Effectiveness of Exercises in Adolescent Idiopathic Scoliosis
Condition: Adolescent Idiopathic Scoliosis
MeSH terms: Scoliosis
Study type: Interventional

Summary: 
      The aim of this study was to compare the effects of spinal stabilization and body awareness
      in addition to brace wearing versus classical exercises on subjective verticality perception,
      trunk symmetry and quality of life in AIS. Study included 30 AIS patients between the ages of
      14.40±201 years (stabilization group), 14.2±2 years (Body awareness) and 13.60±1.65
      (classical). Cobb angles, rotation, subjective visual (SVV), postural (SPV) and haptic (SHV)
      and deformity perception, quality of life were assessed at baseline and after 10th week of
      treatment. Cobb angle decreased in stabilization and awareness groups. Rotation decreased in
      three groups. SVV improved in all groups. SPV and SHV, body asymmetry and cosmetic deformity
      improved in stabilization and awareness groups. Only function improved with stabilization
      treatment. Stabilization and body awareness exercises created positive changes in AIS.
    

Detailed description: 
      In patients with idiopathic scoliosis (IS), in addition to curve progression there are many
      problems including altered posture, gait deviations, muscular imbalance, functional
      limitations, back pain, negative physico-social, body image effects, and in severe cases
      pulmonary symptoms commonly occur. To cope with these complications and more, conservative
      treatment of adolescent idiopathic scoliosis (AIS) involves a variety of bracing methods and
      exercises.

      Spinal bracing is an important treatment option to prevent curve progression in moderate
      curves (between 20-40) and severe curves in AIS. Bracing success rate is reported 80% in the
      long term but the level of evidence is still low.

      In literature, exercises are recommended to reduce progression, to improve spine and thoracic
      cage flexibility, muscle elasticity and strength, to correct postural behavior, and
      neuro-motor control, spine stability. In general, traditional exercises (TE) including
      stretching, strengthening exercises for spinal musculature, postural training, respiratory
      exercises have been used for many years for IS. Besides traditional exercises, there are
      several exercise concepts including SEAS, Schroth, Dobomed, Side Shift methods... etc.
      Effectiveness of exercise is still in debate and there is need for further studies, which
      investigate the role of specific exercises for scoliosis in conservative treatment.

      In scoliosis, muscle imbalances, the deficiency of muscle ability to stabilize posture, the
      loss in balance of pelvis-spine relation due to lateral tilt of the body and postural control
      impairment resulting from these problems are defined. In addition, the tree dimensional
      scoliotic deformity cause sensory disturbances, standing instability and gait modifications.
      Core stabilization exercises (CSE) are described as therapy technique that improve
      neuromuscular control, strength of trunk stabilization muscles, endurance of postural
      muscles, trunk mobilization muscles around spine, balance between pelvis and spine in order
      to maintain functional stability and postural control.

      It was indicated in the literature that patients with AIS exhibit disturbances of vertical
      perception. Postural vertical line is important for a person to perceive body orientation in
      space and thereby to provide and maintain upright posture and gait. Body Awareness Therapy
      (BAT) is a mind-body approach, which aims to improve body awareness, body posture, quality of
      movements, balance, postural control integrating with slow movement co-ordination and
      breathing exercises. BAT programs also contain stretching exercises, relaxing exercises and
      gait training. Patients are instructed to concentrate body vertical line and all movements
      are thought to initiate from body center. BAT have been studied in many medical conditions
      including back pain, anxiety, fibromyalgia, eating disorders, heart diseases, falls in
      elderly.

      However, there are limited studies determining CSE effects on patients with scoliosis: one
      have reported improvement in Cobb's angle and pain and the other in sitting balance with
      lumbar stabilization exercises. There was no research examining the effects of BAT in
      scoliosis. However for the reasons mentioned above, we hypothesized that CSE and BAT
      therapies can have positive effects on postural re-alignment and trunk deformity in patients
      with AIS. The aim of this study was to investigate the effects of core stabilization and body
      awareness exercises versus traditional exercises in addition to brace wearing on vertical
      perception, trunk asymmetry, cosmetic deformity and health related quality of life in
      patients with AIS.

      The aim of this study was to compare the effects of spinal stabilization and body awareness
      exercises in addition to brace wearing versus traditional exercises on subjective verticality
      perception, trunk symmetry, cosmetic deformity and health related quality of life in
      Adolescent idiopathic scoliosis (AIS). This study included 30 AIS patients between the ages
      of 14,40 ± 2,01 years (stabilization group), 14,2 ± 2 years (Body awareness group) ve 13,60 ±
      1,65 (classical group). Following recording demographic data, bone maturation level according
      to Riser, curve types according to King, spinal region, which includes curve, were recorded.
      Cobb angles by antero-posterior X-ray, rotation degrees with scoliometer in Adam's forward
      bend test, subjective visual (SVV), postural (SPV) and haptic (SHV) verticality perception
      with laser stick system, cosmetic deformity perception for patient, family and
      physiotherapist according with Walter Reed Visual Assessment Scale (WRVAS), trunk asymmetries
      with Posterior Trunk Asymmetry Index (POTSI) and health related quality of life with SRS-22
      were assessed at baseline and after 10th week of treatment.
    

Intervention name(s): body awareness therapy; core stabilization exercises; traditional exercises
Intervention type(s): Other; Other; Other
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: scoliosis, verticality perception, body symmetry