Active Self-correction Research Articles

Rehabilitation in adult spinal deformity.

Adult spinal deformity causes significant health-related problems such as pain and disability in adults. Currently, there are several non-operative management strategies such as pain medications, physical modalities, exercises, bracing or interventional procedures. Specific exercises including strengthening of back and abdominal muscles, neuromuscular re-education for daily tasks, and active self-correction are vital to improve postural control and spinal stability. Bracing for a few hours a day can help reduce pain and provide spinal stability in adults. In case of severe disability and pain unresponsive to non-operative treatments, spinal fusion with instrumentation is an alternative. Postoperative rehabilitation can help to reduce pain and disability and improve return to activity or work. Protecting the spine early after surgery and timing of initiation of exercises with respect to osseointegration and bone remodeling phases are important principles of postoperative rehabilitation. In this review, rehabilitation in adult spinal deformity is discussed in the light of the literature.

The Effects of Active Self-correction on Postural Control in Girls with Adolescent Idiopathic Scoliosis: The Role of an Additional Mental Task.

Due to balance deficits that accompany adolescent idiopathic scoliosis (AIS), the potential interaction between activities of daily living and active self-correction movements (ASC) on postural control deserves particular attention. Our purpose was to assess the effects of ASC movements with or without a secondary mental task on postural control in twenty-five girls with AIS. It is a quasi-experimental within-subject design with repeated measures ANOVA. They were measured in four 20-s quiet standing trials on a force plate: no task, ASC, Stroop test, and both. Based on the center-of-pressure (COP) recordings, the COP parameters were computed. The ASC alone had no effect on any of the postural sway measures. Stroop test alone decreased COP speed and increased COP entropy. Performing the ASC movements and Stroop test together increased the COP speed and decreased COP entropy as compared to the baseline data. In conclusion, our results indicate that AIS did not interfere with postural control. The effects of the Stroop test accounted for good capacity of subjects with AIS to take advantage of distracting attentional resources from the posture. However, performing both tasks together exhibited some deficits in postural control, which may suggest the need for therapeutic consultation while engaging in more demanding activities.

Postural control in girls with adolescent idiopathic scoliosis while wearing a Chêneau brace or performing active self-correction: a pilot study.

BackgroundIt is known that adolescent idiopathic scoliosis (AIS) is often accompanied by balance deficits. This reciprocal relationship must be taken into account when prescribing new therapeutic modalities because these may differently affect postural control, interacting with therapy and influencing its results.ObjectiveThe purpose was to compare postural control in girls with AIS while wearing the Chêneau brace (BRA) or performing active self-correction (ASC) with their postural control in a quiet comfortable stance.MethodsNine subjects were evaluated on a force plate in three series of two 20-s quiet standing trials with eyes open or closed; three blocks were randomly arranged: normal quiet stance (QST), quiet stance with BRA, and quiet stance with ASC. On the basis of centre-of-pressure (COP) recordings, the spatial and temporal COP parameters were computed.Results and DiscussionPerforming ASC was associated with a significant backward excursion of the COP mean position with eyes open and closed (ES = 0.56 and 0.65, respectively; p < 0.05). This excursion was accompanied by an increase in the COP fractal dimension (ES = 1.05 and 0.98; p < 0.05) and frequency (ES = 0.78; p = 0.10 and ES = 1.14; p < 0.05) in the mediolateral (ML) plane. Finally, both therapeutic modalities decreased COP sample entropy with eyes closed in the anteroposterior (AP) plane. Wearing BRA resulted in ES = 1.45 (p < 0.05) while performing ASC in ES = 0.76 (p = 0.13).ConclusionThe observed changes in the fractal dimension (complexity) and frequency caused by ASC account for better adaptability of patients to environmental demands and for their adequate resources of available postural strategies in the ML plane. These changes in sway structure were accompanied by a significant (around 25 mm) backward excursion of the mean COP position. However, this improvement was achieved at the cost of lower automaticity, i.e. higher attentional involvement in postural control in the AP plane. Wearing BRA may have an undesirable effect on some aspects of body balance.

Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson's disease: A single-blinded, randomized controlled trial

IntroductionPathological forward trunk flexion is a disabling and drug-refractory motor complication of Parkinson's disease (PD) leading to imbalance, pain, and fall-related injuries. Since it might be reversible, early and multidisciplinary management is emphasised. The primary aim was to compare the effects of a four-week trunk-specific rehabilitation program on the severity of the forward trunk flexion. The secondary aim was to compare the training effects on the motor impairments, dynamic and static balance, pain, falls, and quality of life. Methods37 patients with PD (H&Y ≤ 4) and forward trunk flexion were randomized in the experimental (n = 19) or control group (n = 18). The former consisted of active self-correction exercises with visual and proprioceptive feedback, passive and active trunk stabilization exercises and functional tasks. The latter consisted of joint mobilization, muscle strengthening and stretching, gait and balance exercises. Protocols lasted 4 weeks (60 min/day, 5 days/week). Before, after, and at 1-month follow-up, a blinded examiner evaluated patients using primary and secondary outcomes. The primary outcome was the forward trunk flexion severity (degree). Secondary outcomes were the UPDRS III, dynamic and static balance, pain falls, and quality of life assessment. ResultsThe experimental group reported a significantly greater reduction in forward trunk flexion than the control group from T0 to both T1 (p = 0.003) and T2 (p = 0.004). The improvements in dynamic and static balance were significantly greater for the experimental group than the control group from T0 to T2 (p = 0.017 and 0.004, respectively). Comparable effects were reported on the other outcomes. Pre-treatment forward trunk flexion values were highly correlated to post-treatment trunk deviation changes. ConclusionThe four-week trunk-specific rehabilitation training decreased the forward trunk flexion severity and increased postural control in patients with PD. NCT03741959.

Effect of stabilization exercise on back pain, disability and quality of life in adults with scoliosis: a systematic review.

Adult scoliosis (AS) is the most common spine deformity in adults. Back pain is the main symptom leading patients to seek medical consultation. Stabilization exercise has been shown effective for reducing back pain. No literature review has examined the effects of such exercises in adults with scoliosis. The objective was to systematically review the effects of stabilization exercises on back pain, disability and quality of life in adults with scoliosis. We systematically searched the following databases from inception to March 2017: Medline, CINAHL, Embase, SportDiscus and Cochrane Register of Controlled Trials. Selection criteria included: controlled clinical trials that compare core stabilization exercise to placebo, no treatment or another treatment in participants diagnosed with AS over 18 years old. Studies with participants presenting torso or lower extremity surgery, injection in the last six months, comorbidity that could affect the spine, red flags signs or with a history of spine trauma were excluded. We extracted information about participants, treatments, and results on pain, function and quality of life. We appraised quality using Cochrane risk of bias. We formulated level of evidence summary statements using a priori rules based on quality and consistency of results. We found 630 unique articles and screened the full-text of 98 articles retrieved. Only one article met all selection criteria and was included in this review. Studies were mainly excluded for study design and patient population. The included study presented a low risk of bias for all criteria except for blinding and reporting if the timing of assessments was similar between groups. The literature provides limited evidence from one study with high risk of bias that stabilization exercises in the form of 20 weeks of active self-correction, task-oriented exercises and cognitive-behavioral therapy significantly improves pain, disability and quality of life. Despite the high prevalence of AS, there is an important gap in the literature with limited evidence reporting the effect of exercise on back pain in adults with scoliosis. This review suggest further experimental research is needed and formulates research recommendations.

Efficacy of Task Oriented Exercise Program Based on Ergonomics on Cobb's Angle and Pulmonary Function Improvement in Adolescent Idiopathic Scoliosis- A Randomized Control Trial.

Scoliosis is lateral curvature of the spine greater than 100 accompanied by vertebral rotation. The prime risk factors for curve progression are a large curve magnitude, skeletal immaturity and female gender. The curve progression can be recorded by measuring the curve magnitude using the Cobb's method on radiographs. To assess the effect of task oriented exercises based on ergonomics on Cobb's angle and pulmonary functions on one year outcome of Adolescent Idiopathic Scoliosis(AIS) (defined as curves < 150 for thoracolumbar region and < 200 for thoracic region). A total of 36 patients were enrolled in the study and 18 patients in each group (experimental and control group) were allocated randomly. The subjects in control group underwent spinal strengthening exercises, active self-correction and breathing exercises, whereas subjects in the experimental group followed task oriented exercises based on ergonomics in addition to exercises for conventional group for one year. Chi square test was used to compare the categorical/ dichotomous variables between the groups. Unpaired t-test was used to compare continuous variables between the groups at pre and post intervention. Paired t-test was used to compare the changes in continuous variables from pre to post intervention within the group. Forced Vital Capacity (FVC) was found to be significantly (p=0.001) higher in experimental group (2.68±0.37) than control group (2.20±0.41) at post-intervention. Force Expritatory Volume 1 (FEV1) (p=0.01) and Vital Capacity (VC) (p=0.002) were also found to be significantly higher in experimental group compared to control group at postintervention. Also, there was significant (p=0.001) mean reduction in Cobb's angle from pre to post intervention in both the groups being higher in Experimental group than control group. The task oriented exercise protocol benefited patients with AIS which had a significant improvement of their pulmonary functions and Cobb's angle.

Active self-correction of spinal posture in pain-free women in response to the command “straighten your back”

ABSTRACTEvidence is limited regarding the regional changes in spinal posture after self-correction. The aim of the present study was to evaluate whether active self-correction improved standing and sitting spinal posture. Photogrammetry was used to assess regional spinal curvatures and vertical global spine orientation (GSO) in 42 asymptotic women aged 20–24 years. Upper thoracic spine angle and GSO increased in response to self-correction, while the thoracolumbar and lumbosacral angles decreased. Self-correction in the standing position resulted in decreased inclination of the upper thoracic and thoracolumbar spinal angles. Correction of sitting posture reduced the angle of the upper thoracic spine and GSO. The effects of active self-correction on spinal curvature and GSO were different for the standing versus sitting position; the greatest effects of active correction were noted in the thoracic spine. Balanced and lordotic postures were most prevalent in the habitual and actively self-corrected standing positions, whereas the kyphotic posture was most prevalent in the habitual sitting position, indicative that self-correction back posture in the standing position could be an important health-related daily activity, especially during prolonged sitting.

Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial.

To evaluate the effects of motor and cognitive rehabilitation on disability in adults with idiopathic scoliosis at lower risk of progression. 130 adults with idiopathic scoliosis (main curve <35°) were randomly assigned to a 20-week rehabilitation programme consisting of active self-correction, task-oriented exercises and cognitive-behavioural therapy (experimental group, 65 subjects, mean age of 51.6, females 48) or general physiotherapy consisting of active and passive mobilizations, stretching, and strengthening exercises of the spinal muscles (control group, 65 subjects, mean age of 51.7, females 46). Before, at the end, and 12months after treatment, each participant completed the Oswestry disability index (ODI) (primary outcome), the Tampa scale for kinesiophobia, the pain catastrophizing scale, a pain numerical rating scale, and the Scoliosis Research Society-22 Patient Questionnaire. Radiological (Cobb angle) and clinical deformity (angle of trunk rotation) changes were also investigated. A linear mixed model for repeated measures was used for each outcome. Significant effects of time, group, and time by group interaction were found for all outcome measures (P<0.001). After training, the primary outcome showed a clinically significant between-group change (12% points), which was preserved at follow-up. At follow-up, the radiological deformities showed a significant, although not clinically meaningful, between-group difference of 4° in favour of the experimental group. The experimental programme was superior to general physiotherapy in reducing disability of adults with idiopathic scoliosis. Motor and cognitive rehabilitation also led to improvements in dysfunctional thoughts, pain, and quality of life. Changes were maintained for at least 1year.

Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study.

BackgroundScoliosis fusion surgery is generally considered the only means to stop the progression of adult idiopathic scoliosis (ADIS), but for patients refusing surgery there is lack of evidence in favour of conservative treatment. The aim of the present study was to verify the possible effectiveness of scoliosis-specific exercises when facing ADIS progression.MethodsWe designed a retrospective cohort study.We included 34 ADIS patients in treatment at our Institute (5 males and 29 females, mean age was 38.0 ± 11.0), exclusively treated with specific Scoliosis Specific SEAS exercises.InstrumentationSEAS exercises are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through an active self-correction. Postural integration is a key element, including the neuromotor integration of correct postures and an ergonomic education program. Therapy includes at least two weekly exercise sessions each lasting 45 min.Outcome measuresRadiographic progression was the main outcome and it was analysed as a continuous variable.StatisticsOne way ANOVA and paired t-test were applied for continuous data, while chi-square test was applied for categorical data. Alpha was set at 0.05.ResultsThe mean Cobb angle of the patients included into the present study, was 55.8 ± 13.2 °. Fifteen patients had previous x-rays testifying scoliosis progression: the average curve progression (worsening) was 9.8 ± 6.6 ° at a median of 25 (range 17–48) years. The remaining were characterized by more severe curves, exceeding 40 ° Cobb (mean curvature 50.9 ± 13.6) but it was not possible to prove that the curves had progressed in these cases. After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis. However in one patient (3 %) the scoliosis worsened by 5 ° in 18 years (progression rate reduced from 0.5 ° to 0.27 ° per year). Patients improved 4.6 ± 5.0 ° Cobb (P < 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment.ConclusionsScoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.

The Impact of Core Stabilization Exercise Therapy on Perception of Verticality in Adoescent Idiopathic Scoliosis

Accurate perception of verticality is important in maintenance of upright posture and gait. It is believed that abnormal postural sway present in patients with adolescent idiopathic scoliosis (AIS) may be related to their perception of body orientation in space. PURPOSE: To investigate the effects of core stabilization exercises on perception of verticality which is represented by subjective visual vertical (SVV), subjective postural vertical (SPV) and subjective haptic vertical (SHV) in patients with AIS. METHODS: Twelve female subjects with AIS were included in this study. Mean age was 14,5±1,7 years. The average Cobb angle of the major curve was 28±13° for thoracic and 24±7° for lumbar regions (range: 10°-54°). According to the King-Moe classification, Type I curve was evident in three patients, Type II in seven, Type III in one and Type IV in four. The SVV, SPV and SHV tests were assessed by seating subjects in a chair and instructing them to adjust laser line projections in the directions of vertical, horizontal and at the angles of 30°, 45°, and 60° in a dark room before and after training. The performance, expressed as the deviation from each line (measured in degrees), was calculated by the examiner. Training consists of core stabilization exercises and active self-correction performed two times per week for twelve weeks. RESULTS: In SVV test, accuracy of perception of horizontal, vertical, 30° right, 60° right was improved after treatment (p<0.05). Also in SPV test, better values seemed in vertical, 30° left and 60° left after treatment (p<0.05). In SHP, 45° left was improved (p<0.05). We found no significant difference in other subtests (p>0,05). CONCLUSION: The present study shows that perception of verticality in AIS can be improved with core stabilization exercise therapy.

SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises.

BackgroundSEAS is the acronym for “Scientific Exercise Approach to Scoliosis”, a name related to the continuous changes of the approach based on results published in the literature.Rehabilitation programSEAS is an individualized exercise program adapted to all situations of conservative treatment of scoliosis: stand-alone in low-medium degree curves during growth to reduce the risk of bracing; complimentary to bracing in medium-high degree curves during growth, with the aim to increase correction, prepare weaning, and avoid/reduce side-effects; for adults either progressing or fused, to help stabilising the curve and reduce disability.SEAS is based on a specific active self-correction technique performed without external aid, and incorporated in functional exercises. Evaluation tests guide the choice of the exercises most appropriate to the individual patient.Improvement of the stability of the spine in active self-correction is the primary objective of SEAS. SEAS exercises train neuromotor function so to stimulate by reflex a self-corrected posture during the activities of daily life.SEAS can be performed as an outpatient (two/three times a week 45 for minutes) or as a home program to be performed 20 minutes daily. In the last case, expert physiotherapy sessions of 1.5 hours every three months are proposed.ResultsDifferent papers, including a randomized controlled trial (2014), published over the past several years, documented the efficacy of the SEAS approach applied in the various phases of scoliosis treatment in reducing Cobb angle progression and the need to wear a brace.ConclusionsSEAS is an approach to scoliosis exercise treatment with a strong modern neurophysiological basis, to reduce requirements for patients and possibly the costs for families linked to the frequency and intensity of treatment and evaluations. Therefore, SEAS allows treating a large number of patients coming from far away. Even if SEAS appears simple by requiring less physiotherapist supervision and by using fewer home exercises prescribed at a lower dose than some of the other scoliosis-specific exercise approaches, real expertise in scoliosis, exercises, and patient and family management is required. The program has no copyrights, and teachers are being trained all over the world.

Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial

To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild adolescent idiopathic scoliosis (AIS) (Cobb angle <25°). This was a parallel-group, randomised, superiority-controlled study in which 110 patients were randomly assigned to a rehabilitation programme consisting of active self-correction, task-oriented spinal exercises and education (experimental group, 55 subjects) or traditional spinal exercises (control group, 55 subjects). Before treatment, at the end of treatment (analysis at skeletal maturity), and 12 months later (follow-up), all of the patients underwent radiological deformity (Cobb angle), surface deformity (angle of trunk rotation) and HRQL evaluations (SRS-22 questionnaire). A linear mixed model for repeated measures was used for each outcome measure. There were main effects of time (p < 0.001), group (p < 0.001) and time by group interaction (p < 0.001) on radiological deformity: training in the experimental group led to a significant improvement (decrease in Cobb angle of >5°), whereas the control group remained stable. Analysis of all of the secondary outcome measures revealed significant effects of time, group and time by group interaction in favour of the experimental group. The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS. The effects lasted for at least 1 year after the intervention ended.

Active self-correction of back posture in children instructed with ‘straighten your back’ command

The ability to adopt the properly corrected body posture is one of the factors determining the effectiveness of therapeutic programmes. This study determined the active self-correction expressed by the change of sagittal spinal curvatures (in standing and sitting positions) in 249 children (136 females, 113 males, aged 10–14 years) instructed with ‘straighten your back’ command (SYB). Spinal curvatures (sacral slope-SS, lumbar lordosis-LL, global, lower and upper thoracic kyphosis-TK, LK, UK, respectively) were assessed using Saunders inclinometer. The assessment was done in spontaneous standing and sitting positions and in the positions adopted after the SYB.In a standing position SYB led to the significant (P < 0.001) increase in SS, and the significant (P < 0.01) decrease in LL, TK, LK, UK. In a sitting position SYB led to significant changes (P < 0.001) from kyphotic to lordotic position of SS and LL and to the significant (P < 0.001) reduction of TK (36.5° ± 10.8 vs. 23.5° ± 11) and the flattening of LK (15.2° ± 8.7 vs. 1.0° ± 8.4). There were gender-based discrepancy regarding active self-correction only for LL in a standing and UK in a sitting position. Females demonstrated a significant decrease in LL (P < 0.001). UK significantly increased only in males (P < 0.001).The ‘straighten your back’ command leads to moving the spine away from mid-range towards end range of motion. Therefore, the command should not be used to elicit the most optimal back posture. Further studies are needed to determine if the active self-correction is different in females and males.

Autocorrection – how to measure the skills acquired during physical therapy sessions

Background It is common sense that physiotherapy in the treatment of scoliosis patients should improve the skills for active self-correction of the individual patient [1,2]. Although the autocorrection (AC) patients can achieve when they use certain high correction exercises obviously can be observed, there is no tool to enable the measuremet of this patient skill. Aim of this study was to test whether AC can be measured with the help of the Scoliometer (ATR) [3].

Active self correction during different exercises and movements: a biomechanical study

SOSORT Consensus Conference (Milan 2005) developed about the main important features of a correct treatment based on physical exercises states that the main point is self correction. The SEAS school of treatment focuses on Active Self Correction (ASC) that is the series of movements of reallignemnt as a whole that the patients autonomously performs in order to reduce the scoliotic curves. This movement has to be performed as much as possible in three dimension so the ASC movement sometimes is not easy to be understood and also not easy to be realized by the patient. Aim of this paper is to check ASC in different exercises and during gait through a not-invasive optoelectronic gait analysis system.

Scoliosis manager for physiotherapist. An internet free tool to help in treating scoliosis patients with exercises

Background The coservative treatment based on exercises is the main therapeutic strategy widely used for patients affected by scoliosis not particularly important and as a supporting tool in case of prescription of brace. The specific exercises are furthermore means of treating scoliosis in adults, in order to reduce pain and to contrast the progression of the curves. According to SEAS approach the specifity of scoliosis exercises comes from the combination of the specific Active Self-Correction (ASC) required by each single patient with the pathological and individual functional needs. Accordingly, a big set of exercises can be considered, once individual ASC is known and applied.