Effect of PSSE on Plantar Pressure Distribution and Balance in Scoliosis

The main aim of the study is to investigate the effect of Physiotherapeutic Scoliosis-Specific Exercises (PSSE) on Plantar Pressure Distribution and Balance in Adolescent Idiopathic Scoliosis (AIS). Twenty-four patients with AIS will randomly allocated to two groups. 'Schroth' exercises will apply to the PSSE group for 8 weeks (16 sessions). The control group will teach basic elements. Patients' maintenance of posture during both static and dynamic conditions (Biodex Balance System SD), distribution of foot pressure (Baropedometric Platform), foot posture (Foot Posture Index), frontal-sagittal plan posture (PostureScreen Mobile Application), body symmetry (Anterior Trunk Asymmetry Index and Posterior Trunk Asymmetry Index), deformity perception (The Walter Reed Visual Assessment Scale), quality of life (Pediatric Quality of Life Scale and SRS-22), spinal pain (Visual Analogue Scale) will assess at the first session and at the end of 8 weeks.

Scoliosis is a complex 3-dimensional deformity of the spine characterized by rotation of the vertebra at least 10 degrees lateral deviation and a decrease in the normal kyphotic curvature of the spine. Although the etiology of adolescent idiopathic scoliosis (AIS) is unknown, it is the most common type of scoliosis that occurs in the period from the age of 10 until the skeletal development is completed.

It is reported in the literature that AIS is associated with balance dysfunction, vestibular system defect, proprioceptive disorder, and brain stem dysfunction. In visual, vestibular and somatosensorial systems responsible for postural control, central integration and motor response may be impaired in adolescent idiopathic scoliosis. It was also reported that the foot position and center of pressure was changed.

Postural stability can also be defined as maintaining an upright posture during standing. Different spinal deformities, such as scoliosis, can affect postural stability during upright and equilibrium activities. It has been reported that balance control problems seen in patients with AIS result from the relationship between body shape and body segments. Furthermore, lateral stability of these patients was found to be more inadequate when compared to their healthy counterparts.

Schroth method is a highly effective exercise method in adolescent idiopathic scoliosis. This method mainly focuses on the 3-dimensional scoliotic curvature formed by the combination of lateral, frontal and rotational deviation and tries to normalize the curvature of the spine by combining this curvature with stretching, strengthening and breathing exercises. It is seen that the 3D Schroth exercise method has a high effect on strength and chest expansion and also has an effect on Cobb angle, asymmetry, daily living activity, balance, vital capacity, pulmonary function and foot pressure.There are also studies showing that body weight transfer in AIS changes according to the level and shape of scoliotic curvature. However, the study investigating the effect of Schroth 3D exercises on changing body statics is quite limited and only one study found that Schroth exercises were more effective in weight distribution than Pilates exercises.

Eligibility Criteria:
Inclusion Criteria:

* To have diagnosis of Adolescence Idiopathic Scoliosis
* To be in between 10-17 years
* To be the Cobb angle which determined in Anteroposterior graphy as between 10-45 degree
* To not having any other exercise attitude about scoliosis before.

Exclusion Criteria:

* Spinal surgery or tumor history
* Accompanying mental, rheumatologic, neuromuscular, cardiovascular, pulmonary disease history
* Vision and / or hearing loss
* Disease history related to balance and vestibular system
* Injury or involvement of the lower extremities that may affect balance