Abstract

BackgroundGlobal postural re-education (GPR) is a physiotherapy treatment approach for pediatric idiopathic scoliosis (IS), where the physiotherapist qualitatively assesses scoliotic curvature reduction potential (with a manual correction) and patient’s ability to self-correct (self-correction). To the author’s knowledge, there are no studies regarding GPR applied to IS, hence there is a need to better understand the biomechanics of GPR curve reduction postures. The objective was to biomechanically and quantitatively evaluate those two re-education corrections using a computer model combined with experimental testing.MethodsFinite elements models of 16 patients with IS (10.5–15.4 years old, average Cobb angle of 33°) where built from surface scans and 3D radiographic reconstructions taken in normal standing and self-corrected postures. The forces applied with the therapist’s hands over the trunk during manual correction were recorded and used in the FEM to simulate this posture. Self-correction was simulated by moving the thoracic and lumbar apical vertebrae from their presenting position to their self-corrected position as seen on radiographs. A stiffness index was defined for each posture as the global force required to stay in the posture divided by the thoracic curve reduction (force/Cobb angle reduction).ResultsThe average force applied by the therapist during manual correction was 31 N and resulted in a simulated average reduction of 26% (p < 0.05), while kyphosis slightly increased and lordosis remained unchanged. The actual self-correction reduced the thoracic curve by an average of 33% (p < 0.05), while the lumbar curve remained unchanged. The thoracic kyphosis and lumbar lordosis were reduced on average by 6° and 5° (p < 0.05). Self-correction simulations correlated with actual self-correction (r = 0.9).ConclusionsThis study allowed quantification of thoracic curve reducibility obtained by external forces applications as well as patient’s capacity to self-correct their posture, two corrections commonly used in the GPR approach.

Highlights

  • Global postural re-education (GPR) is a physiotherapy treatment approach for pediatric idiopathic scoliosis (IS), where the physiotherapist qualitatively assesses scoliotic curvature reduction potential and patient’s ability to self-correct

  • Thoracic Cobb angles reduction and forces involved are summarized in Tables 1 and 2

  • The average equivalent force applied by the therapist during manual corrections over the thoracic curve was 31 ± 6 [23–55] N

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Summary

Introduction

Global postural re-education (GPR) is a physiotherapy treatment approach for pediatric idiopathic scoliosis (IS), where the physiotherapist qualitatively assesses scoliotic curvature reduction potential (with a manual correction) and patient’s ability to self-correct (self-correction). The objective was to biomechanically and quantitatively evaluate those two re-education corrections using a computer model combined with experimental testing. Since 2011, the international society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) recognizes physiotherapy specific scoliosis exercises (PSSE) as a complementary or alternative conservative management to bracing [2]. The selection of the appropriate exercises is based on a 3-steps comprehensive evaluation focusing on 1) body morphology and symptomatology, 2) examination of muscle retractions associated with posture alterations [6] and 3) re-equilibration tests to assess back muscle flexibility and spine deformity correction (curve reducibility) [6, 7]

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