Orientador: Aparecido Augusto de Carvalho / Resumo: O pé é o órgão base da sustentação do corpo humano que está constantemente submetido a esforços para garantir a estabilidade deste. Analisando-se a distribuição de força na região plantar de indivíduos, pode-se inferir a respeito de patologias nos pés, problemas posturais e de equilíbrio. O estudo da distribuição de força na região plantar é feito com o baropodômetro, um equipamento composto por sistemas de hardware e software. Neste trabalho é apresentado o desenvolvimento de um baropodômetro implementado no Laboratório de Instrumentação e Engenharia Biomédica do Departamento de Engenharia Elétrica, UNESP – Campus Ilha Solteira, constituído por 120 sensores resistivos, tipo Force Sensing Resistor (FSR), dispostos matricialmente em duas plataformas, e por circuitos de aquisição de dados, comunicação e interfaceamento. Com as informações obtidas, por meio do software é possível identificar deformidades na região plantar e locais desta região submetidos a forças elevadas. Foram feitos testes em um grupo de 30 voluntários com diferentes faixas etárias e diferentes graus de escoliose. Inicialmente os voluntários foram divididos em dois grupos, sendo que o grupo G2 (45-78 anos) apresentou valores de estabiliometria maiores quando comparados com o G1 (13-30 anos). De forma similar, foi segmentada a mesma população (N=30) em dois grupos, segundo o grau de escoliose, GrA (0-9°) e GrB (10-32°). O grupo GrB mostrou maiores valores de estabiliometria do que o GrA e foi possível determi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The foot is the main support organ of the human body that is constantly subjected to efforts to ensure the stability of the body. Analyzing the distribution of force in the plantar region of individuals, it is possible to infer about feet pathologies, postural and balance problems, among others. The study of foot force distribution is made with the baropodometer, an equipment composed by hardware and software systems. This work describes the baropodometer developed at the Instrumentation and Biomedical Engineering Laboratory at the Department of Electrical Engineering, UNESP – Ilha Solteira, composed of 120 resistive sensors (Force Sensing Resistor - FSR) arranged in matrix on two platforms. Furthermore, acquisition and communication boards and software made in LabVIEW were developed. With the information obtained, with the software it is possible to identify deformities in the plantar region and sites of this region subjected to high forces. Tests in 30 volunteers with different ages and different scoliosis angles were made. Firstly, the volunteers were divided into two groups according to ages. The second group G2 (45-78 years old) had higher stabilometry values than first group G1 (13-30 years old). Secondly, the 30 volunteers were divided in two groups according scoliosis angles, GrA (0-9°) e GrB (10-32°). The GrB group showed higher stabilometry values than the GrA group, and it was possible to determine that the higher the degree of scoliosis the lower the dependency of... (Complete abstract click electronic access below) / Mestre

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...

O objetivo deste estudo foi verificar a validade da utilização de uma metodologia de avaliação postural baseada na identificação de estruturas anatômicas ósseas por palpação, na utilização de marcadores de superfície e na aquisição de imagens digitais, e a avaliar a validade do software Avaliação Postural a Partir de Imagens Digitais (APPID) na identificação e caracterização da postura da coluna vertebral estática no plano frontal. Foram avaliados 24 indivíduos (16 mulheres e 8 homens) que possuíam requisição médica para realização de exames radiográficos da coluna vertebral e cujas médias foram: idade (31,9 anos ±12,3), massa corporal (58,4 kg ± 9,4) e estatura (1,66 m ± 0,07). Marcadores reflexivos contendo chumbo foram posicionados sobre os processos espinhosos das vértebras C7, T2, T4, T6, T8, T10, T12, L2, L4 e S2, localizadas por palpação em cada indivíduo. Uma imagem radiográfica foi obtida e em seguida uma imagem fotográfica, ambas no plano frontal e em ortostatismo. Por meio da imagem radiográfica foram observados o posicionamento dos marcadores de superfície e a localização das respectivas estruturas ósseas internas e foram realizados dois procedimentos para verificar sua concordância: a avaliação do posicionamento espacial dos marcadores e a distância dos mesmos ao respectivo processo espinhoso. Estatisticamente não existiram indícios na amostra de diferenças significativas (p<0,05) entre os pontos de marcação na coluna vertebral quanto ao posicionamento espacial dos marcadores (c2=13,118; p=0,157), e nem quanto à distância dos marcadores em relação ao nível espinhal (c2=9,366; p=0,404); ou seja, o marcador identificou da mesma forma todas as vértebras estudadas. Para análise da validade do software APPID foram digitalizadas as imagens fotográficas e o laudo fornecido pelo programa foi comparado ao laudo radiográfico, quanto à identificação e caracterização da escoliose e não houve diferença estatisticamente significativa entre as duas formas de avaliação (z=-0,891; p=0,373). Complementando este resultado, as Flechas de Charrière & Roy, fornecidas pelo software APPID, foram correlacionados ao ângulo de Cobb, nas regiões torácica (r=0,75; p< 0,001) e lombar (r=0,76 p=0,007). Os resultados obtidos demonstram que existiu um forte grau de concordância entre os resultados quantitativos fornecidos pelos dois métodos e que esta concordância é estatisticamente significativa. A partir destes resultados pode-se concluir que a metodologia de palpação utilizada neste trabalho para identificação dos processos espinhosos da coluna vertebral permitiu que o software APPID fornecesse resultados válidos quanto à identificação, classificação e mensuração da escoliose idiopática nos indivíduos estudados. Assim, esta metodologia de palpação e marcação dos processos espinhosos, associada ao software APPID, caracteriza uma alternativa válida e simples para avaliação da postura estática no plano frontal. Novos estudos precisam ser realizados para verificar a reprodutibilidade do método. / The aim of this study was to verify the validity of using a postural assessment methodology based on the identification of bony anatomic structures through palpation, using surface markers and in the acquisition of digital images, and to evaluate the validity of the software Postural Assessment From Digital Images (PAFDI) in the identification and characterization of the static spine column in the frontal plan. 24 subjects (16 females and 8 males) that had a medical statement to perform radiography exams in the spine column and whose averages were: age (31.9 years old ±12.3) body mass (58.4kg ± 9.4) and stature (1.66 m ± 0.07) were evaluated. Reflexive markers containing lead were placed on the vertebras C7, T2, T4, T6, T8, T10, T12, L2, L4 and S2, found through palpation in each individual. A radiographic image was obtained and then a photographic image, both in the frontal plan and in orthostatic position. Through the radiographic image it was possible to observe the positioning of the surface markers and the localization of their internal bony structures and two procedures were performed in order to verify its concordance: the evaluation of spatial positioning of the markers and their distance regarding the spine process. Statistically, in the sample, there were not clues of significant differences (p<0,05) between the marking points in the spine column regarding the spatial positioning of the markers (c2=13,118; p=0,157), nor regarding the distance of the markers in relation to the spine level (c2=9,366; p=0,404); that is, the marker identified all the vertebras under study the same way. For the analysis of the validity of the PAFDI software, the photographic images were digitalized and the report supplied by the program was compared to the radiographic report, regarding the identification and characterization of scoliosis, and there was not a statistically significant difference between the two forms of evaluation (z=-0,891; p=0,373). Complementing this result, the Charrière & Roy’s Arrows, supplied by PAFDI software, were correlated to Cobb’s angle, in the thoracic regions (r=0,752; p< 0,001) and lumbar (r=0,760 p=0,007). The results obtained showed that there was a strong degree of concordance between the quantitative results supplied by the two methods and that this concordance is statistically significant. From these results, it can be concluded that the palpation methodology used in this work to identify the spiny processes of the spine column allowed the software PAFDI to give valid results regarding identification, classification and mensuration of idiopathic scoliosis in the individuals under study. Thus, the palpation methodology and the marking of spiny processes, associated to software PAFDI are a simple and valid alternative for the evaluation of the static posture in the frontal plan. New studies must be performed to prove the reliability of the method.

A escoliose idiopática do adolescente (EIA) é uma deformidade da coluna vertebral que acomete indivíduos entre 10 e 19 anos de idade, caracteriza-se por desvios das curvas nos planos frontal e sagital, e rotação intervertebral no plano axial. Devido a sua natureza tridimensional apresenta alterações biomecânicas que geram adaptações em músculos e ligamentos da coluna vertebral, alterando suas funções no controle postural. O tratamento cirúrgico visa corrigir os desvios e manter as curvas no plano sagital, através de artrodeses. Com base nesses conceitos, o objetivo do estudo foi avaliar a influência da escoliose idiopática do adolescente, e da sua correção cirúrgica, sobre o equilíbrio semi-estático. Participaram do estudo 30 adolescentes divididas em dois grupos: Grupo Controle (GC) [n=15], idade média de 15,13 ± 1,59 anos, massa corporal de 51,22 ± 2,5Kg e estatura de 159 ± 3cm, e Grupo Escoliose (GE) [n=15] com média de idade de 15 ± 1,64 anos, massa corporal de 46,1 ± 3,26Kg e estatura de 156 ± 3cm; das quais foi mesurada a oscilação do centro de pressão a partir de uma plataforma de força avaliando as variáveis: desvio ântero-posterior (DAP); desvio médio-lateral (DML); velocidade ântero-posterior (VAP); velocidade médio-lateral (VML) e área (A²). O GC realizou a avaliação do equilíbrio semi-estático em um único momento, enquanto o GE realizou a avaliação do equilíbrio semi-estático no momento pré-operatório (PRÉ) e no 7°, 30°, 60° e 90° dia de pós-operatório (PO). Foi avaliado o grau de correção da curvatura e a relação entre número de vértebras artrodesadas e a oscilação corporal. O equilíbrio semi-estático foi avaliado nas 4 posições de Romberg (P1 - pés separados, P2 - pés unidos, P3 - série parcial e P4 - série completa) nas condições olhos abertos (AO) e olhos fechado (OF). Os resultados mostram que o GE apresentou uma redução média de 49,8° para a curva torácica e 18,14° para as lombares. O número de vértebras artrodesadas foi de 11,26 ± 1,7. O GE apresentou maior oscilação que o GC, com diferença significativa nas quatro variáveis estudadas (DAP, DML, VAP, VML e A²) e em todas as posições/condições. Com base nos resultados verificou-se que o GE oscila mais que o GC tanto no pré-operatório como nos momentos pós-operatório. Na comparação entre as posições, GE oscilou mais no sentido AP em P1 e no sentido ML em P4, também obteve maior valor para a A². Para a VAP P2 foi a mais desafiadora e para VML foi P4. Os dados apontam para uma diminuição gradativa da oscilação com o passar dos dias de PO, porém no 90° dia o GE ainda apresenta valores superiores ao momento PRÉ. Portanto, os resultados mostram que a escoliose afeta o controle postural e que no 90° dia pós-cirúrgico a oscilação postural ainda se apresenta superior ao período pré-operatório, e que pode estar associado a um comprometimento sensório-motor ou a um problema de integração sensorial pré-existente, também relacionado as alterações biomecânicas decorrentes da cirurgia e seu efeito agudo. / The adolescent idiopathic scoliosis (AIS) is a spinal deformity that affects individuals between 10 and 19 years of age, characterized by deviations of the curves in the frontal and sagittal planes, and intervertebral rotation in the axial plane. Due to its three-dimensional nature presents biomechanical changes that cause changes in muscles and ligaments of the spinal column, altering their functions in postural control. Surgical treatment aims to correct the deviations and maintain the curves in the sagittal plane through arthrodesis. Based on these concepts, the study aimed to evaluate the influence of adolescent idiopathic scoliosis and its surgical correction on the semi-static balance. The study included 30 adolescents divided into two groups: control group (CG) [n = 15], mean age 15.13 ± 1.59 years, body mass 51.22 ± 2.5kg and height 159 ± 3cm, and scoliotic group (SG) [n = 15] mean age 15 ± 1.64 years, body mass index of 46.1 ± 3.26kg and height 156 ± 3cm, which was gauged from the oscillation the center of pressure from a force platform to evaluate the variables: anteroposterior deviation (APD); average-lateral devitation (MLD); anteroposterior speed (APS); average-lateral speed (MLS) and area (A²). CG carried out the assessment of the semi-static balance in a single moment, while the SG was evaluated at the preoperative period (PRE) and at the 7th, 30th, 60th and 90th days post operative (PO). We assessed the degree of curvature correction and the relationship between number of vertebrae arthrodesed and body sway. The static balance was assessed in 4 Romberg\'s positions (P1 - feet apart, P2 - feet together, P3 - partial series P4 and - full series) in eyes open conditions (EO) and eyes closed (EC). The results show that the SG had an average reduction of 49.8 degrees for the thoracic curve and 18.14 degrees for the lumbar. The number of vertebrae arthrodesed was 11.26 ± 1.7. The SG showed greater sway than the CG, with a significant difference in the four variables (APD; MLD; APS; MLS and A²) and in all positions/conditions. Based on the results it was found that the SG oscillates more than the CG (preoperatively and postoperatively). Comparing the positions of the SG volunteers ranged more towards AP in P1 and P4 in the ML direction, which also had higher values for the A². For the APS P2 was the most challenging and MLS was P4. The data indicate a gradual decrease of the oscillation over the postoperative days, but in the 90th day the GE still has higher values when the PRE. Therefore, the results show that scoliosis affects postural control and at the 90th day after the surgery the postural oscillation still superior tham postsurgery period, and maybe it can be associated with an impaired sensorimotor or a sensory integration problem pre-existing, related to the biomechanical changes followed from the surgery and its acute effect.

O subfinanciamento do tratamento cirúrgico das deformidades da coluna vertebral tem resultado em aumento progressivo das listas de espera nos centros de referência para tratamento de alta complexidade pelo sistema público de saúde. O objetivo do estudo foi caracterizar o modo como a gestão pública na saúde tem conduzido o tratamento das deformidades da coluna vertebral e avaliar as consequências clínicas, radiográficas e econômicas do atraso na realização do tratamento cirúrgico. O estudo foi realizado em três estágios: transversal, retrospectivo e prospectivo. Foram avaliados 60 pacientes com deformidades da coluna vertebral e que aguardavam tratamento cirúrgico até Dezembro de 2013, com idade entre 3 e 23 anos, 66,7% femininos, e de etiologias: neuromuscular (28,3%), congênita (26,7%), idiopática (25,0%), sindrômica (16,7%), doença de Marfan (1,7%) e neurofibromatose (1,7%). Os parâmetros avaliados foram idade, gênero, etiologia, origem, modo de encaminhamento, tempo de espera pelo encaminhamento, tempo de espera pelo tratamento cirúrgico, e necessidade de implantes não disponibilizados pelo sistema de gestão da saúde. No segundo estágio foram avaliados: qualidade de vida dos pacientes por meio do questionário SRS-22r e parâmetros radiográficos atuais, comparados aos parâmetros no momento do alistamento para o tratamento cirúrgico. No terceiro estágio, os pacientes foram distribuídos aleatoriamente em grupos cirúrgico e lista de espera. Os pacientes submetidos ao tratamento cirúrgico foram comparados aos que permaneceram na lista de espera quanto ao custo e à efetividade dos tratamentos, utilizando como desfecho a evolução dos parâmetros radiográficos e da pontuação no questionário SRS-22r. Foi observado que 91% dos pacientes foram originários das regionais de Ribeirão Preto e adjacentes. Apenas 25% dos pacientes receberam tratamento no centro primário. O tempo de espera pela consulta no centro de referência foi de medianos 8,5 meses, e, após o alistamento na fila de espera, os pacientes aguardaram medianos 13,5 meses pelo tratamento cirúrgico. 45% dos pacientes da fila de espera apresentaram necessidade de implantes não disponibilizados pelo sistema de gestão em saúde. A deformidade no plano coronal aumentou em média 18,7° durante o período de espera. Houve aumento no número de pacientes descompensados no plano coronal e sagital, e no número de pacientes com obliquidade pélvica. A pontuação mediana no questionário SRS-22r foi 3,73. O custo médio do tratamento dos pacientes submetidos à cirurgia foi R$71.139. Foi observada correção média da deformidade em -49,6% (-42,1°) e melhora na pontuação no questionário SRS-22r em 0,5 pontos. No grupo de pacientes submetidos ao seguimento clínico, o custo médio foi de R$377, com aumento médio da deformidade em 16,0% (11,0°); não houve diferença na pontuação no questionário SRS-22r. Os resultados do estudo indicam que novas políticas de gestão da saúde devam ser adotadas para o tratamento das deformidades da coluna vertebral com a finalidade de evitar a progressão da deformidade dos pacientes e viabilizar o tratamento definitivo / The underfunding of the surgical treatment of spinal deformities has resulted in steadily growing waiting lists in reference centers for high complexity treatment in publicly funded healthcare systems. The aim of the study was to characterize how the management of the public health system has been conducting the treatment of spinal deformities and to evaluate the clinical, radiological, and economic impact of the delay in performing the surgical treatment. The study was conducted in three stages: Cross-sectional, retrospective and prospective stages. Sixty patients with complex pediatric spinal deformities who were waiting for treatment until December 2013 were evaluated. The age range was 3-23 years-old, 66·7% were females, and the etiologies were: neuromuscular (28·3%), congenital (26·7%), idiopathic (25%), syndromes (16·7%), Marfan\'s disease (1·7%), and neurofibromatosis (1·7%). The evaluated parameters were age, gender, etiology, origin, method of referral, waiting time for the referral, waiting time for the surgical treatment, and the need for implants not reimbursed by the healthcare system. For the second stage, the health-related quality of life was assessed through the application of the SRS-22r questionnaire and the present radiographic measurements were compared to the initial parameters (at the time the patients were enrolled for surgery). For the third stage, the patients were randomly assigned into two groups: Surgery and Waitlist. The patients submitted to surgical treatment were compared to the patients who remained on the waiting list considering the costs and effectiveness of the treatments, using the progression of the radiographic parameters and the score in the SRS-22r questionnaire as outcome measures. The results of the study demonstrated that 91% of the patients were from the region of Ribeirão Preto and adjacent regions. Only 25% of the patients received treatment at primary care centers. Patients waited median 8.5 months for referral and 13.5 months for the surgical treatment. 45% of the patients on the waiting list had the necessity for implants not reimbursed by the healthcare system. The deformity\'s Cobb angle increased mean 18.7° during the waiting period. There was an increase in the number of patients with coronal or sagittal decompensation, and in the number of patients with pelvic obliquity. The median SRS-22r® total score was 3.73. The mean cost of treatment for the Surgery group was R$71,139. A deformity correction of mean -49.6% (-42.1°) and a health-related quality of life improvement of 0.5 points in the SRS-22r score were observed. In the Waitlist group, the mean cost was R$377, with a mean increase of the deformity of 16.0% (11.0°); there was no difference in the SRS-22r scores. The results of the study indicate that new policies on the public health management of spinal deformities should be adopted to avoid progression of the deformities and make the definitive treatment viable

La scoliose infantile est une déformation rachidienne évolutive survenant chez l'enfant de moins de 3 ans. La technique de correction la plus répandue actuellement est celle des « tiges de croissance ». Cependant, la rigidité du matériel provoque la dégénérescence des disques intervertébraux, ce qui di-minue l'efficacité du traitement. Des études récentes ont montré l'effet bénéfique d'implants flexibles sur les disques. Notre équipe a donc développé le concept d'une suspension implantable qui permet de garder la mobilité axiale des segments instrumentés, associé à un nouveau système de fixation rotulée. Cepen-dant, quelle valeur de raideur permet de préserver les disques tout en corrigeant efficacement la sco-liose ? Cette thèse a donc pour objectifs de démontrer l'intérêt d'une suspension pour les disques inter-vertébraux et d'obtenir des informations quantifiables sur la valeur optimale de raideur. Pour cela des prototypes de suspension avec fixation rotulée, implantables chez le mammifère quadrupède et l'Homme, ont été développés afin d'étudier in vivo et in silico plusieurs gammes de flexibilité. Une étude in vivo sur chèvres adultes saines a été menée pour tester ces prototypes pour 2 raideurs différentes. L'état des disques intervertébraux après 6 mois a été évalué par IRM et par coupes histologiques. En parallèle la biomécanique d'un rachis humain sain puis scoliotique, instrumenté avec différents disposi-tifs (tiges classiques, suspensions, avec ou sans rotules), a été étudiée avec un modèle numérique mul-ti-corps rigides, préalablement validé par comparaison avec des données in vitro de la littérature. Les résultats de l'étude in vivo n'ont pas montré de différence significative entre les différentes instrumentations testées. Un temps d'essai plus long semble nécessaire pour voir apparaître la dégéné-rescence discale. Les simulations numériques ont montré une nette amélioration de la mobilité des segments ins-trumentés avec une suspension rotulée. La majorité de la mobilité est cependant assuré par le nouveau système de fixation et non par la présence d'une plus grande souplesse axiale. La suspension permet néanmoins un gain supplémentaire pour certains mouvements du rachis. Aucune différence significative n'a été constatée entre les 2 valeurs de raideurs étudiées. La présence de fixations rotulée diminue par contre fortement la correction obtenue lors des simulations de chirurgie de distraction. La suspension seule présente un intérêt certain lors de la correc-tion en diminuant les efforts transmis au matériel. Les développements futurs s'orienteraient donc vers une suspension combinée à des fixations rotulées présentant également des raideurs en rotation pour conserver correction et mobilité / Infantile scoliosis is a progressive spinal deformity occurring in children under 3 years-old. The most common currently correction technic is the "growing rods" one. However, the implant rigidity causes intervertebral discs degeneration, which decreases the treatment efficiency. Recent studies have shown the benefic effect of flexible implants on discs. Our team has developed the concept of an implantable suspension that keeps the axial mobility of the instrumented segments, associated with a new fastening ball joint system. However, which is the stiffness value that preserves discs while correcting scoliosis? This thesis goal is to demonstrate the effectiveness of a suspension device for preserving inter-vertebral discs health and obtain quantifiable information on the optimum stiffness value. Prototype suspensions with ball joint fastenings, implantable in quadruped mammals and humans, have been de-veloped to study several ranges of stiffness values in vivo and in silico. An in vivo study on healthy adult goats was conducted to test these prototypes for two different stiffness values. The intervertebral discs health after 6 months was evaluated by MRI and histological sections. In parallel the biomechanics of a human spine was studied with a rigid multi-body numerical model previously validated against in vitro literature data. Healthy and scoliosis subjects instrumented with different devices (traditional rods, sus-pensions, with or without the ball) were modeled. The results of the in vivo study showed no significant difference between the several instrumen-tations. A longer test time seems necessary to observe the onset of disc degeneration. Numerical simulations have shown a marked mobility improvement for the segments in the in-strumented area with a suspension device associated with a ball joint system. However, the majority of the mobility is provided by the new fixing system and not by a greater axial flexibility. The suspension still allows additional gain for certain spine movements. No significant differences were found between the two studied stiffness values. The presence of a ball joint fastening decreases strongly the correction obtained during surgery distraction simulations. The suspension has an interest during correction by reducing the forces trans-mitted to the material when used alone. Future developments thus would lead to a suspension device associated with ball joint fasten-ings that also have rotational stiffness to keep both good scoliosis correction and segments mobility

The purpose of this study was to investigate whether there is an association between developmental milestones of babies and the prevalence of spinal deformities in adolescents in Middelburg, Mpumalanga. The relationship between spinal deformities in a cross-sectional group of adolescents and parental recall was the focus of the study. One hundred and four adolescents were evaluated to determine if a spinal deformity was present. The subjects were then allocated to either the case (those with spinal deformities) or the control (subjects without spinal deformities) groups. The mothers of the subjects were then interviewed with regard to some of the developmental milestones of their offspring, and other factors which may have had an influence on the development of adolescent spinal deformities. The results showed that a perfectly "normal spine" was seldom found and that even in the control group some minor deviations, within normal limits, were present. Most of the mothers of subjects from the case group did not realise that their offspring had a deformity. There was a non¬significant trend for more crawlers to be present in the control group. Subjects who did not crawl, and who were also late walkers appeared to have an increased tendency to develop adolescent spinal deformities. Despite the fact that the schools approached were multi-racial, only white parents responded to the request for participation in this trial. The possible reasons for this should be investigated and a trial comparing the prevalence of spinal deformities amongst adolescents from all ethnic groups in South Africa should be conducted. Due to the possible recall bias of this study, it is recommended that a longitudinal study, commencing with the babies attending baby clinics in South Africa (representative of the South Africa population), be conducted to determine the influence of developmental milestones on the prevalence of spinal deformities in adolescence. / Dissertation (MPhysiotherapy)--University of Pretoria, 2010. / Physiotherapy / unrestricted

Of back problems experienced in adolescence, scoliosis is the most frequent (Bradford et al, 1987; Lancard-Dusek et al, 1991). Several studies have been conducted to determine the effect of exercise on back pain. The results indicated that certain regimes are more successful than others. The purpose of this study was to determine wether a corrective exercise programme, which was intensively and aggressively applied, will have a positive effect on adolescent scoliosis subjects. The subjects were divided, randomly, into a control and rehabilitation group. The rehabilitation group followed an eight week programme comprising 24 sessions. Both groups were evaluated at session zero (0) and session twenty four (24). A t-test for homogeneity was done at day zero, between the two groups for the variables V3 to V8. The results indicated homogeneity (P>0-05). A paired t-test was done for group one; indicating that there was a meaningful difference in all the variables; except for standing height (P>0*05). For group two the test indicates a meaningful difference for degrees, standing height and lateral flexion. A t-test at day 24 indicated a meaningful difference for degrees and lateral flexion. This indicates that the group which had followed the programme had improved whilst the control group had deteriorated. AFRIKAANS : Van die rug probleme ondervind by jeugdiges,, is skoliose die mees veelvuldig (Bradford et al, 1987; Lancas-Dusek et al, 1991). Verskeie studies is reeds gedoen wat die effek van oefening op die rug evalueer. Die resultate dui aan dat van die programme meer suksesvol is as ander. Die doel van die studie was om te bepaal of 'n korrektiewe oefenings program, wat intensief en aggresief toegepas is, 'n positiewe effek op geringe ado1essent skoliose individue sal hê. Die individue was willekeurig ingedeel in 'n kontrole en 'n rehabilitasie groep. Die rehabilitasie groep het 'n agt weke program gevolg van 24 sessies. Beide groepe was tydens sessie nul en sessie 24 ge-evalueer. 'n Toets vir homogeniteit was gedoen by dag nul, tussen die twee groepe, vir die veranderlikes V3 tat V8. Die resultate was homogeen (p>0-05). 'n Gepaarde t-toets vir groep een het aangedui dat daar 'n betekenisvolle verskil vir al die verander1ikes was; behalwe staande 1engte (p>0-05). Vir groep twee was daar 'n betekenisvolle verskil in grade, staande lengte en laterale fleksie. 'n T-toets op dag 24 het 'n betekenisvolle verskil vir laterale fleksie aangedui. Dit dui aan dat die groep wat die program gevolg het verbeter het, terwyl die kontrole groep agteruit gegaan het. Copyright / Dissertation (MA (MHS))--University of Pretoria, 2011. / Arts, Languages and Human Movement Studies Education / unrestricted

La scoliose est une déformation en trois dimensions de la colonne vertérbale. Les traitements chirurgicaux actuels sont à l’origine d’une perte de mobilité et de croissance du rachis. Pour palier à ces difficultés, un implant innovant de correction à été développé. Cet implant de type « fusionless » a pour but de préserver la mobilité et la croissance de la colonne vertébrale. Des études morphométriques nous ont permis de connaître la croissance du rachis chez le porc. Cette dernière est maximale entre la 6ème et la 10ème semaine de vie. Les corridors d’insertion des vis pédiculaires ont également pu être décrit. Ensuite, des essais biomécaniques nous ont permis de connaître les contraintes s’exerçant sur le rachis du porc au cours de l’apparition des déformations scoliotiques et de décrire la résistance à l’arrachement des vis pédicualires. Chez le porcs, leur implantation doit etre bicorticale. Enfin, le dispositif a pu être implanté avec succès et a été suivi pendant 2 mois chez 6 porcs charcutiers. Nous avons pu montrer que le dispositif ne semble altérer ni la croissance ni la mobilité rachidienne. Aucune dégénérescence discale n’a été observée / Scoliosis is a three-dimensional deformity of the spine. Current surgical treatment are associated with a lost of spine mobility and growth. To avoid those complications, a new fusionless device, preserving spine growth and mobility, has been develloped. Morphometrics studies allow us to evaluated spinal growth in the pigs. This latter one is maximal between the 6th and 10th weeks. Safe corridor of implantation of pedicle screws was also described. During biomechanicals studies, in vivo measurements of forces observed pigs during soliosis deformities induction in a porcine model was performed. Pullout ressitance of pedicle screw in pigs verterbra was also measured in ordre to optimize pedicle screw fixation in the porcine model. In growing pigs, bicortical screw implantation should be used.Finally, the device was implanted during two months in 6 pigs. Spine growth and mobility were not affected and no disc degeneration was observed during the follow up period

Background: Neuromuscular Scoliosis is a frequent complication of Cerebral Palsy that requires surgical management including spinal fusion. The objective of this observational study was to describe differences in the frequency of postoperative complications in children with Cerebral Palsy following spinal fusion surgery compared to children with Idiopathic Scoliosis. Methods: The 2016 Kids’ Inpatient Database was queried to identify pediatric patients (old) with concurrent diagnoses of Cerebral Palsy and Neuromuscular Scoliosis undergoing spinal fusion surgery. Cases were compared to children without Cerebral Palsy and with a diagnosis of Idiopathic Scoliosis undergoing the same procedure. Fitted Poisson regression analysis with robust variance was performed to estimate relative risks in the frequency of various clinical complications while adjusting for several potentially confounding variables of importance. Results: A total of 660 cases and 5,244 comparators were identified. Compared to children with Idiopathic Scoliosis, children with Cerebral Palsy were younger (13.6 vs. 14.3 years), more likely to be male (54% vs. 23%), and more likely to have had governmental insurance (52% vs. 32%). They also had longer hospital lengths of stay (8 days vs. 4 days). After adjusting for a number of potentially confounding sociodemographic and clinical variables, children with Cerebral Palsy were more likely to have postoperative pulmonary, gastrointestinal, and surgical complications, receive blood transfusions, and be admitted to the ICU. Conclusions: Children with Cerebral Palsy have an increased risk of complications following spinal fusion surgery leading to longer hospital stays. These results further inform surgical decision-making and anticipatory guidance for these children and their caregivers.