Made available in DSpace on 2015-07-22T20:50:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-26. Added 1 bitstream(s) on 2015-08-11T03:26:19Z : No. of bitstreams: 1 Publico-140.pdf: 1558335 bytes, checksum: f630d19bbd2da038c706fccd9f88d5f9 (MD5) / Introdução: A escoliose idiopática do adolescente é uma das doenças infantis mais freqüentes, no entanto a sua etiologia permanece desconhecida. Estudos familiares são realizados na tentativa de mapear uma região cromossômica ligada a esta doença. Objetivos: Estudar os aspectos genéticos e pesquisar regiões cromossômicas relacionadas à escoliose idiopática do adolescente em uma família brasileira com múltiplos membros afetados Métodos: Avaliamos 56 membros, distribuídos em quatro gerações, de uma família brasileira com nove indivíduos portadores de escoliose idiopática do adolescente. A probanda apresentava curva escoliótica de 75 graus, mensurada pelo método Cobb. O critério para caracterização como afetado pela doença foi a presença de uma radiografia frontal, em ortostáse, demonstrando curva maior do que 15 graus. Após a assinatura do Termo de Consentimento Livre e Esclarecido, os indivíduos foram submetidos à coleta de sangue periférico para extração de DNA genômico e subsequente análise de ligação, utilizando marcadores microssatélites pertencentes à ABI PRISM® Linkage Mapping Set Version 2 (Applied Biosystems). Resultados: Não foi possível localizar uma região cromossômica ligada à escoliose idiopática do adolescente, na família estudada. Conclusão: Não foi possível, por meio do estudo de ligação genética, encontrar uma região cromossômica responsável pela escoliose idiopática do adolescente, ao analisar quatro gerações de uma família brasileira, com múltiplos membros afetados. / Introduction: The etiology of idiopathic scoliosis remains unknown and different factors have been suggested as causal. Hereditary factors can also determine the etiology of the disease; however, the pattern of inheritance remains unknown. Other studies have suggested possible chromosome regions related to the etiology of idiopathic scoliosis. Objetive: To study the genetic aspects and investigate chromosome regions for adolescent idiopathic scoliosis in a Brazilian family. Methods: Evaluation of 56 family members, distributed over 4 generations of a Brazilian family, with 9 carriers of adolescent idiopathic scoliosis. The proband presented a scoliotic curve of 75 degrees, as determined by the Cobb method. Genomic DNA from family members was genotyped. Results: Locating a chromosome region linked to adolescent idiopathic scoliosis was not possible in the family studied. Conclusion: While it was not possible to determine a chromosome region responsible for adolescent idiopathic scoliosis by investigation of genetic linkage using microsatellites markers during analysis of four generations of a Brazilian family with multiple affected members. / TEDE / BV UNIFESP: Teses e dissertações

Adolescent idiopathic scoliosis (AIS) is an extremely common three-dimensional (3-D) deformity of the spine, affecting the population between 10 and 18 years of age. Early detection of AIS is critical, as the earlier that the spinal deformity can be identified, the more likely it is that curve progression can be minimized or arrested using conservative treatment options. However, today much of the responsibility for detecting AIS falls on untrained parents. Therefore, the purpose of this thesis project is to use images taken with a smartphone containing a depth sensor to create a simple and effective machine learning (ML) algorithm that can detect the absence or presence of scoliosis. Secondarily, this thesis project aims to 1) provide a proof of concept for a regression-based ML algorithm that can predict the main curvature of the scoliotic spine and 2) to determine if the depth information from the smartphone contains additional features or information that can improve the performance of the ML algorithm when compared to regular red-green-blue (RGB) images. Thirty-three participants (28 AIS; 5 Control) were recruited from the Children’s Hospital of Eastern Ontario (CHEO). Images of the unclothed backs of participants were taken with a smartphone (Samsung S20 Ultra 5G) containing a depth sensor, while participants assumed two positions: an upright standing posterior-anterior (PA; mirroring the position participants are in when getting an EOS scan) and a forward bending position. A convolutional-neural-network (CNN)-backed decision tree algorithm was developed and trained using three different data streams: a red-green-blue-depth (RGB-D), a Colourized depth map, and an RGB data stream. It was determined that the model trained with the Colourized forward bending images had the highest overall accuracy. The CNN backed decision tree was able to classify images of participants in a forward bend posture with an accuracy of 93%, specificity of 75%, and a sensitivity of 99%. Additionally, it was found that all algorithms trained with the varying data streams were able to predict the Cobb angle of the spine within 16° of the ground truth Cobb angles. The lowest root mean square error (RMSE) values were obtained from the RGB images when the participants were in the PA position. The PA RGB dataset had RMSE values of 7.17° between the ground truth and predicted Cobb angles. Inter-rater reliability errors typically range between 5-7° for manually measured Cobb angles. Therefore, given the calculated RMSE for the PA RGB dataset were close to this range, there is the potential to use this smartphone technology to screen for scoliosis and predict the curvature of the spine (Morrison et al., 2015). While these results are promising, the dataset is small compared to other studies; therefore, this thesis provides a proof of concept, and more work needs to be done to increase the robustness of the model and to further improve the ability of the model to predict the Cobb angle of the spine.

Title Gait Analysis in Adolescents with Idiopathic Scoliosis: A Systematic Review. Aim The role of spine is vital as a gait stabilizer. Gait analysis may provide a more holistic view of how the body behaves to idiopathic scoliosis among adolescents. The aim of this thesis is to review the effectiveness and validity of gait analysis in examining AIS, and secondly to assess how the gait of AIS patients differ from adolescents without scoliosis. Method A systematic review of the topic was conducted. Information was gathered from six e-databases, and seventeen articles were selected, of which seven focusing solely on AIS subjects (i.e. non-comparative) and ten were focusing on AIS in relation to control subjects (i.e. comparative). Results Spatio-temporal (STP), kinematic, kinetic and EMG parameters show significant changes in AIS subjects during walking. But variations between results, lack of data for certain parameters and no significant relationship between gait parameters and scoliosis was also seen. Furthermore, AIS subjects differ in performance compared to non-scoliosis adolescents in at least one gait parameter across all studies. This includes abnormalities in muscle activity, less economical use of the body, poorer performance in kinematic parameters and differences in STP such as step...

Objective: Research on the role of acute post-surgical pain in children is extremely important in order to have a positive influence on pre-surgical preparation and post-surgical care and to prevent pain from becoming chronic, which can extend decades into adulthood. This project aims to identify predictors of acute post-surgical pain in adolescents with idiopathic scoliosis undergoing spinal fusion by utilizing sensory thresholds obtained through quantitative sensory testing (QST). Methods: Eligible candidates were Adolescent Idiopathic Scoliosis (AIS) patients ages 10-17 who have been recommended to receive elected spinal fusion surgery at Boston Children's Hospital (BCH). 9 successfully recruited and enrolled participants underwent a full series of QST tests on their palmar thenar eminence (non-surgical site), and their lower back (surgical site). Patients' Light Touch Detection Threshold (LTDT) and Pain Detection Threshold (PDT) scores were determined using Von Frey Hairs. Patients' Pressure-Pain Sensation Threshold (PPST) scores were determined using a pressure algometer. Patients' Warm/Cool and Hot/Cold Pain Detection Thresholds were detected using a calibrated thermode strapped to the skin. Following the full-series of QST tests, and after the patient was discharged from the hospital, a retrospective chart review was conducted to determine the patients': Age at Surgery, Gender, Number of Vertebrae Fused (Fusion Length), Length of Surgery, Pre-Operative Self-Identified Pain Level (NRS 0-10), Average Post-Operative Acute-Phase Self-Identified Pain Level (NRS 0-10), and daily Pain Medication Doses (Opiate Vs. Non-Opiate Vs. Total). Correlation calculations were done between each variable, including those determined through QST as well as retrospective chart review. For every QST test, each patient's individual score was compared to the cohort's median score, which helped determine whether the patient was either hyper- or hyposensitive for that particular test. For each QST test, these hyper- and hyposensitive groups were then compared to see if there were any significant differences in post-operative pain experienced. Results: Due to the low number of participants (N = 9), the results should be considered preliminary. Correlation studies demonstrate that pre-operative pain was significantly positively correlated with post-operative pain (r = 0.81, p <0.05), indicating that patients who are pre-operatively already in pain, will consequently experience the most pain post-operatively. Additionally, fusion length had a strong positive correlation to acute post-operative opiate pain medication administration (r = 0.71, P < 0.05), indicating that patients who had more vertebrae fused were given more opiates. Through the use of QST, we discovered that patients hypersensitive in the LTDT-Spine QST test experienced significantly less pain post-operatively (3.22 NRS 0-10) than that experienced by hyposensitive patients (5.52 NRS 0-10) from the same test. Identical results were discovered in patients determined hyper- and hyposensitive using the PPST-Spine test, respectively. Retrospective chart review data show that these hyposensitive patients were experiencing greater pain pre-operatively (0.75 NRS 0-10) than that experienced by the hypersensitive patients (0 NRS 0-10), which may have contributed to the hyposensitive cohort's greater post-operative pain. Although insignificant, patients hypersensitive in the Hot Pain - Spine QST test experienced greater post-operative pain (4.72 NRS 0-10) than that experienced by hyposensitive patients in the same test (4.06 NRS 0-10). Conclusions: The goal of this study was to determine a substantiated hypothesis to test in the future, using larger pediatric cohorts. Even though it initially appears that the hyposensitive patients, as determined by the LTDT-Spine and PPST-Spine QST tests, experienced greater post-operative pain, one must consider the fact that this hyposensitive group experienced a significantly greater amount of pre-operative pain. Not only has pre-operative pain been proven to have a strong correlation to post-operative pain in this study, it has also been proven in other larger studies as well. Other studies have identified a test similar to the Hot Pain - Spine QST test as a potential predictor of post-operative pain. The present study's results, although insignificant, share the same conclusion that hypersensitive patients determined through Hot Pain - Spine QST test experience greater post-operative pain. Therefore, the hypothesis to test in the future in pediatric cohorts should read: AIS patients with no pre-operative pain who demonstrate increased sensitivity to hot pain on their surgical site via thermal stimulation (QST) will experience greater post-operative pain in the acute-recovery phase.

Made available in DSpace on 2016-03-22T17:27:39Z (GMT). No. of bitstreams: 1 Dissert Marcelo D.pdf: 460219 bytes, checksum: 7e6bdf276f771ccc2f3b623a56bfe198 (MD5) Previous issue date: 2006-09-15 / Introduction and aims: Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional alteration of the spine. Its etiology is unknown, and it starts at the beginning of puberty, and its progression is associated to the growth spurt. The movement angular analysis and the body posture would allow the physiotherapist to quantify and qualify the body posture/movement evaluation through static image, which is known as photogrammetry. This study was carried out to evaluate the validity and reliability of this instrument for the AIS detection in school exam. Subjects: fifth and eighth grade-students of elementary teaching at public and private schools from Pelotas. Methods: a cross-sectional study of school basis with digital image collection and radiographic exam in anteroposterior posture and profile. The sensitivity and the specificity of the photogrammetry were verified using three and two degrees of margin for the body surface inclination. Results: 314 students accomplished the computerized photogrammetry at the schools. Among them, 224 also accomplished the pattern radiological exam. The prevalence of adolescent idiopathic scoliosis found in this study was 4.5% (n=10), eight were girls and 2 were boys, with the average Cobb at 13.3º, average of 1.1 for vertebral rotation (Nash-Moe), dorsal kyphosis at 29.5º Cobb, iliolumbar angle at 3.6° and signs of Risser at 1.6. For three degrees, the sensitivity was 21.4% and the specificity was 90.7%. The sensitivity was 50% and the specificity was of 61.5% when two degrees were used. Based on these results, it was verified that the computerized photogrammetry cannot be accomplished as screening to detect scoliosis at schools / Introdução e Objetivos. A escoliose idiopática adolescente (EIA) é uma alteração tridimensional da coluna vertebral. Sua etiologia é desconhecida, e seu início ocorre no início da puberdade, tendo sua progressão associada ao estirão de crescimento. A análise angular de movimento e postura corporal através da imagem estática, conhecida como fotogrametria permitiria ao fisioterapeuta quantificar e qualificar sua avaliação da postura/movimento corporal. Este estudo foi realizado para avaliar a validade e confiabilidade deste instrumento na detecção da EIA no exame escolar. Sujeitos: Alunos de 5ª a 8ª série do ensino fundamental das redes pública e particular de Pelotas. Métodos. Estudo transversal de base escolar com coleta de imagem digital e exame radiográfico em postura antero-posterior e perfil. A sensibilidade e especificidade da fotogrametria foram verificadas utilizando três e dois graus de margem para desnivelamento da superfície corporal. Resultados. 314 alunos realizaram a fotogrametria computadorizada nas escolas. Destes, 224 também realizara o exame radiológico padrão. A prevalência de escoliose idiopática adolescente encontrada neste estudo foi de 4,5% (n=10), sendo oito meninas e dois meninos, com média de 13,3º Cobb, média de 1,1 para rotação vertebral (Nash-Moe), 29,5º Cobb para cifose dorsal, 3,6º para ângulo íleo-lombar e sinal de Risser em 1,6. Para três graus, a sensibilidade foi de 21,4% e a especificidade de 90,7%. Utilizando dois graus a sensibilidade foi de 50% e a especificidade de 61,2%. Com base nestes resultados, verificou-se que a fotogrametria computadorizada não pode ser realizada como screening para detecção de escoliose nas escolas

BACKGROUND: Adolescent idiopathic scoliosis (AIS) surgery is the most common reason for elective pediatric orthopaedic surgery. Minimization of adverse events is an important goal. Institute of Medicine (IOM) outlined 6 facets of healthcare quality improvement within the acronym STEEEP. Two of these facets, Safety and Timeliness for AIS surgery in Canada, are examined in this thesis. METHODS: A three - part study, using clinical records at the largest Canadian pediatric hospital and CIHI national administrative data, determined i) the relationship between surgical wait times and rates of adverse events, along with determination of an empirically derived access target, ii) accuracy of ICD-10 coding of surgical AIS cases along with an optimal search strategy to identify surgical AIS cases, and iii) the volume – outcome relationships for scoliosis surgery using hierarchical and conventional single level multi-variate regression analysis. RESULTS: Access target of 3 months minimized the adverse events related to waiting. Optimal search strategy for AIS surgical cases using ICD-10 coding required combination of codes as each code in isolation was inaccurate due to limitations in coding definitions. There was no significant volume – outcome relationship using appropriate modeling strategies. CONCLUSIONS: Ensuring timeliness of surgical treatment of less than 3 months is important in surgical cases of AIS given the potential for curve progression in higher risk individuals who are skeletally immature with large magnitude curves at time of surgical consent. At the administrative database level, knowledge of coding accuracy and optimal search strategies are needed to capture a complete cohort for analysis. In AIS, several ICD-10 codes need to be combined. AIS surgery cases captured through this optimal search strategy, revealed no significant volume-outcome relationships with appropriate modeling. Based on these results, minimum volume thresholds and regionalization of care for AIS surgery does not appear to be justified. However, a larger sample size was needed to determine whether there was a clinically significant difference in wound infection and blood transfusion rates. Furthermore, clinical variables, not part of an administrative database such as curve pattern were not included.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) surgery is the most common reason for elective pediatric orthopaedic surgery. Minimization of adverse events is an important goal. Institute of Medicine (IOM) outlined 6 facets of healthcare quality improvement within the acronym STEEEP. Two of these facets, Safety and Timeliness for AIS surgery in Canada, are examined in this thesis. METHODS: A three - part study, using clinical records at the largest Canadian pediatric hospital and CIHI national administrative data, determined i) the relationship between surgical wait times and rates of adverse events, along with determination of an empirically derived access target, ii) accuracy of ICD-10 coding of surgical AIS cases along with an optimal search strategy to identify surgical AIS cases, and iii) the volume – outcome relationships for scoliosis surgery using hierarchical and conventional single level multi-variate regression analysis. RESULTS: Access target of 3 months minimized the adverse events related to waiting. Optimal search strategy for AIS surgical cases using ICD-10 coding required combination of codes as each code in isolation was inaccurate due to limitations in coding definitions. There was no significant volume – outcome relationship using appropriate modeling strategies. CONCLUSIONS: Ensuring timeliness of surgical treatment of less than 3 months is important in surgical cases of AIS given the potential for curve progression in higher risk individuals who are skeletally immature with large magnitude curves at time of surgical consent. At the administrative database level, knowledge of coding accuracy and optimal search strategies are needed to capture a complete cohort for analysis. In AIS, several ICD-10 codes need to be combined. AIS surgery cases captured through this optimal search strategy, revealed no significant volume-outcome relationships with appropriate modeling. Based on these results, minimum volume thresholds and regionalization of care for AIS surgery does not appear to be justified. However, a larger sample size was needed to determine whether there was a clinically significant difference in wound infection and blood transfusion rates. Furthermore, clinical variables, not part of an administrative database such as curve pattern were not included.

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This master thesis concerns gait in patients with idiopathic scoliosis. Idiopathic scoliosis constitutes about 80 % of all scoliosis cases and its adolescent type is the most common form of spine deformity in the child population. The theoretical part outlines existing knowledge on this medical condition and its treatment, focusing on conservative therapy by corrective spinal orthoses. It further describes the physiological stereotype of gait and differences observed in patients with idiopathic scoliosis. It also discusses the effect exerted on bipedal locomotion by corrective spinal orthoses. The aim of the practical part is to examine whether there is a relationship between the severity of the main spinal curvature in subjects with scoliosis and the degree of asymmetry between their lower limbs for selected parameters of gait. Since this part concerns gait both without and with bracing, it can also analyse the impact of corrective spinal orthoses on the degree of the given asymmetries. The selected parameters of gait are ascertained by the method of dynamic plantography using a Zebris FDM- T System device. The research sample consists of 14 subjects (12 girls and 2 boys) between the age of 9 and 17 years with idiopathic scoliosis who receive conservative treatment including bracing. The results...