[Orthopaedic technology and neuromuscular scoliosis : Orthotics, wheelchair seating shells and positioning aids]. / Orthopädische Technik und neuromuskuläre Skoliosen : Rumpforthetik, Rollstuhl- und Sitzschalenversorgung.

Children and adolescents with neuromuscular scoliosis usually undergo severe challenges with their respiratory and locomotor systems during growth. Early onset scoliotic deformities take a whole team of specialists to ease the problematic side effects associated with poor posture and seating abilities. Wheelchairs and seating shells need to be adjusted as does suitable bracing for the collapsing spine. Key issues are the maintenance of proper lung function and upright sitting in the wheelchair or seating shell. Although spine bracing can be helpful and has its place in seating, the natural history of progression in neuromuscular curvatures is rarely sustainably stopped. While bracing is sometimes not tolerated by patients with severe hypotonic thoracic collapse and breathing issues, it can otherwise buy time for some patients to gain height and weight before surgical intervention inevitably takes place.

[Physiotherapeutic and rehabilitative options for neuromuscular scolioses : Areas of physiotherapy techniques in the field of tension between hypertonic and hypotonic forms of neuromuscular scoliosis]. / Physiotherapeutische und rehabilitative Möglichkeiten bei neuromuskulären Skoliosen : Arbeitsfelder krankengymnastischer Techniken im Spannungsfeld hypertoner und hypotoner Formen neuromuskulärer Skoliosen.

Conservative treatment and physiotherapy (PT) of neuromuscular scoliosis and its underlying systemic causes is dominated by a pragmatic approach. In the choice of treatment, the observance of the underlying muscle tone sets the essential course to select an appropriate PT technique. Hypertonic forms need the reflex-modulation techniques included in Bobath or Vojta programmes. They sometimes necessitate tone-reducing medication and additional orthotics with a likely risk of pressure sores. In hypotonic forms of scoliosis on the other hand, gravity and spine collapse with pulmonal dysfunction are the key issues addressed by conservative treatment. Sustained quality of life and supported partaking in social life through maintenance of pulmonary function and upright sitting ability are of continuing concern. PT programmes with a neurophysiologic background such as those of Bobath and Vojta are of central significance.

[Conservative and surgical treatment of idiopathic scoliosis]. / Konservative und operative Therapie der idiopathischen Skoliose.

Idiopathic scoliosis is the largest group of all forms of scoliosis in the growth phase accounting for 80-90%. A distinction is made between idiopathic infantile (0-3 years), juvenile (4-10 years) and adolescent scoliosis (>10 years), depending on the age when scoliosis appears. The treatment depends on the skeletal age, the Cobb angle and the progression behavior of scoliosis. Mild cases are treated conservatively using physiotherapy, exercises and bracing but in advanced stages scoliosis should be surgically treated. With existing growth potential various techniques, such as traditional growing rods, magnetically controlled growth rods and vertebral body tethering are available. After the end of the growth phase a fusion should be recommended for scoliosis >50°.

[Disease-specific Knowledge in Conservative Treatment of Adolescent Idiopathic Scoliosis]. / Krankheitsspezifisches Wissen in der konservativen Therapie der idiopathischen Adoleszentenskoliose.

BACKGROUND: The typical onset of adolescent idiopathic scoliosis falls in a sensitive stage of life. Nevertheless, conservative brace treatment requires a high degree of compliance. Disease-specific knowledge influences therapy outcome in many diseases and potentially improves patient compliance and quality of life. We analysed disease-specific knowledge and quality of life of patients with adolescent idiopathic scoliosis. METHODS: Scoliosis patients (n = 67) undergoing conservative brace treatment were asked to answer a questionnaire with items about scoliosis-specific knowledge. This was anonymous and prior to regular interviews and examinations. The scoliosis-research-society-22 r score was determined in order to assess quality of life. RESULTS: The major sources of information for the patients were the attending physicians and the world wide web. The majority stated that they understood the nature of scoliosis, although their answers to more detailed questions revealed a major lack of knowledge. A significant gap in provision of information was found, especially in the field of therapy regimen and treatment goals. The expected duration of the therapy was unclear to most patients. Nevertheless, higher quality of life correlated with high compliance and patients who regarded alleviation of the disturbing appearance of their trunk as a main treatment aim also experienced a lower quality of life in the section of self image. CONCLUSIONS: Our study revealed a significant lack of disease-specific knowledge in patients with idiopathic scoliosis. Facilitation of knowledge might improve quality of life and therapy outcome in the future. As the attending physicians are the main source of information, it is up to us to improve this situation.