Adams Forward Bending Research Articles

The Relationship between Incorrect Body Posture in Elementary School Children on Idiopathic Scoliosis

Idiopathic scoliosis is a condition of spinal deformity characterized by abnormal lateral curvature. The factor that is thought to play a role in the development of idiopathic scoliosis is incorrect body posture. This research is a correlation study which aims to determine the significant relationship between incorrect body posture and the incidence of idiopathic scoliosis in elementary school children. This research approach uses a quantitative approach with a descriptive quantitative research type with a correlational model. Research data was obtained through questionnaires, documentation and measurements using a scoliometer. The population in this study were all sixth grade students at SDIT Bangkinang Elementary School, totaling 35 students. Independent variable is a sitting position using the Questionnaire on Body Awareness of Postural Habits in Young People (Q BAPHYP) measurement tool. The dependent variable is scoliosis measured using the Adam's Forward bending test. Data analysis techniques are descriptive statistical analysis and inferential statistical analysis. After analyzing the research results, it shows that incorrect body posture has a significant relationship with the incidence of idiopathic scoliosis in elementary school children as proven by the results of data analysis, p= 0.000 or p< 0.05. The conclusion of this study is that there is a significant relationship between incorrect body posture and the incidence of idiopathic scoliosis in elementary school children.

Adolescent Idiopathic Scoliosis Minimum Data Set: Towards Standardization of Data Elements in History and Physical Examination.

Nonoperative care represents a cornerstone of adolescent idiopathic scoliosis (AIS) management, although no consensus exists for a minimal data set. We aimed to determine a consensus in critical data points to obtain during clinical AIS visits. A REDCap-based survey was distributed to Pediatric Orthopedic Society of America (POSNA), Pediatric Spine Study Group (PSSG), and International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). Respondents ranked the importance of data points in history, physical examination, and bracing during AIS visits. Results: One hundred eighty-one responses were received (26% response rate), of which 86% were physicians and 14% were allied health professionals. About 80% of respondents worked at pediatric hospitals or pediatric spaces within adult hospitals, and 82% were academic, with the majority (57%) seeing 150+ unique AIS patients annually. Most respondents recommended six-month follow-up for patients under observation (60%) and bracing (54%). Most respondents (75%) considered family history and pain important (69%), with the majority (69%) asking about pain at every visit. Across all time points, Adam's forward bend test, shoulder level, sagittal contour, trunk shift, and curve stiffness were all considered critically important (>60%). At the first visit, scapular prominence, leg lengths, motor and neurological examination, gait, and iliac crest height were also viewed as critical. At the preoperative visit, motor strength and scapular prominence should also be documented. About 39% of respondents use heat sensors to monitor bracing compliance, and average brace wear since the prior visit was considered the most important (85%) compliance data point. This study establishes recommendations for a 19-item minimum data set for clinical AIS evaluation, including history, physical exam, and bracing, to allow for future multicenter registry-based studies.

Assessment of idiopathic scoliosis among adolescents and associated factors in Palestine

PurposeThis study aimed to investigate adolescent idiopathic scoliosis (AIS) and its related risk factors, including body mass index (BMI), physical activity (PA), gender, time of the first menstrual cycle, transportation, backpack weight and the way of carrying a backpack. Design and methoda cross-sectional quantitative design was utilized. A convenient sample of adolescent students in grades seven through ten was included in the study. A self-reported questionnaire with three sections: demographic data; physical data including height, weight and PA; and Adam's forward bend test to determine each student's spine's Cobb angle by measuring the angle of trunk rotation using a scoliometer. The data were analyzed using SPSS version 25, with confidence intervals of 95%. ResultsA total of 820 schoolchildren participated in the study; 53.7% were female and 46.3% were male. Only 22% of these students engaged in vigorous exercise, compared to 36.7% who engaged in low PA; additionally, 10% of the adolescents had a low BMI. After the analysis, it was found that 5.4% of participants had AIS. Low PA (p = 0.001), being underweight (p = 0.038), and time of first menstrual period (p = 0.033) were significantly associated with AIS, while gender, backpack weight, and way of carrying were not statistically related to AIS. Binary logistic regression identified low PA as an independent predictor of AIS (OR = 7.22, 95%CI [1.64, 31.79]). ConclusionsThe frequency of AIS in Palestine was significant, which highlighted the importance of this issue at a national and global level. There was an association between AIS and BMI, PA, and the time of the first menstrual cycle, which signifies the importance of early detection of the problem to limit its burden later in life. Practice implicationsTeachers, teenagers, and their parents should be provided with programs that educate and clarify AIS, and a specific protocol should be established for scoliosis screening in schools.

Prevalence angle of trunk rotation in adolescents: a study from an idiopathic scoliosis school screening in Surabaya

Link of Video Abstract: https://youtu.be/GtRgpMD7tsM Background: Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis. The condition begins in early puberty, affects 1-3% of adolescents, and randomly affects young women. Scoliosis screening is still a hot topic discussed by various researchers, especially in the school child population, and it is still an important preventive program to reduce the progression of spinal deformity. This study aims to determine the prevalence rate angle of trunk rotation in idiopathic scoliosis school screening in Surabaya. Methods: This research is a cross-sectional study with a descriptive observational type using surveys and examinations. In this study, the sample used was 405 junior high school students in Surabaya. The sampling method is cluster random sampling, where each member of the population is divided into subclasses with the school as the cluster. Samples were randomly selected from each area of Surabaya. Data were analyzed using SPSS version 25.0 for Windows. Results: These data found that the age distribution of the scoliosis screening study was an average of 13.87 years and a median of 14 years. The gender distribution of the scoliosis screening study sample was more female, 211 samples (52.1%) compared to men, 194 samples (47.9%). The distribution was obtained from 405 total samples; 2 positive samples were obtained during the Adam's Forward Bend Test, both 14 years old and female. On examination with a scoliometer, both showed 9 and 11 degrees, respectively. The prevalence angle of trunk rotation in idiopathic scoliosis school screening in Surabaya was 0.49%. Conclusion: This figure is lower than several studies conducted in several other countries. This may be obtained due to differences in the number of research samples undertaken in each country.

Frequency of Scoliosis among School Going Students Carrying Heavy Bags: A Cross-Sectional Study in Lahore, Pakistan

Objective: Scoliosis is structural change that occurs in a diversity of conditions. Development of the scoliosis during time periods of rapid child growth may consequence in severe abnormality. This survey had the purpose to find out the scoliosis frequency among school going students with age 11-16 years and determine possible associations among scoliosis and bodyweight and the bagpacks weight.
 Method: A Cross-Sectional study was conducted on 374 students with age of 11-16 years old boys and girls were having no abnormality or any MSK deformity was involved in the survey. All students were monitored by Adam's forward bend test and physical inspection test and for this purpose SRS-22r patient questionnaire was used. All data collected via a questionnaire which coded it into SPSS version 26. Data was constituted in configuration of bar charts, graphs and tables.
 Results: This inquiry contains 374 participants, and means weight of students 43.83±11.98, and mean weight of bags 5.21±1.99. The frequency of scoliosis among respondents was 48.66%, 103(27.54%) students were suffering from right Scoliotic hump, and 79(21.12%) have left Scoliotic hump. The frequency of shoulder & scapular asymmetry 73%, uneven hips 19.7%, head deviation 50.8%, body overweight 1.9%, carrying immoderate heavy school bag packs material 4%.
 Conclusion: The scoliosis frequency among the sample of school going students was high. The statistical analysis showed that scoliosis was positively correlated with weight of students with statistically significant (p=0.000). No association was found among frequency of scoliosis and bags weigh.

Prediction of Cobb Angle Using Deep Learning Algorithm with Three-Dimensional Depth Sensor Considering the Influence of Garment in Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity. Early detection of deformity and timely intervention, such as brace treatment, can help inhibit progressive changes. A three-dimensional (3D) depth-sensor imaging system with a convolutional neural network was previously developed to predict the Cobb angle. The purpose of the present study was to (1) evaluate the performance of the deep learning algorithm (DLA) in predicting the Cobb angle and (2) assess the predictive ability depending on the presence or absence of clothing in a prospective analysis. We included 100 subjects with suspected AIS. The correlation coefficient between the actual and predicted Cobb angles was 0.87, and the mean absolute error and root mean square error were 4.7° and 6.0°, respectively, for Adam's forward bending without underwear. There were no significant differences in the correlation coefficients between the groups with and without underwear in the forward-bending posture. The performance of the DLA with a 3D depth sensor was validated using an independent external validation dataset. Because the psychological burden of children and adolescents on naked body imaging is an unignorable problem, scoliosis examination with underwear is a valuable alternative in clinics or schools.

Is Shoulder Imbalance a Useful Parameter in the Screening of Idiopathic Scoliosis? A Preliminary Study.

Objective The present study aims to analyze the use of shoulder imbalance as a parameter for scoliosis screening as well as its relationship with other parameters of physical examination. Methods This study assesses a smartphone application that analyzes several parameters of the physical examination in adolescent idiopathic scoliosis. Medical and non-medical examiners applied the screening tool in students in a public school and in a private sports club. After data collection, interobserver correlation was done to verify shoulder imbalance and to compare shoulder imbalance with Adam's bending test and with trunk rotation. Results Eighty-nine participants were examined, 18 of whom were women and 71 of whom were men. Two subjects were excluded from the analysis. The mean age of subjects from the public school was 11.30 years and, for those from the sports club, it was 11.92 years. The examiners had poor-to-slight interobserver concordance on shoulder asymmetry in the anterior and posterior view. No significant statistical correlation was found between shoulder asymmetry and positive Adam's forward bending test. Conclusion Our preliminary study shows that the shoulder asymmetry has a poor correlation with the Adam's forward bending test and measuring trunk rotation using a scoliometer. Therefore, the use of shoulder imbalance might not be useful for idiopathic scoliosis screening. Level of Evidence III; Diagnostic Study.

AGENESIS OF MEDIAL PATELLOFEMORAL LIGAMENT (MPFL) WITH HABITUAL PATELLAR DISLOCATION IN ADOLESCENT WOMAN WITH CEREBRAL PALSY – A CASE REPORT

Background: The current treatment for habitual dislocation and nonoperative treatment failure is surgical therapy. Therefore, this study describes chronic patella dislocation's comprehensive evaluation and management in an adolescent woman with cerebral palsy (CP).Case Report: A 15 years old female patient has suffered knee pain for almost three years. Furthermore, the physical examination revealed positive adam's forward bending test and left knee cap dislocation with positive patellar J-sign at 90°. Radiologic examination of the vertebrae and left knee shows scoliosis left thoracolumbar curved with 43 cobb angle and patellar shift. The patient was then diagnosed with habitual patellar dislocation, spastic diplegia type of CP, and neuromuscular scoliosis, consulted to the pediatric department, and then planned for medial patellofemoral ligament (MPFL) reconstruction. During the surgical examination, we discovered the MPFL Agenesis. Finally, lateral release and plication of the medial retinaculum were selected for surgery and planned to receive a Boston brace for scoliosis. After six weeks of follow up, the patient shows a reduction in pain.Discussion: Lateral release and MPFL reconstruction for patellar stabilization generate better results. However, in this case, the absence of the medial patellar facet and the medial femoral condyle enhances Lateral release and plication of the medial retinaculum more preferable to fixate the left patella and improve functional limitation.Conclusion: Comprehensive and immediate treatment for a patient with habitual patella dislocation and other predisposition diseases increases the chances of success.

Analysis of postural asymmetry on sagittal plane between right and left side views using photogrammetry

BackgroundPostural asymmetry is natural and expected during postural assessment. Besides, there are conditions that exacerbate the difference between right and left side views, such as Idiopathic Scoliosis (IS). However, the photogrammetric postural assessment on sagittal plane is usually performed using only one side view. This study aimed testing if there are differences between the right and the left-side views in photogrammetric postural assessment of adults on sagittal plane. MethodsPatients with and without scoliosis were assessed and were grouped into Control Group (CG) and Positive Adam's test Group (PAG) according to Adam's forward bending test. After screening, participants were assessed using the right and the left-side views according DIPA© protocol. Descriptive and inferential analysis were made using Paired t-Test and Independence Chi-square Test (χ2). ResultsSignificant differences were found between right and left side views to knee angle and head position angle to overall sample. The mean difference was low, about 1° on head position and 2.6° on knee angle and did not affect the classification of body segments. ConclusionWe conclude that the postural assessment on sagittal plane of adults without IS can be performed using only one side view, becoming the photogrammetric postural assessment an easy-to-use tool.

Scoliosis Screening.

The national recommendations for school screening programs for scoliosis in the United States have undergone a shift in perspective over the past two decades. In 2004, the United States Preventive Services Task Force recommended against screening programs but changed its recommendation to be inconclusive in 2018. Early diagnosis of scoliosis can allow for close monitoring of the deformity and early initiation of bracing treatment when appropriate, with the goal of preventing costly and invasive surgical intervention. Several different diagnostic tools are available, including Adam's forward bending test alone, Adam's forward bending test with scoliometry, the humpometer, and Moiré topography, each with varying degrees of sensitivity and specificity. Controversy prevails over the cost efficacy of screening programs and possible unnecessary exposure of adolescents to radiation for confirmatory radiographs after a positive screening test. However, the recent definitive evidence of bracing treatment efficacy in slowing the progression of scoliotic curves and preventing the need for surgery indicates that school screening programs may still have a role in allowing early diagnosis.

Association Between Incorrect Posture and Adolescent Idiopathic Scoliosis Among Chinese Adolescents: Findings From a Large-Scale Population-Based Study.

Objectives: Adolescent idiopathic scoliosis (AIS) affects between 1 and 4% of adolescents, and severe curvature may be related to their adverse long-term outcomes. However, whether the change in body appearance is related to AIS remains largely unclear. We aimed to explore the association between incorrect posture and AIS among Chinese adolescents.Methods: Data were collected from a population-based (595,057) school scoliosis screening program in China. A sample of 3,871 adolescents was classified as cases with a diagnosed radiological lateral Cobb angle ≥10°, and 3,987 control subjects with a Cobb angle <10° were randomly selected from the screening system. Adolescents were accessed with demographic information and incorrect posture measured by visual inspection of physical signs, Adam's forward bending test (FBT), and the angle of trunk rotation (ATR). Logistic regression (LR) models were used to examine the associations.Results: Multivariate LR showed that shoulder-height difference, scapula tilt, lumbar concave, and pelvic tilt were associated with AIS. Adolescents with angle of thoracic rotation ≥5° [adjusted odds ratio (AOR) = 5.33–14.67, P < 0.001], thoracolumbar rotation ≥5° (AOR = 4.61–5.79, P < 0.001), or lumbar rotation ≥5° (AOR = 7.49–7.85, P < 0.001) were at especially higher risk for AIS than those with ATR <5°.Conclusions: Incorrect posture may be the potential risk factor for developing AIS, and ATR ≥5° was an important indicator for predicting the occurrence of scoliosis. Early monitoring of incorrect posture for school adolescents should be considered as a routine intervention to effectively identify the progress of scoliosis.

Incidence of scoliosis among junior high school students in Zhongshan city, Guangdong and the possible importance of decreased miR-30e expression.

ObjectiveWe investigated scoliosis incidence among junior high school students in Zhongshan city, Guangdong, China and the expression of miR-30e among those with scoliosis.MethodsA total 41,258 students were included. From July 2015 to December 2017, all students underwent screening including routine observation of the standing and sitting posture, Adam's forward bend test, dorsal tilt angle measurement, and X-ray examination. Age, sex, height, weight, and body mass index (BMI) were recorded. Reverse transcription-quantitative polymerase chain reaction was used to assess miR-30e expression among students with scoliosis and 200 healthy students.ResultsOverall, 743 students were diagnosed with scoliosis, with an incidence rate of 1.80%. A total 646 (86.9%) students were diagnosed with idiopathic scoliosis, 38 (5.1%) with congenital scoliosis, and 59 (7.9%) with other scoliosis types. Compared with healthy students, height was significantly greater whereas weight and BMI were significantly lower among students with scoliosis, and expression of miR-30e was significantly lower. However, no significant difference was found in height, weight, BMI, and mean Cobb angle between high/low miR-30e groups.ConclusionThe incidence rate for scoliosis was 1.80%, Compared with healthy students, those with scoliosis were taller, had lower weight and BMI, and miR-30e expression was significantly downregulated.

Evaluation of Adam's Forward Bend Test and Smartphone Application in Screening of Adolescent Idiopathic Scoliosis

Evaluation of Adam's Forward Bend Test and Smartphone Application in Screening of Adolescent Idiopathic Scoliosis

Patterns of coronal curve changes in forward bending posture: a 3D ultrasound study of adolescent idiopathic scoliosis patients.

The Adam's forward bending test is the most commonly used approach to assess the spine deformity in adolescent idiopathic scoliosis (AIS) patients. However, there are noticeable differences in the hump appearance from standing to forward bending. This phenomenon has yet to be understood due to limitations of conventional radiographs. This study aimed to investigate effects of postural change in the spine deformity in the coronal plane of AIS patients using a 3D ultrasound imaging system. This was a prospective study that recruited 72 AIS patients at a single institute. All patients were scanned twice in the sitting and sitting forward bending postures. A coronal ultrasound image showing the spinal curvature was generated after each scan and the spinous process angle (SPA) representing the deformity was manually measured from it. Correlation of SPAs under sitting and sitting forward bending postures was analyzed. In the comparison test, it was noted that there were three types of spine profile alternation after the postural change. In types I and II, the SPA angle numbers were the same before and after forward bending and only SPA values changed. In type III, the two curvatures were changed to one curvature in the forward bending posture. Moderate correlation was observed between the angles obtained in the two postures (r = 0.55, p < 0.001). Spine deformities of AIS patients vary with different postures. The patterns of changes in sitting and sitting forward bending postures are highly subject dependent. These slides can be retrieved under Electronic Supplementary Material.

Comparing Anthropometric Characteristics of Normal Versus Scoliotic Girl Students in Guidance School

Background: Postural deformities are disabling complications emerging at the early years of life. Therefore, the purpose of this research was to study the frequency of scoliosis condition in guidance schools of the city of Kashan and compare their anthropometric characteristics with the normal counterparts. Methods: This was cross-sectional study including 604 females at guidance-school to determine the frequency of scoliosis in the city of Kashan. Adam's forward bend test was employed to identify the cases of disorder. Descriptive statistics and Independent t-test were used to analyze the data. Results: The result of examining 604 guidance school females showed that 108 (17.9%) female students had scoliosis deformity and 496 (82.1%) were normal. The result suggested that there was a significant difference between the height, weight, waist, waist/hip ratio (WHR) and Body Mass Index (BMI) of normal females compared to the scoliotic female student (P ≤ 0.05). Conclusions: It was concluded that a considerable proportion of females were suffering from scoliosis deformity and their anthropometric factors were in poorer condition compared to normal individuals. Therefore, early identification of scoliosis may significantly improve the effectiveness of treatment and rehabilitation.

Comparing Anthropometric Characteristics of Normal Versus Scoliotic Girl Students in Guidance School

Background: Postural deformities are disabling complications emerging at the early years of life. Therefore, the purpose of this research was to study the frequency of scoliosis condition in guidance schools of the city of Kashan and compare their anthropometric characteristics with the normal counterparts. Methods: This was cross-sectional study including 604 females at guidance-school to determine the frequency of scoliosis in the city of Kashan. Adam's forward bend test was employed to identify the cases of disorder. Descriptive statistics and Independent t-test were used to analyze the data. Results: The result of examining 604 guidance school females showed that 108 (17.9%) female students had scoliosis deformity and 496 (82.1%) were normal. The result suggested that there was a significant difference between the height, weight, waist, waist/hip ratio (WHR) and Body Mass Index (BMI) of normal females compared to the scoliotic female student (P ≤ 0.05). Conclusions: It was concluded that a considerable proportion of females were suffering from scoliosis deformity and their anthropometric factors were in poorer condition compared to normal individuals. Therefore, early identification of scoliosis may significantly improve the effectiveness of treatment and rehabilitation.

A Systematic Review of All Smart Phone Applications Specifically Aimed for Use as a Scoliosis Screening Tool.

The scoliometer is an inclinometer commonly used in scoliosis screening. The device is used during an Adam's forward bend test, in which a patient bends forward at the hips to measure deformity of the rib cage and spinal column. If a sufficient angle of rotation is measured, then the appropriate referrals and x-rays can be made and taken. This ubiquitous screening tool allows for a quick and simple scoliosis screening and is a mainstay of scoliosis management. With the advent and rapid improvement of smart phone technology, many scoliometer applications have become readily accessible. Our study was designed to test the accuracy, precision, and calibration of several scoliometer applications available on both the Apple iPhone and Samsung Galaxy platforms. Application cost was also analyzed to assess the plausibility of using a smartphone scoliometer application in place of a traditional scoliometer in a traditional scoliosis screening. Our data show that available smart phone applications can be used effectively and that, in a controlled environment, some applications performed better than a traditional scoliometer. Application price was not correlated with effectiveness; the cost-free application performed better than the for-purchase application.

Discrepancy between self-awareness and actual diagnosis and treatment of the conditions among adolescent with scoliosis in middle-school age.

[Purpose] The purpose of this research was to determine the awareness of the actual conditions of the diagnosis and treatment of scoliosis by focusing on middle-school students in order to provide a basis for active education and treatment of scoliosis. [Subjects and Methods] The survey was conducted among 4,782 students. The students performed Adam’s forward bend test, and some of the students who showed predictive features of scoliosis were further examined for the spine structure with rasterstereography. [Results] The proportion of students with awareness about scoliosis appeared to be 71.47%. Among the students, 50.84% knew the definition of scoliosis and 4.37% were diagnosed as having scoliosis, of whom 46.37% underwent treatment. It was a significant difference between to get a diagnosis and the predictive scoliosis or the scoliosis. [Conclusion] The results showed that the students in the second grade of middle school had high awareness levels, but about 50% of them did not know the definition of scoliosis. More than 50% of them did not receive treatment after diagnosed as having scoliosis. Therefore, active education and school screening for scoliosis should be provided to adolescent students.

Epidemiological study of adolescent idiopathic scoliosis in Eastern China.

Previous epidemiological studies of adole-scent idiopathic scoliosis in mainland China have had diverse results. The aim of this cross-sectional study was to determine the epidemiology of adolescent idiopathic scoliosis based on a representative sample city, Wuxi, in eastern China. Primary and secondary school students aged 10-16 years were enrolled in the study. Physical examination and Adam's forward bending test, combined with scoliometer measurements were performed at school-based screening. Students with an angle of trunk inclination of 5° or more were referred for whole-spine X-ray. The threshold for confirmed diagnosis was a Cobb angle of 10° or more. A total of 79,122 students were screened. The overall prevalence of adolescent idiopathic scoliosis in Wuxi City was estimated as 2.4%. Girls had a higher prevalence in each age subgroup compared with boys. Higher prevalence was found in individuals with lower body mass index. Mild and moderate curves were the most common types in our study. The prevalence of adolescent idiopathic scoliosis in this region was slightly higher. Medical resources should be considered for children with lower body mass index and high risk of scoliotic progression. Measurement with a scoliometer would be suitable for mild-to-moderate scoliotic deformities, while alternative methods should be developed for those with severe deformities or higher body mass index.

Severe axial vertebral rotation treated with a modified Boston brace: a case report

We report the case of a 13-year-old Caucasian girl suffering from severe axial rotation of the T5 to L4 vertebrae. The patient (initially examined during a school screening study) was at first considered to be suspicious of suffering from scoliosis due to a highly positive Adam's forward bending test. However, her radiographic evaluation revealed the existence of axial rotation in 12 of her vertebrae, without inclination in the sagittal and coronal planes. After an observation period of 12 months and due to the fact that both her physical appearance and the measured vertebral rotation deteriorated, the patient was given a modified thoracolumbar Boston brace that had an immediate positive derotational effect on all but two vertebrae. Twenty four months later, the progress of the vertebral rotation(s) seems to have been halted and most affected vertebrae appear to be stabilized in their new, 'post-brace', reduced position, with better results shown when the Boston brace is worn. The patient remains under constant medical observation. The application of a modified Boston brace seems to have served well (so far) a useful purpose for reducing and stabilizing this case of severe axial vertebral rotation, providing less deformity and (possibly) offering a better final cosmetic result.