0 ± 22.1 and 25.8° ± 10.6°, respectively in the non-braced group. Unlike the Hump Sum, the Sum of Rotation was not dependent on the observer. Conclusions. The POTSI index revealed its utility for the assessment of frontal piane asymmetry and could replace eleven previously used parameters. The Hump Sum and Sum of Rotation were found to be useful for the evaluation of the transverse piane deformity.
Key words:
scoliosis, surface topography parameters
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Some late sequelae of scoliosis diagnosed at school age

Anna Kowalczyk, Olga Nowotny-Czupryna, Iwona Gęgotek

Anna Kowalczyk, Olga Nowotny-Czupryna, Iwona Gęgotek – Some late sequelae of scoliosis diagnosed at school age. Fizjoterapia Polska 2008; 8(4); 418-424

Abstract
Background. Body posture changes throughout life and is influenced by a number of external and internal factors. Scoliosis may develop at any point in a child’s development. It is not only a cosmetic defect, but also one disturbing the normal function of many systems and organs in the body. Marked abnormal curvatures may progress in adult life, mainly because of repeated non-ergonomic body positions. After age 20, spinal pain, limitation of movement, and even distinct abnormalities in the functioning of internal organs may develop. The aim of this study was to determine current angles of scoliotic curvatures in adults as compared to school age records. Some late sequelae of the scoliosis were also identified. Material and methods. The study group consisted of 20 people (aged 18-30 years) who had attended corrective gymnastic classes to correct their scoliosis while at school. Present body posture, in free and corrected standing, was evaluated photogrammetrically. Results were compared with corresponding data obtained at school age. On this basis, changes that had appeared over several years were determined.Results. Half of the subjects were found to have increased curvature angles by about 5°. Following completion of their corrective gymnastics courses, few of the subjects regularly took part in various forms of exercise. More than 90% of the group reported spinal pain, especially in the lumbar spine. Conclusions. Scoliosis diagnosed at school age progresses only slightly after the body growth period but may be associated with spinal pain in adult life.
Key words:
scoliosis, adults, late sequelae, non-ergonomic body positions
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