Friday, July 6, 2018

PT Pathologies: Scoliosis

Scoliosis is defined as a lateral curvature in the normally straight, vertical line of the spine.  The curvature of the spine is normally found in the thoracic or lumbar region.  Not only does scoliosis have a curvature component but it can also have a rotational component.  In about 80% of the cases of scoliosis, the cause is unknown but affects 1:10 children with some form of this pathology and 1:4 of them require treatment for the curve.  This pathology affects multiple body parts such as the vertebral column, rib cage, supporting ligaments and muscles and overal body alignment.  There are five types of scoliosis Adolescent Idiopathic Scoliosis (AIS), Juvenile Idiopathic Scoliosis, Infantile Scoliosis, Congenital Scoliosis, and Neuromuscular Scoliosis.

To attend to any pathology, you need to consider the severity, age of the patient and what has already been done to treat it.  The number one consideration in any case of scoliosis is patient education.  Educating the patient about their diagnoses will not only help them understand it more, but it will help with compliance to HEP.  The long term effects depend on age and severity, however the curvature will likely not progress much after bone growth is complete.  With a 25 degree curvature, the patient needs to be monitored every 3 months and is encouraged to do breathing exercises and a strengthening program for the trunk and pelvis muscles.  With a 25-40 degree curve, the patient will need physical therapy and a spinal orthosis.  The physical therapy will help with posture flexibility, strengthening, respiratory function, and proper utilization of the orthosis.  When a patient has a curvature of 40 degrees or more they will require surgical spinal stabilization.  Scoliosis is surgically fixed through a posterior spinal fusion and stabilization with a Harrington rod.

Treatment for idiopathic and congenital scoliosis is clinical examination/evaluation by an orthopedist, exercises and brace fabrication.  Exercises your PT will help with are: spinal stabilization, balance activities, core strengthening, postural correction, lateral shifts, flexibility, and respiratory activities.  The reason for the brace is to stabilize a curve in an effort to avoid surgery or delay the need.  For neuromuscular scoliosis, a brace is required when sitting in an upright position but is removed during the night, when sleeping.  These patients not only have a brace but also may have a seating system.  This system is there to provide optimal external support and mobility on a stroller manual or power wheelchair base.

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