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KINETOTERAPIA N TULBURRILE

DE STATIC VERTEBRAL

TULBURRILE DE STATIC
- n plan: - frontal
- sagital
n plan sagital - accentuarea cifozei dorsale
- hiperlordoza lombar
- tergerea lordozei lombare
n plan frontal scoliozele - funcionale
(atitudini scoliotice)
- structurale

Scoliozele structurale

- idiopatice

- congenitale

- neuromusculare

- posttraumatice

I. Scoliozele idiopatice
- ntre 0-3 ani - infantile
- ntre 3-12 ani juvenile
- ntre 12-20 ani de adolescen
- >20 ani ale adultului

II. Scolioze congenitale.


- determinate de defecte vertebrale

III. Scolioze neuromusculare


- mai frecvente cele din - neuropatii
- poliomielit
-frecvent asociaz cifoza

1.upper motor neuron lesions such as cerebral palsy,


Frederich's ataxia, and spinal cord trauma and
tumors.
2.lower motor lesions such as poliomyelitis, and spinal muscular
atrophy.
3. myopathic lesions include arthrogryposis, muscular dystrophy, and myotonia

IV. Scolioze posttraumatice


- au la baz defecte traumatice vertebrale
i costale

Denumirea scoliozei se face dup orientarea


convexitii
- -dextoconvex
- -sinistroconvex
scolioze n S
-compensate (fir de plumb cade n pliul
interfesier)
-necompensate

Din punct de vedere al curburii


exist urmtoarele scolioze:
a. cu curbur toracic
- frecvent dextroconvex
- T4-5
- T11-12/ L1
- dau gibozitate mare
- au curburi minore supra/subiacente cu caracter
compensator
- potenial evolutiv mare n lipsa tratamentului
afeciuni cardio
-respiratorii

b. curbur toraco-lombar
- dextro/sinistro-convex
- T4-5-6 L2-3-4
- curburile
- sunt mici
- determin distorsiune costal
- au prejudicii estetice, c-r reduse

c. Curbur lombar
- de obicei dextroconvex
- nivel T11-12 L5
- nu d deformri majore

d. scolioze n S
- au orientri diferite toracice i
lombare
- deformare mic
- sunt echilibrate, dac fir de Pb de la
occiput cade n pliul interfesier

Severitate

- uoare 25-30
- medii 25-30-50
- grave - >50

Principii de tratament

Eficiena este cu att mai mare cu ct


tratamentul este mai precoce
KT izolat nu controleaz i nu amelioreaz!
Tratamentul corect mbin
- KT + corset <50
- KT + trat.chirurgical la >50

Obiective
A.corectarea poziiei c.v.
B.creterea mobilitii c.v.
C.creterea F m abdominali i paravertebrali
D.reechilibrare tonic la nivel de curbur patologic:
!m.din concavitate sunt scurtai trebuie adui la
lungimea normal
E.ameliorarea respiraiei
F. stabilizarea scoliozei
se urmresc continuu pn la ncheierea perioadei de
cretere

Exercises should be performed always in traction.


Exercises are complemented by manual techniques.
Exercises should target activity of spinal stabilization
system (core muscles) responsible for position of
individual spine segments.
Restoration of balance between ventral and dorsal
musculature as well as differentiation of muscle
function.
Induce diaphragmatic and localised breathing patterns
in correct positions.
http://presentations.arabhealthonline.com/2012/
Paediatrics%20Conference/Dr.%20Marc%20Sinclair.pdf

A. Ameliorarea posturii c.v.

- corectare - iniial cifoza i lordoza patologic


- apoi scolioza
a. posturi fixe corectoare/hipercorectoare
- din - decubit : dorsal / lateral/ ventral
- eznd
- ortostatism
- purtarea corsetului

Milwaukee

The Charleston Bending Brace

http://www.scoliosis.org/resources/medicalupdates/images/charleston.gif

Boston

Spinecor scoliosis brace

b.posturi libere ajutate


- din - decubit : dorsal / lateral/ ventral
- eznd
- ortostatism
-ajutate de perne/suluri/perete
- eficiente - hiperlordoza lombar
- cifoza dorsal
- posturile se aplic
- n pauzele programului de gimnastic.
- cnd se scoate corsetul

B. Exerciii de corectare postural


- contientizarea nclinrii pelvisului pentru delordozare
- exerciii la perete
- scderea cifozei dorsale
- ex. de ntindere a c.v. n cele 3 poziii de baz: decubit
/eznd/ortostatism
- se urmrete alungirea gtului i trunchiului
- pentru contientizare terapeutul aplic o uoar presiune cu palma
pe cretetul bolnavului
- ex.se efectueaz cu control n oglind
- scderea curburii scoliotice
- contientizarea staticii vertebrale ajutat de exerciii
- n oglind ptr.control al poziiei
- de corectare a curburii

Ex.1 ortostatism sau eznd


bra ridicat de partea concavitii curburii dorsale
Ex.2 patrupedie
ridicare la orizontal a unui MS sau MI de partea
concavitii
Ex.3 decubit dorsal sau ventral
nclinare n lateral a MI- amndou
- ducndu-le n direcia convexitii.
Ex.4 n genunchi
fese pe taloane
trunchi orientat oblic, avnd grij s se pstreze poziia median a
trunchiului
Ex.5 ortostatism
basculri laterale
basculri bazin/trunchi n sensuri opuse

c. Creterea flexibilitii c.v.

- c.v. scoliotic are mobilitatea limitat, mai ales n zona scoliotic


- mobilizrile globale influeneaz mai ales zonele neafectate
- ex.de flexibilitate trebuie fcute n posturi speciale care blocheaz
segmentele indemne i las posibilitatea micrii doar n segmentul
scoliotic

a. Metoda Klapp
- utilizeaz poziii- lordozate
- cifozate
b. Tehnica Cotrell
- extensie/derotaie/elongaie/flexie lateral
c. Patrupedia Klapp
d. Elongaia Cotrell
e. Ex. de derotare
- se execut sub corset
- se basculeaz pelvisul
Sporturi indic.: not, scrim, volei, baschet

C. Tonizare muscular

a. m abdominali (obligatorie tonizarea)


b. m fesieri mari
c. m paravertebrali

1. tehnica Kabat
2. decubit ventral
- ridicare cap./umeri/MS pentru tonizarea
m.dorsali superiori bilateral
- ridicare ambele MI pentru tonizarea m. lombari
- ridicare MI i MS de aceai parte pentru tonizarea
m paravertebrali resp.
3. tehnica Berger
- contracii izometrice ale m. paravertebrali de partea convexitii
curburii, avnd pacientul poziionat n poziii Klapp

D. Ameliorarea respiraiei

mijloace:
1. KT de corecie a poziiilor defectuoase
2. echilibrare - tonus
- lungime m.scaleni
3. deblocare omoplai
4. creterea expansiunii toracice
5. scderea travaliului ventilator prin asuplizarea
artic.constovertebrale i constosternale
6. sporirea contribuiei ventilaiei diafragmatice
7. creterea randamentului pompei musculare ventilatorii
8. tonizarea m. respiratori

Creterea flexibilitii c.v.

A. Metoda Klapp

- poziia iniial: n genunchi


- exist 2 variante poziionale: - lordozate
- cifozate
- pentru fiecare : 1. poz. redresate
(deasupra orizontalei)
2. poz.orizontal
3. poz.coborte

Poziii lordozate
flexii laterale
.

Trei poziii redresate ,


1-segmentul- L4-L5
2-segmentului-L1-L2
3-segmentului-D11-D12

Poziia orizontala
4-segmentului-D8-D10

Dou poziii coborte


(sub orizontal)
5-segmentului-D7-D6
6-segmentului-D5-D3

Poziii cifozate
Trei poziii redresate
1-segmentul- D
2-segmentului-D

Poziia orizontala
4-segmentului-D8-D10
Dou poziii coborte
(sub orizontal)
5-segmentului-D7-D6
6-segmentului-D5-D3

S-a ncercat mbuntirea metodei prin ridicarea MS


Pentru a facilita colntracii maximale ale
m.paravertebrali se recomand:
- c.v.cervical - poz. coborte
- cu braele nainte
- c.v.dorsal - poz. orizontal
- cu minile pe ceaf
- c.v.lombar - poz. cobort
- cu braele nainte
- aezarea minilor pe olduri sau la spate diminueaz din
fora de contracie a m paravertebrali

B. Tehnica Cotrell
- combin:

- extensia
- derotaia
- elongaia
- flexia lateral
Unii autori consid.c este mai bun ca tehnica Klapp
Ex.1 - decubit ventral
- MI extinse complet
- MS extinse, paralele cu capul
- se ntinde ntreg corpul
- treptat se extind braele
- corpul se lordzozeaz
- MI extind articulaiile CF (ntreg corpul descrie un arc concav
superior/posterior)
- corectarea curburii se face ducnd un MS spre articulaia CF care se
extinde, cellalt MS este orientat pe lng ureche n sus

Ex.2- mobilizarea toracelui din poziia pe genunchi


- fese pe taloane
- trunchi aplecat nainte peste coapse
- braele ntinse peste urechi
- minile pe sol
(blocare lombar permite corecia dorsal )
- cu minile se pete pe sol, n direcia
convexitii

Ex.3 pacient n decubit ventral pe masa de


KT
- prinde cu minile marginile laterale
ale mesei
- blocheaz toracele
- terapeutul face priz pe ambele MI,
translatndu-le n direcia convexitii
pentru a corecta scoliozele lombare

Ex.4 ex. Cotrell de trre (notul pe


uscat)
- decubit ventral
- membrele de o parte sunt ntinse
- celelalte se apropie
n micarea de apropiere c.v. se
ncurbeaz, la revenire este extins

C. Elongaia Cotrell
- ex.de autotraciune
- pacientul este n decubit dorsal
- are cpstru de traciune cervical, de la care
pleac o coard, trecut peste un scripete
aezat postero-superior fa de cap
- coarda este dus spre MI i fixat de picioare
- extensia MI ntinde c.v.

D. Exerciii de derotatare
- sub corsetul Milwankee
- se basculeaz pelvisul pentru delordozare
- se mpinge anterior hemitoracele cu gibozitate,
ncercnd desprinderea lui de peretele posterior
al corsetului
- cellalt hemitorace este mpins posterior pe
barele corsetului, concomitent cu inspiraia

E. Patrupedia Klapp
- mersul n 4 labe
- se pornete din poziie neutr a spatelui sau puin cifozat
- pe parcursul mersului se ajunge la poz. lordozat
a. Pentru o curbur unic se utilizeaz mersul obinuit al patrupedelor
se duce nainte MS contralateral i genunchiul homolateral
scoliozei, se revine cu membrele paralele, apoi se reia pirea:
Ex. scol.dextroconvex: - se duce n fa MS stg. i genunchiul dr.
b. Pentru o curbur dubl se utilizeaz pasul cmilei, animal ce
pete concomitent cu membrele de aceeai parte
Ex. curbur- dextroconvex dorsal
- sinistroconvex lombar
- se duc nainte membrele de partea stg. i apoi se reia

http://www.scoliosisjournal.com.

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic


scoliosis during growth.
Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P,
Kotwicki T, Maruyama T, Minozzi S, O'Brien JP, Papadopoulos D, Rigo M, Rivard CH,
Romano M, Wynne JH, Villagrasa M, Weiss HR, Zaina F.

Current guidelines from the International


Scientific Society on Scoliosis Orthopaedic and
Rehabilitation Treatment (SOSORT) recommend
physical therapy from curve magnitudes >15
Cobb [9]. Furthermore it is recommended that
physical therapy and/or bracing of conservative
treatment for AIS be implemented when curve
magnitudes of 25-45 are apparent [9]. Surgical
intervention for AIS is generally first considered
when curve magnitudes reach >50 [10]

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic


scoliosis during growth.
Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P,
Kotwicki T, Maruyama T, Minozzi S, O'Brien JP, Papadopoulos D, Rigo M, Rivard CH,
Romano M, Wynne JH, Villagrasa M, Weiss HR, Zaina F.

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic


scoliosis during growth.
Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P,
Kotwicki T, Maruyama T, Minozzi S, O'Brien JP, Papadopoulos D, Rigo M, Rivard CH,
Romano M, Wynne JH, Villagrasa M, Weiss HR, Zaina F.

Night Time Rigid Bracing (8-12 hours per day) (NTRB): wearing
a brace mainly in bed.
Soft Bracing (SB): it includes mainly the SpineCor brace
[102,103], but also other similar designs [104,105]
Part Time Rigid Bracing (12-20 hours per day) (PTRB):
wearing a brace mainly outside school and in bed.
Full Time Rigid Bracing (20-24 hours per day) or cast (FTRB):
wearing a brace all the time (at school, at home, in bed, etc.). Casts
have been included here as well. Casts are used by some schools as
the first stage to achieve correction to be maintained afterwards
with rigid brace [106-108]; others propose casting only in worst
cases [92,93,109,110]; a cast is considered a standard approach in
infantile scoliosis [111]. Recently, a new brace has been developed
that has been claimed to achieve same results as casting
[77,112,113]

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic


scoliosis during growth.
Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P,
Kotwicki T, Maruyama T, Minozzi S, O'Brien JP, Papadopoulos D, Rigo M, Rivard CH,
Romano M, Wynne JH, Villagrasa M, Weiss HR, Zaina F.

4. It is recommended not to apply bracing to treat


patients with curves below 15 5 Cobb, unless
otherwise justified in the opinion of a clinician specialized
in conservative treatment of spinal deformities (SoR: B)
(SoE: VI)
5. Bracing is recommended to treat patients with curves
above 20 5 Cobb, still growing, and demonstrated
progression of deformity or elevated risk of worsening,
unless otherwise justified in the opinion of a clinician
specialized in conservative treatment of spinal
deformities (SoR: B) (SoE: III) [76,78,131,132,137139,141]

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during
growth.
Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P, Kotwicki T,
Maruyama T, Minozzi S, O'Brien JP, Papadopoulos D, Rigo M, Rivard CH, Romano M, Wynne JH,
Villagrasa M, Weiss HR, Zaina F.

Recommendations on "Sports activities"


40. It is recommended that sports is not prescribed as a treatment for idiopathic
scoliosis (SoR: C) (SoE: III) [317,321-324,326,327]
41. It is recommended that general sports activities are performed because of the
specific benefits they offer to patients in terms of psychological, neuromotor and
general organic well-being (SoR: B) (SoE: V)
42. It is recommended that, during all treatment phases, physical education at school
is continued. Based on the severity of the curve and progression of the deformity and
the opinion of a clinician specialized in conservative treatment of spinal deformities,
restrictions may be placed on practicing certain types of sports activities (SoR: B)
(SoE: V)
43. It is recommended that sports activities are continued also during brace
treatment because of the physical (aerobic capacity) and psychological benefits these
activities provide (SoR: B) (SoE: IV) [316]
44. It is recommended that, during brace treatment, contact or highly dynamic sport
activities are performed with caution (SoR: B) (SoE: VI)
45. It is recommended that competitive activities that greatly mobilize the spine are
avoided in patients with scoliosis at high risk of progression (SoR: C) (SoE: III) [284287,317,322-324]

SpineCor orthosis.

The continuous correction can be explained by the capacity


of the SpineCor orthosis to create a neuromuscular
integration of the Corrective Movement through active bio-feedback.