Made available in DSpace on 2016-06-02T20:18:23Z (GMT). No. of bitstreams: 1 5995.pdf: 2869208 bytes, checksum: 78818b61943b25fd2cc3f8d00a47f406 (MD5) Previous issue date: 2013-06-06 / The anatomical alterations of spine have been researched in experimental and clinical studies. The present study focused the analysis on the three aspects. The scoliosis and the alterations on the metabolic profile of the paravertebral and pectoral muscles (study I), the scoliosis and stretching influence in the plasma citocines concentration (study II) and the status of cardiac autonomic function front the scoliosis implantation (study III). The three studies were performed with male rats, which were divided into different experimental groups, with a total n of 68 animals. For the scoliosis induction were applied a non-invasive model composed by vests made of polyvinyl chloride (PVC). All data were expressed as mean ± epm. For the statistical analysis the Kolmogorov-Smirinov test was applied to investigate the normality of the data, whereas studies I and II were followed by the variance analysis ANOVA and Tukey post hoc (p<0,05), in the study III were used the Student-t test or the sum of rank in the Mann-Whitney test (p<0,05). In the first study were applied vests to the scoliotic group since the initial growth phase (post weaning) until the sixth week of growth, however in the studies II and III the vests application went up to the twelfth week. To the achievement of the first study the rats were divided into 2 experimental groups with n=6: control (C) and scoliotic (S). The outcomes from this study showed a reduction on the relation total protein/DNA, in the glycogen content and in the total weight of the scoliotic animals. This study established a homeostatic impairment of the pectoral and paravertebral muscles during the scoliosis induction process. In the second study the animals were distributed into 4 groups with n=8: control (C), stretched (S), scoliotic (SG) and stretched scoliotic (SS). The stretching consisted in 3 series of 30 seconds with 10 seconds of interval among the series. The results revealed an important increase in the concentration of IL-2, IL-6 and e TNF-&#945; in the scoliotic group, whereas the intervention with stretching exercises could achieve a decrease of 4, 9 and 6% respectively on the concentration increase. These results suggest that the proposed model used to induce the scoliosis lead to a muscular disuse and the stretching has showed to be effective to minimize the deriving consequences of this disuse. In the third study the animals were divided into 2 groups again, control group (C, n=12) and scoliosis group (S, n=12). On this study the attention referred to possible alterations in the cardiovascular autonomic control system. Evaluations of heart rate variability, cardiac autonomic tonus and cardiac baroreflex sensitivity. From these results was possible to certify that scoliosis causes an alteration in the autonomic control, being that the scoliotic group presented best sympathetic modulation, greater vagal tone and greater cardiac baroreflex sensitivity. The outcomes suggest that scoliosis promote alterations in the autonomic function of the cardiac system. In general, the results from this study demonstrated that the scoliotic animals have smaller glycogen reserves and lower ratios of total protein/DNA; higher concentration of the citocines IL-2, IL-6 and TNF-&#945;, while the scoliotic and stretched rats have lower concentrations from the same citocines; referring to the autonomic modulation the scoliosis led to a higher total variance, greater sympathetic cardiac modulation, greater vagal tono and best baroreflex sensitivity proving a better condition in the cardiovascular autonomic function through the most part of the evaluated items in the scoliotic rats. / As alterações anatômicas da coluna vertebral têm sido investigadas em estudos clínicos e experimentais. O presente trabalho concentrou suas análises em três vertentes: A escoliose e suas alterações no perfil metabólico da musculatura paravertebral e peitorais (estudo I), as influências da escoliose e do exercício de alongamento sobre a concentração de citocinas plasmáticas (estudo II) e o status da função autonômica cardiovascular frente à implantação da escoliose (estudo III). Os três estudos foram realizados com ratos machos divididos em diferentes grupos experimentais, com n total de 68 animais. Para a implantação da escoliose foi utilizado um modelo não invasivo constituído por um colete de filme de policloreto de vinil (PVC). Os dados foram apresentados em média ±epm. Para a avaliação estatística os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov, sendo que nos estudos I e II foi seguido da análise de variância ANOVA e post hoc de Tukey (p<0,05), no estudo III teste t-Student ou pela soma dos ranks no teste de Mann-Whitney (p<0,05). No primeiro estudo o grupo escoliótico recebeu a aplicação do colete desde as fases iniciais de crescimento (pós-desmame) até a sexta semana de crescimento, e nos estudos II e III a aplicação do colete foi até a décima segunda semana. Para a realização do primeiro estudo os animais foram distribuídos em 2 grupos experimentais de n=6: controle (C) e escoliótico (E). Os resultados desse estudo revelaram redução na relação proteína total/DNA, no conteúdo de glicogênio e no peso total dos animais escolióticos. Com esse estudo foi constatado comprometimento homeostático de músculos peitorais e paravertebrais durante o processo de indução de escoliose. No segundo estudo os animais foram distribuídos em quatro grupos de n=8: controle (C), alongado (A), escoliótico (E) e escoliótico alongado (EA). O alongamento consistiu de 3 séries de 30 segundos com intervalos de 10 segundos entre as séries. Os resultados revelaram importante aumento das concentrações de IL-2, IL-6 e TNF-&#945; no grupo escoliótico, por outro lado a intervenção com exercício de alongamento foi capaz de reduzir em 4, 9 e 6% respectivamente esse aumento. Esse resultado sugere que a indução de escoliose com o modelo proposto promove desuso muscular e o alongamento se mostrou capaz de minimizar os efeitos decorrentes desse desuso. No terceiro estudo os animais foram divididos novamente em 2 grupos experimentais, grupo controle (C, n=12) e grupo escoliose (E, n=12). Nesse estudo a atenção foi voltada para possíveis alterações no sistema de controle autonômico cardiovascular. Foram realizadas avaliações da variabilidade da frequência cardíaca, do tônus autonômico cardíaco e da sensibilidade barorreflexa cardíaca. Com os resultados foi possível constatar que a escoliose promove uma alteração no controle autonômico, de forma que o grupo escoliótico apresenta maior modulação simpática, maior tônus vagal e maior sensibilidade baroreflexa cardíaca. Os dados sugerem que a escoliose promove alterações na função autonômica do sistema cardiovascular. No geral, os resultados desse trabalho revelam que os animais escolióticos possuem menores reservas glicogênica e menor relação proteína total/DNA; maiores concentrações das citocinas IL-2, IL-6 e TNF-&#945;, ao passo que os ratos escolióticos e alongados possuem menor concentração das mesmas citocinas; quanto a modulação autonômica cardiovascular a escoliose levou a maior variância total maior modulação simpática cardíaca, maior tônus vagal e maior sensibilidade baroreflexa mostrando melhor condição da função autonômica cardiovascular pela maioria dos índices avaliados nos ratos escolióticos.

A escoliose é considerada a quinta patologia mais comum em desenvolvimento na adolescência. Sendo que no Brasil a prevalência desta patologia varia de 2% a 4% em adolescentes na faixa etária de 10 a 16 anos. O método Pilates pode ser considerado como alternativa no tratamento conservador desse desvio postural. O objetivo deste estudo foi avaliar o método Pilates no alinhamento postural de adolescentes portadores de escoliose, por meio da eletromiografia e da simetrografia. Foi realizado um estudo exploratório no período de Fevereiro a Abril de 2015, com 22 adolescentes, com idade de 12 a 18 anos, de ambos os sexos, que apresentaram o desvio postural escoliose, fisicamente ativos, sem experiência em treinamento resistido do Método Pilates e que não tinham realizado cirurgia corretiva ortopédica na coluna vertebral e nem recebido diagnóstico de doença reumática. Os voluntários pesquisados preencheram termo de assentimento informado livre e esclarecido e os responsáveis preencheram o termo de consentimento livre e esclarecido. Os adolescentes investigados inicialmente foram submetidos à avaliação antropométrica, percentual de gordura, simetria corporal, teste de Adams e avaliação eletromiográfica nos músculos trapézio, eretores espinhais, oblíquos e reto abdominal, na posição sentada equilibrando um livro sobre a cabeça processados no domínio temporal (EMGAmp) e espectral (EMGFmed). Na sequência foram submetidos á 24 sessões com dois atendimentos semanais de um protocolo de tratamento constituído por exercícios do método Pilates. Após a aplicação deste protocolo, foram novamente submetidos às avaliações iniciais. Os dados foram analisados pela ANOVA e processados utilizando o software estatístico R versão 3.2.0. e teste de McNemar. Os resultados com relação à escoliose mostraram que nove adolescentes melhoraram o alinhamento postural (40,9%) (p=0,001) e também no encurtamento do trapézio (p=0.031) e nos ombros assimétricos (p=0.001). Relativo à EMGAmp na escoliose postural à direita (EPD) houve diferença entre antes e depois (p=0.081) e também entre os músculos (p=0.031); na escoliose torácica à direita (ETD) houve diferença entre antes e depois (p≈0), o lado direito do esquerdo (p=0.04) e também entre os músculos (p≈0); na escoliose torácica à esquerda (ETE) e na escoliose tóraco-lombar destro convexa (ETLDC) houve diferença entre antes e depois (p≈0) e entre os músculos (p≈0). Referente à EMGFmed na EPD houve diferença entre antes e depois (p≈0) e entre os músculos (p=0.001); na ETD houve diferença entre antes e depois (p≈0) e entre os músculos (p=0.007); na ETE e ETLDC houve diferença apenas entre antes e depois (p≈0); na ETLE houve diferença entre antes e depois (p=0.007). Em todos os casos de escoliose estudados, houve aumento da EMGFmed com destaque para os músculos OBLI e RA. Verificaram-se diferenças estatísticas nas variáveis estatura (p=0,003) e aumento na flexibilidade (p=0,000). Conclui-se que os resultados apontam para a importância dos exercícios do método Pilates como forma de tratamento conservador da escoliose, ocasionando mudanças no padrão de ativação neuromuscular. Porém em relação ao tempo de aplicação terapêutico relativo ao alinhamento postural, sugere-se desenvolvê-lo em prazos maiores. / Scoliosis is considered the fifth most common pathology in development during adolescence. And in Brazil the prevalence of this disease ranges from 2% to 4% in adolescents aged 10-16 years old. The Pilates method can be considered as an alternative to conservative treatment of this postural deviation. The aim of this study was to evaluate the Pilates method in the postural alignment of adolescents with scoliosis through electromyography and symmetrography. An exploratory study was conducted from February to April 2015, with 22 12 to 18 year old male and female adolescents who had the scoliosis postural deviation, physically active, without experience in resistance training of Pilates and who had not performed orthopedic corrective surgery on the spine and not been diagnosed with rheumatic disease. Both surveyed volunteers and their parents filled informed consents. The investigated teenagers initially underwent anthropometric measurements, body fat percentage, body symmetry, Adams test and electromyographic assessment in trapezius, erector spinal, obliques and rectus abdominis, in a seated position balancing a book on their heads processed in the time (EMGAmp ) and spectral domains (EMGFmed). After that they were submitted to 24 sessions with two weekly appointments of a treatment protocol consisting of Pilates exercises. After the application of this protocol, they were again subjected to initial assessments. Data were analyzed by ANOVA and processed by using the statistical software R version 3.2.0. and McNemar test. Results regarding scoliosis showed that nine adolescents improved postural alignment (40.9%) (p = 0.001) and there was also an improvement in the shortening of the trapezius (p = 0.031) and asymmetrical shoulders (p = 0.001). Concerning the EMGAmp in right postural scoliosis (EPD), there was a significant difference between before and after (p = 0.081) and also between muscles (p = 0.031); in the right thoracic scoliosis (ETD) there was a difference between before and after (p≈0), the right side of the left (p = 0:04) and between muscles (p≈0); in the left thoracic scoliosis (ETE) and convex left thoracolumbar scoliosis (ETLDC) differences between before and after (p≈0) and between muscles (p≈0) were found. Concerning the EMGFmed in the EPD there was a difference between before and after (p≈0) and between muscles (p = 0.001); in the ETD there was a difference between before and after (p≈0) and between muscles (p = 0.007); in ETE and ETLDC there was a difference only between before and after (p≈0); in ETLE there was a difference between before and after (p = 0.007). In all cases of scoliosis studied here, there was an increase of EMGFmed notably in the OBLI and RA muscles. There were statistical differences in height variables (p = 0.003) and increased flexibility (p = 0.000). One can conclude that the results point to the importance of Pilates exercises as a form of conservative treatment of scoliosis, causing changes in the pattern of neuromuscular activation. However, in relation to the therapeutic application time relative to postural alignment, it is suggested to develop it in longer periods.

A escoliose é considerada a quinta patologia mais comum em desenvolvimento na adolescência. Sendo que no Brasil a prevalência desta patologia varia de 2% a 4% em adolescentes na faixa etária de 10 a 16 anos. O método Pilates pode ser considerado como alternativa no tratamento conservador desse desvio postural. O objetivo deste estudo foi avaliar o método Pilates no alinhamento postural de adolescentes portadores de escoliose, por meio da eletromiografia e da simetrografia. Foi realizado um estudo exploratório no período de Fevereiro a Abril de 2015, com 22 adolescentes, com idade de 12 a 18 anos, de ambos os sexos, que apresentaram o desvio postural escoliose, fisicamente ativos, sem experiência em treinamento resistido do Método Pilates e que não tinham realizado cirurgia corretiva ortopédica na coluna vertebral e nem recebido diagnóstico de doença reumática. Os voluntários pesquisados preencheram termo de assentimento informado livre e esclarecido e os responsáveis preencheram o termo de consentimento livre e esclarecido. Os adolescentes investigados inicialmente foram submetidos à avaliação antropométrica, percentual de gordura, simetria corporal, teste de Adams e avaliação eletromiográfica nos músculos trapézio, eretores espinhais, oblíquos e reto abdominal, na posição sentada equilibrando um livro sobre a cabeça processados no domínio temporal (EMGAmp) e espectral (EMGFmed). Na sequência foram submetidos á 24 sessões com dois atendimentos semanais de um protocolo de tratamento constituído por exercícios do método Pilates. Após a aplicação deste protocolo, foram novamente submetidos às avaliações iniciais. Os dados foram analisados pela ANOVA e processados utilizando o software estatístico R versão 3.2.0. e teste de McNemar. Os resultados com relação à escoliose mostraram que nove adolescentes melhoraram o alinhamento postural (40,9%) (p=0,001) e também no encurtamento do trapézio (p=0.031) e nos ombros assimétricos (p=0.001). Relativo à EMGAmp na escoliose postural à direita (EPD) houve diferença entre antes e depois (p=0.081) e também entre os músculos (p=0.031); na escoliose torácica à direita (ETD) houve diferença entre antes e depois (p≈0), o lado direito do esquerdo (p=0.04) e também entre os músculos (p≈0); na escoliose torácica à esquerda (ETE) e na escoliose tóraco-lombar destro convexa (ETLDC) houve diferença entre antes e depois (p≈0) e entre os músculos (p≈0). Referente à EMGFmed na EPD houve diferença entre antes e depois (p≈0) e entre os músculos (p=0.001); na ETD houve diferença entre antes e depois (p≈0) e entre os músculos (p=0.007); na ETE e ETLDC houve diferença apenas entre antes e depois (p≈0); na ETLE houve diferença entre antes e depois (p=0.007). Em todos os casos de escoliose estudados, houve aumento da EMGFmed com destaque para os músculos OBLI e RA. Verificaram-se diferenças estatísticas nas variáveis estatura (p=0,003) e aumento na flexibilidade (p=0,000). Conclui-se que os resultados apontam para a importância dos exercícios do método Pilates como forma de tratamento conservador da escoliose, ocasionando mudanças no padrão de ativação neuromuscular. Porém em relação ao tempo de aplicação terapêutico relativo ao alinhamento postural, sugere-se desenvolvê-lo em prazos maiores. / Scoliosis is considered the fifth most common pathology in development during adolescence. And in Brazil the prevalence of this disease ranges from 2% to 4% in adolescents aged 10-16 years old. The Pilates method can be considered as an alternative to conservative treatment of this postural deviation. The aim of this study was to evaluate the Pilates method in the postural alignment of adolescents with scoliosis through electromyography and symmetrography. An exploratory study was conducted from February to April 2015, with 22 12 to 18 year old male and female adolescents who had the scoliosis postural deviation, physically active, without experience in resistance training of Pilates and who had not performed orthopedic corrective surgery on the spine and not been diagnosed with rheumatic disease. Both surveyed volunteers and their parents filled informed consents. The investigated teenagers initially underwent anthropometric measurements, body fat percentage, body symmetry, Adams test and electromyographic assessment in trapezius, erector spinal, obliques and rectus abdominis, in a seated position balancing a book on their heads processed in the time (EMGAmp ) and spectral domains (EMGFmed). After that they were submitted to 24 sessions with two weekly appointments of a treatment protocol consisting of Pilates exercises. After the application of this protocol, they were again subjected to initial assessments. Data were analyzed by ANOVA and processed by using the statistical software R version 3.2.0. and McNemar test. Results regarding scoliosis showed that nine adolescents improved postural alignment (40.9%) (p = 0.001) and there was also an improvement in the shortening of the trapezius (p = 0.031) and asymmetrical shoulders (p = 0.001). Concerning the EMGAmp in right postural scoliosis (EPD), there was a significant difference between before and after (p = 0.081) and also between muscles (p = 0.031); in the right thoracic scoliosis (ETD) there was a difference between before and after (p≈0), the right side of the left (p = 0:04) and between muscles (p≈0); in the left thoracic scoliosis (ETE) and convex left thoracolumbar scoliosis (ETLDC) differences between before and after (p≈0) and between muscles (p≈0) were found. Concerning the EMGFmed in the EPD there was a difference between before and after (p≈0) and between muscles (p = 0.001); in the ETD there was a difference between before and after (p≈0) and between muscles (p = 0.007); in ETE and ETLDC there was a difference only between before and after (p≈0); in ETLE there was a difference between before and after (p = 0.007). In all cases of scoliosis studied here, there was an increase of EMGFmed notably in the OBLI and RA muscles. There were statistical differences in height variables (p = 0.003) and increased flexibility (p = 0.000). One can conclude that the results point to the importance of Pilates exercises as a form of conservative treatment of scoliosis, causing changes in the pattern of neuromuscular activation. However, in relation to the therapeutic application time relative to postural alignment, it is suggested to develop it in longer periods.

Introdução: Escoliose é definida como um complexo desalinhamento tridimensional da coluna vertebral na qual há o aparecimento de uma curvatura lateral no plano coronal, normalmente associada com o aplanamento das curvaturas no plano sagital e rotação vertebral em seu eixo longitudinal. O padrão ouro para seu diagnóstico e monitoramento é a medida radiográfica pelo ângulo de Cobb, que possui como principais desvantagens o fato de não avaliar as curvas em três dimensões e expor os pacientes, principalmente os que estão em fase de crescimento, a consideráveis doses de radiação. Objetivo: Esta pesquisa teve como objetivo principal o desenvolvimento de um sistema de avaliação e representação da coluna vertebral em três dimensões, capaz de possibilitar ao usuário a análise quantitativa dos desvios da coluna vertebral nos planos coronal, sagital e transverso. São objetivos secundários estimar a precisão e a exatidão do sistema proposto, e avaliar a sua aplicabilidade a partir de um estudo de caso. Métodos: O Sistema desenvolvido, denominado de Spine 3D, é baseado no uso do controle de videogame Wiimote para rastrear LEDs infravermelhos que compõe um marcador multiplanar em uma cena, e tem como objetivo reconstruir em um ambiente 3D a pose das vértebras torácicas e lombares e, com isto, obter as variáveis angulares e de translação que descrevem seu alinhamento nos planos coronal, sagital e transverso. O experimento para a avaliação da exatidão e precisão consistiu em posicionar o marcador a 50 centímetros de distância do Wiimote, ambos alinhados em um mesmo plano. O marcador foi transladado em intervalos de 10 mm e rotacionado em 5°, 10°, 20° e 30° nos eixos X, Y e Z, com auxílio de um inclinômetro e um paquímetro digital. Os dados foram coletados a 100 Hz. A exatidão foi calculada comparando os resultados encontrados pelo sistema com os valores obtidos pelo inclinômetro e paquímetro digital. A precisão foi calculada a partir do desvio-padrão dos pontos coletados. Resultados: A exatidão média do sistema foi de 0,90° e 0,78mm. A precisão média do sistema foi de 0,62° e 0,42mm. Para o ângulo de Cobb na escoliose, a exatidão e precisão foram de 1,46° e 1,72°, e para a cifose torácica e lordose lombar, a exatidão e precisão foram de 2,82° e 1,60°, respectivamente. Durante o estudo de caso, a diferença entre o Spine3D e a radiografia, para o ângulo de Cobb foi de 1,3° para escoliose curva torácica e 2,24° para escoliose curva lombar. Conclusão: O sistema mostrou ter boa exatidão e precisão após os testes de validação interna. O estudo de caso sugere que a técnica possui potencial para aplicação clínica na avaliação dos desvios da coluna vertebral em três dimensões. / Introduction: Scoliosis is a complex three-dimensional malalignment of the vertebral column in which there is lateral curvature of the spine in the coronal plane, usually associated with flattening of the contour in the sagittal plane and rotation of the vertebrae around their longitudinal axes. Routine clinical analysis of the scoliotic spine is currently based on the radiographic measurement of Cobb angle. Although considered as the golden standard, it has the disadvantage of look over only the two-dimensional aspects of the curve and, over a period of years, the patient will be exposed to a large dose of radiation, especially in early onset curves. There is evidence that this may increase the risk of developing several types of cancer. Objective: This paper describes a new low-cost and radiation-free system to evaluate the three-dimensional aspects of scoliosis, and its concurrent validation in terms of accuracy and precision. Its applicability was tested in a case study. Methods: The system, named Spine3D, has the ability to track an infrared beacon equipped with LEDs (IRLED) to reconstruct the pose of each lumbar and thoracic vertebra in 3D space. The system also calculates the spine alignment to the coronal, sagittal and transverse planes. For accuracy and precision evaluation of the system, the beacon was positioned 50 cm away from the IR camera (Wiimote), aligned with in the same plane. The beacon was increasingly translated at 10 mm intervals and rotated at 5°, 10°, 20° and 30° on all three axes. The capture achieved rate was of 100 Hz roughly and accuracy was calculated comparing the results of Spine3D, digital paquimeter and digital inclinometer. Precision was considered as the standard deviation of the collected data. Results: The average accuracy obtained for the system is 0.90° and 0.78 mm, with precision of 0.62° and 0.42 mm. For Cobb angle calculations in coronal plane, accuracy and precision were of 1.46° and 1.72°, and for thoracic kyphosis and lumbar lordosis, the values were 2.82° and 1.60°. During the case study, the difference between the Cobb angle measured by Spine3D and radiography was 1.3° for thoracic scoliosis curve and 2.24° for lumbar scoliosis curve. Conclusion: The Spine3D system offers a non-invasive and radiation-free alternative for three-dimensional spine assessment and representation. Future studies should indicate if the measures taken by the Spine3D system have correlation with the Cobb angle measured by other methods.

La scoliose idiopathique de l’adolescence constitue la déformation tridimensionnelle de la colonne vertébrale la plus couramment rencontrée chez les adolescents. Cette condition a fait l’objet de plusieurs études quant à ses facteurs étiologiques, ses facteurs de risque de progression et ses approches thérapeutiques. Les études démontrent que l’étiologie de cette pathologie serait multifactorielle, regroupant entre autres des causes génétiques, hormonales, mécaniques et neuromusculaires. Malgré le fait qu’il soit difficile de prédire quelles sont les déformations qui progresseront, certains facteurs tels que l’âge et le sexe du patient, l’âge du début de la ménarche, le type et la sévérité de la déformation ainsi que la maturité osseuse (signe de Risser) ont fait l’objet de nombreuses études et représentent par le fait même des critères de référence utilisés pour estimer cette probabilité. La scoliose idiopathique a souvent été considérée comme une condition non douloureuse, faisant en sorte que peu d’études se sont arrêtées à évaluer les douleurs au dos chez les patients affligés de cette pathologie. On retrouve donc, au cours des vingt dernières années, seulement une dizaine d’études qui ont spécifiquement évalué ce phénomène. Parmi ces études, on note une grande hétérogénéité des facteurs d’inclusion, des définitions des douleurs au dos, de la période de prévalence et des instruments de mesure utilisés, rendant difficile la détermination de cette prévalence. Considérant la relation entre les douleurs exprimées chez les adolescents et celles chez les adultes, ainsi que les coûts sociétaux associés à ces douleurs, il serait important d’obtenir un portrait plus exact de l’ampleur de la douleur chez cette clientèle. ii Les objectifs généraux de cette thèse visaient à (objectif 1) mettre à jour les connaissances relatives à la prévalence des douleurs au dos chez les adolescents avec une scoliose idiopathique (SI), à (objectif 2) vérifier s’il existe une relation entre la sévérité de la déformation, sa localisation et la présence de douleurs au dos chez ces patients, à (objectif 3) valider à nouveau l’aspect psychométrique du questionnaire SRS-22fv et enfin à (objectif 4) explorer une possible prise en charge alternative des patients avec scoliose idiopathique de l’adolescence (SIA) exprimant des rachialgies. La première étude rétrospective que nous avons effectuée a permis d’évaluer de quelle façon les douleurs exprimées par plus de 300 patients étaient rapportées dans les dossiers et d’établir la prévalence de ces douleurs chez ces derniers. De plus, cette étude a évalué le type de prise en charge recommandée lorsque des douleurs étaient mentionnées au dossier. Cette étude a permis de confirmer que près de 50 % des patients avec SIA exprimaient de la douleur au dos et que la majorité de ces derniers (80 %) n’avaient aucune prise en charge de celle-ci. La deuxième étude prospective que nous avons réalisée a évalué les douleurs au dos chez plus de 500 adolescents avec scoliose idiopathique de l’adolescence. Plus de 68 % de ces patients rapportaient la présence de douleurs au dos. Pour les régions thoraciques et lombaires, les douleurs étaient positivement associées avec la sévérité de la scoliose, alors que le port du corset avait un effet modérateur sur la douleur. La troisième étude incluse dans la présente thèse visait à (objectif 3) vérifier la validité de contenu et de construit de la version canadienne-française du questionnaire SRS- 22, soit le SRS-22fv, rempli par les patients recrutés lors de la deuxième étude. Ce iii questionnaire est couramment rempli par les patients scoliotiques. Notre étude a bénéficié d’un échantillon de 352 patients qui ont entièrement répondu au questionnaire SRS-22fv. L’analyse découlant de notre étude nous a menés à produire une version abrégée du SRS-22 contenant 18 éléments, avec une meilleure consistance interne ainsi qu’une variance explicative supérieure, soit 63,3 % pour le SRS-18fv, comparativement à 47,4 % pour le SRS-22fv. La dernière étude que nous avons menée (objectif 4) met en lumière une option de prise en charge alternative des patients avec scoliose exprimant ou non des douleurs au dos. En effet, les manipulations vertébrales font partie des options de traitements couramment utilisées chez les adolescents sains. Une grande incertitude demeure toutefois quant à l’utilisation de cette approche thérapeutique chez les patients avec scoliose idiopathique de l’adolescence. Cette étude a permis de confirmer qu’il y a un manque de données probantes dans ce domaine. Les résultats de cette thèse permettent de mieux comprendre le phénomène de la douleur au dos chez les adolescents avec scoliose idiopathique. Ces douleurs semblent plus prévalentes qu’initialement estimées, et il s’avère qu’un lien semble probable entre l’intensité des douleurs ressenties et la localisation de la courbe, ainsi qu’avec la sévérité de la scoliose chez ces adolescents. / Adolescent idiopathic scoliosis is a three-dimensional spinal deformity. This pathology is the most common spinal deviation encountered in adolescents and has been thoroughly researched over the past few decades regarding its aetiological factors, its risk of progression and management. It is now commonly accepted that the aetiology of adolescent idiopathic scoliosis is multifactorial and includes, among other things, genetic, hormonal, mechanic, and neuromuscular factors. Though predicting which deviation will progress remain challenging, certain factors such as the age of the patient at presentation, its gender, bone maturity (Risser sign), menarchal status, and the severity of the spinal deformity are now widely accepted as factors that may provide some guidance to estimate this probability. Adolescent idiopathic scoliosis has often been considered as a non-painful pathology, and this is perhaps why researchers have failed to assess back pain in this population more systematically. Only a few studies have been published over the last two decades on this subject. Among those studies, inclusion criteria are widely heterogeneous, as is the working definition of back pain, how the prevalence period was estimated, and which outcome measure was relied upon to assess back pain in this population. Because of this, the determination of back pain prevalence in scoliosis patients remains challenging. Considering the relationship between adolescent and adult spinal pain, and the high societal cost associated with this condition, it would be appropriate to obtain a clearer picture of this condition in this population. v The primary objectives of this thesis were to (objectif 1) update the current knowledge of back pain prevalence in adolescent idiopathic scoliosis patients, to (objectif 2) ascertain if a relationship was present between the severity and localisation of the scoliosis and the back pain, too (objectif 3) reassess the psychometric properties of the SRS-22fv questionnaire, and to (objectif 4) explore an alternative back pain management for those patients. The first retrospective study included in this thesis assessed back pain prevalence in 300 adolescent idiopathic scoliosis patients. It also looked at how pain was reported and if pain management was recommended for patients reporting back pain. This study confirmed that back pain was a prevalent condition in this population and that in the vast majority of those reporting back pain, there was no kind of management recommended. The second prospective study assessed back pain prevalence in more than 500 adolescent idiopathic scoliosis patients. Point prevalence of back pain was close to 68 %. For the thoracic and lumbar regions, the pain was positively associated with the severity of the scoliosis and bracing, prescribed to stabilise or prevent the curve progression, had a protective effect. Data collected in the previous study were employed to validate the most commonly utilised outcome measure in adolescent idiopathic scoliosis, the SRS-22. The SRS-22 is a measurement instrument used to ascertain the quality of life and pain in scoliotic patients. The third article includes a report on analyses done regarding the validation of the SRS- 22fv. Complete data were available for 352 adolescents. The study demonstrated that a briefer version (18 items) had a better internal consistency and explained a greater proportion of the variance thus 63,3 % instead of 47,4 % for the SRS-22fv. vi The last study included in this thesis looked at an alternative treatment for the management scoliotic patients with or without back pain. This modality of spinal manipulation is a treatment that healthy adolescents commonly utilised. However, it was found that the rate of utilisation remains unclear within adolescent idiopathic scoliosis patients. A literature review revealed the need to have better-designed studies to assess the efficacy of spinal manipulation in this population adequately. The acquired knowledge throughout this thesis leads us to a better comprehension and understanding of back pain in adolescent idiopathic scoliosis patients. Back pain appears to be more prevalent than initially estimated and a relationship seems to be present between the level of pain intensity and the scoliosis localisation and severity in patients suffering from this pathology.

L’évaluation classique de la posture rachidienne chez les patients porteurs d’une scoliose idiopathique de l’adolescent (SIA) se fait habituellement dans une position contrainte et statique en radiographie standard. Les conséquences sur la fonction rachidienne dynamique de ces déformations sont mal connues. Par ailleurs, les changements de la posture rachidienne au cours de la croissance et avec l’acquisition d’une marche stable n’ont encore jamais été explorés. L’analyse quantifiée du mouvement (AQM) d’une cohorte d’enfants sains a permis de mettre en évidence des modifications de la posture rachidienne dynamique au cours de la croissance, avec une augmentation de la gîte du tronc vers l’avant. Ces modifications s’accompagnaient de modifications anatomiques, en particulier au niveau des facettes articulaires cervicales. En AQM, les patients porteurs d’une SIA avaient des modifications du schéma de marche avec un décalage de phase à la marche entre la rotation des épaules et du bassin chez les patients scoliotiques. Il n’y avait pas de différence dans le schéma de marche entre les patients ayant une courbure thoracique droite et ceux ayant une courbure lombaire gauche. L’analyse de ces patients à 11 mois postopératoire a montré une restauration de certains paramètres grâce à la fusion vertébrale. Notamment, l’arthrodèse rachidienne postérieure de la courbure scoliotique a pour effet de faire disparaître le décalage de phase dans le plan transversal. L’AQM permet de mettre en évidence des modifications de la posture rachidienne chez ces patients et apparait comme un outil d’évaluation fondamental, qui pourrait nous permettre de mieux évaluer les traitements de la SIA. / In adolescent idiopathic scoliosis (AIS) patients, spinal posture is usually assessed in a constraint position with radiographic evaluation. However, the consequences of spinal deformity in these patients on the daily functioning of the spine remains unclear. On the other hand, spinal posture changes with normal growth and mature gait achievement have never been explored.A gait analysis was performed on a cohort of healthy children and highlighted changes in dynamic spinal posture with growth, showing that the trunk was increasingly leaning forward with mature gait achievement. These modifications were associated with anatomical changes, especially in the cervical spine.Changes in gait pattern were also observed in AIS patients thanks to gait analysis. In particular, there was a modification of upper trunk and pelvic rotation during gait. There was no difference in gait pattern according to major curve location. Eleven month postoperatively, our results showed that spinal fusion allowed restoration of a normal gait pattern, especially in the transversal plane.Gait analysis was able to highlight changes in dynamic spinal posture that occur in AIS patients, and thus appears as a major tool for spinal posture assessment in these patients. It could help us to improve the evaluation of the treatments that are proposed for spinal deformity correction.

Although scoliosis is defined as a deviation of the spine in the frontal plane above 10ř according to Cobb, the spine is deformed in three planes. The chest is also affected at the same time. The most common type is idiopathic scoliosis, which has multifactorial etiopathogenesis. The thesis summarizes available information on kinesiology of the spine, classification of idiopathic scoliosis, its incidence, etiology, diagnostics, treatment and specific physiotherapeutic exercises. The practical part is devoted to assessing the symmetry of the patient's torso from the photographic documentation of the posture by SCODIAC 2.3. Indices evaluating hull asymmetry from the back or front (POTSI, ATSI) result from mathematical calculation. The smaller the number, the more symmetrical the posture. Correlation of POTSI index and Cobb angle is explored. 20 patients (18 girls and 2 boys) with idiopathic scoliosis up to 47ř according to Cobb aged between 7 to 18 years were selected for the study. All patients were subjected to anamnestic data collection, kinesiology analysis and a questionnaire. The results were statistically processed. SCODIAC software is one of the options offered to evaluate torso asymmetry and assess posture changes after therapy. It acts as a feedback for a physiotherapist and motivates...

Adolescent idiopathic scoliosis (AIS) is characterised as a three-dimensional deformity of the spine with unknown etiopathogenesis. There is evidence that scoliosis may be associated with abnormalities of the vestibular system. Examination of postural stability and verticality perception is a way to assess vestibular function. The objective of this work is to compare postural stability and subjective visual vertical (SVV) between adolescents with idiopathic scoliosis and healthy controls. Twelve AIS patients and twelve controls participated in the study. Examination of postural stability was performed through a Kistler force platform and the SVV was tested using a pre-programmed computed equipment Synapsys. An instrument for evaluating the perception patients have of their trunk deformity, Trunk Appearance Perception Scale (TAPS), was also part of the examination. Our results did not show a significant difference between the two groups in postural stability and static SVV-S. Statistically significant difference was found on dynamic SVV-D with clockwise rotation (p  0,01): AIS patients (1,19ř ± 1,03ř), control group (-0,17ř ± 0,82ř). There was also a significant difference on absolute deviation of dynamic SVV-D with clockwise rotation (p  0,05): AIS patients (1,50ř ± 0,77ř), control group (0,81ř ±...

La scoliose idiopathique de l’adolescence (SIA) est une déformation tridimensionnelle complexe du rachis affectant majoritairement les filles. L’atteinte progressive est surtout esthétique avec, notamment, une déformation de la cage thoracique résultante. L’asymétrie mammaire est une préoccupation fréquente chez ces jeunes filles. Se définissant comme une différence de forme, de position ou de volume des seins ou des complexes aréolo-mamelonnaires, l’asymétrie mammaire est courante chez les femmes, mais habituellement mineure et non visible. Il demeure incertain dans la littérature si l’asymétrie mammaire est plus fréquente chez les scoliotiques. De plus, très peu d’études ont évalué la relation entre la scoliose et l’asymétrie mammaire. De façon instinctive, on serait porté à croire que ce ne sont pas les seins qui sont asymétriques, mais plutôt la déformation du thorax en rotation qui donne cette impression. Les seins représentent un des organes les plus difficiles à mesurer étant donné leur grande variabilité. Plusieurs méthodes de mesure ont été décrites. L’imagerie par résonance magnétique (IRM) est considérée l’outil le plus précis pour définir la glande mammaire et plus particulièrement, sa délimitation sur la cage thoracique. Ce projet consiste à quantifier l’asymétrie mammaire, représentée par une différence de volume entre les deux seins, chez une cohorte de jeunes filles présentant une SIA significative, en utilisant l’IRM comme outil de mesure. Ensuite, une méthode de mesure automatisée, à partir de la topographie surfacique 3D, est proposée. Les résultats obtenus avec cette méthode sont confrontés à ceux de l’IRM. L’influence de la posture sur le volume mammaire est également étudiée à partir de ces deux modalités différentes. Pour réaliser ces objectifs, une cohorte de 30 patientes scoliotiques a été recrutée sur la base de leur courbure thoracique et de leur maturité osseuse et mammaire. Deux imageries de tronc ont été effectuées : la topographie surfacique 3D et la résonance magnétique. Dans un premier temps, la sommation des images segmentées acquises par IRM nous a permis de mesurer de façon très précise le volume mammaire. Notre cohorte présente une asymétrie mammaire moyenne statistiquement significative de 8.32%. 66.6% des patientes présentent une asymétrie ≥ 5%. Par ailleurs, le sein gauche est plus volumineux chez 65.5% des patientes. Une faible corrélation non-significative existe entre les volumes mammaires et l’angle de Cobb ainsi que la gibbosité thoracique. Par la suite, une méthode de mesure automatisée, développée à partir de l’environnement mathématique Matlab, est appliquée directement sur les reconstructions 3D. En bref, elle consiste à identifier les contours des seins pour les exciser afin d’exposer la cage thoracique puis, à soustraire le thorax complet du thorax sans seins pour déterminer les volumes mammaires. Les volumes mammaires acquis par la méthode automatisée sont, de manière attendue, de plus petites tailles que ceux obtenus à l’IRM. Une forte corrélation est établie entre les volumes mammaires obtenus par les deux différentes techniques de mesure. Bien que statistiquement significatives, les asymétries mammaires (r= 0.614, p< .001) ne sont pas aussi fortement corrélées entre elles que les volumes. Le sein droit (r=0.805) présente une corrélation plus élevée que le sein gauche (r=0.747). Finalement, l’influence de la posture est étudiée à partir des maillages 3D de l’IRM (décubitus ventral) et de la topographie surfacique 3D (position debout). D’excellentes corrélations sont confirmées entre les volumes mammaires ; r= 0.896 et r= 0.939, respectivement pour les volumes mammaires gauches et droits. Ce projet a permis de démontrer, pour la première fois, qu’il est possible de calculer le volume mammaire de façon objective et précise avec l’IRM, chez une cohorte scoliotique. Grâce à la précision des repères anatomiques, l’IRM nous a permis de revisiter une croyance populaire dans la communauté de la scoliose. Celle soutenant que l’asymétrie mammaire ressentie par les patientes n’est qu’une perception. Ces nouvelles données nous permettrons de conseiller les jeunes filles avec la SIA, concernant leurs préoccupations sur l’asymétrie de leurs seins. Nous avons confirmé que la méthode de mesure automatisée est réalisable cliniquement et pourrait être utilisée pour prédire les volumes obtenus à l’IRM. Par ailleurs, c’est le premier outil de mesure de volumétrie mammaire complètement automatisé à notre connaissance. Les volumes mammaires obtenus debout et en décubitus ventral sont comparables. / Adolescent idiopathic scoliosis (AIS) is a complex tridimensional deformation of the spine affecting primarily girls. The progressive course is mostly aesthetic with, in particular, a resulting rib cage deformity. Breast asymmetry is a frequent concern expressed by these girls. Defined as a difference in shape, position or volume of the breasts or the nipple complex, breast asymmetry is common in women but usually minor and not visible. It remains unknown in the literature if breast asymmetry is more frequent in scoliotics. Moreover, very few studies have evaluated the relationship between scoliosis and breast asymmetry. It is commonly believed that it is not the breasts that are asymmetric, but rather the trunk rotation giving this perception. The breasts represent one of the most challenging organs to measure due to their great variability. Many measuring methods have been described. Magnetic resonance imaging (MRI) is considered the most precise tool to define the mammary gland and its delimitation on the rib cage. This study aims at measuring objectively breast asymmetry, as described by a volume difference between the breasts, in a cohort of young girls presenting with significant AIS, using the MRI as a measuring tool. Then, an automated measuring method, applied on the 3D surface topography, is proposed. The results obtained with this method are confronted to those of the MRI. The influence of posture on breast volume is also examined from the two different modalities. To achieve these objectives, a cohort of 30 scoliotic patients was enrolled on the basis of their thoracic curvature and their bone and breast maturity. Two torso imaging were performed: 3D surface topography and MRI. Initially, the sommation of segmented images acquired by MRI enabled us to measure very precisely breast volume. The statistically significant mean breast asymmetry was found to be 8.32%. 66.6% of the patients presented an asymmetry ≥ 5%. A weak positive non-significant correlation exists between breast volumes and Cobb angle as well as thoracic gibbosity. Thereafter, an automated measuring method, developed from the numeric environment Matlab, is applied directly on the 3D reconstructions. In short, it consists in identifying the breasts contours to excise them in order to expose the rib cage, then subtracting from the complete thorax, the thorax without breasts to determine the breast volumes. The breast volumes acquired by the automated method are, as expected, smaller than those obtained with MRI. A strong correlation is established between breast volumes obtained from the two different techniques. Although statistically significant, breast asymmetries (r= 0.614, p< .001) are not as strongly correlated therebetween as are breast volumes. The right breast (r=0.805) presents a higher correlation than the left breast (r=0.747). Finally, the influence of posture is studied from the meshes obtained from MRI (prone) and 3D surface topography (standing position). Excellent correlations are confirmed between breast volumes; r= 0.896 and r= 0.939, respectively for the left and right breast volumes. This project enabled us to demonstrate, for the first time, that it is possible to measure breast volume objectively and accurately in a cohort of scoliotic patients. As a result of the anatomic landmarks precision, the MRI allowed us to revisit a common belief in the scoliosis community, which states that breast asymmetry expressed by patients, is in fact a perception. These new data will help us counsel our young girls with AIS, regarding their concerns with the asymmetry of their breasts. We have confirmed that the automated measuring method is clinically feasible and could be used to predict MRI volumes. Furthermore, it is the first breast volumetric measuring tool completely automatic, to our knowledge. Also, the breast volumes obtained in standing and in prone are comparable.

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