Neurophysiological basis of rehabilitation of adolescent idiopathic scoliosis

[Dr Kalla]

A great paper illustrating the need for daily training/exercising in order to efficiently treat scoliosis.

Neurophysiological basis of rehabilitation of adolescent idiopathic scoliosis.

Results. We considered several neurophysiological issues relevant for AIS rehabilitation, namely, the peculiar organization
of patterns of trunk muscle recruitment, the structure of the neural hardware subserving axial and arm muscle control, and
the relevance of cognitive systems allowing mapping of spatial coordinates and building of body schema.
Discussion and conclusion. We made clear the reason why trunk control is generally carried out by means of very fast,
feedforward or feedback driven patterns of muscle activation which are deeply rooted in our neural control system and very
difficult to modify by training. We hypothesized that augmented sensory feedback and strength exercises could be an
important stage in a rehabilitation program aimed at hindering, or possibly reversing, scoliosis progression. In this context we
considered bracing not only as a corrective biomechanical device but also as a tool for continuous sensory stimulation that
could help awareness of body misalignment. Future research aimed at developing strategies of trunk postural control
learning is essential in the rehabilitation of adolescent idiopathic scoliosis.

[Dr Kalla]

and here are some quotes from the text itself

Studies on mechanisms of trunk control showed
that patterns of muscle recruitment during trunk
postural and movement tasks have several peculiarities.
Unlike distal movements, trunk activities
require a global coordination and recruitment of
spinal muscles. In order to maintain trunk stability
and adaptation to destabilizing inputs deriving from
internal and external forces, patterns of muscle
activity shall be activated very rapidly, mostly by
means of pre-programmed (feedforward) adjustments
[69]. A straightforward implication of this
condition is that trunk postural patterns are normally
activated with a minor involvement of a conscious
control [70 – 72].

in order to stop curve
progression, or improve scoliosis, a long-term and
repetitive exercise training should be carried out.

[DrStitzel]

The neurophysiological theory of scoliosis development is strong and getting stronger with each passing research effort.

And this is why the CLEAR rehab protocols are almost entirely based on NMR of the righting reflexes (which is the primary neurological system for orienting the spine to gravity).

The rehab concepts behind how to go about doing this can be tricky. Mostly we are taking advantage in the advancements in anthropometry (yes it is an actual word meaning "the study of human body measurements") that can give us new and more accurate info in regards to the center mass points in the human body (Ex: the center mass of the head is located 4 mm anterior from the center of the sella tursica). Who cares right? Well, the center mass of an object acts as though it is the entire object (aka: the center mass of an object is it's balancing point), so the whole concept of early stage scoliosis may revolve around the body’s inability to align the center mass of the upper torso (the head) and the lower torso (the pelvis) in relation to each other. Therefore, the spine connecting the two major center masses (head and pelvis) becomes crooked in order to connect the two. Bingo! Early stage scoliosis! The real trick is that center mass misalignment appears to be occurring in the side view (sagittal) and front view (coronal) plane at the same time (gotta think 3-D to understand this one).

It obviously takes more spine, spinal cord, muscle tissue (on one side of the curve), ect to travel a crooked line rather than a straight line and thus the adverse mechanical tension is created on the spine cord (kind of like an acquired spinal cord tethering) which results in an uncoupling of the spinal rotation patterns in the thoracic spine seen in curves 30 degrees or larger (that's what creates the rib humping). Keep in mind that while all this is happening, the center masses (head and pelvis) are getting further and further out of alignment, which is creating even more instability within the system and then the poor kid hits a growth spurt that adds another 10-20lbs of compression force on the spine. That system further collapses on itself and the curvature buckles even further to the side creating more adverse mechanical tension on the spinal cord, which in turn stimulates even more rotation into the concavity (rather than the biomechanically expected convexity) in order to allow the stressed out spinal cord to travel though the inside of the curvature instead of forcing it to travel the longer distance around the outside of the curve. Of course this increased rotation creates even more spinal torque and the curve coils down even further to continue reducing the total vertical distance it must travel (again, 3-D thinking required).

Now that we have outlined the mechanism, the problem can be solved through early intervention rehab that trains the involuntary reflex arches (righting reflexes) by manipulating (through the use of weighted hats and diving belts, not adjustments) where the body perceives the center masses of the upper and lower torso (AKA: Head and pelvis). Then we have the patient perform neurologically challenging rehab at the same time we are creating the corrective stimulus with the head weighting and hip weighting.

Now, that doesn't sound so crazy does it? I don't know why everyone wants to jump down CLEAR's throat as voodoo science all the time.

[DrStitzel]

Dystonia.......a fancy name for the Neurophysiological basis for AIS.......the evidence continues to mount.

Here is a great article on it.

http://www.springerlink.com/content/j1tk2k12q20606v1/


Just wait until the "2.0 version" genetic profile of the next generation of the Scoliscore test comes out........(hint, hint)

[Dr Kalla]

Interesting link Dr Stitzel, thanks for posting it.

The first sentence in the article says:
"The aetiology of idiopathic scoliosis (IS) remains unknown; however, there is a growing body of evidence suggesting that spine deformity could be the musculoskeletal expression of a subclinical nervous system disorder."

I guess it seems to be saying the similar things that you've been talking about for a while and deems that treating the Cobb angle is approaching the problem from the wrong end.

[DrStitzel]

I guess it seems to be saying the similar things that you've been talking about for a while and deems that treating the Cobb angle is approaching the problem from the wrong end.

Yep. In a candid conversation with Dr. Ken Ward, one of the primary developers of the Scoliscore test, he mentioned that the current genetic AIS research they are doing shows a very high percentage of the DNA markers in AIS are asscociated with neurological control centers in the CNS.

[DrStitzel]

Perhaps the DYT1 gene is an example of what Dr. Ward was talking about?

http://www.wemove.org/dys/dys_ddyt1.html

[DrStitzel]

Perhaps the DYT1 gene is an example of what Dr. Ward was talking about?

http://www.wemove.org/dys/dys_ddyt1.html

I just checked with an inside source at Axial Bio-tech and the DYT1 gene is not included in the Scoliscore test, because their research has ruled it out as a genetic link to AIS.