Doctors are encouraging parents to better understand the mental health risks associated with children and adolescents diagnosed with scoliosis.

In addition to physical pain and discomfort, having an abnormality like scoliosis at a sensitive age can take an emotional toll. Some effects of scoliosis include relationship issues, low self-esteem and social withdrawal. Having an abnormality during formative years like adolescence can leave a patient feeling singled out because of outward appearances.

Around one in 25 adolescent girls and one in 200 teenage boys develop scoliosis, a condition that can develop due to abnormal growth, bodily injury or as a complication of cerebral palsy, muscular dystrophy, and other central nervous system disorders.“Visible disfigurement caused by scoliosis can have a profound psychological impact on an individual, especially children and teens, which is why it is so important for parents to act quickly and provide proper emotional support before, during and after treatment,” said Dr. David Siambanes, director of the Children’s Scoliosis Center at St. Joseph’s Children’s Hospital in Tampa.

In 2015, the CDC calculated teenage suicide among boys had increased by about 30 percent since the mid-2000s, while the suicide rate for teenage girls has hit a 40-year high. With the recent spike in teenage suicide, medical professionals are giving increased attention to the emotional effects of scoliosis and how to cope.

According to Siambanes, parents need to convey the importance of following the doctor’s orders while remaining sensitive to the impact scoliosis can inflict on a young person’s self-identity and self-confidence.

“Scoliosis can cause a lot of distress and confusion for young people. These emotions need to be addressed as part of the healing process,” said Siambanes. “Speak with your child’s doctor about the best strategies for them and if resources like scoliosis support groups could be beneficial.”

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Miss Ghana Foundation, the charity wing of Miss Ghana organization, has donated $5,000 to Foundation of Orthopaedics and Complex Spine (FOCOS) Hospital to support the surgery of 13-year-old Gifty Amuzu, who is  suffering scoliosis.

Scoliosis is a life-threatening medical condition in which one’s spine curves. The curve is usually S or C shaped. A severe scoliosis case interferes with breathing.

The donation is a first installment to commence surgical procedure for the teenager, out of a total cost of $15,000.

Gifty Amuzu currently requires an urgent surgery to save her life or she will be paralysed.

She was diagnosed about five years ago while in primary school but all efforts by her mother to curb this deformity proved futile.

Currently, Gifty has dropped out of school due to the intense pain in the back which causes her to lose concentration in class. She is unable to sit, stand or walk for long periods and also cannot perform simple house chores. She also feels stigmatised, sad and often isolates herself in social gatherings.

Gifty Amuzu enjoys singing and aspires to become a soldier in future.

She caught the eye of the Miss Ghana Foundation recently when the foundation’s current ambassadors, Miss Ghana 2017 Margaret Dery and runners-up Priscilla Gameli and Marigold Frimpong, visited the FOCOS Hospital as part of the Miss Ghana Foundation’s charity plans for the year.

Presenting the donation, Chairperson of the Miss Ghana Foundation, Ms Inna Patty, reiterated that Miss Ghana Foundation is passionate about health, especially that of less-privileged children.

She commended the queens for their efforts and appealed for more support to complete the surgery by the end of February 2018.

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January 9, 2018  The U.S. Preventive Services Task Force released today a final recommendation statement on screening for adolescent idiopathic scoliosis. The Task Force found insufficient evidence to recommend for or against screening for idiopathic scoliosis in children and adolescents ages 10 to 18 years who do not have any signs or symptoms. To view the recommendation and the evidence on which it is based, please go to The final recommendation statement can also be found in the January 9, 2018 online issue ofJAMA.

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Fort Collins, CO, Nov. 07, 2017 (GLOBE NEWSWIRE) — Fort Collins-based startup company Green Sun Medical was awarded the top prize of a $50,000 grant during the Fifth Annual Pediatric Device Innovation Symposium, which is an FDA-sponsored pediatric medical device competition in San Jose, Calif. organized by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System.

Green Sun Medical is developing a dynamic scoliosis brace that applies continuous corrective pressure and allows physicians to remotely monitor the performance of their patients. Current treatments for scoliosis include spinal fusion surgeries, and braces developed over 40 years ago.

Green Sun Medical is a graduate company of Colorado’s high-tech incubator, Innosphere, and is also a tenant of Innosphere’s Fort Collins building. “Green Sun Medical’s tech-­enabled spinal brace is an innovation that addresses an unmet need in today’s healthcare space,” said Mike Freeman, Innosphere CEO. “The company has a very talented team that’s dedicated to addressing this critical need for patients around the world.”

“We are honored to have our scoliosis brace recognized with these other pediatric device innovations,” said Jamie Haggard, CEO of Green Sun Medical.  The Western Colorado State University graduate said this grant will help fund the pilot study that will begin this winter at the National Scoliosis Center.

The pitch competition which Green Sun Medical won was sponsored by the National Capital Consortium for Pediatric Device Innovation (NCC-PDI), an FDA-funded consortium led by Children’s National and the A. James Clark School of Engineering at the University of Maryland. The competition was part of the annual symposium to foster innovation that will advance pediatric healthcare and address the unmet surgical and medical device needs for children.

“Our heartfelt congratulations to Green Sun Medical who was selected from a highly competitive field of worthy devices,” said Kolaleh Eskandanian, Ph.D., executive director of the Sheikh Zayed Institute and NCC-PDI. “In our role as a catalyst for pediatric innovation, we see this as the beginning of our relationship with Green Sun Medical.” In addition to financial support, awardees will have access to consultation services for all phases of  pediatric device development – from ideation through marketing – to help them get their devices to market faster.

During the competition, 12 finalists had five minutes to present their proposal to the judging panel, which included: Susan Alpert, M.D., of SFA Consulting, a former director of the FDA Office of Device Evaluation and former senior vice president and chief regulatory officer of Medtronic; Charles Berul, M.D., of Children’s National; Andrew Elbardissi, M.D., of Deerfield Management; Rick Greenwald, Ph.D., of the New England Pediatric Device Consortium (NEPDC); James Love, J.D., of Oblon; Josh Makower, M.D., of NEA; Jennifer McCaney, Ph.D., of MedTech Innovator; Jackie Phillips, M.D., of Johnson & Johnson; and Tracy Warren of Astarte Ventures.

This competition was created to foster innovation in the pediatric device sector, which continues to lag behind adult device development and creates a host of challenges for doctors when treating children. Since inception in 2013, NCC-PDI has supported 67 pediatric devices and the companies and research labs owning these devices have collectively raised $55 million in additional funding.

To learn more about Green Sun Medical visit


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O’CONNOR, Attorney Jeremiah V. In Malden, formerly of Dorchester, November 13th. Beloved son of the
late Patrick J. and Mary C. (Tobin) O’Connor. Loving twin brother of Catherine M. and her husband William
J. Murphy of Quincy, and the late Patrick J. O’Connor. Devoted uncle of Andrea Keane, Sheila
Chamberlain, Shawn Murphy, Maureen Murphy Narbonne, Christopher O’Connor, all of Quincy, Thomas
O’Connor of Norwell, Judy O’Connor of Quincy, and the late Karin Murphy. Survived by many grandnieces
and grandnephews. Visiting hours in the Murphy Funeral Home, 1020 Dorchester Ave., DORCHESTER,
Thursday 4-8 P.M. Funeral Mass in the Basilica of Our Lady of Perpetual Help, Mission Church, 1545 Tremont St.,
Mission Hill, Friday morning, November 17, at 10 A.M. Interment in Bourne National Cemetery at 1 P.M. Relatives and
friends invited. Jerry was an attorney for the Boston Municipal Juvenile Court. He served as a medic in the U.S. Army
during the Vietnam War. He was an active member of the National Scoliosis Foundation, involved in numerous political
campaigns, and attended and supported many charity events throughout Boston. He was also active with the Jesuit
Urban Center and St. Cecilia’s Parish for over 35 years. Jerry especially enjoyed spending time with his family,
discussing current events, and was always prepared with a witty comment, showing his great sense of humor.  For further details, go to


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NEWS PROVIDED BY Shriners Hospitals For Children Nov 02, 2017, 07:00 ET
Unique collaboration between Shriners Hospitals for Children – Canada, CHU Sainte-Justine and McGill University leads to a publication in The American Journal of Human Genetics

MONTREAL, Nov. 2, 2017 /CNW Telbec/ – “Mutations in fibronectin cause a subtype of spondylometaphyseal dysplasia with ‘corner fractures'” is the title of the article that appears online on November 2, 2017 on the website of The American Journal of Human Genetics and some time later in its printed version.
The adventure began when Amaya’s pediatrician observed that in addition to an abnormal thigh fold, the infant’s hips were not quite aligned. Amaya was referred to Shriners Hospitals for Children – Canada.  Reggie Hamdy, M.D., the hospital’s chief physician, then conducted extensive  examinations, identifying Amaya’s hip deformity and scoliosis. The Shriners team suspected a genetic cause and referred Amaya to Philippe Campeau, M.D., a geneticist specialized in bone diseases, who works at both Canada Shriners Hospitals and CHU Sainte-Justine, to perform genetic tests and ultimately identify the faulty molecular mechanism.

In Dr. Philippe Campeau’s laboratory at CHU Sainte-Justine

Amaya’s medical history and X-rays were compatible with spondylometaphyseal dysplasia (SMD), a medical term that encompasses scoliosis and abnormal growth plates in the bones. Initially Dr. Campeau and his team tested known genes already associated with SMD, but the tests proved negative. “Extensive research then showed that there was a mutation in fibronectin, an important protein found in the blood and in connective tissues such as cartilage,” Dr. Campeau explains. Mutations in fibronectin had previously been found by other researchers in a kidney disease, glomerulopathy, but never in a bone disease. Before identifying the mutation in Amaya’s fibronectin, Dr. Campeau had observed similar fibronectin mutations in other children with the same disease by using exome sequencing (reading 20,000 From left to right: Dr. Philippe Campeau, Mrs. Fraser (mother), Dr. Dieter Reinhardt, Chae Syng (Jason) Lee, Nissan Baratang and little Amaya (CNW…genes). “I have been working for more than three years with Dieter Reinhardt, Ph.D., of McGill University’s Faculty of Medicine and Faculty of Dentistry, to better understand how certain mutations in fibronectin can affect bones.”

In Dr. Dieter Reinhardt’s laboratory at McGill University

Dr. Reinhardt’s lab studies extracellular matrix proteins, how they function together with cells, and the negative consequences of genetic mutations. “Dr. Campeau asked me if we could try to understand the cellular mechanism of these mutations in fibronectin, which is normally an organizer of the extracellular matrix. That’s when we became equal partners in this research project. The Quebec network “Réseau de recherche en santé buccodentaire et osseuse” immediately provided team funding for this new emerging project” says Dr. Reinhardt. “We then selected three mutations of the seven identified in different patients.” Our work has clearly shown that the studied mutations prevent the secretion of fibronectin from cells. This work was performed by Chae Syng (Jason) Lee, Research Assistant in Dr. Reinhardt’s lab, assisted by He Fu, then a postdoctoral fellow in Dr. Campeau’s lab. Our current hypothesis is that blockage of fibronectin secretion occurs in cartilage cells (especially growth plates) and consequently prevents normal bone growth.

The importance of studying rare genetic mutations

The publication of these two teams’ research results in The American Journal of Human Genetics is important for the following reasons. In addition to discovery and scientific advancement, it concerns a genetic disease that, though rare, is a risk for recurrence in future generations. Knowing that Amaya and other affected individuals might one day want to have children makes identifying the responsible gene important. For now, twelve families around the world are identified with this disease. In the years to come there will certainly be many more families recognized, guided by the publication of the findings of Drs. Campeau and Reinhardt. Knowing the affected gene, it is now possible to understand how the mutation
leads to the disease and how to eventually arrive at the therapeutic stage within a few years. Dr. Campeau’s student, Nissan Baratang, is working on developing experimental models of this disease with that idea in mind. This discovery will also have broader spin-off effects beyond SMD and understanding the role of fibronectin in cartilage: Dr. Campeau and Dr. Reinhardt, in collaboration with Dr. Florina Moldovan of CHUSJ, and Stefan Parent, orthopedic surgeon at CHUSJ and Shriners Hospitals for Children – Canada, have also found mutations in fibronectin in families with another more common bone-related disorder.

About Shriners Hospital for Children – Canada

Established in Montreal in 1925, Shriners Hospitals for Children – Canada is the only Canadian institution within the network of 22 Shriners hospitals. As a bilingual hospital, it offers short-term ultra-specialized orthopedic care to children in Canada, the United States and the world. Infants, children and young adults with orthopedic and neuromuscular problems such as scoliosis, osteogenesis imperfecta, club foot, hip dysplasia and cerebral palsy benefit from the expertise of our medical teams in treatment and rehabilitation.  Affiliated with McGill University, the hospital has a Simulation Center and a Motion Analysis Center to spur excellence and innovation in care, teaching and research. Residents and health professionals take advantage of our hospital to complete their training and experience. Besides providing a patient- and-family-centered care environment, the hospital, through telemedicine, outreach clinics and satellite clinics, is present in communities across Canada. Recognized as a health promoting institution, Shriners Hospitals for Children – Canada has been helping children reach their full potential.

About the CHU Sainte-Justine Research Center

CHU Sainte-Justine Research Center is a leading mother-child research institution affiliated with Université de Montréal. It brings together more than 200 research investigators, including over 90 clinician-scientists, as well as 450 graduate and postgraduate students focused on finding innovative prevention means, faster and less invasive treatments, as well as personalized approaches to medicine.  The Center is part of CHU Sainte-Justine, which is the largest mother-child center in Canada and second pediatric center in North America. More on

About McGill University

Founded in Montreal, Quebec, in 1821, McGill is a leading Canadian post-secondary institution. It has two campuses, 11 faculties, 11 professional schools, 300 programs of study and some 40,000 students, including more than 9,400 graduate students. McGill attracts students from nearly 150 countries around the world, its 10,900 international students making up 27% per cent of the student body. Over half of McGill students claim a first language other than English, including approximately 20% of our students who say French is their mother tongue.

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By Greg Cergol

On Long Island a mother is heartbroken after her son committed suicide. She says he was relentlessly bullied at school. Greg Cergol reports.

A Long Island mother says she never realized how bad her son was bullied by kids at school until it was too late.

Angie Collazo said her 17-year-old son Angelo, who suffers from scoliosis, took his own life last week and she blames vicious bullying throughout his life as the reason for his death.

“He was bullied so bad that he felt his only option was to end his own life,” Collazo said. “Children used to punch him, kick him. They tortured him. That’s exactly what these children did. They tortured him.”

Collazo said the bullying began when Angelo was 10 years old, right around the time he started wearing a brace for his scoliosis. The teasing followed Angelo all the way to Hicksville High School, where Collazo said she made multiple complaints to school officials to stop the relentless bullying.

She claims the school didn’t do enough to stop Angelo from being bullied and says she spoke to his guidance counselor about it just three days before his death.

“I absolutely blame the school,” Collazo said. “They should have done more prior to this. My son did not deserve this at all.”

Hicksville Schools didn’t confirm any bullying.

“We extended our sincere condolences to the individual’s family and friends,” the school said in a statement to NBC 4 New York. “Our Crisis Intervention Team has been activated and support services will be available as needed.”

After Angelo’s death, Collazo says she found a journal documenting all he endured. She said Angelo went to counseling before his death, but it wasn’t enough to help to save his life. She is now urging parents to sit down with their children and talk to them about the impacts bullying can have.

“He ended his life because of the pain that he was in and he just wanted it to end,” she said. “He wanted them to stop.”

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17 October 2017

From the sectionHealth

Patients in Northern Ireland are waiting three years to see a consultant about having surgery following a GP referral.

The BBC has obtained exclusive figures showing long waiting times before a decision to operate.

In Northern Ireland, targets say most patients should be seen within 9 weeks and none should wait over 15 weeks.

Yet some patients are waiting 155 weeks or more to see a specialist for spinal conditions.

A spokesman for the Health and Social Care board said it was ‘unacceptable’ that waiting lists had grown so long.

Longer and longer waits

The health service has not met the targets for several years.

Figures obtained by Freedom of Information requests in April this year and seen by the BBC show that in one of Northern Ireland’s five healthcare trusts, the minimum waiting time for an appointment with an orthopaedic consultant specialising in spinal conditions was 155 weeks.

For upper limb conditions, the minimum wait was 127 weeks.

By June, waits for spinal appointments at the same trust had risen to 159 weeks.

Megan’s story

Megan Fleming, who is 14 years old, needs an urgent operation to correct a curvature, or scoliosis, of her spine.

Her health is deteriorating fast, and she has trouble breathing. Despite her condition, the teenager from Carrickfergus continues to go to dance classes, but says her future is on hold until her operation, which surgeons have told her will be a year away.

Her mother Karen said: “Megan loves dancing. It’s just her life at the minute. She just wants to dance.

“But at the minute she needs the surgery to help her. You could see the consultant was absolutely gutted and you could see it was hurting to say a year, but it’s out of his control.

“I’ve paid taxes, I’ve paid national insurance. So why can’t I get the surgery that she deserves?”

Megan and Karen are now trying to raise the £50,000 that her surgery will cost privately, fearing that the long wait will put Megan’s long-term health at risk.

Dr Ursula Brennan, a GP in Belfast, said that seeking private healthcare was a decision more and more patients were having to make in the current climate.

“You’re going to have to wait, and it may be several months. It may be into 52 weeks, or 80 weeks, or beyond.

“It’s very difficult to turn this conversation to – and these are our elderly folk – that you may have to use your life savings to actually improve your quality of life.”

When asked about the long waits, which are far higher than in other parts of the UK, the deputy chief executive of the Health and Social Care Board, Michael Bloomfield, said: “That is absolutely unacceptable, and that’s why we need to clearly illustrate the need for reform.

“There are about 35,000 more surgical procedures required than the health service currently has capacity for.

“Without the additional funding to see those patients or have them treated in different ways, it is regrettably inevitable that waiting times will increase to the position that they are now in.”

Political vacuum

The political commentator Deirdre Heenan is working on a report with the Nuffield Trust into the emerging healthcare crisis in Northern Ireland.

She said: “In the last nine months we’ve had no government in Northern Ireland. We’re in a political vacuum.

“This system reverts to keeping the show on the road, and any ideas about transformation or change are simply mothballed.”

In a blog co-authored with health economist John Appleby, she writes: “There is a difficult backdrop: austerity, increasing demand, rising expectations, and political uncertainty.

“It is not clear that the public are in a position to call for change. They may not have good information about how well the service meets their needs, and have not necessarily been made part of the long conversations about change, which as a result can sound like it brings bad news.

“But the impact on patients of the current impasse in implementing necessary changes is stark. In June this year, for example, one in six of the entire Northern Ireland population was currently on an outpatient or inpatient waiting list. In England the figure is one in 14.

“And over 64,000 people had been waiting over a year for their first outpatient appointment – a quarter of all those on the waiting list. In England, by contrast, around 1,500 people were still waiting over a year – just 2 per cent of the number in Northern Ireland for a population over 30 times larger.”

On Wednesday, the BBC will be publishing its NHS tracker, which allows users to look at how their local hospitals are performing on waiting times for A&E, cancer and planned operations.


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Oct. 17, 2017, at 4:00 p.m.

By Mary Elizabeth Dallas, HealthDay Reporter


TUESDAY, Oct. 17, 2017 (HealthDay News) — Routine screenings for scoliosis, or curvature of the spine, help ensure the condition doesn’t take a toll on children’s health and self-esteem, according to an orthopedic specialist.

One out of every 25 children develops scoliosis, says Dr. Scott Sorenson, a pediatric orthopedic surgeon at Penn State Children’s Hospital in Hershey, Pa. The condition usually occurs when kids reach their preteen years but it can happen in babies or toddlers. It’s unclear what causes scoliosis but genetics may play a role, he added.

Girls are more often affected than boys. As a result, the Scoliosis Research Society recommends that girls be screened twice for scoliosis and boys screened once during their developing years.

Screening for scoliosis typically involves examining the back and looking for asymmetry, such as a shoulder or hip that is higher than the other. One side of the chest may also be more prominent, Sorenson explained.

“Initially, it’s more of a physical observation,” Sorenson said in a hospital news release. “They don’t usually complain of pain.”

Scoliosis can range from mild to severe. X-rays can reveal the severity of the curvature. Mild cases of scoliosis typically don’t affect people’s health or limit their activity.

Very severe cases could lead to reduced lung or heart function. Severe scoliosis can also increase children’s risk for arthritis and take a toll on their self-esteem, Sorenson said.

Treatment for scoliosis depends on the severity of the condition and the age of the patient.

The only treatment needed for spinal curves of less than 25 degrees is observation. Curves between 25 and 45 degrees usually require children to wear a brace for at least 13 hours each day for one or two years. This helps prevent the curve from getting worse or affecting growth. Surgery is usually considered once spinal curves reach 50 degrees, Sorenson said.

“That’s the point where we’ll usually see the curvature continue to increase no matter how mature your bones are,” he said. “Plus, it’s easier and safer to fix a 50-degree curve than one that is 80 degrees.”

During scoliosis surgery, doctors realign the bones by placing screws at each level of the spine needing correction. These screws are attached to rods running along each side of the spine.

“Usually it occurs in the thoracic spine where your ribs are, so it’s not a huge deal to fuse because that’s already a pretty rigid part of the spine,” Sorenson said. “If we have to go lower in the back, it can affect motion and bending.”

Younger children are often placed in a full-torso cast that is changed every few months for up to 18 months. Preteens tend to grow too fast for their bones to be fused so surgeons may opt for a new technique that involves implanting growing rods along their spine.

Sorenson noted that while yoga, physical therapy and chiropractic care have some benefits, these treatments don’t reverse or treat scoliosis. “Those are all very important for helping with your posture, strength and overall conditioning,” he said. “But none of them have been scientifically proven to alter the course of scoliosis.”


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Kenny Yat Hong Kwan1*, Aldous C.S. Cheng2 , Hui Yu Koh1 , Alice Y.Y. Chiu2 and Kenneth Man Chee Cheung1


Background: Bracing has been shown to decrease significantly the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis (AIS), but the treatment failure rate remains high. There is evidence to suggest that Schroth scoliosis-specific exercises can slow progression in mild scoliosis. The aim of this study was to evaluate the efficacy of Schroth exercises in AIS patients with high-risk curves during bracing.

Methods: A prospective, historical cohort-matched study was carried out. Patients diagnosed with AIS who fulfilled the Scoliosis Research Society (SRS) criteria for bracing were recruited to receive Schroth exercises during bracing. An outpatient-based Schroth program was given. Data for these patients were compared with a 1:1 matched historical control group who were treated with bracing alone. The assessor and statistician were blinded. Radiographic progression, truncal shift, and SRS-22r scores were compared between cases and controls.

Results: Twenty-four patients (5 males and 19 females, mean age 12.3 ± 1.4 years) were included in the exercise group, and 24 patients (mean age 11.8 ± 1.1 years) were matched in the control group. The mean follow-up period for the exercise group was 18.1 ± 6.2 months. In the exercise group, spinal deformity improved in 17% of patients (Cobb angle improvement of ≥ 6°), worsened in 21% (Cobb angle increases of ≥ 6°), and remained stable in 62%. In the control group, 4% improved, 50% worsened, and 46% remained stable. In the subgroup analysis, 31% of patients who were compliant (13 cases) improved, 69% remained static, and none had worsened, while in the non-compliant group (11 cases), none had improved, 46% worsened, and 46% remained stable. Analysis of the secondary outcomes showed improvement of the truncal shift, angle of trunk rotation, the SRS function domain, and total scores in favor of the exercise group.

Conclusion: This is the first study to investigate the effects of Schroth exercises on AIS patients during bracing. Our findings from this preliminary study showed that Schroth exercise during bracing was superior to bracing alone in improving Cobb angles, trunk rotation, and QOL scores. Furthermore, those who were compliant with the exercise program had a higher rate of Cobb angle improvement. The results of this study form the basis for a randomized controlled trial to evaluate the effect of Schroth exercises during bracing in AIS.

Trial registration: HKUCTR-2226. Registered 22 June 2017 (retrospectively registered)

Keywords: Schroth, Scoliosis-specific exercise, Adolescent idiopathic scoliosis, Bracing, Curve progression, Conservative management


The aim of treatment of adolescent idiopathic scoliosis (AIS) is to prevent curve progression to 50°, beyond which there is a risk of continued progression in adulthood. Surgery is therefore usually recommended if the curve reaches 50° during adolescence. Treatment with rigid bracing has recently been shown in the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST) to decrease significantly the progression of high-risk curves to the threshold for surgery [1] and is the most widely accepted form of treatment for the prevention of curve progression worldwide. Nonetheless, the rate of treatment success was reported to be 72%, suggesting a proportion of patients will still need to undergo surgery despite bracing.

The standard of care for non-operative management of scoliosis varies widely between North America and Europe [2, 3], and the use of physiotherapy scoliosisspecific exercises (PSSE) is not universally established or accepted. Exercise therapy is well-received by patients and parents [4], and several systematic reviews and randomized controlled trials have reported the positive effects of PSSE on slowing curve progression, improving cosmetic appearance, and quality of life (QOL) outcomes [5–7]. Nonetheless, these studies consisted of a heterogeneous population receiving mixed treatment regimens, various stages of skeletal maturity, and non-standardized outcome measures. Thus, the effect of PSSE on curve progression in the clinical scenario where the curves are at the highest risk of progression has remained unclear.

The Schroth method is the most widely studied and used PSSE approach. It consists of three-dimensional principles of correction, namely auto-elongation, deflection, derotation, rotational breathing, and stabilization [8]. It uses specific rotational angular breathing for vertebral and rib cage derotation, with muscle activation and mobilization. It emphasizes postural corrections throughout the day to change habitual postures and improve alignment, pain, and progression. The Schroth method exercises are curve pattern specific and can be applied in ordinary daily activity, thereby allowing the patients to spend more time in leisure activities and to live a normal life [9].

The Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guidelines recommend the use of PSSE as a stand-alone therapy, add-on to bracing, and during the postoperative period [2]. Romano et al. [10] found that exercises produced a significant increase in the mechanical forces exerted at rest by the fiberglass brace in AIS patients. The positive effects of PSSE can exert its maximal clinical benefit if it improves the outcome of bracing in patients with the highest risk for progression. An improvement of the treatment success of bracing will decrease the rate of surgical interventions in AIS patients.

Therefore, the aim of this study was to assess prospectively the effect of Schroth exercise on curve progression, appearance, and QOL in AIS patients with high-risk curves during bracing.


Study design

A prospective, historical cohort-matched study was conducted. The study was done in compliance with the principles of Good Clinical Practice and the Declaration of Helsinki. The local Institutional Review Board approved the study protocol (Reference Number: UW 17-136). All patients’ parents or legal guardians gave written informed consent.

Patient enrolment

Consecutive patients with AIS who met the Scoliosis Research Society (SRS) criteria for bracing [11] and received bracing were enrolled for the study. Inclusion criteria were as follows: age of 10 to 15 years, skeletal immaturity (defined on the Risser scale [12] as 0–2 inclusively or R6 U5 score or below on the Distal Radius Ulna Classification [13]), a Cobb angle for the largest curve of 25° to 40° [14], and ability to attend all the physiotherapy sessions. Exclusion criteria were diagnoses other than AIS, disabilities or systemic illnesses preventing exercise performance, and any other previous treatment for AIS.

Study interventions

All patients received a rigid underarm orthosis (Fig. 1), prescribed to be worn for a minimum of 18 h per day. The SOSORT Management for bracing guidelines for the physicians, orthotists, and physiotherapists were followed [15].

Schroth-certified therapist was involved and provided all the therapy sessions. No other treatments were advised during the study period.

Experimental group

The Schroth exercise intervention consisted of an individualized 8-week outpatient program that included four initial private training sessions, once every 2 weeks, where exercises were taught to the patient and their caregivers. A home exercise program was instituted thereafter, and patients were required to return for supervised sessions once every 2 months. Exercises were given in a pamphlet with a description of the corrective movements required, the curve type for which they were recommended, and digital photos of all the exercises taken during their private sessions which they were expected to perform at home. Figure 2 illustrates a case example of a specific curve type and the exercises that were prescribed.

Compliance was monitored and verified daily by their caregivers and during the review sessions by the therapists. During these sessions, adequate exercise performance was assessed using a checklist. Attendance was calculated as a percentage of the prescribed visits attended and compliance as a percentage of the prescribed exercises completed to the therapists’ satisfaction. Compliance was defined as > 80% of attendance of therapy sessions and completion of the prescribed home exercise program at least five out of 7 days per week.

Control group

A 1:1 historical cohort who was treated in the same institute with bracing only and matched for age, gender, skeletal maturity, and curve magnitude was used as a control group.

Outcome measures

The outcome measures were radiological deformities (primary outcome), clinical deformities, and QOL scores (secondary outcomes).

Cobb angles of all the major structural curves were measured on a standing posterior-anterior full-spine radiograph. Radiographic definitions of change were based on the SOSORT and SRS non-operative committee consensus

[16]: improvement as 6° or more, unchanged as ± 5°, and progressed as 6° or more.

Clinical deformity was recorded in terms of truncal shift and angle of trunk rotation (ATR). The Bunnell scoliometer was used to measure the ATR, i.e., the angle between the horizontal plane and a plane across the posterior aspect of the trunk, of the hump in the main structural curve with the patient bending forward [17].

The SRS-22 questionnaire is a scoliosis-related QOL questionnaire that assesses five domains: function, pain, self-image, mental health (five questions each), and satisfaction with care (two questions). Each question is scored from 1 to 5, where 1 is the worst and 5 the best. The Chinese version was administered, which had been validated [18].

Adverse effects Patients were asked to record any serious symptoms or events they experienced during the study.


Student’s paired t test (p < 0.05) was made for each of the outcome measures. Sub-analysis was performed within the experimental group to study the effects of compliance. The data were analyzed using SPSS 21.0 software.



Twenty-four (5 males and 19 females) were recruited into the experimental group, and 24 patients were matched in the control group. Both groups did not differ at baseline for age, gender, Risser sign, and magnitude of the main structural curves (Table 1). The mean age was 12.3 ± 1.4 years in the experimental group and 11.8 ± 1.1 years in the control group. The experimental and control groups had a mean follow-up period of 18.1 ± 6.2 and 38.8 ± 11 months, respectively.

Effects of the interventions

After training, the spinal deformity improved in 17% of the patients in the experimental group (Cobb angle decreases by 6° or more), worsened in 21% (Cobb angle increases by 6° or more), and remained stable in 62% (Cobb angle was ± 5°). In the control group, 4% improved, 50% worsened, and 46% remained stable.

After training, the mean ATR improved from 9.43° ± 3.27° to 8.45° ± 3.45°, although it did not reach statistical significance (p = 0.08), and it remained stable in the control group. There was no statistical significant difference in the mean truncal shift in the experimental and the control groups.

For the SRS-22 domains, high scores were noted at the baseline for both groups (mean of 4.25 ± 0.38 and 4.10 ± 0.52 out of 5). Statistical significant improvements were found in the experimental group in the function domain (4.60 ± 0.44 to 4.76 ± 0.33, p = 0.05) and the total score (4.25 ± 0.38 to 4.45 ± 0.34, p = 0.04) whereas changes in the other domains did not reach statistical significance. No significant changes were noted for the control group in any of the domains or the total score.

Effects of compliance

Brace compliance was rated as good in 70.8% in the experimental group and 79.2% in the historical cohort group. In the experimental group, 76.9% of patients who were compliant to the Schroth exercises had good bracing compliance, whereas only 63.6% of those who were non-compliant to the exercises had good bracing compliance.

In the experimental group, 13 patients were found to be compliant to Schroth exercises according to our definition above, and 11 patients did not meet this criterion. Compliance was strongly associated with curve improvement (31 vs 0%) and negatively associated with curve progression (0 vs 46%). Compliance was also positively associated with improvements in truncal shift from 11.87 ± 8.16 to 7.09 ± 6.41 mm (p = 0.01) and ATR from 10.15° ± 3.65° to 8.69° ± 3.01° (p = 0.043).

Adverse effects No adverse effects were noted during the study period.


This is the first prospective study investigating the effect of Schroth exercises on curve progression, topographical changes, and SRS-22 scores in AIS patients during bracing. The findings of this study show that Schroth exercises during bracing can increase the proportion of patients with Cobb angle improvement ≥ 6° by 6% compared with bracing alone. In addition, our results suggest that 20% more patients have improved Cobb angles of ≥ 6° if they are compliant with Schroth exercises during bracing compared with bracing alone. However, the outcomes of non-compliant patients were slight worse than the historical cohort, which might partly due to a worse compliance to brace treatment in this group.

Although previous studies have demonstrated the superiority of scoliosis-specific exercises in reducing curve progression, they were performed in a population undergoing conservative treatment for mild AIS only [19–23]. Furthermore, their data cannot be generalized to rehabilitation under other clinical scenarios, such as during bracing or after surgical correction. This preliminary study focused on a group of high-risk patients who were all treated with bracing. The usual intervention after treatment failure in these patients would be surgical correction and fusion and was recently reported in the BRAIST to be 25–28% [1]. Thus, any further treatment during bracing that can improve the outcome can lower the surgical rate. We show that the efficacy of bracing can be further improved by the addition of Schroth exercises with a strong compliance-response relationship.

Although there was a trend towards ATR reduction in the experimental group, it did not reach statistical significance in our study. All previous studies that reported ATR showed a decrease after scoliosis-specific exercises ranging from 0.33° to 4.23° [24, 25]. Schroth exercises have been shown to improve the cosmetic appearance in children, demonstrated in some studies to decrease the height of the hump [26], and improving waist asymmetry [27]. Although we cannot make a definite conclusion from our results, a more reliable and valid measure of objective cosmetic changes needs to be included in future studies.

The effect of the treatment on the SRS-22 scores shows that Schroth exercises improve the overall QOL in AIS patients during bracing. However, it is now increasingly noted that the SRS-22 questionnaire was designed to study the effects of surgery in AIS and suffers a ceiling effect in conservative treatments [7, 28, 29]. The high scores reported at the baseline therefore limit the ability of this questionnaire to measure large improvements. Different tools, such as SRS-7, Trunk Appearance Perception Scale (TAPS), Patient-Reported Outcomes Measurement Information System (PROMIS), and computer adaptive testing (CAT) instruments, may be administered together in future studies to detect clinically significant differences in their function and QOL. Currently, no alternative validated evaluating tools are available.

Our findings suggest that administering Schroth exercise program as an outpatient is feasible and has a reasonable compliance. These results are consistent with earlier findings that a physiotherapist-supervised Schroth exercise program is superior to a home-based program or no treatment [25]. In their study, the supervised program consisted of 18 sessions (1.5 h a day, 3 days a week) for 6 weeks. However, this would be too demanding for patients in this locality, and we predicted this would have deleterious effects on the study enrolment, the attendance, and compliance rate. We therefore modified the protocol to four sessions (1 h per session fortnightly) for 8 weeks. This was a compromise between maintaining adequate supervision and minimalizing disruption to the patients’ and their families’ lives.

The study has several limitations. First, it was a historical cohort comparison but every effort has been made to ensure the two groups are compatible by age, gender, and curve magnitude matching. However, there was a difference in the follow-up period between the two groups. At the time of analysis, all patients in the experimental group had a minimum of 12 months of follow-up, but some patients in the historical cohort had already completed treatment. Nonetheless, we felt this cohort provided a reasonable control since the only difference in intervention between the groups was the addition of Schroth training. Secondly, exercise compliance and adherence to treatment could not be fully assured, although the patients’ diaries were checked, and full engagement of the caregivers ensured accurate data collection. Thirdly, although brace compliance between the two groups was comparable, sub-analysis based on exercise compliance found a difference in brace compliance between the groups and historical control. Hence, these results should be interpreted with caution. Fourthly, the therapists could not be blinded to the treatment group, although the analyses were done by an independent assessor. Finally, the sample size in the sub-analysis for compliance is small.


This is the first study to investigate the effects of Schroth exercises during bracing in patients with a high risk of curve progression. The findings from this preliminary study suggest that Schroth exercises during bracing can further improve the Cobb angle compared with bracing alone and compliance is associated with greater benefit. Based on the results of this study and using the current protocol, appropriate sample size calculation and attrition rate can be performed for a large-scale trial. Given the promising findings, a prospective, randomized-controlled trial to evaluate the effect of Schroth exercises during brace treatment in AIS patients is now warranted.


AIS: Adolescent idiopathic scoliosis; ATR: Angle trunk rotation; BRAIST: Bracing in Adolescent Idiopathic Scoliosis Trial; CAT: Computer adaptive testing; PROMIS: Patient-Reported Outcomes Measurement Information System; PSSE: Physiotherapy scoliosis-specific exercises; QOL: Quality of life; SOSORT: Society on Scoliosis Orthopaedic and Rehabilitation Treatment; SRS: Scoliosis Research Society; TAPS: Trunk Appearance Perception Scale


Not applicable.


None declared.

Availability of data and materials

Please contact author for data requests.

Authors’ contributions

KK conceived of the study, participated in the study design, and drafted the manuscript. ACSC performed the study and statistical analysis. HYK collected the data and participated in its design and coordination. AYYC participated in the study design and coordination. KC supervised the study and helped to draft the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB)—IRB Reference Number: UW 17-136. Written informed consent was obtained from all participants and/or their legal guardian.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author details

1 Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong. 2 Department of Physiotherapy, Duchess of Kent Children’s Hospital, Sandy Bay, Hong Kong. Received: 22 June 2017 Accepted: 30 August 2017


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Kwan et al. Scoliosis and Spinal Disorders (2017) 12:32

DOI 10.1186/s13013-017-0139-6

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