Berdishevsky Hagit, Lebel Victoria Ashley, Bettany-Saltikov Josette, Rigo Manuel, Lebel Andrea, Hennes Axel, Romano Michele, Białek Marianna, M'hango Andrzej, Betts Tony, de Mauroy Jean Claude, Durmala Jacek
Conservative Care for Spine and Scoliosis, ColumbiaDoctors Midtown, Columbia University Medical Center, New York, NY USA.
Saba University School of Medicine, Saba, Dutch Caribbean Netherlands.
Scoliosis Spinal Disord. 2016 Aug 4;11:20. doi: 10.1186/s13013-016-0076-9. eCollection 2016.
In recent decades, there has been a call for change among all stakeholders involved in scoliosis management. Parents of children with scoliosis have complained about the so-called "wait and see" approach that far too many doctors use when evaluating children's scoliosis curves between 10° and 25°. Observation, Physiotherapy Scoliosis Specific Exercises (PSSE) and bracing for idiopathic scoliosis during growth are all therapeutic interventions accepted by the 2011 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). The standard features of these interventions are: 1) 3-dimension self-correction; 2) Training activities of daily living (ADL); and 3) Stabilization of the corrected posture. PSSE is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery. The model is oriented to the patient. Diagnosis and patient evaluation is essential in this model looking at a patient-oriented decision according to clinical experience, scientific evidence and patient's preference. Thus, specific exercises are not considered as an alternative to bracing or surgery but as a therapeutic intervention, which can be used alone or in combination with bracing or surgery according to individual indication. In the PSSE model it is recommended that the physical therapist work as part of a multidisciplinary team including the orthopeadic doctor, the orthotist, and the mental health care provider - all are according to the SOSORT guidelines and Scoliosis Research Society (SRS) philosophy. From clinical experiences, PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, more than a year after passing the peak of growth. In non-progressive scoliosis, the regular practice of PSSE could produce a temporary and significant reduction of the Cobb angle. PSSE can also produce benefits in subjects with scoliosis other than reducing the Cobb angle, like improving back asymmetry, based on 3D self-correction and stabilization of a stable 3D corrected posture, as well as the secondary muscle imbalance and related pain. In more severe cases of thoracic scoliosis, it can also improve breathing function. This paper will discuss in detail seven major scoliosis schools and their approaches to PSSE, including their bracing techniques and scientific evidence. The aim of this paper is to understand and learn about the different international treatment methods so that physical therapists can incorporate the best from each into their own practices, and in that way attempt to improve the conservative management of patients with idiopathic scoliosis. These schools are presented in the historical order in which they were developed. They include the Lyon approach from France, the Katharina Schroth Asklepios approach from Germany, the Scientific Exercise Approach to Scoliosis (SEAS) from Italy, the Barcelona Scoliosis Physical Therapy School approach (BSPTS) from Spain, the Dobomed approach from Poland, the Side Shift approach from the United Kingdom, and the Functional Individual Therapy of Scoliosis approach (FITS) from Poland.
近几十年来,参与脊柱侧弯治疗的所有利益相关者都呼吁做出改变。脊柱侧弯患儿的家长抱怨,太多医生在评估10°至25°的儿童脊柱侧弯曲线时采用所谓的“观察等待”方法。观察、物理治疗性脊柱侧弯特定运动(PSSE)以及在生长期间对特发性脊柱侧弯进行支具治疗,都是2011年国际脊柱侧弯矫形与康复治疗协会(SOSORT)认可的治疗干预措施。这些干预措施的标准特点是:1)三维自我矫正;2)日常生活活动训练(ADL);3)矫正姿势的稳定。PSSE是脊柱侧弯护理模式的一部分,该模式包括脊柱侧弯特定教育、脊柱侧弯特定物理治疗运动、观察或监测、心理支持与干预、支具治疗和手术。该模式以患者为导向。在这个模式中,根据临床经验、科学证据和患者偏好进行以患者为导向的决策时,诊断和患者评估至关重要。因此,特定运动不被视为支具治疗或手术的替代方法,而是一种治疗干预措施,可根据个体指征单独使用或与支具治疗或手术联合使用。在PSSE模式中,建议物理治疗师作为多学科团队的一员开展工作,该团队包括骨科医生、矫形师和心理健康护理人员——所有这些都符合SOSORT指南和脊柱侧弯研究协会(SRS)的理念。从临床经验来看,PSSE可以在生长高峰期过后一年多的进展中期暂时稳定进行性脊柱侧弯曲线。在非进行性脊柱侧弯中,定期进行PSSE可以使Cobb角暂时显著减小。PSSE除了减小Cobb角外,还能给脊柱侧弯患者带来其他益处,比如基于三维自我矫正和稳定的三维矫正姿势,改善背部不对称,以及继发性肌肉失衡和相关疼痛。在更严重的胸椎脊柱侧弯病例中,它还可以改善呼吸功能。本文将详细讨论七所主要的脊柱侧弯治疗学派及其PSSE方法,包括它们的支具技术和科学证据。本文的目的是了解和学习不同的国际治疗方法,以便物理治疗师能够将每种方法的最佳之处融入自己的实践中,从而尝试改善特发性脊柱侧弯患者的保守治疗。这些学派按照其发展的历史顺序呈现。它们包括法国的里昂方法、德国的卡塔琳娜·施罗斯·阿斯克勒庇俄斯方法、意大利的脊柱侧弯科学运动方法(SEAS)、西班牙的巴塞罗那脊柱侧弯物理治疗学派方法(BSPTS)、波兰的多博梅德方法、英国的侧移方法以及波兰的脊柱侧弯功能个体治疗方法(FITS)。