Weiss H-R, Klein R
Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany.
Pediatr Rehabil. 2006 Jul-Sep;9(3):190-200. doi: 10.1080/13638490500079583.
Physiotherapy programmes so far mainly address the lateral deformity of scoliosis, a few aim at the correction of rotation and only very few address the sagittal profile. Meanwhile, there is evidence that correction forces applied in the sagittal plane are also able to correct the scoliotic deformity in the coronal and frontal planes. So it should be possible to improve excellence in scoliosis rehabilitation by the implementation of exercises to correct the sagittal deformity in scoliosis patients. An exercise programme (physio-logic exercises) aiming at a physiologic sagittal profile was developed to add to the programme applied at the centre or to replace certain exercises or exercising positions.
To test the hypothesis that physio-logic exercises improve the outcome of Scoliosis Intensive Rehabilitation (SIR), the following study design was chosen: Prospective controlled trial of pairs of patients with idiopathic scoliosis matched by sex, age, Cobb angle and curve pattern. There were 18 patients in the treatment group (SIR + physio-logic exercises) and 18 patients in the control group (SIR only), all in matched pairs. Average Cobb angle in the treatment group was 34.5 degrees (SD 7.8) Cobb angle in the control group was 31.6 degrees (SD 5.8). Age in the treatment group was at average 15.3 years (SD 1.1) and in the control group 14.7 years (SD 1.3). Thirteen of the 18 patients in either group had a brace. Outcome parameter: average lateral deviation (mm), average surface rotation ( degrees ) and maximum Kyphosis angle ( degrees ) as evaluated with the help of surface topography (Formetric-system).
Lateral deviation (mm) decreased significantly after the performance of the physio-logic programme and highly significantly in the physio-logic ADL posture; however, it was not significant after completion of the whole rehabilitation programme (2.3 vs 0.3 mm in the controls). Surface rotation improved at average 1.2 degrees in the treatment group and 0.8 degrees in the controls while Kyphosis angle did not improve in both groups.
The physio-logic programme has to be regarded as a useful 'add on' to Scoliosis Rehabilitation with regards to the lateral deviation of the scoliotic trunk. A longitudinal controlled study is necessary to evaluate the long-term effect of the the physio-logic programme also with the help of X-rays.
迄今为止，物理治疗方案主要针对脊柱侧弯的侧方畸形，少数旨在纠正旋转，仅有极少数涉及矢状面轮廓。与此同时，有证据表明，在矢状面施加的矫正力也能够纠正冠状面和额状面的脊柱侧弯畸形。因此，通过实施纠正脊柱侧弯患者矢状面畸形的锻炼，应该有可能提高脊柱侧弯康复的效果。制定了一项旨在实现生理性矢状面轮廓的锻炼方案（生理逻辑锻炼），以补充中心应用的方案或替代某些锻炼或锻炼姿势。
为检验生理逻辑锻炼可改善脊柱侧弯强化康复（SIR）效果这一假设，选择了以下研究设计：对特发性脊柱侧弯患者按性别、年龄、Cobb角和曲线类型进行配对的前瞻性对照试验。治疗组（SIR + 生理逻辑锻炼）有18例患者，对照组（仅SIR）有18例患者，均为配对。治疗组平均Cobb角为34.5度（标准差7.8），对照组Cobb角为31.6度（标准差5.8）。治疗组平均年龄为15.3岁（标准差1.1），对照组为14.7岁（标准差1.3）。两组18例患者中有13例佩戴支具。结果参数：借助表面地形测量（Formetric系统）评估的平均侧方偏差（毫米）、平均表面旋转（度）和最大后凸角（度）。
进行生理逻辑锻炼方案后，侧方偏差（毫米）显著降低，在生理逻辑日常生活姿势下显著降低；然而，整个康复方案完成后差异不显著（对照组为2.3对0.3毫米）。治疗组表面旋转平均改善1.2度，对照组改善0.8度，而两组后凸角均未改善。
就脊柱侧弯躯干的侧方偏差而言，生理逻辑方案必须被视为脊柱侧弯康复的一项有用的“补充”。有必要进行一项纵向对照研究，借助X射线评估生理逻辑方案的长期效果。
