Postural re-education
Background: Postural re-education 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. Methods: Finite 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.
Methods
Experimental study design
Patients A total of 17 patients diagnosed with pediatric IS, aged10.5 to 15.4 (one boy, 16 girls) and Risser sign 0 to 4,were recruited during their routine visit at our ortho-pedic clinic over a three months period. They all had aright thoracic major curve or a double major curve withright thoracic component, with a thoracic Cobb angleranging from 11° to 45° (average 33° ± 9°), analyticallymeasured between the perpendicular to the spine curveat its side change point near the end vertebrae. Their ap-ical thoracic vertebral rotation ranged from 22° to −6°(average 11° ± 9°), analytically measured using a 3D re-construction method using pedicles and vertebral bodyorientation. One patient was excluded because the thor-acic curve was less than 10°.
Experimental protocol
The recruited patients had their routine surface topog-raphy (InSpeck 3D Capturor, Creaform inc., Québec,Canada) and low dose biplanar radiographs (EOS™, EOSImaging, Paris, France) taken in the presenting standing(reference) posture. A therapist who was trained specif-ically for this study (co-author IL) by a certified GPRphysiotherapist (co-author CF) then performed the man-ual correction.
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