vestibular testing [Archive] - National Scoliosis Foundation Forums

structural75

12-23-2006, 09:31 PM

gerbo,

Sorry folks that this is so long, but it's concise and makes a point. It's certainly more in depth and comprehensive than anything else that's being offered. I know you're [Gerbo] a spincor user, ...Are you really against this vestibular rehab? It is in fact an integral part of the premise behind the spincor brace as noted by the Doctors themselves.

The Spinecor(TM) brace is fitted and worn home the same day. Adults can be fitted in New York, Chicago, Atlanta, Los Angeles and Phoenix as an ongoing clinical study to determine the long-term efficacy of Spinecor(TM) and vestibular rehabilitation in the adult population.

Dr. Collaird (creator of spincor) and her team of physicians are now convinced the success of the program is due to changes in postural control from the brain.

Through a collaborative effort, Scoliosis Systems(TM) and SpineCor(TM) are responsible for amazing advancements in spinal and neurological rehabilitation. Today's sophisticated medical equipment allows for monitoring of how the brain controls posture. An imbalance in specific parts of the brain including the vestibular cortex and the brainstem has been reported in scoliosis for nearly 25 years

Vestibular tests can help determine if more expensive tests, such as magnetic resonance imaging (MRI), are needed. Recent studies (Levy and Arts, 1996) have shown that vestibular testing is much more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.

Recent studies have documented that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996).

Abstract from Scoliosis Research Society (SRS) 2003 Meeting

Matthew T. Provencher M.D., Derin Wester, Ph.D., Bruce Gillingham M.D.; Naval Medical Center- San Diego, CA. Orthopedic Research and Education Foundation- Resident Research Grant
Conclusion: A central vestibular deficit is present in scoliosis patients. Central vestibular function is worse with larger curves, and the dysfunction is opposite to the curve. Curves with location in the mid-thoracic region demonstrated less central deficit than low-thoracic and lumbar scoliosis curves. The data supports a central vestibular dysfunction in patients with scoliosis

In a study published in SPINE 1995, researchers tested linguistic processing, a higher cortical function, and concluded children with scoliosis had an entire brain dominance lateralized to one side, unlike unaffected children in the control group. This study demonstrates the need for advanced neuro-diagnostic testing and clinical correlations which leads to meaningful neurologically based rehabilitation.

Patients with scoliosis are known to have neurological dysfunction which contributes to the progressive nature of scoliosis, as well as interfering with the rehabilitation of posture in the adult and child. Studies have identified an increased incidence of brainstem and cerebellar abnormalities such as brainstem hypoplasia and Arnold Chiari Malformation in patients with Scoliosis. Certain findings such as cervical lordosis, thoracic kyphosis, abnormal Somatosensory evoked potentials (SSEP) and nystagmus on electronystagmographic testing have been linked to neurogenic causes of scoliosis. In the event neurological dysfunction is identified, MRI imaging may be necessary. Other interventions may include neuromuscular rehabilitation which can be offered on an individual basis. Vestibular and oculomotor dysfunction has been shown to respond to personalized treatment programs, which are designed to re-educate the brain perception of subjective postural vertical.

Physiotherapy techniques have been successfully utilized in scoliosis treatment for the past sixty years. Myofascial Release Technique (MRT) is designed to neurologically inhibit the connective tissues which become fibrotic when a muscle is in a shortened state for a prolonged period of time, thereby preparing the muscle to be lengthened.

There are numerous studies lending to the efficacy of vestibular rehab.

The evidence that it works as an integrative aspect of treatment is all over the place.

Although, I certainly agree that there is no evidence or probability that it will ever change a scoliosis by itself (there are so many factors at play in attempting to "stabilize" a curvature that no one thing is going to do it. And certainly nothing but a forceful approach, i.e. - rods/fusion or bracing possibly, is going to hold it if the underlaying cause is never found). Therefore I do believe it has varying degrees of importance in the management of scoliosis, either pre or post operatively. To say that its purely "academic" is a brash assumption Gerbo. Considering the medical fact/reality that neurology is an extremely infantile field of study, it would be hard to formulate any definitive stance on this subject. Any neurologist will tell you that we know very little about the brain and how/why it works. This topic dealves into an abyss of unknown realities... no studies does not equate to illigetimacy. Maybe if we started giving this field some credibility we might start getting some answers. But until we give attention to it, we'll continue to remain ignorant on the matter. The creators of the spincor brace certainly see its relevance.

structural

structural75

12-23-2006, 09:36 PM

From the Scoliosis Care Foundation

Beyond Only The Spine

Current research in the U.S. and Britain is showing that idiopathic scoliosis is a multifaceted disease that compromises all five of the body’s systems: neurological, digestive, hormonal, muscular and osseous (bone). These newer insights about the impact of the disease of scoliosis on a patient recognize that the body’s systems work together in an integrated fashion. When one of the body’s systems suffers a malady it can create problems with one or more of the body’s other systems.

Older 20th century based philosophy about scoliosis treatment considered only the osseous part of the equation, with the focus of treatment being just on stopping skeletal curvature from progressing. The attention was on supporting the spine, while ignoring the body’s four other systems.

Take, for example, bracing, an important component in the non-surgical treatment of idiopathic scoliosis. Its purpose was to keep the curve from progressing while the patient is growing. Studies have shown bracing to be an effective treatment halting the progression of many a scoliosis curve; and that’s great. However, after skeletal growth has concluded and the brace removed, the curvature is expected to return. While bracing has traditionally been used to prevent things from getting any worse, there had not been simultaneous courses of action taken in non-surgical scoliosis treatment to attempt to make things any better.

The new thinking in idiopathic scoliosis research holds that helping patients achieve their own level of optimal health in each of their five body systems can result in more effective non-surgical treatment.

The Scoliosis Care Foundation supports research and non-surgical treatment for idiopathec scoliosis that takes into account all of the body’s systems.

structural75

12-23-2006, 09:43 PM

Celia wrote: ...take methods which are completely unproven and make them sound mainstream and effective when in fact there is no scientific basis for their validity.

Vestibular testing and rehabilitation is very scientifically based and valid as proven in studies.

Timothy C. Hain, MD
Professor of Neurology, Otolaryngology, and Physical Therapy/Human Movement Science, Northwestern University Medical School, Chicago IL, USA.
OFFICE PHONE NUMBER: 312-274-0197
OFFICE LOCATION: Chicago Dizziness and Hearing , 645 N. Michigan, Chicago 60611
WEB SITE: http://www.tchain.com/
EMAIL ADDRESS: cdb@dizziness-and-balance.com
FAX NUMBER: 312-274-0198
EDUCATION: MD and Neurology Residency: University of Illinois, Chicago IL. Fellowship: Johns Hopkins University (Neurophysiology and Neuro-ophthalmology). Board certified in Neurology (1981)

Dr. Hain states:

Why get vestibular tests ?

1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety. Recent studies have suggested that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996). Hearing pathway tests (audiometry, ABR, ECOG) can also be used for the same purpose, and are frequently combined with vestibular tests. In a cost-effectiveness analysis for evaluation for vertigo it was concluded that hearing testing followed by either posturography or ENG (electronystagmography) was the most effective method (Stewart et al, 1999).
2.To detect central disorders. Recent studies have suggested that internuclear ophthalmoplegia, a central eye movement disorder, is missed by 71% of physicians unaided by quantitative oculomotor testing (Frohman et al, 2003).
3.To decide if more expensive tests like MRI (Magnetic Resonance Imaging) are needed. Vestibular testing is more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.(Levy and Arts, 1996)
4.To document objectively vestibular conditions such as BPPV and Perilymph fistula, which commonly occur after head injury, vestibular neuritis, and Gentamicin ototoxicity, which commonly is a side effect of medication.

http://www.dizziness-and-balance.com/index.html
http://www.lifelinerehab.com/vestibular.html
http://www.vestibular.org/index.php
ETC.....

Celia Vogel

12-24-2006, 05:19 AM

Structural,

You have completely butchered the discussion we had under the Spinecor thread and I'm not even going to waste my time!

Happy Holidays to you!

gerbo

12-24-2006, 07:23 AM

celia, please blame me, i asked for this, just to keep spinecor thread clean and as an opportunity to stake stock of the various arguments.

i suggested stick to essentials only and get rid of the rest (specially non-factual and personal comments)

apologies

gerbo

Celia Vogel

12-24-2006, 08:40 AM

Gerbo,

It's funny that structural conveniently omitted the one paragraph in response to your question above that sparked this debate. If I remember correctly, you responded by saying that patients shouldn't be required to fund studies of any sort.

Originally Posted by gerbo:

I think that in the context of treatment of scoliosis, there is nothing wrong with vestibular testing as long as it is made clear that it is only of academic interest, patients are advised that there is no evidence at all that "treatment" based on this testing does anything to improve scoliosis or helps to maintain a curve, and of course no large additional payments are demanded (Did I pick up that dr d charges more than 1000 dollar for this; correct me if i am wrong)

Originally Posted by Structural:

Gerbo - I know we all want more definitive answers to help loved ones... but to get those answers costs $$$ (for studies that you often demand). Donating to causes such as this just might get us some of those answers with the "studies" to back them up.???

Who exactly is doing this study ? According to parents who have been to the chiropractors, claims are being made by the chiropractors that there is a study. Drs. Rivard and Coillard are not conducting such tests on their patients. How do these expensive tests affect how the brace works ? In fact, patients who are going to Montreal are getting better results than the chiropractors who are conducting these tests and recommending patients use wobble boards to enhance proprioceptive capacities! Furthermore...in one of your quotes you state that it can be used as a predictive test for chiari and the like however no red flags went up to the chiropractors who were treating Mom37's daughter - I'm not implying that you wouldn't have sent the young lady to see a neurosurgeon but that didn't happen in Mom37's case! So what exactly are these *tests* useful for ? Are the results being used in any meaningful way ?! As far as I know the chiropractors are charging patients $6,000.00 for the brace inculsive of tests/wobble boards versus $3,000.00 in Montreal.

Children who present at chiropractic/osteopathic offices for these "tests" have scoliosis hence the "test" is worthless as a predictive measure. As for the exercises/wobble board... we all agree it doesn't work. I've noticed when I ask you a direct question you distance yourself and argue the case from an empirical stance. You have an uncanny ability to skirt around questions and take methods which are completely unproven and make them sound mainstream and effective when in fact there is no scientific basis for their validity.

Here is a study: "Etiology of Idiopathic Scoliosis by T.G. Lowe, C.H. Rivard," Refer to page 1161 - 1162 under the heading: Neurological Mechanisms http://www.scoliosis-support.org/uploads/central_vestibular_dysfunction.pdf

1: Clin Orthop Relat Res. 1980 Oct;(152):232-6.

Equilibrium factors as predictors of the prognosis in adolescent idiopathic scoliosis.
Sahlstrand T, Lidstrom J.

Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.
PMID: 7438607 [PubMed - indexed for MEDLINE]

1: Spine. 1980 Nov-Dec;5(6):512-8. Links

An analysis of lateral predominance in adolescent idiopathic scoliosis with special reference to convexity of the curve.

Sahlstrand T.

An analysis of lateral predominance of 51 patients with adolescent idiopathic scoliosis is presented. Determination of handedness, the dominant foot, and the dominant eye was performed. Postural equilibrium was studied by stabilometry, and the vestibular function was evaluated with electronystagmography. Central and peripheral nervous function were evaluated as reflected by electroencephalography and nerve-conduction velocity measurements. Results were compared with those obtained for a control group and were evaluated with special reference to convexity and location of the curve. Significant differences were found between patients with right convex curves and those with left convex curves in the distribution of eye predominance and in labyrinthine sensitivity. The direction of convexity was correlated with the predominant labyrinth for both groups. An analysis of these findings indicates that they can be of pathogenetic importance.
PMID: 7466460 [PubMed - indexed for MEDLINE]

ARE ASYMMETRIC OTOLITH VESTIBULO-OCULAR REPONSES A PREDICTIVE FACTOR FOR IDIOPATHIC SCOLIOSIS IN CHILDREN?

Sylvette R. Wiener-Vacher, and Dominique Antolini., Nn. 1

In idiopathic scoliosis spinal deformities start to develop at the time of the initial rapid growth at the onset of puberty. A suggested cause of IS is a disequilibrium in the otolith vestibular control of the trunk muscles. Supporting this hypothesis our previous results (2) showed that 67% of children with IS, but no other inner ear or neurological abnormalities, had an asymmetry of their otolith vestibulo-ocular reponses to the Off Vertical Axis Rotation test. These were significatively greater than in a control age-matched
group of normal children. We suggested that this asymmetry was a central otolith vestibular system disorder and could lead to a vestibulospinal system imbalance, which would then provoke IS.

The goal of this study was to determine if this asymmetry exists prior to the appearance of the spinal deformities. Our preliminary results show that the vestibulo-ocular asymmetry appears before the spine starts to show any significant clinical and radiological deformity. In patients at risk for IS(e.g. a family with IS history) screening for otolith functional asymmetry could be used as predictive factor of scoliosis and help for earlier prescription of IS preventative treatment.

1 Thanks to the Cotrel Foundation (Fondation de France) for supporting this research.

2 S.R. Wiener-Vacher, K. Mazda. Asymmetric otolith vestibulo-ocular responses in children with
idiopathic scoliosis. J. Pediatr 1998 ;132:1028-1032.

Celia Vogel

12-24-2006, 08:49 AM

This is something Structural stated in the Spinecor thread:

...Despite the lack of studies on scoliosis/vest., the field of neurophysiology has a lot to offer many conditions. I am pleased to see it being used in combination with other things. There are methods being used everyday to help people learn to walk again following serious trauma/injury to the spine and/or head.... There are documented cases of formerly parapalegic/quadrapalegic individuals who learned to WALK again (despite the prognosis from their doctors) due, in part, to methods and excersices designed to correct vestibular dysfunctions, usually under the guidance of Physical Therapists and neurologists. (In fact, learning to walk again REQUIRES vestibular re-programming, otherwise it is literally impossible) From my working knowledge of these methods there is nothing mystical or airy fairy about it..... The evidence that it works as an integrative aspect of treatment is all over the place. Although, I certainly agree that there is no evidence or probability that it will ever change a scoliosis in and of itself

Show me *one* documented case of vestibular rehab correcting a scoliotic spine! This is a scoliosis forum and you insist on bringing up matters which have absolutely nothing to do with scoliosis!

structural75

12-24-2006, 08:54 AM

Celia,

That is probably a good idea for us all... I think all of our points have been made.

However, I don't believe there was even a "discussion" in the first place, and that was my point. After I deleted all of posts from the spinecor thread as Gerbo intelligently suggested, I went on to read the previous "discussion" he referenced on the matter. I was uphauld to see that you did the same thing to another member, denigrating the topic and again making the same false statements about it. Making condescending remarks about "eye exercises" and claiming the field is "bogus" is not a "discussion". You could have inquired with questions for clarification and understanding instead of dismissing what you didn't know. That's partly why we are gere, to learn something.

We know now that it is: not a chiro thing, but an MD, not about the eyes/eye exercises per se, but the inner ears, and that the field is not "bogus, but very much scientifically validated for its importance/relevance in a variety of conditions including scoliosis. There may not be the studies you'd like to see at this time, but it is applicable and relevant nonetheless.

I mean seriously now, Are there any studies proving the efficacy of the spinecor brace 20 -30 -40 years from now? Do we really know that it is going to stabilize the curve indefinitely/permanently, any moreso than other braces have? No, but I still support its use due to its integration of postural re-education via the nervous system(vestibular re-programming). And those folks using the brace are undergoing a generalized vest. re-programming by lessening the curvature and moving/activating the spinal soft tissue at the same time... that is largely the reason for its success... and that is vestibular rehabilitation.

And by the way, I have nothing, absolutely nothing to gain from people utilizing this approach(financially or otherwise... I use my hands in treatment, no interst in fancy machines... I'll leave that up to the Docs). I do not do this "expensive" testing/rehab that the chiros/MDs do, but rather take a functional approach in working with the dysfunctions.(by the way, haven't I read that bracing costs/replacement parts/straps can be quite expensive. With x-rays, visits, etc.... why keep spending money on frequent x-rays when you know the curve "already exists" and you're using a "proven and effective" method?

My only stake in this is to prevent the less educated from disseminating false information.

Gerbo,

...just holding people accountable for their comments. What I have posted to end my contribution on this is quite factual.

structual

Celia Vogel

12-24-2006, 08:57 AM

.. After I deleted all of posts from the spinecor thread as Gerbo intelligently suggested, I went on to read the previous "discussion" he referenced on the matter.

Sure you did ;) You knew it all along and I really don't see how it was your discussion to reference in the first place and take my words out of context! But since you chose to reference it, I'll post it here to save people the aggravation of going back 50 pages in the Spinecor thread!

Posted by DizzyMom:
New to site, interesting read. Have 14 yr daughter- been Boston bracing- 4 yrs- curve worsening. Referral to surgeon. now 30 in brace-thoracic.

Looking at Spinecor..... Atlanta is closest for me- 7 hours- I'm in eastern NC. Do those of you who have used this awhile feel it is helping? I take it from the site, most kids prefer it over the hard brace.

Anyone have trouble with getting approval thru insurance?

Also saw where Shriners does it free. Any other info on this and are they as good there as Dr D and Dr L- except for the Canadian Docs.

Actually got an appt in just 1 month when I called- but having difficulty with the $6000 up front. Any suggestions or helpful info would be great!

Posted by Gerbo:
blasted, $6000 upfront, that's a lot, is that the going rate??

For what it is worth, and you might have seen this already, this is link to the spinecorwebsite http://www.spinecorporation.com/English/index.htm , with a list of treatment centres

Posted by Sherie:
I think we paid $4500, 6k sounds high to me.

Posted by Celia:
I think the chiropractors charge more *coughs* because they do some phoney baloney eye exercise testing to "correct" the scoliosis.

Posted by Christine:
We just went to Montreal 3 weeks ago. We paid a total of $3534.00 which include 2 x tra body suits. We are also expecting reinbursement of $2434. in out of network insurance. From all of the research we have done the placement of the brace is extremely important to get the best results!!!!

Perhaps if you could get a referal from a orthopedic in network you may be able to fight for in network benefits.

Posted by JGD1991:
Celia, I would be careful to discredit someones work without giving good back up research to support your opinion. There seems to be a number of research articles connecting scoliosis to a vestibular problem. I think that the additional cost to evaluate the vestibular system is worth doing, based on my readings.

For example i found this paper

ARE ASYMMETRIC OTOLITH VESTIBULO-OCULAR REPONSES A
PREDICTIVE FACTOR FOR IDIOPATHIC SCOLIOSIS IN CHILDREN?

Sylvette R. Wiener-Vacher, and Dominique Antolini., Nn. 1

The goal of this study was to determine if this asymmetry exists prior to the appearance of the spinal deformities. Our preliminary results show that the vestibulo-ocular asymmetry appears before the spine starts to show any significant clinical and radiological deformity.

In patients at risk for IS (e.g. a family with IS history) screening for otolith functional asymmetry could be used as predictive factor of scoliosis and help for earlier prescription of IS preventative treatment.

Posted by Celia:
I don't see the point of expensive *tests* by chiropractors if the children that go there *already* have scoliosis and as the above study points out "vestibulo-ocular asymmetry appears before the spine starts to show any significant or radiological deformity". What exactly are the chiropractors planning to do with their results ????? Brain surgery ?????

Posted by JGD1991:
The vestibular Systems controls the muscle tone of the back muscles surounding the spine . If that system is not working symetrically, the scoliosis is being supported in negative way. Vestibular exercises have been well established and in the research. I rather have this system working with me then against me.

Posted by Celia:
You mean eye exercises ? Where is it well established ?

Posted by Cheryl:
This may be a factor in scoliosis, but it is one theory of possible causes. It may deserve further study, and probably does. But should the patient pay huge sums to be the recipient of such research? I highly question, not the study, but the profit from the study. That, I think, is where Celia is coming from...

A true researcher is not going to charge astronomical sums. A true researcher rather is looking for a participant willing to take the risk to be a part of his study.

The vestibular component of scoliosis and treatment of that component of scoliosis are still under research.

I think this practice is a racket motivated by profit. It cannot cost 3000 dollars a patient to run these tests and teach the exercises. There is no documentation that these exercises do anything to help the scoliosis. Therefore, they are still experimental. I think it is highly suspect to charge such astronomical sums and prey upon the fears of the parents and patients.

When and if this is ever a well documented treatment for scoliosis, it would be ethical to charge a reasonable fee.

Posted by Christine:
Well said Cherylplinder !!! Dr. Rivard's Office visit was only $100. and he spent approx. 3 hours on my daughters case.

Posted by Celia:
The man is a Saint! I have to agree with Christine that Cheryl made some EXCELLENT points!

JGD: Nowhere in the studies that you have referred to, does it elaborate on how to *correct* this asymmetry. You are trying to legitimize these bogus eye exercises which are totally unproven by referencing studies conducted by *true* researchers such as the Cotrel Foundation.

Posted by Cheryl:
Yes, Dr. Rivard is a Saint. He asks so little for his time, I am tempted to make a donation!

Posted by JGD1991:
I have two neices in the Spinecor Brace. They both had vestibular imbalances that are being addressed with home exercises. The reason we brought them to NewYork City for Spinecor was that this was the only office that seemed to address other aspects conected to scoliosis. We also found that most of the other spinecor offices did not offer even the exercise program from spinecor. They offered testing that made sense to us. The Vestibular system controls balance and spinal muscle tone. The fees for the testing ranged from 800-1200 for my neices. This test is a well established medical test and these fees were normal for this test. I' m sure Spinecor also had this type of atitude from patients when they first came out. People were being charged for the spinecor brace and wondering why it should cost the same as a hard brace. Over time people are becoming very happy with results and are glad they found it at almost any price.
In addition, when I was in the new York office for a quartly visit recently with my neices. There was a young child that had been in for 3 months earlier for an examination and had come back for a followup. I was told that the child had a 9 degree curve and was given only vestibular exercises. The parents were expecting that she may have progressed and need a brace only to find out that her curve reduced to less than 1 degree. I was very excited for them and was real happy that we didn't try to cut corners and miss out on any possible benefits from there program.

Everybody has to do what they feel is the right thing to do. I only came on the forum with my coments because I thought people were being guided improperly.

Posted by Celia:
Oh...you're actually a patient ??? I thought you were a chiropractor! These tests are medically established and necessary? According to who ? Do you have studies that show that these eye exercises are nothing but pure fiction ?

Posted by JGD1991:
I'm at work but I found a study for you.

Role of vestibular adaptation in vestibular rehabilitation.
Herdman SJ. Department of Orthopaedics and Rehabilitation, University of Miami, Coral Gables, Florida 33146, USA.

Posted by Karen Ocker:
I see that one of the studies was published in 1979 from Scandinavia; are there any more than 3 such studies?
Unless other studies ---with other populations by other researchers replicate those results there is not enough evidence suggesting validity as a basis for a treatment modality. Also, were there any flaws in the conduction of those studies? There were not very many subjects.

Posted by JGD1991:
I really think that this is going to be the next Ah ha. of course we should have been doing these exercises

Posted by Celia:
I think we may be on to something BIG... so, if I have scoliosis and I train my eyes to move in a certain direction this will straighten my spine ?

gerbo

12-24-2006, 09:39 AM

We know now that it is: not a chiro thing, but an MD, not about the eyes/eye exercises per se, but the inner ears, and that the field is not "bogus, but very much scientifically validated for its importance/relevance in a variety of conditions including scoliosis. There may not be the studies you'd like to see at this time, but it is applicable and relevant nonetheless.

to a patient with scoliosis there is only one issue which determines relevance; and that is whether effort, time and money spend results in stabilisation, improvement or slowing down of progress, which would not have occured without the particular testing/ treatment.

With regards to vestibular testing exercises; if we do not have evidence that it improves matters, we do not have evidence that it doesn't make things worse neither.

Personally i really think that you are a very caring, knowledgeable and responsible practitioner, and i believe that for you this testing is only a small part of your overall approach.

What has been bothering both celia a nd me that it has appeared to us that some chiropracters has been charging their patients an awful lot of money for having the "benefit" of this testing, without being told about the lack of evidence about the method.

Remember that the discussion started following a posting about vestibular testing done by doctorsr in the context of scoliosis, so no issue was taken as such about it being done for scientific reasons and/or for the treatment or diagnosis of other conditions by other practitioners, including yourself.

I mean seriously now, Are there any studies proving the efficacy of the spinecor brace 20 -30 -40 years from now? Do we really know that it is going to stabilize the curve indefinitely/permanently, any moreso than other braces have

no but the available evidence shows impressive results 2 or more years following completion of treatment, and we are awaiting the publication of the next study which is showing results over an even longer period. And i am sure that you know that if a curve can be maintained below 30 degrees by the time growth has finished the chance of deterioration in later life if much smaller that if the curve is above that level folllowing end of growth

regards

gerbo

structural75

12-24-2006, 01:59 PM

Gerbo,
Thank you for that honest and respectful post. I agree and I sincerely hope that the future studies you refered to on the spincor brace show additional promise.

I myself, look forward to it, as well as the potential for more direct studies on neurophysiology as it relates directly to scoliosis.

I'm very sorry that there are practitioners out there who put their financial interests in front of their patients' health. I'm not in any position to judge those said chiros on the matter, but I hope it's not the case.

Although I stand behind the 'factual' and relevant content of previous posts, I am deeply ashamed for being a part of that kind of negative energy on this forum. I never had the intention of taking personal assualt on anyone, but in the heat of the moment it was all I could do to defend legitimate ground. I will continue to support complimentary, alternative and conventional approaches, but my days of poetic slamming are through. It simply serves no purpose if people aren't willing to listen to both sides.

My apologies to everyone on this forum for my role in perpetuating a hopeless "discussion" from the start.

structural

Mom37

12-24-2006, 09:30 PM

I just wanted all to know that my Insurance covered in it full, so I meant 100 percent, and considered it medically necessary. It is something that must be researched and decided upon individually. My understanding was that it was in connection with the whole Spinecor treatment. It is true not all doctors who fit Spinecor use that testing. It is like Spinecor, still being used by some doctors, but not all.

Celia Vogel

12-25-2006, 06:15 AM

Celia,

However, I don't believe there was even a "discussion" in the first place, and that was my point...

True! The rest of us were having a discussion on scoliosis it was pretty clear to all you were out in left field arguing the relevance of vestibular rehab as it pertains to *other* medical conditions.

Celia Vogel

12-27-2006, 06:26 PM

The vestibular system consists of the inner EAR, not the eyes as this poster has wrongfully assumed. It is established in many, many studies done by M.D.s specializing in this field (neurophysiology).

They are FAR more than eye exercises.. had she known what vestibular was she wouldn't make such brash statements. Nobodies "trying" to do anything, they've been "legitimized" already.

We know now that it is: not a chiro thing, but an MD, not about the eyes/eye exercises per se, but the inner ears, and that the field is not "bogus, but very much scientifically validated for its importance/relevance in a variety of conditions including scoliosis.

I never had the intention of taking personal assualt on anyone, but in the heat of the moment it was all I could do to defend legitimate ground.

Posted by Majestnic when she was seeing Dr. D. in New York before switching to Dr. Rivard:

Nicole has specific exercises to do to strengthen her eye muscles. They involve eye tracking, etc.

Posted by LATigner:

My daughter also had the neurological testing done. Dr. Ron Marinaro explained what it was for and we chose to do it - no pressure or other tactics to try and force us. The reason we elected to do the testing is that there is a theory that occular vestibular inbalance is associated with scoliosis. Dr. Ron said that all of the scoliosis patients he has tested have had positive results. He was also clear that it is unknown whether this causes scoloisis or is a result of scoli. But it makes sense to me that if a person's brain does not perceive the vertical plane correctly and thinks they are standing up straight when they are not - this is a deterimental thing.

Yes, the testing added $1200 to the cost but we were willing to try it based on our own research and conversations with Dr. Ron and others. Our daughter has some simple eye excercises to do.

Posted by BlueCrystalMan:

As for the extra testing... the data collected is going toward research, as there is a possible correlation between the ocular vestibular imbalance and scoliosis... the way I understood it is that the mind thinks the patient is out of balance and the brain uses the back muscles to balance a person. Over time, the muscles on one side or the other, depending on the perception of which way the body thinks its falling, get built up and in turn pull the spine that way. The testing determines which side is the more dominant side, and based on the data, eye exercises are prescribed to 'retrain' the brain to eliminate the imbalance. The testing goes toward prescribe specific exercises for the specific curves in his spine.

The exercises prescribed, both for the eyes and the physical part go toward helping to eliminate the curve and its causes. Software is provided to help retrain the brain for a minute every day, and he has to do a spinning exercise in his desk chair while focusing on his thumb in the distance. All this goes toward helping the brain adjust to the fact that my son isn't really off balance.

So personally, the tests made sense, and the data compiled for the greater good of current and future patients, and no I don't think I was scammed at all. Research dictates that they are on the right track, and so far my son's progression in terms of doing his exercises has been tremendous... I can see difference in his balance already both on the exercise ball and when doing his eye exercises.

structural75

12-27-2006, 10:06 PM

Celia,

I thought we laid this one to rest... :confused:

You Said:
The rest of us were having a discussion on scoliosis it was pretty clear to all you were out in left field arguing the relevance of vestibular rehab as it pertains to *other* medical conditions.
:confused: :) What you're calling a discussion consisted of you telling people that vestibular testing/rehab was a bunch of nonsense. You wouldn't let me past first base in terms of having a discussion on its relevance to scoliosis. You clearly felt it was irrelevant.

I will kindly say... It was obvious I was arguing the relevance of vest testing/rehab as it pertains to scoliosis. I used its application to "other" medical conditions (once or twice) to exemplify its scientific validity and proven effect, which was originally discredited by you. You kept telling others and myself there was no evidence that it works, much less has anything to do with scoliosis. So I used "other" scientific applications of it to show its legitimacy and likely relevance to scoliosis, despite the lack of studies specifically in regards to scoliosis.. .

If you hadn't been on my case the entire time, arguing against its validity and relevance to scoliosis, then maybe we could have gone in a more positive and productive direction with the "discussion". My original effort was to support the validity of the vest. testing as it related to scoliosis, and you wouldn't let that happen.

Therefore, I'm a bit confused about the content of your last post here. It seems to point out everything that I've been trying to say this entire time.

I'm not certain why you posted those quotes from me... they seem to make perfect sense, especially in context to your previous assumptions and comments. And the testimonials below them show positive and relevant application of vestibular testing/rehab in cases of scoliosis. Isn't this what I've been trying to say all along???

Our proprioceptive inputs for balance and coordination (which then informs the musculoskeletal systems) comes from both the inner ear and eyes alike (vestibular and occular). I'm pretty certain I mentioned that earlier somewhere... ...not about the eyes/eye exercises per se, but the inner ears, and They are FAR more than eye exercises.. was meant to be a simple correction in the purpose of vest. test, specifically the actual system those "eye exercises" are working to correct. By doing eye exercises, as well as others, they're working to correct the discrepency between the vestibular system (inner ear) and the proprioception of the eyes.

So what seems to still be the problem?

structural

LindaRacine

12-27-2006, 10:56 PM

Celia Vogel

12-28-2006, 03:39 AM

...What you're calling a discussion consisted of you telling people that vestibular testing/rehab was a bunch of nonsense. You wouldn't let me past first base in terms of having a discussion on its relevance to scoliosis. You clearly felt it was irrelevant..

One simply has to look at the length of your posts to know this is total rubbish! Your "poetic slamming" consists of going off on a tirade discussing matters totally unrelated to scoliosis.

...Therefore, I'm a bit confused about the content of your last post here. It seems to point out everything that I've been trying to say this entire time. I'm not certain why you posted those quotes from me... they seem to make perfect sense, especially in context to your previous assumptions and comments. And the testimonials below them show positive and relevant application of vestibular testing/rehab in cases of scoliosis. Isn't this what I've been trying to say all along???

There could only be one of two things: 1) there is something wrong with your mental faculties or 2) you think we're all a bunch of idiots! I personally think it's the former and I would highly recommend having vestibular testing done for yourself :D :cool:

...My original effort was to support the validity of the vest. testing as it related to scoliosis, and you wouldn't let that happen.

In response to this please refer to the following article: "Etiology of Idiopathic Scoliosis by T.G. Lowe and C.H. Rivard et/ al., ," Page 1161 - 1162 under the heading: Neurological Mechanisms, http://www.scoliosis-support.org/uploads/central_vestibular_dysfunction.pdf

Further...*nowhere* in the following quote that you posted previously does it specifically state that the testing should be done for scoliosis. Your arguments are a SHAM!!!!!

Why get vestibular tests ?

1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety. Recent studies have suggested that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996). Hearing pathway tests (audiometry, ABR, ECOG) can also be used for the same purpose, and are frequently combined with vestibular tests. In a cost-effectiveness analysis for evaluation for vertigo it was concluded that hearing testing followed by either posturography or ENG (electronystagmography) was the most effective method (Stewart et al, 1999).
2.To detect central disorders. Recent studies have suggested that internuclear ophthalmoplegia, a central eye movement disorder, is missed by 71% of physicians unaided by quantitative oculomotor testing (Frohman et al, 2003).
3.To decide if more expensive tests like MRI (Magnetic Resonance Imaging) are needed. Vestibular testing is more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.(Levy and Arts, 1996)
4.To document objectively vestibular conditions such as BPPV and Perilymph fistula, which commonly occur after head injury, vestibular neuritis, and Gentamicin ototoxicity, which commonly is a side effect of medication.

structural75

12-28-2006, 07:56 AM

Celia,
you continue w/ the personal attacks...
posted by Celia: There could only be one of two things: 1) there is something wrong with your mental faculties or 2) you think we're all a bunch of idiots! I personally think it's the former and I would highly recommend having vestibular testing done for yourself
"you think we're all a bunch of idiots!"... Don't be silly, I'm only having this dialogue with you ;) . Are you saying people with balance/coordination problems are stupid as well (intellectually challenged)? Vest. testing for me??? maybe I wasn't clear on what the vestibular system was... because I don't have any issues with balance, coordination, proprioception, etc.? :rolleyes: I realize it must be frustrating to try and dig yourself out of the hole you're in, but seriously... act like an adult and move on........ !!
Further...*nowhere* in the following quote that you posted previously does it specifically state that the testing should be done for scoliosis. Your arguments are a SHAM!!!!!
That quote I posted was to point out the purpose/importance of vestibular testing in general. If you have a difficult time seeing the neurologic connection with scoliosis here then maybe I can spell it out to you in another lengthy, "irrelevant" post. Do you see the reason why this keeps going in circles yet?

I acknowledged there aren't formal studies specifically pertaining to vest. testing/rehab in the treatment of scoliosis (hopefully that will change). Clinical successes and relevance, as the ones you highlighted in that previous post, do not need formal studies for confirmation. As for the rest of your posts, I simply won't dignify your attempt at redemption with a response. You're clearly reaching with all your might here, picking my skin out from under your fingernails.

I have a few questions... Do you think scoliosis is more than just a curvature of the spine? Do you believe that it can affect, or can be affected by, other systems in the body? Is there validity in taking a multi-faceted approach, especially in ideopathic cases, to address these other systems? What do you consider relevant in the treatment of scoliosis? So what are the causes of ideopathic scoliosis or the progression of any scoliosis? What would assist bracing to have a better success rate? What is your medical/health training that makes you an expert on musculoskeletal dysfunctions, or the significance/insignificance of the nervous system as it pertains to scoliosis?

Just curious.

Celia Vogel

12-28-2006, 09:56 PM

Celia,
you continue w/ the personal attacks...

Are you saying people with balance/coordination problems are stupid as well (intellectually challenged)? Vest. testing for me???

One of the *many* reasons for getting vestibular tests:

Why get vestibular tests ?

1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety.

I may not be an expert but I can tell what is genuine from deception. The spinecor brace is attempting to address the neuromusculo-skeletal side to this scoliosis puzzle and neither vestibular tests nor phoney baloney eye exercises have to be conducted to know that the system is being affected.

Excerpt from Spinecorporation Website:

THE CONCEPT

Scoliosis is not only a deformation of the spinal column, it is also a disease of the neuro-musculo-skeletal system. If it progresses, it can have serious consequences for the patient. This complex system's unstable balance during growth may, perhaps, be governed by the theory of chaos.

Scoliosis is more than a 3D deformation of the spine. It also involves postural disorganization, neuro-musculoskeletal dysfunction and unsynchronized growth patterns all evolving with time. Using these four defining criteria, we can adopt a more specific approach to the static and dynamic properties of scoliosis that evolve over a period of time. Scoliosis is a four-dimensional deformation! Even though the aetiology of scoliosis remains unknown in 80% of cases, technological progress and the creation of multi-disciplinary teams mean that, in addition to the spinal deformation, a child's or adolescent's morphological and postural abnormalities can be recognized, together with their dysfunction, growth and maturation problems. The therapeutic concept of the SpineCor System is closely related to the aetiopathogenic concept. In keeping with this therapeutic concept, the design of this Dynamic Corrective Brace incorporates various independent, yet related, components.

It provides dynamic control of the shoulders and pelvic girdles and thorax, controls movement, and modifies the three-dimensional postural geometry. This allows us to correct the three-dimensional deformation while harmonizing the function and maintaining it over time. More harmonious growth patterns can thus be achieved.

Mom37

12-29-2006, 12:36 AM

Would you mind telling us what insurance company covered the testing? Just curious.

Thanks.

--Linda

I am insured by American Airlines, which self funds our health insurance, but is underwritten by United Healthcare. It was covered in full. Ultimately I paid for it, being self funded, but didn't find any need for concern. It now is a help to us to support further explanation of our daughters symptoms of nystagmus and scoliosis caused by Chiari and Syringomyelia. Information on eye movement evaluation from Dr. D in NYC can be found on www.scoliosissystems.com/neuro.html

structural75

12-29-2006, 08:55 AM

Celia,

Anxiety is not an intellectual deficit, nor do psychological problems necessarily reflect ones intellectual capacities.

Fact or Fiction?
Without neurologic testings, beyond vestibular as well, how does one determine precisely where the neurologic problem might be? How do you treat the neurologic component of this puzzle if you don't know precisely where the dysfunction is? It's like saying you don't need x-rays because you already know that scoliosis is a curvature of the spine, and any trained eye can see that without an x-ray.?? Putting on a brace and hoping for the best is a shotgun approach, as we've seen with unsuccessful bracing attempts.

I think the spinecor brace is certainly adding a general functional neurologic component to the treatment, however it's quite far from being the be all, end all in regards to this aspect.

Celia Vogel

12-29-2006, 10:03 AM

Without neurologic testings, beyond vestibular as well, how does one determine precisely where the neurologic problem might be? How do you treat the neurologic component of this puzzle if you don't know precisely where the dysfunction is?

I've already stated my case and I have nothing further to say to you! If you need further clarification please re-read *any* of the references I've referred to already. Dr. Rivard's article specifically states that no clear cut neurological tests either for diagnosing idiopathic scoliosis or predicting it's progression have been established. Further... please re-read the following:

1: Clin Orthop Relat Res. 1980 Oct;(152):232-6.

Equilibrium factors as predictors of the prognosis in adolescent idiopathic scoliosis.

Sahlstrand T, Lidstrom J.

Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.
PMID: 7438607 [PubMed - indexed for MEDLINE]

If you want to ponder those questions please do so, either by going back to medical/chiropractic/osteopathic school or where ever it is you got your "training".

structural75

12-29-2006, 11:29 AM

Celia,

Thank goodness... !

p.s. - I know you're not answering any of my questions, so take these as retorical.
The spinecor brace is addressing the neuromusculo-skeletal side to this scoliosis puzzle and neither vestibular tests nor phoney baloney eye exercises have to be conducted to know that the system is being affected.
As Gerbo has pointed out many times, how do we know if it's being affected for the better or for the worse? Given that some bracing attempts are not successful, how do we know it's not because the affect on the nervous system is actually harmful in those cases? How long do we wait to find out its actual affect? Maybe testing and specific neurologic rehab would shed some light on this matter, rather than just assuming its affect. Much the same as repeated x-rays show the progress, or lack thereof, of the curvature for confirmation of therapeutic effect. If the testing revealed that neurolgic deficits were worsening then appropriate intervention could happen sooner than later. (In the same way that the studies you referenced on the predictability factor could allow proper intervention BEFORE an ideopathic scoliosis asserted itself. Address the neurologic imbalance and maybe the potential scoliosis won't have an opportunity to occur.?). Just another musing to consider.

Given that every individual is different, we cannot expect a 'one-size-fits-all' approach to affect everyone the same.

Karen Ocker

12-29-2006, 12:10 PM

This Polish study(among others they have done) makes a lot of sense to me especially since my surgeon noted, during one of my abdominal surgeries, that my right rectus abdominus muscle was abnormal. It says nothing about the vestibular system:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17108471&query_hl=5&itool=pubmed_docsum

macky

12-29-2006, 08:03 PM

I just read all of this and got absolutely lost. Am I dumb, no I am just a person who has lived with scoliosis for 40 years and was operated on many years ago.

I enjoy reading posts from people who actually are experiencing the scoliosis itself and from parents who are looking to help their little ones, but as far as people who have no idea what it is like to live with it, well please just keep your opinions to yourself. You see you have no first hand experience to back up anything you say as you have not FELT it yourself.

Dont start another getting nasty lession on me either ,as this forum is here to help each other.
If you havent felt the pain, havent felt the brace, havent felt the plaster cast as in my case,,well in my opinion you havent got a clue.

Macky

structural75

12-29-2006, 10:43 PM

Macky,

Why so rude and bitter. Please be clear, you know nothing about me, or my experiences.

Do all, or any of the Doctors helping people with scoliosis have it themselves?... hhmmmm? I work with people with scoliosis so I'd say I have a pretty good idea of what they're going through. Practitioners of any discipline do not need to suffer from a condition to be able to provide assistance to others. My education and profession in the health care/medical field is plenty to "back up" my statements. If you want to share you're personal experiences, that's obviously fine.

People come to this forum for many reasons. Support, comfort, empathy and first-hand experience are among those very important and necessary reasons. I have never attempted to give my "opinions" on those matters. However, some are also seeking input from others on this vast and elusive condition.
parents who are looking to help their little ones
It would be a shame if those parents you speak of didn't do everything they could... clearly surgery alone is generally a temporary fix. And if treatment hasn't changed much in the past thirty years despite the results (surgery + bracing), then I would be curious myself about additional options in management and self-care. Your body is telling you now that it is not a machine or an inanimate object, and you can't continue treating it as such. Just because the curve has been reduced with implants, doesn't mean you're out of the woods.

If you don't agree with non-surgical approaches, then stay out of those threads! But don't be a discouraging obstacle to others who believe in a more comprehensive approach, and aren't too lazy to do all they can to help themselves. And remember, this forum represents only a minute fraction of the population of people throughout the world who are afflicted with this condition. Nobody on this forum, including myself, has the final word on what works, and what doesn't... That is a unique and individual experience.

structural
p.s. - This is the vestibular thread... Did you have anything productive to say about it?

macky

12-30-2006, 05:12 AM

Sorry guys for saying language like I did which I have now edited out.

I knew you would post back Structural and I dont know why. You are so defensive.

What upsets me and really breaks my heart is that all this medical jargon that is going on about non surgical scoliosis fixes, well people dont have any idea at all what the end result will be. It certainly hasnt been around long enough for it to be proof that in years to come the spines will not curve once again.

We all have our opinions and I have as much right to disagree with you as anyone else and to post on here if I want. I wish with all my heart that all the medical research will one day help scoliosis and people will not have to have operations. Until all this is proved, I myself ,and I am allowed to my own opinion, cannot agree.

I am a mum of two adult boys I am not rude or bitter, just a person who has lived with scoliosis for 40 years and it hurts me that people like yourself get up on your soap boxes. You probably mean well but you could also be offering false hope. My surgery, and I was so very lucky even though I have pain which I cope with, was not a tempory fix, it was a permanent one and has not in any way stopped me from living a full life.
Now please I do not want to go on with this. This is my opinion and mine only, and maybe in 10 - 20 years time if I have any proof that any of this will actually be one of the medical discoveries of our time, I may apologise, but I dont think I will have too.

I absolutely do not like putting this opinion on here because everytime I feel like I have to be truthful with my own self and post same, I know I will get abused and I just did. I now know my place and will make sure I keep it from now on.

Macky

structural75

12-30-2006, 06:05 AM

Macky,

I'm only defensive because certain people are offensive toward me. I respect your position to disagree... but it often goes beyond disagreement and becomes insulting and denigrating. Let's please just end the personal insults and I won't have a need to defend. I do it primarily because some of you have driven others off this site in the same manner, and I don't think that's fair or appropriate simply because you disagreed.

I completely understand your point. However I really don't believe that I have suggested the use of any of these non-surgical approaches in exclusivity from surgical ones or as "fixes", but rather as an a compliment to a well rounded and realistic treatment strategy. I strongly believe they have value in combination... so that doesn't put forth "false hope" of any kind. It could very likely increse the longevity of the surgical procedures, minimizing or reducing the likelyhood of problems later on, such as your own. I'm certain that surgery helped you for many years, and since you can't have another, maybe some type (I'm not suggesting vestibular testing for you specifically) of non-surgical approach could bring you a better quality of life and comfort. I wish you the best with whatever you do.

Non-surgical approaches are not new. The Scroth Method has been around for quite some time. It's no less valid than the spinecor brace, which doesn't yet have the longevity that you're asking for. Nobody here knows what the spincor brace will do for someone in 20, 30, or 40 years down the road... so that is still speculative at this point, but clearly worth the effort.

structural

Celia Vogel

12-30-2006, 09:08 AM

Macky,

Don't let structural intimidate you! Keep in mind he is here passionately arguing that we should all give "eye exercises" serious consideration in the treatment of idiopathic scoliosis and even raise it to the level of Schroth therapy and yes it costs big bucks! So....depending on the location of your curve you either move your eyes to the left or to the right spin around in your chair and try to focus on your thumb. Would wiggling the ears and rubbing one's tummy while saying three Hail Marys help :confused: :D

macky

12-30-2006, 04:45 PM

Actually Structural I said it hasnt been around long enough, but I may be wrong again.

Celia you absolutely cracked me up. I am sitting here laughing with tears running down my face, you are an absolute delight. Golly what would we do without people like you on our forum.

Structural get over yourself.

Happy New Year to all my friends here, I love you all and thankyou Celia, boy did I need that.

God bless,
Macky xx

Karen Ocker

12-30-2006, 04:47 PM

This abstract suggests conservative therapy can reduce not eliminate need for surgery:

Pediatr Rehabil. 2003 Jul-Dec;6(3-4):209-14. Links
Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis.Rigo M, Reiter Ch, Weiss HR.
Instituto Elena Salva, Barcelona, Spain. rigo.quera.rehab@eresmas.net

STUDY DESIGN: Retrospective analysis of outcome in terms of prevalence of surgery for adolescent idiopathic scoliosis in patients receiving conservative management. OBJECTIVES: To determine whether a centre with an active policy of conservative management has fewer patients who eventually undergo surgery for adolescent idiopathic scoliosis than a centre where the practice is non-intervention. BACKGROUND DATA: The efficacy of orthoses for the treatment of idiopathic scoliosis was called into question in a recent publication. Because the prevalence of surgery in an untreated group of patients (28.1%) was not significantly different from that in a braced group (22.4%), the authors concluded that bracing appears to make no difference. Based on prior experience, this conclusion is questioned. METHODS: Since 1991, bracing and physical therapy have been recommended for children with adolescent idiopathic scoliosis at a centre in Barcelona, Spain. The scoliosis database was searched for patients with adolescent idiopathic scoliosis who were at least 15 years of age at last review and who had adequate documentation of the Cobb angle. The prevalence of surgery was compared with that of published data from a centre where the practice is non-intervention. RESULTS: From a total of 106 braced cases out of which 97 were followed up, six cases (5.6%) ultimately underwent spinal fusion. A worst case analysis, which assumes that all nine cases that were lost to follow-up had operations, brings the uppermost number of cases that could have undergone spinal fusion to 15 (14.1%). Either percentage is significant statistically when compared to the 28.1% reported surgeries from the centre with the policy of non-intervention. CONCLUSIONS: If conservative management does reduce the proportion of children with adolescent idiopathic scoliosis that require surgery, it can be said to provide a real and meaningful advantage to both the patients and the community. It is contended that conservative methods of treatment should never be ruled out from scoliosis management, because they can and do offer a viable alternative to those patients who cannot or will not opt for surgical
treatment.

From the Schroth Klinik:

1: Stud Health Technol Inform. 2002;91:342-7. Links
Conservative management in patients with scoliosis--does it reduce the incidence of surgery?Weiss HR, Weiss G, Schaar HJ.
Asklepios Katharina-Schroth-Klinik, Korczakstr. 2, D-55566 Bad Sobernheim.

The effectiveness of conservative scoliosis treatment, including bracing, is widely denied. Like any therapeutic intervention, conservative scoliosis treatment including patient education, techniques of brace moulding, and time-consuming follow-ups is reasonable only if the benefits outweigh the strain placed upon the patient by the treatment. The most important benefit of early intervention in scoliosis is prevention of the need for spinal fusion surgery. Retrospective analysis of the incidence of surgery for patients with scoliosis, by comparison with incidence in an untreated control group. Since 1992 the bracing technique according to Cheneau has been applied in parallel with the scoliosis inpatient intensive rehabilitation programme (SIR). For this study we chose from our data base the scoliosis patients who had conservative treatment at our center between 1993 and 1996. All patients, like those of the control group, were at least 15 years of age at the time they were evaluated for the last time. The incidence of surgery of our group was compared with that reported by a center in Ireland. Of 343 female scoliosis patients with a curve angle of 33.4 AE (SD=18.9), 41 (11.95%) had surgery. The incidence of surgery of our collective was significantly lower than the incidence of surgery of the control group which reported an incidence of 28,1%. The AIS matched group of patients (n = 179) had an incidence of surgery of slightly more than 7%. When compared with a matched control group of untreated patients, incidence of surgery was significantly reduced by SIR combined with bracing. So conservative management is indicated in patients with scoliosis.

PMID: 15457752 [PubMed - indexed for MEDLINE]1: Orthopade. 2003 Feb;32(2):146-56. Links
[Conservative treatment of idiopathic scoliosis with physical therapy and orthoses][Article in German]
Weiss HR.
Asklepios Katharina-Schroth-Klinik,Bad Sobernheim.

Opinions differ in the international literature about the efficacy of conservative approaches to scoliosis treatment.Because this divergence of opinion corresponds to a great discrepancy in the standards applied to conservative treatment methods, it is not astonishing that the results of conservative treatment as described in the literature also differ. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated.Moreover, it is clear from the published literature that it is the functional and physiological impairments of scoliosis patients--including pain, torso deformity, psychological disturbance, and pulmonary dysfunction--which require therapeutic intervention. In Germany the triad of outpatient physiotherapy, intensive inpatient rehabilitation, and bracing has proven effective in conservative scoliosis treatment.Indication, content, and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative scoliosis treatment as an alternative to patients, including those for whom surgery is indicated.

This abstract summarizes a search of the literature regarding results of conservative approaches:

1: Phys Ther. 2005 Dec;85(12):1329-39. Links
Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials.Lenssinck ML, Frijlink AC, Berger MY, Bierman-Zeinstra SM, Verkerk K, Verhagen AP.
Department of General Practice, Erasmus Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.

BACKGROUND AND PURPOSE: Many conservative treatments are available for adolescents with idiopathic scoliosis, but the evidence for their accepted use is still unclear. The purpose of this study was to evaluate the effectiveness of braces and other conservative treatments of idiopathic scoliosis in adolescents by systematically reviewing the literature. METHODS: The literature was searched in the PubMed, CINAHL, Cochrane, and PEDro databases. Studies were selected if the design was a randomized clinical trial or a controlled clinical trial, if all patients had an idiopathic scoliosis, if all patients were less than 18 years of age during the intervention, and if the type of intervention was a conservative one. Two reviewers independently assessed the methodological quality using the Delphi list and performed data extraction. Analysis was based on the levels of evidence. RESULTS: Thirteen studies met the final inclusion criteria, showing a wide range of interventions such as bracing, electrical surface stimulation, and exercises. DISCUSSION AND CONCLUSION: The authors conclude that the effectiveness of bracing and exercises is not yet established, but might be promising. They found no evidence of the effectiveness of electrical stimulation.

Here's a long term follow-up comparing surgically treated with brace treated:

1: Spine. 2006 Feb 1;31(3):350-4. Links
Outcome at 10 years after treatment for adolescent idiopathic scoliosis.Andersen MO, Christensen SB, Thomsen K.
Spine Section, Department of Orthopaedic Surgery, University Hospital of Odense, Odense, Denmark.

STUDY DESIGN: A total of 215 consecutive patients treated either by bracing or operation received a questionnaire after 9.7 years. OBJECTIVE: The aim of the present study was to elucidate the long-term outcome in a group of brace (BT) or surgical treated (ST) patients suffering AIS. SUMMARY OF BACKGROUND DATA: In adolescent idiopathic scoliosis (AIS), the options are BT or ST and, together with the disease itself, they may both be physically and psychologically demanding. METHODS: The main topics of a questionnaire were demographics, back pain, activities of daily living, and SF-36. RESULTS: A total of 181 replied. The mean age at follow-up was 26.0 years. The level of back or leg pain was relatively low, and the BT patients had more pain than their ST peers. We saw a generally high level of ADL and found no significant difference between BT and ST patients in the present study for any of the SF-36 variables. Compared with age-matched controls, the SF-36 scores were lower in the AIS patients. Brace related questions revealed a significant impact of the disease and the treatment on the patients' lives. CONCLUSIONS: The patients had moderately reduced perceived health status and activities of daily living, and increased pain with the ST patients generally at a better level than the BT.

There are lots of abstracts in the National Library of Medicine from all over the world to be explored. So far I have not found any conservative approach which totally eliminates the need for surgery.

macky

12-31-2006, 05:29 PM

Thankyou Karen so much for going to the trouble of posting that, it was brilliant to read.

It is 2007 over here now and my wish for all on this forum is a healthy and happy one.

Lorraine. xx (Macky)

Celia Vogel

01-01-2007, 09:09 AM

Happy New Year to you Lorraine and I'm glad my last post made you laugh!

This whole thread is quite ridiculous isn't it ? Anyway....I'm still trying to figure out why I was singled out for expressing my views months and months ago and now having to defend myself! As far as anyone is concerned those comments would have remained buried in the Spinecor thread - who in their right mind reads the entire 1000 posts ??? So now we have a separate thread with my words ( a parent's views ) plastered for ALL to see. Do we not live in a democracy and have free speech?? Is there an ethics committee that governs what I say ??? I find this whole thing quite bizarre.

Karen,

Thanks for the studies on bracing! I wonder why the Cheneau isn't offered here in North America ?

macky

01-01-2007, 05:05 PM

Celia I totally agree with you, I actually really and truly thought the same thing.

I am so sorry you had problems a few months ago. I did not read the post you are speaking of as I would not read 1000 posts(haha), but sweety what I have been so glad about is how absolutely wonderful it is that your precious little girl is doing so well. That is the type of thing I absolutely love reading, it makes me so very ,very happy and puts a smile on my face.

We should start a happy, good news, positive thread instead of defending our thoughts all the time on this one.

Yeah for free speech, Yeah for Women and thank the Lord for miracles.

God bless
Lorraine. xx

structural75

01-01-2007, 10:07 PM

Celia/Macky,

Great to hear that you were reimbursed for the costs of the test! I don't have much time right now but we did discuss vestibular testing back on page 59 and 60 of this thread. As for right now... I have visions of sugar plums and fairies dancing in my head :p Clearly it was YOU Celia that read through "1000 posts" to find and reference that discussion. That's where I got the page numbers from... .

I'm still trying to figure out why I was singled out for expressing my views months and months ago and now having to defend myself against this Charlatan! YOU made the following statement, that is why I held YOU accountable for it.
As for vestibular testing....I think it's strictly a chiropractic thing and it's not done in the Montreal office.I simply clarified matters by saying that it was not "strictly a chiro thing", but actually a legitimate M.D. practice. Things persisted because you refused to acknowledge that correction and your biased misrepresentation of it. Plain and simple.

We should start a happy, good news, positive thread instead of defending our thoughts all the time on this one. That's exactly what myself and others have been doing since your onslaught of unintelligible jabber on... "it's a chiro thing" and 'there's no medical validity to this'... All I've been doing this entire time is defending myself against you two and your denigrating attempts at 'free speech'... ! Think twice before opening your mouth Celia... you've 'edited' every post but one on this thread. Did you say something wrong the first time? Or were you just 'fine tuning' your attacks?

Free speech..., I absolutely agree with you both! But the following is clearly not about free speech, but purely meant to belittle others and their efforts. All of you involved should be ashamed for such discouraging efforts.
Linda, I agree with you 100% and all this guff is a real "talk about a lot of rot"
as far as I am concerned.
I know people are looking for a non surgical fix for scoliosis but peoples it just aint gonna happen.
Loved the way you answered that Linda, with your usual finesse.

Happy christmas to one and all.

Macky xxxx

This forum was meant for both surgical and non-surgical inquiries and support. Keep your bitterness and insecurities to yourselves, or at least within the confines of your "happy, good news, positive thread". When will either of you get it through your heads that people are utilizing these various methods in combination with the more 'favorably conventional' ones. I don't recall any stark claims recently of people saying this will "fix" the curve by 'itself', or that any of this is meant to be used exclusively. However, based on the "brilliant" studies that you presented here, there is evidence that complimentary, conservative approaches do in fact REDUCE the need for surgery. That's what I, and others, have been supporting all along.

structural

Celia Vogel

01-01-2007, 11:19 PM

... there is evidence that complimentary, conservative approaches do in fact REDUCE the need for surgery. That's what I, and others, have been supporting all along.

I fail to see where you have shown that expensive eye exercises either alone or in combination with other methods can actually reduce the need for surgery. :rolleyes: I don't think you have any right to come here and harass people with your hostile comments! What I said months and months ago was an exchange between parents and quite frankly it was non of your business!

I didn't have to read all 1000 posts because I've been posting all along and I remember the discussion occurred sometime in September. My question to you is how did you know about the discussion on page 23 ????? I don't care what you call yourself ( M.D. I highly doubt! ) but in my books you're one GRADE A NUT!!!!

macky

01-02-2007, 01:41 AM

Once again Celia you crack me up, in a nice way.

If 75 means Structural you were born in 1975 you would be the age of my youngest son and believe me he would not have the audacity to speak to me or anyone else they way you do. You infuriate me because you will not listen and give the people PARENTS and patients who have been through all this the benefit of the doubt that they may know what they are talking about.

To make myself a little clearer I thoroughly believe in bracing to help scoliosis, I must do because I was in one for 6 months.

This is the end of this thread for me. Your attitude toward women Structural leaves a lot to be desired and how did I work that out? When you told me to keep my place. That told me all I need to know. Exactly where is a womans place??mmmm I wonder,

One more thing. Celia would undoubedly know a lot more than yourself as she has a dear little girl that she loves and is doing everything she can to help her. She is a delightful person who has been posting on this forum for a long time and her posts are humorous and interesting and worth reading.

She got it in one, GRADE A NUT, yep little little chickie agrees.

Macky

macky

01-02-2007, 02:18 AM

Now it all makes sense., silly silly me.

I just read your occupation "licensed and certified structural integration pracitioner/visceral manipulation" well there you go, explains everything.

Nothing like a bit of free advertising.

Macky!!!!!

cherylplinder

01-02-2007, 10:43 AM

cherylplinder

01-02-2007, 10:48 AM

I'll say it again. There is nothing wrong with medical research to determine the causes and treatments of scoliosis, but fantastic profit from this research makes this type of testing a financial quest rather than an effort to help patients. You don't have to be a genuis to see that.

Structual, I am tired of your rude posts to people dealing with scoliosis. I invite you to go somewhere else and post.

Celia Vogel

01-02-2007, 11:29 AM

...I simply clarified matters by saying that it was not "strictly a chiro thing", but actually a legitimate M.D. practice. Things persisted because you refused to acknowledge that correction and your biased misrepresentation of it. Plain and simple...

Structural,

Let me clarify things a little further for you ;) this is not a Dr. Rivard M.D./ Dr. Coillard M.D. who are also the INVENTORS of the brace practice/thing! Name *one* orthopaedic surgeon who treats idiopathic scoliosis with eye exercises as an adjunct to other therapies?

You also didn't answer my question about your knowledge regarding the discussion on vestibular testing on page 23.

structural75

01-02-2007, 01:15 PM

Celia,
You also didn't answer my question about your knowledge regarding the discussion on vestibular testing on page 23. When you're logged on to the forum it's page 23, when you're logged off it's pages 59 & 60 that YOU referenced. They are the SAME pages. Does that answer your question directly enough?

If you're so intent on knowing about other surgeons and what they do, pease do the research yourself. As there are thousands of them out there.

Are you arguing with me just for the sake of being "right". Because I think it's safe to say that there are very few right and wrong answers to the problems faced with scoliosis.

Maybe a different perspective would help. There are "theories" on mechanotransduction influencing scoliosis and the uneven growth of endplates, etc., etc.... . Mechanotransduction occurs as the connective tissues exert imbalanced tension on the skeletal body, thereby affecting growth patterns. Stretching, bracing and torsorotations are a few simplistic approaches to assist the correction of this imbalanced mechanotransduction (as does my field of professional studies, but with greater specificity). Why does it seem so off-the-wall to address the neurologic side to this more specifically? By addressing inner ear imbalances (which are either reflecting or influencing irregular muscular/ligamentous tonus), one would be further assisting the process of limiting the uneven mechanotransduction that's influencing growth.

It seems quite logical... after all, the muscular system is being partially controlled autonomically by information being supplied via the nervous system, which is being informed, in part, by the vestibular system & cerebellum (balance and coordination).

Are we really in such a drastic state of disagreement, or just having difficulty accepting mistakes/inaccuracies in comments?

structural75

01-02-2007, 01:25 PM

Cheryl,

I beg your pardon? My initial posts on this forum are anything but rude. They become rude when I get attacked by 'others'.... . I don't like the rude nature of these posts anymore than you do, but let's consider how it began and how it continues to persist with those two individuals making sarcastic and denigrating comments long after I willing "surrendered" to their attacks. I think you're showing a bit of selective favoritism here.

I'm sorry you condemn an entire field of medicine because of a few bad apples out there... but those few 'financially motivated' practitioners do not represent them all, nor does it illigitimize the efforts put forth.

structural

Celia Vogel

01-02-2007, 02:05 PM

.... Why does it seem so off-the-wall to address the neurologic side to this more specifically? By addressing inner ear imbalances (which are either reflecting or influencing irregular muscular/ligamentous tonus), one would be further assisting the process of limiting the uneven mechanotransduction that's influencing growth.

It seems quite logical... after all, the muscular system is being partially controlled autonomically by information being supplied via the nervous system, which is being informed, in part, by the vestibular system & cerebellum (balance and coordination).

Why is it off the wall ?! Because there is lack of proof that what you're doing is actually going to have any affect whatsoever on the scoliosis. This is still an *unknown* field and hence very experimental and patients should not be charged for experimental/unproven efforts.

Excerpt taken from:

Scoliosis. 2006; 1: 16.
Published online 2006 October 18. doi: 10.1186/1748-7161-1-16.
Copyright © 2006 Stokes et al; licensee BioMed Central Ltd.

Biomechanical spinal growth modulation and progressive adolescent scoliosis –a test of the 'vicious cycle' pathogenetic hypothesis: Summary of an electronic focus group debate of the IBSE
Ian AF Stokes,1 R Geoffrey Burwell,2 and Peter H Dangerfield3

1Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont 05405, USA
2The Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK
3Sherrington Buildings, Ashton Street, Liverpool, L69 3GE, UK

Mechanotransduction in articular cartilage, vertebral growth plates and other tissues and organs

Comment no. 43

Mechanotransduction is the process by which cells convert mechanical energy into electrical or chemical signals [72,73,75]. It lies within the field of mechanobiology that in the skeleton includes the three effects of Hueter-Volkmann, Pauwels and Wolff [85,132-134]. (The Pauwels' effect is where intermittent pressure within the limits of physiological stress and strain stimulates the growth plates of a healthy bone [2,7]). In addition to studies on the intervertebral disc [162,163] there is much recent study of articular cartilage as efforts expand to discover disease-modifying drugs to treat or prevent osteoarthritis [164-167]. According to Ingber [73] mechanical signals may be integrated with other environmental signals – including growth factors and extracellular matrix – and transduced into a biochemical response through force-dependent changes in scaffold geometry or molecular mechanics. Stoltz [168] states that in chondrocytes many genes are regulated up and down by mechanical forces and the response depends not only on the duration and amplitude of the forces, but also on their variations in time. Lammi [169] reviewing articular cartilage states that possible mechanotransduction pathways in chondrocytes activated by load include the integrin-interleukin-4 route, NMDA receptors, and P2Y2 purinoceptors the latter involving ATP [170]. If such load-sensitive receptors are present in chondrocytes of endplate physes variation in gene expression by age, gender and topography may underlie the vulnerability to curve progression under eccentric load. There is preliminary work evaluating the effect of mechanical loads on mRNA expression of rat tibial growth plate cells [20]. Are any of the current methods now being used to study articular cartilage mechanotransduction being applied to endplates?

Response

The mechanical influences on articular chondrocytes and extra-cellular matrix synthesis and degradation are reviewed in Grodzinsky et al [171]. However, I suspect that little of this information can be applied to the very different growth plate chondrocytic phenotype characterized by high rates of proliferation (cycle time about 48 hours), rapid hypertrophy and abundant matrix synthesis, and eventual apoptosis. The mechanisms of mechanotransduction and their effects on cells in each stage of this differentiation cascade (and the rate of differentiation itself) are probably very specific to growth plate chondrocytes.
Moderator: In addition to skeletal tissues, muscles, tendons and ligaments [78,79], mechanotransduction is involved in the senses of touch, balance (spindle receptors and proprioceptors), hearing, baroreceptors (blood pressure), vascular remodeling from fluid shear stress [172] and systemic osmolarity [74]. Little is known about how mechanical input forces delivered to a cell result in a repertoire of output physiologic responses [74,75,172] though recently force-transducing molecules – mechanosensitive ion channels – have been identified in cell membranes with lipids [74] and calcium channels in osteoblasts [173] intimately involved. In certain connective tissues mechanotransduction appears to involve cyclical mechanical strain upregulating extracellular matrix genes suggesting that such genes are possible targets for novel therapeutic intervention [81].

structural75

01-02-2007, 02:36 PM

Celia,
Yes, I understand what you're saying... point taken, but it doesn't mean it's off-the-wall but rather awaiting further exploration. Ideopathic scoliosis itself is still an "unknown" field, seeing as we still don't have definitive answers on its causes, prevention or consistently effective treatments. Just attempting to put a more broad spectrum view on things.

I think many of these are feasible possibilities, including visceral malformation/develpment during the embryonic and fetal stages causing the ribs and/or spine to grow asymmetrically, etc.. While there are no studies proving it is a contributing factor, there are also no studies proving it's not. So it's yet another question that will remain unanswered until more research, studies and knowledge is gained on the matter.

My main concern for treating ideopathic scoliosis without regard for possible causation is that it is unlikely to respond to treatment for very long if the underlaying possible causes are not explored and addressed. And for my clients sake (all of them are also under the guidance/care of orthopods), I can't wait for a study to come out before considering the possibilities unique to them. What I do is very conservative and non-invasive so I'm not concerned about doing harm, as it's never been a problem. In fact its been nothing but helpful to the majority of them.

macky

01-02-2007, 08:47 PM

What I do is very conservative and non-invasive so I'm not concerned about doing harm, as it's never been a problem. In fact its been nothing but helpful to the majority of them. That is a quote from yourself.

How on earth do you know it WILL never be a problem," its been nothing but helpful to the majority of them" HOW LONG FOR WILL IT BE NOTHING BUT HELPFUL, short term, long term, for the rest of their lives.

I could not help but notice how you were so respectful and nice to Gerbo and yet so abusive to women who post here. You cant handle a woman being correct. Of course you knew I was a woman, you had looked back into my posts and quoted from one a few weeks ago so there is the proof of that.

I am not a person who closes their eyes to medial break throughs. In fact one of my most fervent wishes is that there are break throughs in Diabetes which is only one I have hope for.

It is just when people like you just rant and rave and think they know everything about a subject when there is no evidence to back it up long term, it just makes me cringe that some people will believe you, waste thousands on something that will not help them. WILL not because of as I said no long term proof.

I have tried alternate therapies , but the majority of practicioners of those therapies honesly run a mile when they see me, as they cannot help me. I am fine. OK I am in pain, big deal I can cope with that, what I cant cope with are people like you.

It is even getting to the stage that I dont even want to post here on this forum any more because of your comments, and that breaks my heart..

Lorraine. (macky)

structural75

01-02-2007, 10:45 PM

Lorraine,

How do I know? Many reasons (mind you, educated discretion is always used) including the fact that it has been in use for treatment of a variety of conditions for over 60 years with no adverse affects! And it's founder, Dr. Ida Rolf (a Biochemist and researcher at Georgetown University and the Rockefellar Institute), was inspired to create a unique approach to physical dysfunctions due to her son's SCOLIOSIS!!! He is now a grown adult roughly about your age, I presume, and is doing just great!!! He lives in Austria if you want to track him down and ask for yourself. Just as there are no studies "proving" the efficacy of many complimentary therapies, there are NONE proving there ineffectiveness as well (because NOBODY is doing them!). That should leave us all on neutral ground, right?

And this women thing you've made up... put it to rest as you've seriously crossed a line! I never said I didn't know you were female, what the heck are you talking about? I can handle anyone being correct, unfortunately you're not one of them. You don't even have anything to be correct about as you're spurting off insults and jibberish about a whole "lot a rot" and so forth... . In fact, Gerbo and I had a heated discussion of our own not too long ago... through it all we learned a bit about one another and knew when to draw the line in future discussions. In fact, the profession I have chosen was created by a brilliant woman, way ahead of her time. I have tremendous respect for ALL people deserving.

The difference between you and Gerbo in this thread is that he isn't dragging this on with insults as you are. Both he and I alike wanted to end this discussion and then you and Celia kept it going! He also seems to have intelligent, well thought out and productive things to say... just about the only thing you two have done is insult me, my perspective, my experience and discredit things that you're simply against. I'm not "ranting and raving", I'm defending myself from you two. If you actually tried to have a curious dialogue then I could be certain things would look very different.

Bottom line... enough with the insults and denigration, PLEASE!!! I'm fine with you having your opinion, and me having my own. We come from different backgrounds... and so I'll continue to share what I've seen CLINICALLY, and you can share what you read in STUDIES. I have nothing to gain by supporting certain methods on this forum, except to know that someone might be helped by it. That's all the "payment" I need.

For what it's worth, I hope you continue posting on this forum, as you are actually very sweet when you're not attacking others.

structural

Celia Vogel

01-06-2007, 10:28 AM

Structural,

You stated at the start of this thread:

They are FAR more than eye exercises.. had she known what vestibular was she wouldn't make such brash statements. Nobodies "trying" to do anything, they've been "legitimized" already.....I have nothing to gain by supporting certain methods on this forum, except to know that someone might be helped by it. That's all the "payment" I need.

That's all you should get and not a penny more! I'm holding YOU accountable for your false misleading statements that this is *proven* and *legitimate* when in fact there is no basis for these assertions.

structural75

01-06-2007, 12:38 PM

Celia,

I thought we were done with this rediculous arguement... ?

You may analyze my posts further to realize that I was justifying/defending vestibular testing and rehabilitation as a valid, "proven" and "legitimate" form of treatment in its own right (meaning it has applications for a wide variety of conditions that involve the nervous system, and has clearly "proven" its effectiveness in that regard). Nowhere did I say that it was "proven" to "CORRECT" a scoliosis on its own, nor did I claim there were "studies" to "prove" its efficacy or "legitimacy" SPECIFICALLY in regards to scoliosis. Until you can quote me as making that previous statement, get off my back and stop twisting my comments around to suit your slanderous agenda here.

My statements were therefore NOT FALSE by any means. I think it's more than obvious that neurologic testing and rehabilitation in the context of scoliosis is a logical, rational and important factor in treatment programs. I did not say there were studies "proving" its "legitimacy" as it pertains to scoliosis! What I was doing was making a deductive and educated statement about its relevancy and importance to this condition, and that regardless of studies specifically on the topic, it has merit.

And lastly, I was making it clear that vestibular testing and rehab was NOT a bunch of "phoney baloney" as you so eloquently put it. Just because there aren't many studies available on scoliosis specifically doesn't mean that the field in question is "phoney baloney"... give me a break! It IS a legitimate field of practice which has proven valuable to many people with a variety of conditions... there's no reason to exclude scoliosis from that list.

You know, it's obvious by now that we disagree. Leave it at that. I don't care if you're opposed to non-surgical approaches or the like... So unitl you can give me a valid anatomical and physiological reason why something couldn't be helpful, then please mind your own business. You can't just shoot down things that you clearly don't understand. Reading studies is NOT a substitute for proper education and knowledge about the workings of the human body. Nor are they there to offer definitive answers to problems faced, but merely reflect isolative perspectives on consistancies/inconsistancies in order to help practitioners and the like make more informed decisions. (But they aren't always the RIGHT decisions) The fact that few studies have been done to "prove" its efficacy doesn't mean that it's not effective, applicable or legitimate in the context of scoliosis, it simply means that we just don't know enough about it.

Celia Vogel

01-06-2007, 09:39 PM

Structural,

If you treat patients with methods that have no scientific validity or studies to back them up why should insurance companies pay for it? In fact many parents have not been reimbursed for these expenses. You will probably find yourself one day in the same predicament "dr" Copes found himself in.... jail. I'll quote Gerbo here because I think he said it best:

...to a patient with scoliosis there is only one issue which determines relevance; and that is whether effort, time and money spend results in stabilisation, improvement or slowing down of progress, which would not have occured without the particular testing/ treatment....Remember that the discussion started following a posting about vestibular testing done by doctors in the context of scoliosis, so no issue was taken as such about it being done for scientific reasons and/or for the treatment or diagnosis of other conditions by other practitioners....In the context of treatment of scoliosis, there is nothing wrong with vestibular testing as long as it is made clear that it is only of academic interest, patients are advised that there is no evidence at all that "treatment" based on this testing does anything to improve scolosis or helps to maintain a curve, and of course no large additional payments are demanded.

structural75

01-06-2007, 10:40 PM

Celia,
Obviously you're irritated because you just won't let this one rest.

How did we get on the topic of insurance coverage? I'll answer anyhow... I choose not to participate in insurance billing even though I certainly could... none whatsoever. People pay me strictly out of pocket... because it works for them and it doesn't break their bank in the process! Besides, I find that when people are forced to pay out of pocket entirely, they have more of a vested interest in what they're doing and are usually more objective about the results of treatment. If it's not effective for them, they don't keep coming, ...as many often do for chiropractics or pt simply because 'insurance covers it, so why not'.... .

Structural integration is covered by some insurance companies and not others... and the numbers are growing, I simply choose not to involve myself with the hassle for many reasons. (Mind you here, despite my argument for the appropriate use of vestibular testing, I have made clear that I do not do that testing in my practice as that's the domain of an M.D.. I do however utilize a functional approach to vestibular rehabilitation, but it is in no way meant to 'imitate' anything else that might be used elsewhere.)

When did this turn into a debate over the legitimacy of MY chosen profession? Are you trying to tell me that structural integration/visceral manipulation is scientifically invalid??? (I'd say you are.) I'd be happy to offer you a study or two if wish to go there ;) .

And how do you debate the "scientific validity" of something that is based on science (biochemistry, fascial plasticity, neurobiology, fluid dynamics, physiology, etc. and GRAVITY - Are you saying the effect of gravity on the human structure is immeasurable or 'unproven'???? Do you mean to say that all of the M.D.s, Physical Therapists, PhDs and the like out there practicing structural integration are doing something scientifically invalid???

Maybe this will calm your ranting and raving... Here is a colleague of mine and an M.D. in Physical Medicine (one of the first few),.. He's one of the research directors for the Kessler Institute as well and has specialized in neurologic dysfunctions for the over 30 years.
http://www.njpainandrehab.com/bios/tfindley_bio.htm

I'll find myself in jail... for what???????? I'm sorry, but re-stating Gerbo's OPINION doesn't do much for me. As for your opinion and accusations...... ????????? Stop waisting peoples time.

structural
p.s. - Studies are STILL NOT the definitive be all, end all in ANY decision making process. At this point Celia, I think a "legitimate" education on the topic at hand is required of you in order to make any potential progress in this discussion. Otherwise it's just a conitinuation of this study, that study and an insult here and there .

Celia Vogel

01-07-2007, 01:08 PM

Despite your feeble attempts to throw this whole discussion into different directions, I think we have made remarkable progress. :)

According to the following link, "dr" Copes was also using Vestibular Rehabilitation before he was thrown in jail.

http://www.quackwatch.org/11Ind/copes.html

Questionable Claims

Copes claims that scoliosis impairs the neurological, hormonal, and nutritional systems and "affects the body down to the cellular level." [8] His "Scoliosis Treatment Advanced Recovery System" ("STARS") includes: "scoliosis muscle stimulation therapy," chiropractic spinal manipulation, "ocular/vestibular therapy," "nutritional/hormonal support," the Copes Lateral Fulcrum Board, and the Copes Dynamic Brace. According to his Web site:

The Scoliosis Treatment Advanced Recovery System is designed to reverse idiopathic scoliosis. Unlike other treatment plans, STARS addresses the full spectrum of symptoms including bone deformities, muscle imbalance, neurological changes, cellular nutrition and cellular hormonal deficits. . . .

With STARS, success comes without the need for painful and sometimes dangerous surgery. . . .

STARS . . . . not only arrests spinal curvature progression, it straightens it.... much like orthodontic braces straighten teeth. Spinal curvatures are reversed while every system in the body is re-educated to hold the straightened spine. . . .

Through years of clinical research, component development and continuous improvement, the STARS methodology has helped patients of all ages and degrees of severity. It is the exclusive scoliosis treatment protocol of Physicians from all around the world. . . .

When patients choose the STARS they enter into the most advanced scoliosis treatment program in the world. With adequate time and dedication, and compliance with all aspects of the STARS program, a patient can be certain they are on the road to non-surgical recovery from scoliosis [9].

Copes advises chiropractors who refer to him to have their patients undergo hair analysis to determine what dietary supplements they need [10]. Hair analysis is not valid for this purpose [11]. Moreover, nutrition is not a factor in the development or treatment of scoliosis. The electrical treatments Copes recommends are also unwarranted. Scientific studies have concluded that bracing is far more effective than electrical treatments [12].

Copes was one of the four initial trustees of the Scoliosis Care Foundation, which was founded by Gary A. Deutschman, D.C., who practices in New York City. After working with Copes for several years, Deutschman developed his own program that he says "offers corrective and palliative therapy for all degrees of spinal curvature." [13]

There is no evidence that chiropractic treatment can reduce or prevent scoliotic curvature. In 2001, for example, researchers at two chiropractic colleges reported that chiropractic intervention had no discernible effect on the scoliotic curves of children ages 6 to 12. The study involved 42 children who were treated for a year with full-spine manipulation. Some were also treated with heel lifts, postural counseling, and/or lifestyle counseling. The scoliotic curves ranged from 6 to 20 degrees. The authors stated that although case reports abound, this was the first published clinical trial of the effect of chiropractic treatment on adolescent scoliosis [14].

gerbo

01-07-2007, 02:30 PM

What you have proposed as your basis for this 'discussion' (studies) is not invalid, but it is not 'clinically' conclusive by any means eitherstudies are important, but only a small part of the big picture

I am sure though that you agree that it is a question of emphasis, and that properly conducted studies are more then just a small part, they must be the major component of the "big picture" which determines whether treatment is safe and effective and therefore worthwhile. The fact that some studies fail to find "unforeseen consequences", as you correctly point out, doesn't mean that this reduces the relevance of studies, it means that we even have to try harder to improve the quality of the studies which get conducted.

If studies sometimes fail to foresee certain consequences, thepicture for treatment without any properly conducted studies must even be bleaker, and risk of onforeseen consequences even larger.

as I have said before "if we do not have evidence somethings works, we do not have the evidence neither that it is not going to do any (unforeseen) harm"

Still, I agree that there is a small part in all this for a bit of experimental or common sense type of work; many major scientific discoveries and breakthroughs started of as an unsubstantiated hypothesis. (but subsequently would have been subject to rigorous scientific studies and validation)

gerbo

Karen Ocker

01-07-2007, 05:34 PM

Dr. G. Deutchman,DC, New York City has this link on his web page:

http://www.scoliosissystems.com/Corner/chiro_vestib.htm

However, my search of the National library of Medicine shows vestibular rehabilitation sometimes useful for dizziness, instability from brain injuries, ear disorders and brain tumors-to name a few. Nothing at all about scoliosis. One reference, by chiropractors discuss "exploration".

structural75

01-07-2007, 06:21 PM

Gerbo,
I understand your point on working harder to perform better studies and I agree... and some things require time to discover their full impact, successful or not.

As you know, I agree they play an important role. But clinical findings are a major compenent in the big picture as well, if not more so than a study (10 -20 people, as one study had that you cited to support something one time, is not enough to constitute a "major componenet"). I'm right there with you Gerbo, but I'm also not the type of person who needs a study to be performed on my shoes, just to show their effectiveness at protecting my feet from the elements. :) Some things are quite logical and based upon data already compiled in related categories. And since ideopathic scoliosis is not genetically derived, at least in many cases that we know, then we must view it for what it is... a condition involving a lateral curvature/rotation of the spine, but not always or necessarily a 'problem' with the spine itself.

I think it's safe to say that there is an adequate amount of education behind the M.D.s practiciing vest rehab to know that people are in good hands. Also, we're talking about proprioceptive exercises (yes, including use of the eyes as well)... when was the last time you heard or read of someone being injured or harmed by such activities???

I know you're intentions are good here Gerbo... I do want to ask this though to know that you're not being hypocritical. Have there been studies done to show the effect (positive/neutral/negative) on "stretching ligaments" along the spine as a complimentary treatment for scoliosis? And are you actually stretching the "ligaments" or the muscles/muscular fascia?(retorical question) I know the stretching you do with your daughter "makes sense" to you, however do you hold yourself and all of your chosen methods to the same standards as you do this current topic? Are there significant studies done to prove the efficacy of that approach and how do you know those tissues you're stretching aren't contracting/bracing to protect something? Etc.....

You can see that this type of questioning could go on and on.... . Perspective is key here, and acknowledging its legitimacey in other disorders involving the neuromusculoskeletal system doesn't really place it very far from scoliosis... would you not agree?

My whole point here being, you cannot base an argument on studies alone. And unless someone has the qualifications to speak of it otherwise, it's a rather mute point.

structural

structural75

01-07-2007, 10:36 PM

Celia,

Quackwatch is your source for info... That explains a lot!

I don't know why or how you can compare me, or a valid medical practice (vestibular rehab), to some chiropractor who thought he was going to change scoliosis with nutrition/hormonal support, muscle stimulation and chiropractic adjustments. Whatever this Mr. Copes was doing sounds absurd... the only valid aspect to his treatment seamed to be the bracing (although I know nothing about the Copes brace specifically so maybe that's a sham too) and the vest/ocular rehab. You've got to be crazy to think that nutrition/hormonal support and electric stim. is going to change a curve... that's NOT my belief.

Working with a central informational component to the source of sympathetic neural activity (vestibular system) in the spine... YES, that makes perfect sense.

My beliefs, experience and practice are rooted quite firmly in the physical and direct nature of the condition, don't attempt to redeem yourself by lumping me or others into this guys category.

I STILL stand behind vestibular rehab in its applicable use in some cases of scoliosis! And you, or anyone else, cannot discredit the field in general, or its potential relevancy in the matter. Your studies/quotes/'research' is strictly black and white - this will 'fix' it by itself and this won't.... However nobody here, including myself, was proposing that it would "correct" a scoliosis by itself... ! And I still haven't seen anything that has been more than mild to moderately consistantly successful in "fixing" scoliosis and it's associated problems. Those statistics might get better however if we look beyond the mechanical aspect alone.

Have you found any of the info on the surgeons out there who have been found responsible for negligence, fraud and deceit as well? Or should I get it for you just to be clear this rediculous display of fraud and negligence goes both ways Celia? You are clearly anti-chiropractic.... yet what we are talking about here is not chiropractics! It's a field of internal medicine. To dismiss it's potential benefit due to your own personal bias, well... .?