Orthotics in rehabilitation
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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.

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Orthotics in rehabilitation

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Orthotics in rehabilitation

Orthotics in rehabilitation

Secondary scoliosis


Orthotics in rehabilitation

  • 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.


Orthotics in rehabilitation

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

The Hippocrates solution


Physical exam

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

Forward Bend TestAdam’s sign


Orthotics in rehabilitation

Rib hump


Scoliometer

scoliometer


Clinical presentation

Clinical presentation


Rotation

Rotation

  • Spinous process rotates into concavity

  • Pedicle position


Orthotics in rehabilitation

COBB’S ANGLE

Measures severity

Intersecting angle between lines drawn from upper and lower surfaces of vertebrae at the end of the curve.


Orthotics in rehabilitation

100


Skeletal maturity

Skeletal Maturity

  • Gruelich & Pyle atlas

  • Triradiate cartilage fusion

  • Risser sign


Orthotics in rehabilitation

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


Orthotics in rehabilitation

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


Orthotics in rehabilitation

  • 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


Orthotics in rehabilitation

  • 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 athetosiswill all have an impact on the scoliosis.


Orthotics in rehabilitation

A standard physiotherapy programme is essential to

  • maintain the range of movement(ROM) of joints

  • reduce muscle spasticity

  • improve sitting balance.


Orthotics in rehabilitation

  • 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 functionon one side and support and stabilisation on the othe.


Orthotics in rehabilitation

  • 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.


Orthotics in rehabilitation

  • moulded seats


Orthotics in rehabilitation

  • 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.


Orthotics in rehabilitation

  • 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.


Orthotics in rehabilitation

  • 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.


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