Here's the SEAS protocol (if you don't want to read, the summary is that exercise is prescribed in "curves likely to progress" - mainly those of at least 15 degrees. Bracing begins at 35 degrees. So, the additional cost is for children with curves between 15 and 35 degrees - basically, those in the wait and watch group):
"Exercises immediately follow observation alone, and come before bracing106. Several formulae in the literature have been developed to calculate the risk of scoliosis progression, but they have all been derived from populations with a high degree of scoliosis, with the avoidance of surgery being the primary objective. Our aim with exercises is to avoid or at least postpone bracing, and to arrive at the end of growth with a presumably stable curvature (as much as possible far from 30°, so that a value between 20° and 25° can be acceptable).74 Therefore, these formulae cannot be applied, and the risk of progression is considered looking at a combination of factors, including:
- There is evidence of scoliosis progression coming from radiographs and/or clinical changes superior to the known measurement error (5° for radiographs, 2° for Bunnell, 3 mm for hump height);56,120
- The starting radiographic and clinical data are near to previously defined acceptable boundaries (i.e. around 15° Cobb, or 5° Bunnell, or 5 mm of hump);106 these points should be considered provisional and should be better understood in the future with new research;
- There is a very high postural component, as evidenced by an important decompensation and/or by the Aesthetic Index;194
- There are high risks due to other known factors of progression, such as a family history of an important scoliosis, flat back, start of puberty, etc.16,74,169.
On the other hand, i.e., when looking at the highest boundaries for exercise treatment we must consider that as far as we know today, exercises do not reduce the curvature105 (even if recently we ourselves raised some doubts about this hypothesis)119 nor, importantly, change the cosmetic appearance.119 So, exercises should never be proposed (in favour of bracing) when 30° curves have been attained unless the pubertal growth spurt is very far in the future and an important postural component is presumed, with the only aim of postponing (possibly avoiding) bracing.106 Moreover, exercises should be proposed when there are uncertainties regarding the application of a brace, even in curvatures exceeding 25°, and there is the possibility of stability due to the absence of other progression factors and a relatively advanced age. In such cases it is important to decide together with the patient and his/her family. Regardless, due to the very short period of research in this field177 all these points will have to be thoroughly studied and refined in the future.
When a brace has already been prescribed, exercises are mandatory in order to avoid all side effects of bracing, to increase its function, and to allow the spine to be stable during the weaning period and when the brace is abandoned.106,136 These points are thoroughly discussed elsewhere in this chapter."
"Exercises immediately follow observation alone, and come before bracing106. Several formulae in the literature have been developed to calculate the risk of scoliosis progression, but they have all been derived from populations with a high degree of scoliosis, with the avoidance of surgery being the primary objective. Our aim with exercises is to avoid or at least postpone bracing, and to arrive at the end of growth with a presumably stable curvature (as much as possible far from 30°, so that a value between 20° and 25° can be acceptable).74 Therefore, these formulae cannot be applied, and the risk of progression is considered looking at a combination of factors, including:
- There is evidence of scoliosis progression coming from radiographs and/or clinical changes superior to the known measurement error (5° for radiographs, 2° for Bunnell, 3 mm for hump height);56,120
- The starting radiographic and clinical data are near to previously defined acceptable boundaries (i.e. around 15° Cobb, or 5° Bunnell, or 5 mm of hump);106 these points should be considered provisional and should be better understood in the future with new research;
- There is a very high postural component, as evidenced by an important decompensation and/or by the Aesthetic Index;194
- There are high risks due to other known factors of progression, such as a family history of an important scoliosis, flat back, start of puberty, etc.16,74,169.
On the other hand, i.e., when looking at the highest boundaries for exercise treatment we must consider that as far as we know today, exercises do not reduce the curvature105 (even if recently we ourselves raised some doubts about this hypothesis)119 nor, importantly, change the cosmetic appearance.119 So, exercises should never be proposed (in favour of bracing) when 30° curves have been attained unless the pubertal growth spurt is very far in the future and an important postural component is presumed, with the only aim of postponing (possibly avoiding) bracing.106 Moreover, exercises should be proposed when there are uncertainties regarding the application of a brace, even in curvatures exceeding 25°, and there is the possibility of stability due to the absence of other progression factors and a relatively advanced age. In such cases it is important to decide together with the patient and his/her family. Regardless, due to the very short period of research in this field177 all these points will have to be thoroughly studied and refined in the future.
When a brace has already been prescribed, exercises are mandatory in order to avoid all side effects of bracing, to increase its function, and to allow the spine to be stable during the weaning period and when the brace is abandoned.106,136 These points are thoroughly discussed elsewhere in this chapter."
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