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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