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SCOLIOSIS

Scoliosis (from Ancient Greek: skoliosis"obliquity, bending")is a medical condition in

which a person's spine is curved from side to side. Although it is a complex three-dimensional

deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look

more like an "S" or a "C", rather than a straight line. Scoliosis is typically classified as

either congenital (caused by vertebral anomalies present at birth),idiopathic (cause unknown,

subclassified as infantile, juvenile, adolescent, or adult, according to when onset occurred),

orneuromuscular(having developed as a secondary symptom of another condition, such

as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma). A lesser known

underlying cause of scoliosis could be attributed to a condition called Chiari malformation.

Recent longitudinal studies reveal the most common form of the condition, late-onset idiopathic

scoliosis, is physiologically harmless and self-limiting even without treatment.[2][3]

The rarer

forms of scoliosis pose risks of complications.

Patients having reached skeletal maturity are less likely to have a worsening case. Some

severe cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart,

and restricting physical activities.

The signs of scoliosis can include:

Uneven musculature on one side of the spine

A rib prominence and/or a prominent shoulder blade, caused by rotation of the ribcage

in thoracic scoliosis

Uneven hips, arms or leg lengths

Slow nerve action (in some cases)

An estimated 65% of scoliosis cases are idiopathic, about 15% are congenital and about 10%

are secondary to a neuromuscular disease.[6]

Idiopathic scoliosis is a lifelong condition, but it does not lower one's expected life span .[7]

Adolescent idiopathic scoliosis has no clear causal agent, and it is generally believed to be

multifactorial, although genetics are believed to play a role.[8]Various causes have been

implicated, but none has consensus among scientists as the cause of scoliosis, though the role

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of genetic factors in its development is widely accepted.[9]Still, at least one gene, notablyCHD7,

has been associated with the idiopathic form of scoliosis.[9][10]

Congenital scoliosis can be traced to a malformation of the spine during weeks three to sixin

utero. It is a result of either a failure of formation, a failure of segmentation, or a combination of

both.

Scoliosis secondary to neuromuscular disease may develop during adolescence, such as

with tethered spinal cord syndrome.]Scoliosis often presents itself, or worsens, during the

adolescence growth spurt and is more often diagnosed in females than males.

Physiotherapy

The Schroth method, a noninvasive, physiotherapeutic treatment, has been used successfully in

Europe since the 1920s. Originally developed in Germany by scoliosis sufferer Katharina

Schroth, this method is now taught to scoliosis patients in clinics specifically devoted to Schroth

therapy in Germany, Spain, England, and North America. The method is based upon the

concept of scoliosis as resulting from a complex of muscular asymmetries (especially strength

imbalances in the back) that can be at least partially corrected by targeted exercises .[19]

The Schroth method has proven effective at reversing abnormal scoliotic curvatures by an

average of 10% in four- to six-week in-patient programs, and by 30% or more in an out-patient

program over a period of a year.One study of nearly 200 adolescent Schroth patients found no

curve progression three years following the in-patient program. Several studies have

documented the Schroth method's efficacy in substantially reducing or eliminating pain, which

tends to be a problem, in particular, for adults.

Small curvatures between 15 and 20 during growth may be treated with the physio-logic-

program, curvatures between 20 and 30 during growth spurt with "3D-made-easy". This

program has been tested in the environment of in-patient treatment, as well. In curvatures

exceeding 30, a combination of the methods described together with the Schroth program may

be helpful and a specialized centre with trained and certified staff should be taken into account.

Out-patient rehabilitation treatments today may reach the same outcome as in-patientprograms.]Out-patient programs may be successful when pattern-specific programs are

provided. A certain intensity is necessary to allow the very best compliance with conservative

treatment, and to acquire strategies for coping with scoliosis and with the conservative

treatment.

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The indications for treatment depend on degree of curvature, maturity of the patient, and the

individual curve pattern. While evidence supporting such conservative, noninvasive treatments

is weak, today, conservative management of scoliosis can be regarded as being evidence-

based; no substantial evidence has been found to support surgical intervention.[29]

Occupational therapy

An occupational therapist helps those having experienced an injury or illness regain or maintain

the ability to participate in their everyday activities. For those with scoliosis, an occupational

therapist can provide assistance through assessment, intervention, and ongoing evaluation of

the condition, which will help them manage physical symptoms so they can participate in daily

activities, such as those in self-care, productivity, and leisure.

One intervention involves bracing. During the past several decades, a large variety of bracing

devices have been developed for the treatment of scoliosis Studies demonstrate that preventingforce sideways across a joint by bracing prevents further curvature of the spine in idiopathic

scoliosis, while other studies have also shown that braces can be used by individuals with

scoliosis during physical activities.]

Other interventions include postural strategies, such as posture training in sitting, standing, and

sleeping positions, and in using positioning supports such as pillows, wedges, rolls, and corsets.

Adaptive and compensatory strategies are also employed to help facilitate individuals to

returning daily activities.

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