Scoliosis Screening

1. 1 Scoliosis Screening

2. 2 Scoliosis Update Quiz Name of spinal curvature forward at the waist ?Scoliosis ?Kyphosis ?Lordosis A spinal lateral curvature of 16-23 degrees would be considered ?Mild ?Moderate ?Severe This type of scoliosis represents 85% of cases ?Idiopathic ?Neuromuscular ?Congenital ?Idiopathic Percentage of adolescents will have some degree of spinal curvature ?2% ?10% ?22% Primary age of onset for idiopathic scoliosis ?3-7 ?10-15 ?18-22 ?75-99

3. 3 True or False Most curvatures of the thorax are toward the left Scoliosis can be caused by carrying heavy book bags and poor posture. Lower back pain in adolescents is an early indicator of scoliosis. Race, ethnic background and socioeconomics are not factors for scoliosis. Treatment is not needed for the vast majority of adolescent scoliosis cases. Parents can give verbal permission for screening to a school official if the student forgets his/her form. Red Cross and School Health Nurses are the BEST!!!

4. 4 Normal Spinal Curvature

5. 5 Linear Spinal Curvatures Kyphosis Lordosis

6. 6 Scoliosis Sideways curvature of the spine Spine turns on its axis like a corkscrew Normal spine has a �l� appearance Scoliosis produces an �S� or �C� appearance

7. 7 Degrees of Curvature Scoliosis is a lateral deviation of the normal vertical line of the spine which, when measured by an X-ray, is greater than 10 degrees.

8. 8 Causes for Scoliosis Congenital Problem with the formation of vertebrae or fused ribs during prenatal development Present at birth Neuromuscular, Connective Tissue & Chromosomal Abnormalities Caused by a neurological disorder of CNS or muscular weakness Cerebral palsy, Muscular dystrophy, Spina bifida, Paralysis Marfan�s Syndrome Down�s syndrome Idiopathic Structural spinal curvature with no established cause Appears in a previously straight spine 80-85% of cases

9. 9

10. 10 Diagnosis Physician Physical Exam Scoliometer measurements X Ray MRI

11. 11 Incidence 10% of population will have some degree of adolescent curvature Affects approx 1 million children in the US 3-5 out of every 1,000 cases are severe enough to require treatment 25% will require medical attention to monitor for progression YEARLY in the US (all forms) Affects 2-3% of the general population- 6 million 600,000 physician office visits 30,000 children are treated with a brace 38,000 undergo spinal surgery

12. 12 Scoliosis Mythology Scoliosis can be caused by carrying heavy book bags, poor posture or sleeping on a bad mattress Sports favoring one side can cause scoliosis Lower back pain in adolescents is an indicator for scoliosis Scoliosis always progresses and requires some form of treatment Scoliosis is similar to osteoporosis in it�s destruction of the bone

13. 13 Weighing In on the Back Pack Issue

14. 14 Scoliosis Facts Race, ethnic background & socioeconomics do not appear to be factors Tends to occur in families Usually painless and without symptoms Child is generally unaware of curvature Untreated scoliosis of greater than 30 degrees can lead to back pain in adults 60 % of curvatures in rapidly growing prepubertal children will progress Increased risk for osteoporosis & gall bladder problems later in life Poor nutrition may play a role

15. 15 Girls Vs Boys Primary age of onset 10-15 years During the last major growth spurt of adolescence Time of greatest risk: Girls: 6 months before & after onset of menstruation Boys: Time when their voices deepen risk Mild scoliosis occurs equally between boys and girls(?) 1 in 10 girls vs 1 in 25 boys More serious curves (<30 degrees) are 8-10X greater in girls than in boys.

16. 16 Scoliosis Treatment

17. 17 Screening Purpose: Identify physical characteristics that are suggestive of excessive or abnormal curvatures of the spine Screening is not meant to be a diagnostic exam or substitute for physician evaluations Target Population: Adolescents during age of puberty and accelerated growth 7th graders Adolescents have a decreased frequency of routine physical exams

18. 18 Screening Program Cooperation between Red Cross, Sullivan County Schools & Sullivan County Health Department Screening averages approx 1-2 min per student Screening for most schools can be completed in 1-2 hrs Nurses must review scoliosis training either via classroom or self review module every 2 years. After training review each nurse will confirm update by signing a confirmation form and faxing to chapter office.

19. 19 Screening Process Introduction/ Overview with students Screen 2-3 days later allowing time for students to return signed parent permission form to school Students are segregated by sex and screened individually Follow up letters are sent to parent/legal guardian

20. 20 Parent Permission Form

21. 21 Lets Get Started Observe school dress code & wear Red Cross ID Wash hands prior to & after screening Use hand sanitizer between students Sign in at school office as a visitor Arrive at least 15 min prior to scheduled time

22. 22 Student Considerations Modesty & Insecurities Students should not be allowed to see each other during screening Face student toward wall before lifting shirt Pull arms out of shirt and leave around neck Students are told they WILL NOT have to remove their shirts. Call student by first name Thank student after screening

23. 23 Student position Be sure student holds head/chin up Looking forward- not down Lose & relaxed, not tense or stiff Stand with feet slightly apart

24. 24 6 Step Screening Process Front standing position Back standing position Back bending away from you Side bending position Front bending toward you Side bends

25. 25 Step 1 Front View

26. 26 Step 2 Back Standing View

27. 27 Adam�s Bending Technique

28. 28 Step 3 Back Bending Away

29. 29 Step 4 Side View

30. 30 Step 5 Bending Front View

31. 31 Step 6 Side Bends

32. 32 Results Screening is subjective Trust your observations When in doubt ask for another opinion or mark YES Be sure to mark either YES or NO and sign initials Mark each student�s form before moving on to the next student

33. 33 Important Reminders Always double check for parent signature and �yes� box is checked Introduce yourself as a Red Cross Nurse Ask if the student has been screened previously or if they have a history of scoliosis Respect student modesty & privacy during exam Do not ask student to completely remove top Maintain confidentiality

34. 34 Final Thoughts

35. 35 Scoliosis Quiz Answers Lordosis Moderate Idiopathic 10% 10-15 TRUE OR FALSE False False False True True False Absolutely TRUE