Neuromuscular Scoliosis

Question 1

Neuropathic conditions linked to scoliosis (2)

Answer 1

Spastic cp (upper motor neurone lesion)
Poliomyelitis (lower motor neurone lesion)

Question 2

Myopathic scoliosis (1)

Answer 2

Eg muscular dystrophy

Question 3

Pulmonary problems due to neuro scoliosis (4)

Answer 3

Intercostal paralysis
Reduction in vital capacity
Compression of diaphram
Possible loss of normal thoracic kyphosis

Question 4

Effect of neuro scoliosis (10)

Answer 4

Balance
Ambulant may become wheelchair dependent
In wheelchair user scoliosis may affect:sittinf balance, head control, ul function 
Reapiratory infections common 
Pelvic obliquity
Asymmetrical weightbearing
-ischial tuberosity
-trochanter
Rib pelvis impingement
Pain

Question 5

Neuro vs idiopathic scoliosis (8)

Answer 5

Progression more likely
Progression is likely from onset of disease
Progression continues after skeletal maturity
Curve magnitude is likely to be great 
Orthosis required to counteract gravity
Bracing unnecessary when asleep
No active correction by pt
Other problems common

Question 6

Associated neuro scoliosis problems (10)

Answer 6

Joint contractures
Hip subluxation/dislocation
Seizures
Mental retardation
Bladder/bowel incontinence (+-stoma) 
Insensate skin
Pressure sores
Hydrocephalus
Renal/cardiac problems
Spasticity/flaccidity

Question 7

Neuro curve patterns (3)

Answer 7

Most common is long c shape
Thoracolumbarsacral common
Pelvic/shoulder obliquity common

Question 8

Aims of neuro scoliosis orthotic treatment (10)

Answer 8

Improve/control curve alignment
Prevent/retard progression
To delay surgery (10yrs girls, 12yrs boys) 
Improve respiration
Maintain functional level
Improve functional level
Free upper limbs for adl 
Ease nursing care
Prevent back pain
Prevent future physiological problems (provided disease process is static)

Question 9

Thermoplastic tlso for neuro scoliosis (11)

Answer 9

Most common type of orthosis
Essentially total contact
-best correction
-fewer skin problems
-fewer rib deformities 
Wrap around polyethylene
-simple to manufacture
2 piece bivalve polyprop
-may be easier to don/doff
-when rotation is severe
-when kyphosis/lordosis is severe

Question 10

Dis of thermoplastic tlso for neuro scoliosis (4)

Answer 10

Heat esp in certain climates
-cotton undergarment
Difficult to adjust for growth
-extra removable liner?

Question 11

Soft boston brace for neuro scoliosis (3)

Answer 11

Soft foam orthosis
Thermoplastic inner frame for strengtg
Made individually to cast

Question 12

Neuromuscular scoliosis (2)

Answer 12

Neuropathic nerve

Myopathic muscle