Interventions

Question 1

Determination of Treatment

Answer 1

Depends on skeletal maturity (Risser Sign), growth potnetial, and curve magnitude

Question 2

Nonsurgical Intervention

Answer 2

Idiopathic < 25d, curves of nonsurgical magnitude of any skeletally mature patient, and non-progressive congenital curves— evaluated by clinical exam every 4-6 months, get x-rays each visit

Question 3

Exercise

Answer 3

Research found that exercise may decrease progression of AIS

HEP: maintain/improve trunk and pelvic strength/flexibility
– prescribed to children with IS or CS

PT should encourage activity

Question 4

Exercises prescribed

Answer 4

spinal stabilization
balance activities
core strengthening
postural correction- SEAS protocol

Question 5

SEAS Protocol

Answer 5

Patient actively corrects his own posture with goal of max curve correction and follows specific exercise program designed to increase spinal stability, improve balance reactions, and retain physiologic curves of the spine

Question 6

Schroth Method

Answer 6

Exercise protocol tailored to each patient

strives to decrease curve progression, decrease pain, increase vital capacity, and improve posture and appearance

Question 7

Orthotic Mgmt

Answer 7

Indication depends on curve type
Typically prescribed to children with IS who are skeletally immature (Risser 0-2), curve from 25-45d

Effect of orthotic decreases as magnitude of curve increases

Exercises can be performed with brace on- pelvic tilts, thoracic flexion, and lateral shifts

Orthotic treatment continues until curve is no longer controlled or when skeletal maturity occurs—then start weaning brace

Weaning takes 12 mo

Question 8

Milwaukee Brace

Answer 8

CTLSO

Rarely used today

Question 9

Boston System Brace

Answer 9

TLSO- treats apex at level of T7 or below

More simple design, decreased cost, improve acceptability of orthotic wear

Padded foam lining with rigid shell

Prefabricated brace modified to fit pt

More effective than Charleston in preventing curve progression

Question 10

Wilmington Brace

Answer 10

TLSO

Total contact, custom molded, tight fit and contact

Question 11

Charleston Brace

Answer 11

Rx of IS

Worn at night

position in max side bend correction

Most effective in rx of smaller single thoracic or lumbar curves

Improved adherence due to wear at night time

Question 12

Surgical Mgmt

Answer 12

Indicated in a progressive curve with a Cobb angle that reaches 45d or greater in an immature spine

Correction method should provide correction in all 3 planes, provide rigid fixation, and attain maximal correction with minimal fusion levels

Important to treat children with CS while they are still growing, important for early surgical intervention due to rapid growth early on

Question 13

Factors considered when determining if surgery is indicated in CS

Answer 13

attainment of spinal length
mobility, 
fxn of thorax
performing fewest surgeries possible
risk of surgery

Question 14

Expandable growing rod surgery

Answer 14

indicated for children without bony anomaly of vertebrae or rib cage and with curve flexibility

Serial lengthening must be performed every 6 mos during growing years

Question 15

Post-Op Mgmt

Answer 15

use of orthosis that is worn for 9-12 months until fusion is solid– determined by x-ray
average length of hospital stay = 5-7 days, PT initiated on day 2

Trunk rotation contraindicated

Don shoes and socks in figure 4 sitting

Education regarding donning and doffing orthotic

Return to school 6 weeks post op, can lift up to 5 lbs