The Effectiveness of Early Rehabilitation in Limiting the Progression of Idiopathic Scoliosis.

Background: The purpose of this study was to assess specific rehabilitation methods' effectiveness in early idiopathic scoliosis (IS) development, focusing on lower limb functional inequality's role in scoliosis progression. Materials and Methods: This study comprised 812 patients aged 6-16 years at risk of developing idiopathic scoliosis (IS). The mean (SD) age was 10.66 (3.16) years. Patients were categorized into high- and medium-risk groups based on the angle of trunk rotation (ATR) size. Specific scoliosis physiotherapy was used, and the average follow-up period was 28.1 ± 14.5 months. Changes in ATR, Cobb angle, and functional length of the lower limbs pre- and post-treatment were statistically analyzed across three age groups (6-9, 10-12, and 13-16 years) and three scoliosis locations. Results: Significant effectiveness of early rehabilitation was observed in the high-risk group of children aged 6-9 years. In the medium-risk group, significant reductions in ATR were observed in both the 6-9 and 10-12 age groups across all three scoliosis locations. Additionally, there was a significant decrease in the Cobb angle in the thoracolumbar region and a significant reduction in lower limb inequality across all age groups and scoliosis locations. Conclusions: The early implementation of specific physiotherapy may enhance the efficacy of idiopathic scoliosis treatment by attenuating factors contributing to its progression.

Congenital Muscular Torticollis-Current Understanding and Perinatal Risk Factors: A Retrospective Analysis.

INTRODUCTION: Congenital muscular torticollis (CMT) is an asymmetrical head position resulting from structural changes in the sternocleidomastoid (SCM) muscle that occurs early during a child's development or due to perinatal trauma. Children with CMT exhibit a marked imbalance in tension between the SCMs. In a typical clinical picture, an ultrasound scan is performed to reveal characteristic lesions, such as tissue fibrosis or post-traumatic changes. An early diagnosis of CMT in newborns and the implementation of treatment offer the chance of a complete resolution. Torticollis treatment aims to restore the SCM's normal function. Surgical treatment is performed when conservative methods fail to improve the patient's condition. The indications that surgery is needed include a marked shortening of the SCM, persistent fibrosis in the muscle, constant head and facial asymmetry, and rotation or lateral flexion in the cervical spine restricted by >15°. Of all the newborn and infant anomalies, congenital torticollis is the third most common after hip dysplasia and equinovarus deformities. Some authors demonstrate that torticollis coexists with hip dysplasia. AIM: The aim of this study was to collect data on infants referred to paediatric rehabilitation and to identify the risk factors associated with CMT in this group of patients, as well as to assess demographic and clinical characteristics concerning risk factors. MATERIALS AND METHODS: The target population for this retrospective study consisted of 111 infants aged 0 to 5 months born in Poland and diagnosed with and undergoing treatment due to CMT. The following were determined: the relationship between the side of the CMT location and the type of delivery (caesarean section vs. vaginal), the relationship between the body weight at birth and the side of the CMT location, the relationship between the extent of SCM thickening and the type of delivery, and the incidence of CMT depending on the order of delivery. RESULTS AND CONCLUSIONS: The data revealed that CMT is less common in female infants (n = 51, 46%) compared to male (n = 61, 54%) infants, in whom a greater birth weight was reported (p < 005). Seventy-six percent (76%) of the paediatric patients with CMT were the offspring of primipara mothers. More often, children born via vaginal delivery had left-sided torticollis with a more significant broadening of the SCM, as shown on ultrasound scans, than right-sided torticollis. Theories of torticollis development pathophysiology should be deepened and systematised, and further research is needed.

TLSO with Graphene Sensors-An Application to Measurements of Corrective Forces in the Prototype of Intelligent Brace.

This study presents a prototype of Intelligent Brace-the gold medal winner in the 68th edition of the International EUREKA 2019 Competition, in Valencia, Spain. It shows how to improve the effectiveness of a static orthopedic brace, with modern technology based on advanced electronic solutions. The research uses in-house-made thin-film graphene sensors, an electronic system with a microcontroller and derotating pads, a mobile application for Android system, and a remote database. The article presents a description of the real project, the system principle of operation, and the layout of the system elements in the orthosis. A prototype device was designed and built that was tested not only in laboratory conditions, but also during trials with the first patient. Approximately two months of data were collected and interpreted. The collected research results provided basic knowledge about the range of forces exerted by the brace on the patient's body, as well as the regularity of wearing the orthosis by the patient and compliance with the doctor's recommendations.

The Effect of an Innovative Biofeedback SKOL-AS® Treatment on the Body Posture and Trunk Rotation in Children with Idiopathic Scoliosis-Preliminary Study.

Background and Objectives: The deformity in idiopathic scoliosis (IS) is three dimensional and effective correction involves all three planes. Recently, the biofeedback method has been implemented in the treatment of scoliosis. The aim of this study was to evaluate the effectiveness of an innovative biofeedback SKOL-AS® postural training among children with scoliosis. Materials and Methods: The target population for this study was 28 patients (25 girls and 3 boys) aged between 5 and 16 years old diagnosed and treated with progressing low-grade scoliosis. The postural diagnosis consisted of anthropometric measurements, posterior-anterior X-ray imaging, SpinalMeter® postural assessment and the angle of trunk rotation (ATR) assessment. The SKOL-AS® treatment comprised of 24 sessions conducted in lying and sitting positions, two times a week. Results: It has been shown that the postural training resulted in the decrease in the ATR value (pre- vs. post-exercise in younger: 5.55 vs. 3.0 and older patients: 5.2 vs. 3.0). The increase in height of the subjects seemed to confirm a positive effect of SKOL-AS® elongation treatment. In the posterior view, a statistically significant decrease in shoulder asymmetry in the sitting position in younger children has been observed. In the anterior view, the changes in the head position (based on mouth and eye symmetry) have been observed. The statistically significant increase in acromion-heel, acromion-iliac crest and posterior superior iliac spine (PSIS)-heel length values has been shown in younger children on the left side of the body. After treatment, older subjects had higher acromion-iliac crest and PSIS-heel values on the left side of the body. On the right side only PSIS-heel length was higher. In a sitting position, only a small increase in acromion-iliac crest length value has been observed. Conclusions: The SKOL-AS® biofeedback method could teach good postural habits and teach patients the auto-correction of the spine.

The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis.

OBJECTIVE: The aim of the study was to evaluate the loss of truncal rotation over 54 hours after removing Chêneau brace. METHODS: The studied groups consisted of 39 girls aged 10-18 years old, diagnosed with adolescent idiopathic scoliosis (AIS) and treated with Chêneau brace (CAST) and 20 AIS girls aged 10-18 years old, not treated with bracing. Posterior-anterior radiographs were obtained from the clinical assessment of all subjects and were subsequently used to determine Cobb angles. The measurements of the angle of trunk rotation (ATR) were taken with the Scoliometer® and back-contour device during Adams forward bending test by the two evaluators. The changes in ATRs during 54 hours of observation were performed after the brace had been taken off (0, 2, 24, 30, 48 and 54 hours after debracing). This was described using VATR variable, defined as the change in the absolute Scoliometer® readings in the time intervals against the time interval Δt between the measurements. During back-contour assessment the differential factor (kra) has been used for the digital analysis. The changes in kra over 54 hours of observation were expressed as Vkra factor, defined as the difference in the absolute value of the amplitude differential factor (kra) in the time intervals against the time interval Δt between the measurements. RESULTS: The highest changes were observed in the thoracic as well as in lumbar spine in patients with Cobb angle ≥30°, axial rotation of the apical vertebrae within 5-15°, Risser sign 0-2. The biggest change in the trunk rotation after Chêneau brace had been taken off was noted within the first two hours of observation. CONCLUSION: The patients should be advised to take the brace off for a minimum of two hours before the scheduled x-ray, to allow full relaxation of the trunk in order to obtain reliable radiological images of the deformation. LEVEL OF EVIDENCE: Level III Therapeutic study.

Fibromyalgia Syndrome - a multidisciplinary approach.

According to American College of Rheumatology fibromyalgia syndrome (FMS) is a common health problem characterized by widespread pain and tenderness. The pain and tenderness, although chronic, present a tendency to fluctuate both in intensity and location around the body. Patients with FMS experience fatigue and often have sleep disorders. It is estimated that FMS affects two to four percent of the general population. It is most common in women, though it can also occur in men. FMS most often first occur in the middle adulthood, but it can start as early as in the teen years or in the old age. The causes of FMS are unclear. Various infectious agents have recently been linked with the development of FMS. Some genes are potentially linked with an increased risk of developing FMS and some other health problems, which are common comorbidities to FMS. It is the genes that determine individual sensitivity and reaction to pain, quality of the antinociceptive system and complex biochemistry of pain sensation. Diagnosis and therapy may be complex and require cooperation of many specialists. Rheumatologists often make the diagnosis and differentiate FMS with other disorders from the rheumatoid group. FMS patients may also require help from the Psychiatric Clinic (Out-Patients Clinic) due to accompanying mental problems. As the pharmacological treatment options are limited and only complex therapy gives relatively good results, the treatment plan should include elements of physical therapy.

Arthrogryposis in infancy, multidisciplinary approach: case report.

BACKGROUND: Arthrogryposis multiplex congenita is an etiopathogenetically heterogeneous disorder characterised by non-progressive multiple intra-articular contractures, which can be recognised at birth. The frequency is estimated at 1 in 3,000 newborns. Etiopathogenesis of arthrogryposis is multifactorial. CASE PRESENTATION: We report first 26 weeks of life of a boy with severe arthrogryposis. Owing to the integrated rehabilitation approach and orthopaedic treatment a visible improvement in the range of motion as well as the functionality of the child was achieved. This article proposes a cooperation of various specialists: paediatrician, orthopaedist, specialist of medical rehabilitation and physiotherapist. CONCLUSIONS: Rehabilitation of a child with arthrogryposis should be early, comprehensive and multidisciplinary. Corrective treatment of knee and hip joints in infants with arthrogryposis should be preceded by the ultrasound control. There are no reports in the literature on the ultrasound imaging techniques which can be used prior to the planned orthopaedic and rehabilitative treatment in infants with arthrogryposis. The experience of our team indicates that such an approach allows to minimise the diagnostic errors and to maintain an effective treatment without the risk of joint destabilisation.

Effectiveness of Chêneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity.

BACKGROUND: Progressive idiopathic scoliosis can negatively influence the development and functioning of 2-3% of adolescents, with health consequences and economic costs, placing the disease in the centre of interest of the developmental medicine. The aim of this study was to evaluate the effectiveness of Chêneau brace in the management of idiopathic scoliosis. METHODS: A prospective observational study according to SOSORT and SRS recommendations comprised 79 patients (58 girls and 21 boys) with progressive idiopathic scoliosis, treated with Chêneau brace and physiotherapy, with initial Cobb angle between 20 and 45 degrees, no previous brace treatment, Risser 4 or more at the final evaluation and minimum one year follow-up after weaning the brace. Achieving 50° of Cobb angle was considered surgical recommendation. RESULTS: At follow-up 20 patients (25.3%) improved, 18 patients (22.8%) were stable, 31 patients (39.2%) progressed below 50 degrees and 10 patients (12.7%) progressed beyond 50 degrees (2 of these 10 patients progressed beyond 60 degrees). Progression concerned the younger and less skeletally mature patients. CONCLUSION: Conservative treatment with Chêneau orthosis and physiotherapy was effective in halting scoliosis progression in 48.1% of patients. The results of this study suggest that bracing is effective in reducing the incidence of surgery in comparison with natural history.