Scoliosis Screening

Scoliosis Screening

Normal Spinal Curvature There are 4 natural curves in the vertebral column

Kyphosis Lordosis Linear Spinal Curvatures Spine curves forward at the waist “Swayback” Spine curves backward in the chest area “Roundback”

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 Scoliosis

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. MILD MODERATE SEVERE

Causes for Scoliosis Congenital Neuromuscular, Connective Tissue & Chromosomal Abnormalities Idiopathic

Diagnosis • Physician Physical Exam • Scoliometer measurements • X Ray • MRI

Incidence Most common onset around puberty & growth spurt, ages 10-15 Affects 2-3% of the general population (can affect adults, most seen in adolescents) Occurs equally in both genders Females eight times more likely to progress to a curve that requires treatment

Screening • Purpose- to identify the child at risk for postural deviation, not to diagnosis • 704 KAR 4:020 (2)(12)- requires 6th & 8th grades be screened annually. • The Kentucky Commission for Children with Special Health Care Needs recommends school age children in grades 5-9 yearly

Screening • Schedule date for screening, training, * parent permission*, follow-up and reports for KDE • Provide overview with teachers & students • Location for privacy • Screen males and females separately and individually; barefooted; males without shirts on; females with blouses on backwards (may suggest wearing a bathing suit) • List all abnormal finding under “R” for rescreening; mark those absent for rescreen (with parental permission)

Positive findings MUST be re-screened by a health professional (this step may be omitted if doctor or RN does the initial screening) • Refer those needing financial assistance for PMD evaluation to the Commission for Children with Special • Use criteria for referral to PMD. The PMD should complete the referral letter with his/her findings and the originals returned & placed in the students health record • Students with questionable findings should be re-screened in 4-6 months (within the annual year) • Good communication is essential for the parents (* Parents should always be notified if their child failed the screening • Resources are available from the National Scoliosis Foundation website (http://www.scoliosis.org/)

Screening Process • Observe the student walk toward you and then away • Note leg length discrepancies • With bare back, have student stand straight, feet together and looking straight ahead, with arms at his/her side observe for the following:

Step 1Front View • Shoulders should be level • and at the same height • Distance between arm and • torso equal on both sides • Crest of hips level on • horizontal plane • Head straight and centered Normal Abnormal

Step 2Back Standing View • Shoulders should be level and • the same height • Distance between arm and • torso equal on both sides • Crest of hips level on • horizontal plane • Head straight and centered • Scapula level on both sides

Adam’s Bending Technique • Feet slightly apart • Palms together • Arms outstretched with straight elbows • Head out • Bend forward at waist • Place hands between legs at knee level

Step 3Back Bending Away • Look For: • Rib prominence • Lumbar Prominence • Differences in height of hip • crests

Step 4Side View • Look for exaggerated rounding of the back • Kyphosis

Step 5Bending Front View • Shoulders level? • Is one side of torso more • rounded than the other? • Look for lumbar prominence

Step 6Side Bends Ask the student to bend at The waist to each side Look for S curvatures

Results • Any one of the findings suggests an underlying scoliosis curve, which deserves further evaluation • Scoliometer- is a device that provides a way to measure the angle of trunk rotation in spinal screening, providing objectives guidelines for referral. It should be used in conjunction with routine screening. Follow manufacturer's guidelines. • Document and notify parents according to school policies

Referral Criteria To be used by second screeners as a guide to base referrals. If a student has any three of the following, the student should be referred to a PMD or the Commission for Children with Special Health Care Needs: • 1. One shoulder higher than the other • 2. One scapula more prominent than the other • 3. Waist folds not even • 4. Arms not hanging equal distance from the sides • 5. Pelvis not level • 6.Unequal symmetry of the upper back, lower back or both • If any one or two of the above are seen, re-screen in 6-12 months.

Scoliosis Treatment • Treatment is not indicated for the vast majority of cases • Observation- minor curvatures (up to 20 degrees); skeleton is close to maturity; exercise may help with surrounding muscular strength • Bracing- usually with curves of 25-40 degrees • Surgery- Major curvatures (>45 degrees); rapid deterioration/progression, generally spinal fusion • General physical therapy/exercises are not always effective

FORMS/INFORMATION • KDE- Health Services Reference Guide • Chapter 3- will have the Matrix of Health Services and examples of all forms and guidelines for screenings, (including scoliosis permission), work sheets, vision and hearing • PHPR Volume I – Physical Assessment/Vital Signs

Scoliosis Screening