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Global postural re-education in pediatric idiopathic scoliosis: a biomechanical modeling and analysis of curve reduction during active and assisted self-correction

Sarah Dupuis, Carole Fortin, Christiane Caouette, Isabelle Leclair and Carl-Éric Aubin

Article (2018)

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Abstract

BACKGROUND: Global postural re-education (GPR) 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 degrees ) 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. A stiffness index was defined for each posture as the global force required to stay in the posture divided by the thoracic curve reduction (force/Cobb angle reduction). RESULTS: The average force applied by the therapist during manual correction was 31 N and resulted in a simulated average reduction of 26% (p < 0.05), while kyphosis slightly increased and lordosis remained unchanged. The actual self-correction reduced the thoracic curve by an average of 33% (p < 0.05), while the lumbar curve remained unchanged. The thoracic kyphosis and lumbar lordosis were reduced on average by 6 degrees and 5 degrees (p < 0.05). Self-correction simulations correlated with actual self-correction (r = 0.9). CONCLUSIONS: This study allowed quantification of thoracic curve reducibility obtained by external forces applications as well as patient's capacity to self-correct their posture, two corrections commonly used in the GPR approach.

Uncontrolled Keywords

Biomechanical modeling; Finite element model; Global postural re-education; Scoliosis

Subjects: 1900 Biomedical engineering > 1900 Biomedical engineering
2500 Electrical and electronic engineering > 2500 Electrical and electronic engineering
9000 Health sciences > 9000 Health sciences
Department: Department of Mechanical Engineering
Funders: CRSNG/NSERC, Fonds de Recheche du Québec - Santé
PolyPublie URL: https://publications.polymtl.ca/3561/
Journal Title: BMC Musculoskeletal Disorders (vol. 19, no. 1)
Publisher: BioMed Central
DOI: 10.1186/s12891-018-2112-9
Official URL: https://doi.org/10.1186/s12891-018-2112-9
Date Deposited: 27 Mar 2020 08:24
Last Modified: 30 Sep 2023 19:37
Cite in APA 7: Dupuis, S., Fortin, C., Caouette, C., Leclair, I., & Aubin, C.-É. (2018). Global postural re-education in pediatric idiopathic scoliosis: a biomechanical modeling and analysis of curve reduction during active and assisted self-correction. BMC Musculoskeletal Disorders, 19(1). https://doi.org/10.1186/s12891-018-2112-9

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