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      Forces exerted during exercises by patients with adolescent idiopathic scoliosis wearing fiberglass braces

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          Abstract

          Objective

          To quantify and compare the forces exerted by scoliosis patients in fiberglass braces during exercises usually prescribed in departments where casts are made. The exercises are intended to increase corrective forces, activate muscles, stimulate ventilation and help the patient psychologically.

          Setting

          Outpatient care.

          Patients

          17 consecutive adolescent patients wearing fiberglass brace for idiopathic scoliosis.

          Interventions

          Exercises (kyphotization, rotation, "escape from the pad") in different positions (sitting, supine, on all fours).

          Main outcome measure

          Pressure detected by the F-Socket System between the rib hump and the pad of the brace.

          Results

          In static and dynamic conditions, the position adopted did not alter the total pressure exerted by the brace, although the part of the sensor stimulated did vary. Kyphotization and rotation exercises produced a significant increase of pressure (+ 58.9% and +29.8%, respectively); however, the "escape from the pad" exercise, despite its name, did not produce any significant variation of pressure.

          Conclusion

          Exercises in the brace allow adjunctive forces to be applied on soft tissues and through them, presumably on the spine. Different exercises can be chosen to obtain different actions. Physical exercises and sporting activities are useful in mechanical terms, although other important actions should not be overlooked.

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          Most cited references49

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          Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up.

          The study was conducted on the possibility of predicting the final outcome of bracing for idiopathic scoliosis at a follow-up period of 6 months. In a retrospective study, 62 adolescent female patients with right thoracic scoliosis (20-40 degrees Cobb angle) treated with a brace were examined. A new compliance score was developed. The sample was divided into four groups based on compliance (compliance score) and initial correction (half-year after start bracing): group A, good compliance/high initial correction; group B, good compliance/low initial correction; group C, bad compliance/high initial correction; group D, bad compliance/low initial correction. The final outcome (1 year after weaning) was defined as successful if a curve correction of at least 5 degrees was achieved. The influence of factors on final outcome was analysed by ANOVA. Differences between continuous data were analysed by a two-sample Wilcoxon test. The overall final outcome was not successful (thoracic curve -3 degrees). However, the average outcome of the compliant group was successful (-5 degrees), while no success was achieved without good compliance (+5 degrees). High initial correction of more than 40% (p < 0.002) and good compliance (p< 0.004) were of significant impact for the outcome. Patients showing good compliance and high initial correction presented a successful outcome of 7 degrees Cobb angle. Compliant patients with a high initial correction can expect a final correction of around 7 degrees, while compliant patients with low initial correction may maintain the curve extent. Bad compliance is always associated with curve progression.
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            Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis.

            Retrospective analysis of outcome in terms of prevalence of surgery for adolescent idiopathic scoliosis in patients receiving conservative management. To determine whether a centre with an active policy of conservative management has fewer patients who eventually undergo surgery for adolescent idiopathic scoliosis than a centre where the practice is non-intervention. The efficacy of orthoses for the treatment of idiopathic scoliosis was called into question in a recent publication. Because the prevalence of surgery in an untreated group of patients (28.1%) was not significantly different from that in a braced group (22.4%), the authors concluded that bracing appears to make no difference. Based on prior experience, this conclusion is questioned. Since 1991, bracing and physical therapy have been recommended for children with adolescent idiopathic scoliosis at a centre in Barcelona, Spain. The scoliosis database was searched for patients with adolescent idiopathic scoliosis who were at least 15 years of age at last review and who had adequate documentation of the Cobb angle. The prevalence of surgery was compared with that of published data from a centre where the practice is non-intervention. From a total of 106 braced cases out of which 97 were followed up, six cases (5.6%) ultimately underwent spinal fusion. A worst case analysis, which assumes that all nine cases that were lost to follow-up had operations, brings the uppermost number of cases that could have undergone spinal fusion to 15 (14.1%). Either percentage is significant statistically when compared to the 28.1% reported surgeries from the centre with the policy of non-intervention. If conservative management does reduce the proportion of children with adolescent idiopathic scoliosis that require surgery, it can be said to provide a real and meaningful advantage to both the patients and the community. It is contended that conservative methods of treatment should never be ruled out from scoliosis management, because they can and do offer a viable alternative to those patients who cannot or will not opt for surgical treatment.
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              Idiopathic scoliosis and the central nervous system: a motor control problem. The Harrington lecture, 1983. Scoliosis Research Society.

              An etiologic concept linking an impaired axial motor control system to the structural deformity of idiopathic scoliosis (ISc) is proposed. Postural studies reveal that during quiet stance, adaptation is marked in conditions associated with visual control of sway, particularly of lateral sway; during imposed perturbations of the body, destabilized postural reactions are pronounced in tests requiring visual-vestibular coupling. Observations of visual and/or vestibular generated eye movements indicate ocular instability among a high proportion of the ISc. Previously, the authors argued that a direct relationship exists between visual and/or vestibular functioning and a disordered axial motor system. This was attributed to an aberrant brain stem mechanism. In this presentation, however, we propose that a higher level CNS disturbance may be responsible for reports of EEG abnormalities, visuo-spatial impairment, motor adaptation, and learning deficits. Among the wide range of visual-vestibular variables studied, those representing processing of vestibular signals within the CNS yield the highest degree of correlation with the magnitude of the curve. Moreover, differences in vestibular processing between two subsets of ISc, namely ISc with (70%) and without (30%) normal academic achievement are significant. Variables referable to both vestibular and visual processing correctly classify 87% of the ISc with normal academic achievement and 100% of the ISc with a history of academic problems. The association between learning deficits, altered processing of vestibular information, and ISc suggest a unique syndrome complex, and an important role of cortical structures in the etiology of this disorder. The presence of a visuo-spatial perceptual impairment may be the common feature of ISc. In an attempt to restore perceptual dysfunction (by rearrangement), the ISc adopts a new axial and vestibular motor control strategy based upon recalibration or reinterpretation of proprioceptive signals arising from the axial musculature.
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                Author and article information

                Journal
                Scoliosis
                Scoliosis
                BioMed Central (London )
                1748-7161
                2006
                21 July 2006
                : 1
                : 12
                Affiliations
                [1 ]ISICO (Italian Scientific Spine Institute), Via Carlo Crivelli 20, 20122, Milan, Italy
                [2 ]Don Carlo Gnocchi Foundation ONLUS, Care and Research Institute, Via Capecelatro 66, 20148 Milan, Italy
                Article
                1748-7161-1-12
                10.1186/1748-7161-1-12
                1578587
                16859544
                4db18353-dff2-4688-9c95-ad47805d757b
                Copyright © 2006 Romano et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 February 2006
                : 21 July 2006
                Categories
                Research

                Orthopedics
                Orthopedics

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