Recovery of dynamic balance following external posture disturbance in children with idiopathic scoliosis.

Background. The aim of this study was to attempt the implementation of the method of mathematical modelling for motor properties estimation in children with idiopathic scoliosis on the process of keeping the balance in a standing position in the presence of mild disturbances. Material and methods. 42 children with idiopathic scoliosis (13-18 yr) and 40 healthy children were included into the study. Stabilography method was used to estimate body balance and the COP time series were recorded for subsequent analysis. Motor parameters of the evaluated individuals were determined based on the coefficient values of equation assessed through mathematics model. Results. The analysis of obtained calculated results showed that there are significant differences in meandered reaction induced by balance disturbation in a standing posture in evaluated patients. In scoliosis group there was a bigger loss of balance than in healthy children.The speed of loosing of balance after its deviation was slower and was dependent on the magnitude of the curvature angle. The bigger the angle values of the curvature the slower is the process of balance loss and at a lower speed and acceleration. And the time required for regaining the posture is prolonged. Conclusions. Standing posture of children with lateral curvature of the spine is more susceptible to balance disturbances and is characterised by worse stability. The reaction of nervous system to balance disturbances in scoliosis is visibly delayed and is characterised by lower impulsiveness.

The effectiveness of self-correction of body posture in girls with idiopathic scoliosis.

Background. The aim of our study was to assess self-correction of body posture depending on the position assumed. We made observations of the body posture of subjects in the habitual-unrestrained position and the forced erect position, and on that basis we assessed the capacity for self-correction in girls with lateral idiopathic scoliosis. Material and method. The research group consisted of 20 girls, aged 11-18 years (ave. 13.8), divided into two groups depending on the location of the primary scoliosis. The quality of the body posture in habitual and erect position was assessed by computerized photogrammetry, using the moiré technique. Results. In both groups, the mean values in habitual position indicate moderate (indicated by angular indexes) or large asymmetry (indicated by linear indexes). After the subjects had assumed upright position, linear indexes indicated moderate scoliosis and angular indexes indicated slight scoliosis. There were statistically significant differences in asymmetry of the trunk between the habitual and right position in the group of primarily thoracal and primarily thoracolumbar scolioses. A high correlation coefficient may be useful for detecting these types of scolioses. In both groups the asymmetry of the bone points was primarily large or moderate. The differences between the two types of scoliosis were not statistically significant. The only statistically significant correlation was observed between the differences in the distance of the lower scapular angles from the spine (OL).

Outcome assessment after the surgical correction of scoliosis using the Cotrel-Dubousset method.

Background. The goal of our study was to assess the outcome of the surgical treatment of scoliosis using the Cotrel- Dubousset method. Material and methods. The study population consisted of 30 girls, aged 13-19 years, with right-sided thoracic scoliosis, grades II, III and IV. All these subjects were operated using the Cotrel-Dubousset method. The research program included measurements of the primary scoliosis angle (Cobb's angle), the vital capacity (VC) of the lungs, chest mobility, and body height. Examinations were performed before surgery, immediately after surgery, and one year after surgery. Results. Comparison of the Cobb's angle before, directly after, and a year after surgery showed that the Cotrel-Dubousset method caused significant correction of scoliosis. The mean VC was below normal before surgery, and despite some improvement remained below physiological values one year later. Chest mobility examinations found that respiratory mobility was adequate before surgery. The mean body height increase one year after surgery was statistically significant. Based on the Risser test performed before surgery we found that ossification was still in progress in the majority of patients one year later. Conclusions. Surgical treatment using the Cotrel-Dubousset method had a significant impact on the correction of scoliosis, as measured by Cobb's angle. The operation did not, however, cause a significant increase of VC in girls with lateral, primarily thoracic scoliosis. A large increase in height was observed in the operated patients. This may have been evoked by significant correction of the scoliosis.

Impact of physiotherapy on the functional status of elbow and knee joints and quality of life in patients with hemophilia.

Background. The objective of our research was to assess the impact of physiotherapy on the frequency of intraarticular and intramuscular hemorrhages and on elbow and knee joint function, in hemophilic patients. Material and methods. We examined 22 boys, 6-14 years of age, suffering from hemophilia A. The research program included patient history in respect to intraarticular hemorrhages in elbows and knees before therapy, observation of intra-articular bleeding during physiotherapy, goniometric measurements of the range of movement in the elbow and knee, measurement of the circumference of the arm, forearm, thigh and calf, and momentum dynamometric measurements of the relative and absolute force of the flexors and extensors of the lower leg at the knee joints and of the forearm at the elbow joints, in static conditions. The treatment program included deficit coagulant agent replacement therapy, physiotherapy, and kinesitherapy. Results. The physiotherapy program we applied resulted in a considerable improvement in mobility, as well as increased muscle strength and mass. Conclusions. Our research showed that, due to the application of the appropriate replacement treatment, there was a decrease in the frequency and size of intraarticular hemorrhages, despite intense rehabilitation and physical activity.

Changes in body posture in children with first-degree scoliosis taking part in corrective exercises in a water environment.

Background. Swimming and aquatic exercises are a very attractive form of movement for children and young people, which is helpful in correcting posture defects. The water environment relieves pressure on the spine, relaxes muscles, and makes it easier to assume the proper posture. Swimming allows to join pleasure - water play and learning to swim - with therapeutic action. The primary purpose of our research was to evaluate the effectiveness of corrective swimming, based on our own program, and to determine the effect on swimming on spine arrangement in two position in children with posture defects. Material and methods. We studied 106 children (age 9-12). All these had been referred for corrective swimming by a specialist. The subjects were examined twice at a three-month interval. In particular we analyzed the shape of lordosis and kyphosis and the symmetry of the trunk in the frontal plane. We evaluated spinal positioning using a computer program designed to assess posture by photogramometry. Results. The initial results showed that posture defects are very common in children. The primary defects are rounded backs, concave-rounded back, and asymmetry of shoulders and shoulder blades. Conclusions. Our initial research shows that the computer photogram can be used for diagnosis and outcome measurement in hydrotherapy for children with posture defects.

Somatic features and parameters of anterior-posterior spinal curvature in 7-year-olds with particular posture types.

Background. One of the key elements in the examination and evaluation of body posture is defining the shape and size of anterior-posterior curvature of the spine and the location of symmetrical bone points in the trunk area. The aim of our study was to determine which somatic features and parameters of spinal curvature in the sagittal plane show statistically significant differences among children with given types of body posture. Material and methods. We examined 298 children (146 boys and 152 girls) attending four primary schools in Wroclaw, Poland. The examinations were carried out in specially prepared darkened rooms, using computer equipment to evaluate body posture. Results. The most significant similarities regardless of gender were observed in the inclination of the lumbosacral spine (a) and the angle of thoracic kyphosis, as well as in the size and index of thoracic kyphosis. The highest values in these parameters were found in children with lordotic posture, in whom the lowest values were found in the inclination of the upper thoracic segment (g) and the angle and size of lumbar lordosis. However, in children with kyphotic posture the most significant differences were observed in the length of thoracic kyphosis, and the least significant in the actual length of lumbar lordosis. Conclusions. The size parameters and indexes of anterior-posterior spinal curvature appeared to be the least differentiating factors among posture types. The strongest similarity of posture types was found in somatic features and weight-height ratios.

[The use of thermographic examination to evaluate outcome in the conservative and surgical treatment of lateral scoliosis]. / Bandania termowizyjne w ocenie wynikow leczenia zachowawczego i operacyjnego bocznych skrywien kregoslupa.

Background. Diagnosis and evaluation of treatment outcome in scoliosis require the implementation of simple, noninvasive and accurate diagnostic methods. Thermovision, depending on remote skin surface temperature measurement, has found application in various medical disciplines. The goal of of our study was to evaluate the possibility of thermographic evaluation in assessing outcome for patients with scoliosis treated conservatively and operatively. Material and methods. The evaluated group consisted of 392 patients 6-17 years of age (mean 14.01 years), including 164 healthy children without scoliosis and 228 children with scoliosis (193 treated conservatively and 35 surgically). In group treated conservatively, we formed an additional subgroup of 31 patients treated with symmetrical and asymmetrical exercises. In the control group without scoliosis we performed orthopedic and thermographic examination in order to establish thermographic norms for the back. In the scoliosis group we performed several orthopedic, thermographic and radiographic examinations. Thermographic examination was performed with an AGEMA 470 camera in standardized microclimatic conditions, and the results were analyzed in reference to the mechanical and anatomical axis of the spine. Results. The thermographic examination of healthy children provide normal thermographic patterns of the back. Before exercise the difference in temperatures ranged from 0.4 degrees C to 1.6 degrees C (mean 0.7 degrees C). The average temperature difference between sides after asymmetric exercises was 0.1 degrees C; after symmetric exercises, 0.3 degrees C. In the group of patients treated operatively the average temperature difference was 0.88 degrees C, whereas the average temperature difference in 6 cases with postoperative complications was 2.16 degrees C. Conclusions. Thermographic examination is a simple, noninvasive and useful method for monitoring and assessing outcomes, in both conservative and operative treatment of scoliosis. A special area of application of this method is the early diagnosis of postoperative complications.