Orthotics in rehabilitation Secondary scoliosis

Scoliosis is a more complex, helical deformity in which a curve in the coronal plane is combined with abnormal rotation of the vertebrae in the transverse plane.

The definition and classification of the causes of scoliosis made more than two millennia ago by Hippocrates still stands true today. He stated that: ‘There are many variations of curvatures of the spine, even in persons who are in good health, for it takes place from natural conformations (congenital and idiopathic) and from habit (functional) and the spine is liable to be bent from old age (degenerative) and pains (acquired).’

The Hippocrates solution

Physical Exam Iliac crest height Leg length discrepancy Shoulder height Arm trunk space Scapular position Trunk shift Inspection of skin Café au lait spots

Forward Bend Test Adam’s sign

Rib hump

scoliometer

Clinical presentation

Rotation Spinous process rotates into concavity Pedicle position

COBB’S ANGLE Measures severity Intersecting angle between lines drawn from upper and lower surfaces of vertebrae at the end of the curve.

100

Skeletal Maturity Gruelich & Pyle atlas Triradiate cartilage fusion Risser sign

The Scoliosis Research Society: has defined a medically significant scoliosis as any curve that is 10 degrees or more with or without a rotatory component.

Scoliosis secondary to congenital or acquired neurological disorders usually results from paraspinal muscle weakness in conditions leading to lower motor neurone muscle weakness.

contribute to the development of scoliosis muscle weakness poor central balance control impaired sensory feedback Pelvic obliquity and hip joint dislocation are also common complications of cerebral Palsy

Patients with secondary scoliosis provide a unique challenge, as the standardways to manage scoliosis often fail to correct or stop the progression of the scoliosis. Problems such as hip joint dislocation, poor sitting balance, or movement disorders such as athetosis will all have an impact on the scoliosis.

A standard physiotherapy programme is essential to maintain the range of movement(ROM) of joints reduce muscle spasticity improve sitting balance.

Appropriate seating and sleeping systems are essential in the management of severe scoliosis in both children and adults. A balance needs to be struck between comfort and function on one side and support and stabilisation on the othe.

Most patients with severe scoliosis will need foam carved or moulded seats. Appropriate seating can improve posture and facilitate care with activities such as feeding but it will not stop progression of the scoliosis.

moulded seats

Orthotic management: valuable for patients with idiopathic scoliosis as it can correct and stop its progression. limited role to play in the management of secondary scoliosis, as they are unable to stop its progression.

Rigid thoraco lumbar–sacral orthoses may reduce spinal curvature and improve sitting ability while the orthosis is worn. The treatment goal is to enable a comfortable and functional sitting posture, over correction may not be indicated.

Spinal orthoses may prevent forward leaning and improve pulmonary function. Orthotic use for adult patients with secondary scoliosis is neither practical nor effective. Surgical management for secondary scoliosis is also rarely successful.