Advances on Scoliogeny, Diagnosis and Management of Scoliosis and Spinal Disorders

This book contains research articles on the advances in the aetiology of idiopathic scoliosis (IS), the spinal growth related to the implementation of growth modulation for the surgical treatment of early-onset IS, the non-surgical treatment of IS using Physiotheraputic Scoliosis Specific Exercises, and braces. Additionally, it focuses on issues related to surgical treatment, issues related to body posture and the quality of life of this sensitive group of people. The high quality of published papers in this Special Issue of the JCM serve these objectives

Conception d’un modèle interprofessionnel d’interventions de soutien à l’adhésion au traitement par corset chez les adolescents atteints de scoliose idiopathique

Le port d’un corset orthopédique de 20 à 23 heures par jour est reconnu comme efficace pour prévenir la progression de la courbe chez les adolescents atteints de scoliose idiopathique, mais il engendre des conséquences biopsychosociales importantes qui perturbent leur quotidien et qui contribuent à un problème de non-adhésion au corset généralisé. En effet, le temps de port réel observé est d’environ 12 heures par jour. Il n’existe aucune intervention dans la littérature qui vise à améliorer l’adhésion au corset pour cette population spécifique. Le but de ce mémoire était de concevoir un modèle interprofessionnel d’interventions de soutien à l’adhésion au traitement par corset chez les patients atteints de scoliose idiopathique. Pour répondre à ce but, nous avons effectué des entrevues individuelles auprès de neuf professionnels d’expertises variées afin de comprendre leurs perspectives et leurs stratégies potentielles pour soutenir les patients vers une meilleure adhésion au corset. Les entrevues ont été enregistrées, transcrites et codées. Nous avons procédé à l’analyse thématique des verbatim et conçu le modèle d’intervention résultant. Lors des entrevues, les participants ont relevé des barrières à l’adhésion au corset et au soutien professionnel ainsi que des stratégies fonctionnelles, éducatives, motivationnelles, psychologiques et interprofessionnelles pour répondre à ces barrières. Le modèle a été validé par un panel d’experts cliniques. Le modèle d’intervention Interprofessionnel en Soutien à l’Adhésion (IPSA) au traitement par corset est structuré en trois paliers (préparation au corset, ateliers de groupe et consultation individuelle) et nous estimons qu’il a un grand potentiel d’implantation en clinique de scoliose.Wearing a spinal brace between 20 to 23 hours a day is recognized as effective to prevent curve progression in adolescents with idiopathic scoliosis, but it generates important biopsychosocial consequences that disturb patients’ daily activities and that contribute to the generalized problem of brace nonadherence. Indeed, the observed time spent in-brace is approximately 12 hours a day. A thorough review of the literature could not yield any intervention to enhance brace adherence for this specific population. The purpose of this master’s thesis is to develop an interprofessional support intervention model to enhance brace adherence in adolescents with idiopathic scoliosis. To fulfill this purpose, we have conducted individual interviews with 9 professionals of various expertise in order to understand their perspectives and their potential strategies to support patients towards better brace adherence. The interviews were audiotaped, transcribed and coded. We proceeded to a thematic analysis of the interview transcripts, which resulted in the intervention model. During the interviews, participants mentioned adherence barriers to brace treatment and professional support barriers as well as functional, educational, motivational, psychological and interprofessional teamwork strategies for answering these issues. The model was reviewed by an expert panel of clinicians. The Interprofessional Adherence Support intervention model (IPAS) to brace treatment is three-tiered to provide different levels of intensity of support to patients (brace preparation, group workshops and one-on-one consultations) and has great potential for implementation in clinical practice

Modélisation physique des tissus mous du tronc scoliotique pour la simulation de l'apparence post-chirurgicale

RÉSUMÉ La scoliose idiopathique de l'adolescence (SIA) est une déformation tridimensionnelle complexe de la colonne vertébrale et de la cage thoracique. Dans le cas de déformation sévère, le recours à la chirurgie correctrice de la colonne vertébrale est requis comme moyen de traitement. Environ un patient sur mille atteint de SIA aura à subir une chirurgie correctrice de la colonne vertébrale. Cependant, dans la plupart des cas, une correction optimale de la colonne vertébrale n'entraine pas nécessairement une correction optimale de l'apparence externe. Une asymétrie du tronc peut persister à l'issue de la chirurgie et cela est difficile à prédire par les chirurgiens. Cela est problématique, car l'apparence externe est un facteur important de satisfaction pour les patients. Il serait intéressant de disposer d'outils d'assistance à la planification de chirurgie pour la scoliose prenant en compte les attentes du patient concernant l'esthétique de l'apparence du tronc. La simulation médicale sur ordinateur est devenue un outil important d'assistance à la prise de décision clinique. Elle est utilisée pour permettre de prédire et analyser les effets de traitements médicaux, ainsi que la prédiction de changements anatomiques dus à l'évolution d'une pathologie. Dans le contexte de la chirurgie pour la scoliose, des simulateurs de chirurgie correctrice de la colonne vertébrale existent. Des modèles biomécaniques pour la simulation de l'instrumentation de la colonne vertébrale en chirurgie de la scoliose ont été développés par différents chercheurs. Toutefois, ceux-ci ne prédisent pas la forme externe du tronc après chirurgie. De cet état des choses, découle la problématique et les objectifs de cette thèse: modéliser le tronc scoliotique en vue de la simulation de la forme postopératoire du tronc, et améliorer la précision des prédictions afin de proposer une stratégie opératoire optimale. La question de recherche abordée dans cette thèse concerne le développement de méthodes pour la simulation et la prédiction de la forme post-opératoire du tronc en chirurgie pour la scoliose. Quatre objectifs spécifiques de recherche ont été définis. La première partie du travail (traitant du premier objectif) a consisté à développer un modèle physique de déformation pour le tronc scoliotique. Contrairement au modèle existant, un nouveau modèle physique de déformation incrémentale est proposé pour tenir compte des grandes déformations du tronc. L'inspection qualitative des surfaces de tronc simulées et réelles montre une bonne approximation de la correction de la gibbosité. L'évaluation quantitative de la simulation est basée sur l'indice de rotation de la surface du dos (indice BSR). Il se définit comme l'angle formé par la double tangente du côté postérieur de chaque section horizontale de la surface du tronc et l'axe passant par les épines iliaques antéro-supérieures (ASIS) projeté sur le plan frontal. Les valeurs d'indices BSR, mesurées à différents niveaux vertébraux, montrent une erreur moyenne de 1.20º (± 0.73) à 3.20º (± 0.83) dans la région thoracique, indiquant un accord entre les troncs prédits et les données réelles. La deuxième partie (regroupant les trois autres objectifs spécifiques) a consisté à améliorer la précision des prédictions. Nous proposons deux méthodes de détermination de formes à priori de tronc postopératoire (soit basé sur une prédiction statistique, soit basé sur une prédiction de type proche voisin). Ces outils exploitent l'intuition de choisir la restriction du champ de déplacement à la frontière du domaine du tronc (la surface externe) comme une première approximation de la déformation du tronc. La réalisation des objectifs de cette recherche est à l'origine de contributions originales à l'état de l'art aussi bien en simulation physique de tissus mous qu'en apprentissage machine pour l'analyse de formes. Ce projet propose une nouvelle méthode de modélisation des déformations de tissus mous du tronc scoliotique pour la simulation de l'apparence postopératoire. Cette méthode présente, ainsi, l'avantage de constituer un outil pour les systèmes de planification par ordinateur de traitement chirurgical de la scoliose. En perspective, des études complémentaires sont suggérées pour surmonter certaines limitations des méthodes proposées. En particulier, l'incorporation d'un modèle du tronc obtenu par une fusion multimodale d'images (IRM/RX/TOPO) de patients scoliotiques, pour une meilleure personnalisation géométrique, devrait conduire à une amélioration de la précision de la simulation.----------ABSTRACT Adolescent Idiopathic scoliosis (AIS) is a complex three-dimensional deformation of the spine and rib cage. In case of severe spine deformity, a spine surgery is required as a treatment. Approximately one in a thousand patients suffering from AIS will have a spine surgery. However, in most cases, an optimal correction of the spine does not necessarily results in an optimal correction of the external appearance. A trunk asymmetry may persist after surgery and it is difficult to predict by surgeons. This is problematic because the external appearance is one of the most important factor for the patient satisfaction. It would be interesting to have available computer based scoliosis surgery planning assistance tools that takes into account the expectation of the patient regarding the aesthetics of the trunk appearance. Computer based medical simulation is becoming an important tool to support clinical decision making. It is used to predict and analyze the effects of treatments, as well as the predictions of changes due to pathology evolution. In the context of scoliosis surgery, spine correction surgery simulators exist. Biomechanical models for the simulation of the spine instrumentation in scoliosis surgery have been developed by different researchers. However, they do not simulate the postoperative appearance of the trunk. From this observation arise the problem and objectives of this thesis: modeling the scoliotic trunk in order to simulate the postoperative trunk shape, and improve predictions accuracy in order to propose an optimal surgery strategy. The research question of this thesis concerns the development of methods for the simulation and the prediction of the trunk postoperative shape in scoliosis surgery. Four research objectives have been defined. The first part of this work (dealing with the first objective) consisted in developing a physically based deformation model of the scoliotic trunk. Unlike the existing model, a novel incremental approach is proposed to take into account large deformations of the trunk. The qualitative visual inspection of the simulated and actual trunk surfaces show a good approximation of the correction of the rib hump. The quantitative evaluation of the simulation is based on the back surface rotation index (BSR index). It is defined as the angle formed by the dual tangent to the posterior side of each section of the trunk surface and the axis passing through the patient's anterior superior iliac spines (ASIS), projected onto the axial plane. The BSR indices, measured at different vertebral levels, shows an average error in the range of 1.20º (± 0.73) to 3.20º (± 0.83$) in the thoracic region, indicating a good agreement between the predicted and actual trunk surfaces. The second part (dealing with the remaining three objectives) addressed the prediction accuracy improvement. In this regard, two tools have been developed: one for predicting 3D trunk shapes based on a statistical approach, and the other being a prediction tool based on nearest neighbor methods. These tools make use of the intuition of choosing the restriction of the displacement field on the trunk domain boundary (the external surface) as a first approximation of the trunk deformation. The achievement of the research objectives has resulted in original contributions to the state of the art in physical simulation of soft tissues as well as in machine learning for shape analysis. This project proposes a novel method for modeling scoliotic trunk soft tissue deformation for the simulation of the postoperative appearance. This method has, thus, the advantage of being a potential tool for computer based scoliosis surgery planning systems. As perspectives, further research studies may be suggested in order to overcome the limitations of the proposed methods. In particular, the incorporation of a trunk model obtained from a multimodal image fusion (MRI / RX / TOPO) for a better personalization of the physical constants may lead to the improvement of the simulation accuracy

Analysis of the backpack loading efects on the human gait

Gait is a simple activity of daily life and one of the main abilities of the human being. Often during leisure, labour and sports activities, loads are carried over (e.g. backpack) during gait. These circumstantial loads can generate instability and increase biomechanicalstress over the human tissues and systems, especially on the locomotor, balance and postural regulation systems. According to Wearing (2006), subjects that carry a transitory or intermittent load will be able to find relatively efficient solutions to compensate its effects.info:eu-repo/semantics/publishedVersio

Respiratory mechanics during upper body exercise in healthy humans

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonThe physiological responses to upper-body exercise (UBE) are well established. Few published studies, however, have attempted to elucidate the mechanical ventilatory responses to UBE. There is empirical evidence that respiratory function may be compromised by UBE during which the ventilatory and postural functions of the ‘respiratory’ muscles may be exacerbated. Therefore, the aims of this thesis were: 1) to characterise the mechanical-ventilatory responses to UBE in healthy subjects; 2) to explore the putative mechanisms that underpin the respiratory responses to UBE; and 3) to assess whether the mechanical-ventilatory stress imposed by UBE induces contractile fatigue of the respiratory muscles. Compared to lower-body exercise (LBE; leg cycling) at ventilation-matched work rates, UBE (arm-cranking) resulted in constraint of tidal volume, higher respiratory frequency, and greater neural drive to the respiratory muscles. Furthermore, end-expiratory lung volume was significantly elevated during peak UBE compared to LBE (39 ± 8 vs. 29 ± 8% vital capacity, p 0.05). In conclusion, mechanical-ventilatory function may be compromised during UBE due to complex interactions between thoracic muscle recruitment, central neural drive and thoracic volume displacement. This thesis presents novel findings which may have important functional implications for clinical populations who report breathlessness during activities of daily living that involve the upper-body, as well a

Virtuální rekonstrukce, její význam a přínos k paleobiologickému studiu fosilního člověka

Zachovalost kosterního materiálu je hlavní překážkou paleoantropologických studií. Virtuální metody se od 90. let 20. století staly důležitou součástí antropologického výzkumu, přičemž značně pomáhají překonat problémy zachovalosti, a to dvěma hlavními způsoby: zlepšují extrakci informací z fragmentárního materiálu a umožňují objektivnější rekonstrukci fragmentárních a nekompletních nálezů. Tato práce se zaměřila na virtuální rekonstrukci dvou fosilních nálezů: lebky moderního člověka Zlatý kůň (ZK; Česká republika) ze svrchního paleolitu a neandertálské pánve Regourdou 1 (R1) z Francie. Rekonstrukce lebky ZK nám umožnila revidovat pohlavní diagnózu a analyzovat její morfologickou afinitu. Na základě sekundární pohlavní diagnózy byl jedinec ZK s vysokou pravděpodobností žena a lebka vykazuje afinitu k rané svrchně paleolitické populaci. Pánev R1 vykazuje značnou asymetrii, která byla nejprve analyzována na křížové kosti v porovnání se zdravými moderními lidmi a neandertálci. Asymetrie výrazně překračuje variabilitu pozorovanou v současné populaci a mohla souviset s asymetrickým přenosem zátěže. Výrazná asymetrie byla proto zohledněna při následné rekonstrukci pánve, která nám umožnila posoudit pohlaví jedince a analyzovat transverzální rozměry pánevního kanálu a orientaci křížové kosti. Na základě...Preservation is a major obstacle in paleoanthropological studies. Since 1990s virtual methods have become an important part of anthropological research helping to overcome preservation problems in two principle ways: they improve extraction of information from a fragmentary material, and they permit a more objective reconstruction of fragmentary and incomplete remains. This thesis has focused on the virtual reconstruction of two fossil specimens: the modern human cranium from the Upper Paleolithic site of Zlatý kůň (ZK; Czech Republic) and the Neandertal Regourdou 1 (R1) pelvis (France). The reconstruction of the ZK cranium allowed us to revise sex attribution and analyze morphological affinity. Based on the secondary sex diagnosis, the ZK individual was most probably a female and exhibits a great affinity to Early Upper Paleolithic population. The R1 pelvis shows considerable asymmetry that was first analyzed on the sacrum in comparison with healthy modern humans and Neandertals. The asymmetry exceeds normal variation observed in the extant population and could have related to asymmetrical load dissipation. Therefore, the asymmetry was considered in the subsequent preliminary pelvic reconstruction which allowed us to assess sex of the individual and to analyze transverse dimensions of the pelvic...Katedra antropologie a genetiky člověkaDepartment of Anthropology and Human GeneticsPřírodovědecká fakultaFaculty of Scienc

Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients