PRNY, PC
Scoliosis Specific Exercise Program
Schroth-based
SRS and SOSORT guidelines lead the evidence based program.
SOSORT guidelines, due to the non-surgical component have a more extensive outline of bracing, physical therapy, combinations and general sports.
PRNY therapists have years of significant advance training and certification in neurological development in addition to the BSPTS certifications for SSEs. This allows us to maximize the evaluation of individual patients to include their neuromotor presentations, including tone, hypermobility, and motor learning strengths and impairments. We have found this component of SSEs to be critical when individualizing patient treatment plan and prognosis.
Current Protocols:
AIS
0-10Cobb - screening every 1-3 months depending on age, family hx. Screening must include rotational measurements and postural assessments. Ideally formetric measurements if feasible. A 2-D x-ray only is not recommended as early rotational anomalies may not be detected by x-rays.
10-20Cobb – continue with screening. Begin SSEs for general postural education and self corrections. Full SSE training is described and offered for families.
20-50Cobb – Recommendations are for full SSE program training. HEP recommendations are 5x/wk for 30-45min till skeletal maturity. Specific training for exercises within a 3-D brace such as Rigo-Cheneau or now available in NY by Grant Wood CPO the Wood Cheneau Rigo (WCR)., and Ortholutions.
Regular monitoring of brace, compliance, and communication with CPO/MD.
>50Cobb – SSE program is provided with direct communication with surgeon. Patient and family are educated on long term risks of progression beyond skeletal maturity. Patient/family sign off on receiving this education.
Pre-surgical SSE training is available with direct communication with surgeon.
Post-surgical SSE training is modified and available with direct communication with surgeon.
Full SSE training is recommended at frequency of 2hrs per day/5days per week/2weeks for total of 20 hours.
Follow up sessions are 1 hr at a frequency to be determined by therapist/patient level of independence/family.
Currently our patients have been receiving a treatment for a range of 25-35 hours total.
We have found clinically that the intensive model maximizes the motor learning and neuro-re-education that is necessary for this complex program. There are factors that may limit this model and modifications are regularly offered. These factors include, patient tolerance, size of progression risk window based on skeletal maturity, geography, or financial resources.
ADULT SCOLIOSIS
0-50Cobb without pain, degenerative or sagital modifiers (BSPTS curriculum). - Full SSE training at general frequency of 1-3xs per week for 1hr each.
>50Cobb without pain, degenerative or sagital modifiers (BSPTS curriculum). -Full SSE training is available with direct communication with ortho MD. Patient signs off on education of progression risks with age. 1-3xs per week. Sessions are 1 hr.
0-50Cobb with pain and/or presence of modifiers. -Full SSE training is available with communication with ortho MD. External traction via belts and hangs are modified for individual patients. 1-3x/wk for 1hr ea
>50Cobb with pain and/or presence of modifiers. – SSE training is modified and performed with communication with MD. External traction via belts and long hang are eliminated.
Individual patient evaluation may result in therapy POC modification from these general protocols.
Adult bracing has been utilized by a few patients in this clinic as a tool for pain/postural endurance/ ADL and activity management. Currently only the 3-D braces have been integrated into our adult population.
EOS/SPECIAL NEEDS
Due to advanced neuro-Development training and certification within our staff, PRNY is able to modify scoliosis specific exercise for younger learners and special needs population. Individual evaluation and team consults with family and lead surgeons are required.
PRNY, PC Positions.
The following areas may deviate from SRS/SOSORT published guidelines.
Sports/Activities- general participation in school gym and social activities is encouraged. Mass practiced sports or competitive level sports are individually evaluated for general bio-mechanics that may detract from the SSE training. Modifications to activity mechanics and/or frequency are introduced in cooperation with patient/family and coaches if need be, this includes Yoga or Pilates.
Psycho-Social assistance is highly recommended. Professional mental health providers are skilled at providing support and care to this chronic condition during child and adolescent development.
The Curvy Girls is a non-profit international support group with many US state chapters. We fully support this organization including vending/lecturing/conference attendance/ and Marissa Muccio PT is the official PT for their blog in “Ask the PT”.
The utilization of soft braces for scoliosis is not recommended at this facility.
Massage therapy is approved.
Chiropractic, acupuncture, or other ancillary treatments are at the patient/family discretion with the note that there is no current research that has identified its benefits of scoliosis. We remain open to research information that may progress in these or other areas.
