Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 151-167). Also available in print.

Thesis (MAppSc in Physiotherapy) -- University of South Australia

published_or_final_version / Nursing Studies / Doctoral / Doctor of Philosophy

Previous studies of the effect of exercise therapy on scoliosis have demonstrated progression of spinal curves despite vigorous exercise regimens. This study presents evidence to the contrary. Ten children with functional scoliosis and attendant upper thoracic asymmetries were analyzed both before and after a specific exercise therapy programme, in order to determine the effect of the therapy on spinal functionality and the scoliotic curve. The effect of this intensive treatment, in which the subjects underwent a five-month exercise training programme with a total of 60 one-hour sessions, was investigated in a controlled clinical trial. A subjective and objective appraisal of posterior trunk asymmetry in schoolchildren aged 7-18 is reported. Selected functional and anthropometric measurements were made before and after the treatment, and antero-posterior x-rays were used to indicate changes in the scoliotic curve. New methods are described for quantifying the scoliotic curves in each child. Post-treatment tests showed a significant (p<0.05) decrease in Cobb's angles as well as a significant reduction in all the spinal and thoracic functional asymmetries observed in the study. The findings suggest that selective exercise programmes can contribute to improvement in cases of functional scoliosis. The study sheds new light on problems related to scoliosis and the benefits of exercise rehabilitation. Data on the incidence of scoliosis amongst 1052 black children are also presented and discussed.

Robotic exoskeletons are important tools in medicine for characterizing certain aspects of diseases, enabling physical therapy treatments, or providing assistance to those with impairments. One area in particular where these devices can make an impact is the study and treatment of scoliosis. First, I adapt a design of a robotic torso exoskeleton to serve the population most susceptible to scoliosis, female adolescents. I used the device to compare the torso stiffness of members of this group with and without scoliosis, and found an interaction effect of degree of freedom (DOF) and torso segment on translational stiffness, and an interaction effect of DOF and group on rotational stiffness. These results can inform the models used to create rigid orthoses for conservative treatment or to simulate the effects of surgical procedures. Second, I explore the effects of different types of augmented sensory feedback commonly used in scoliosis physical therapy. I compare visual and force feedback provided by the exoskeleton on one’s ability to replicate static poses and dynamic movements. I find that while force feedback leads to faster initial improvement, visual feedback may enable the user to learn finer details of the movement. Third, I design a torso exoskeleton for people with neuromotor impairments. People who are not able to sit up independently are at a high risk of developing neuromuscular scoliosis, and must balance the benefits of treatment with rigid orthoses, with the limits that these devices place on functional movements. The device allows users four degrees of freedom, to support functional movements such as reaching and pressure relief maneuvers, but prevents lateral translation and axial rotation, which can contribute to neuromuscular scoliosis. Together, these results demonstrate the potential for robotic exoskeletons in torso study, training, and assistance.