Rehabilitation of adolescent patients with scoliosis—what do we know?

[mamamax]

In 2003 Dr. Hans Weiss wrote the above article with the editorial assistance of Martha Hawes. It was published in Pediatric Rehabilitation, 2003, VOL. 6, NO. 3–4, 183–194.

The file is too large to upload to the NSF forum, and yet it is an article which contains information that those of us interested in non surgical rehabilitation would find most interesting.

For those not familiar with his work, for decades he oversaw the operations of the Schroth Clinic in Germany, which is the gold standard of non surgical treatment in Europe. In the last decade, a reported 3,000 patients (approximate) have been treated there on a yearly basis, with varying degrees of success - many with most impressive results. This makes Dr. Weiss (MD (surgeon) and German School Chiropractor), someone who has seen and treated more scoliosis patients than anyone else in the world. Making him someone I pay attention to, with no exception.

There are answers to many questions in this paper. Of note also, Dr. Martha Hawes (who reduced her adult curvatures through non surgical methods, on a level matching reported surgical outcomes in cases like her own), provided him with editorial assistance in this paper. Martha did not use the Schroth method, which leaves me questioning, what were/are the elements of her own therapy which may share some commonality with Schroth? Improvement of chest wall, with exercise specific to curvature pattern, comes immediately to my mind.

For others who may wish to read this article, it can be accessed in another forum, found here in posting #10: http://www.fixscoliosis.com/threads/...-Cor-Pulmonale

Access is limited to members I believe - but membership is open to all at no charge, and posting is optional :-)

Since NSF does not allow uploads of files this large - I'm just passing the info along to those who are interested.

[mamamax]

An equestrian thing ...

As some know, Dr. Weiss is an equestrian in his spare time. I was watching a few of his videos on his Youtube channel this evening and stumbled across one he had listed as a favorite of his.

Reminded me of my youngest sister who passed many years ago - she could ride like Stacey Westfall, having a special bond with a quarter horse named Sugarfoot. No bridle, no saddle .. only love. Enjoy!

http://www.youtube.com/watch?v=a-7v8Ck1crg

[mamamax]

Rehabilitation - AIS - Schroth Update 2010

Full Text Article (Weiss, Goodal, 2010) available in English, Spanish & French:

http://cirrie.buffalo.edu/encycloped...&language=e#s4

Latest developments

The change from the classical 'teacher / pupil' setting to modern concepts of learning seem to allow a reduction of total training time of in-patient scoliosis rehabilitation to 14 days or even less, without reducing the effectiveness of treatment (Weiss et al. 2006a). The role of the physical therapist changes from being that of a teacher to a supervisor, who acts as a catalyser to empower the active role of the patients and to foster the ability of the patients to develop their individual treatment protocol by themselves via experiential learning.

This new concept called 'Integrated Scoliosis Rehabilitation (ISR)' is currently applied (Weiss 2007a) at the first few centres. 'Integrated' is used to describe the teamwork of all professionals 'acting as one'. The physician, physical therapist and (where available) psychologist are integrated in each others' work and are acting together in synchronicity in the diagnosis and treatment.

The limitation of this concept is that it is restricted to patients where scoliosis is the major problem. Patients with neuromuscular scoliosis and patients with a significant reduction of learning capability cannot be included in this treatment. The majority of the scoliotic population however, patients with idiopathic scoliosis (80 – 90% of all scoliosis) can easily be treated using the ISR - approach.

As has been shown, Scoliosis Intensive Rehabilitation (SIR), in its original form can no more be regarded as being effective when rehabilitation times have been reduced to 3-4 weeks, only (Weiss and Goodall 2009). The incidence of surgery for the patients receiving this in-patient program (Weiss, Weiss and Schaar 2003) is comparable to out-patient approaches (Maruyama et al. 2003, Rigo, Reiter and Weiss 2003), although the different studies have patient samples which are not necessarily comparable. The development of such research means that more intensive out-patient approaches seem more appropriate when one considers; time efficiency and new teaching approaches including experiential learning (ISR), as described within the book on "Best Practice" treatment (Weiss 2007a). Therefore an in-patient program, such as SIR is today regarded as outdated. Actually three day intensive programs based on the "experiential learning" approach of ISR are provided in the US, UK and in Germany at the first authors centre.

[Pooka1]

Actually three day intensive programs based on the "experiential learning" approach of ISR are provided in the US, UK and in Germany at the first authors centre.

I predict the Schroth centers in the US will be slow to adopt this if it is much less lucrative than in-patient treatment as is likely the case. In fact I doubt any of them will do this.

[mamamax]

I can appreciate the above comment, and am even grateful for it - thank you, sincerely.

What will such mean into the future? A good question. From the above article: The majority of the scoliotic population however, patients with idiopathic scoliosis (80 – 90% of all scoliosis) can easily be treated using the ISR - approach.

If ISR were widely implemented outside of large centers, this means large centers can only capture about 20% (and maybe far less) of the patient population, making large centers perhaps not so profitable. If the new Schroth is implemented on a large scale throughout the country, say in hospital affiliated PT departments, will large centers be able to remain open? If a patient is in the typical scoliotic population, they could benefit from a new Schroth implemented in hospital affiliated physical therapy departments - if one is not in the majority population, it is possible that treatment could become more difficult to obtain. A conundrum - with many unknowns.

It would seem the answer would be - to do both. Implement ISR in the large centers and also in hospital affiliated PT departments. Now the question becomes, will this be lucrative enough for the hospital affiliated therapy departments? The answer to that would seem at first, driven by geographics and patient population. Florida looks like a good start .. you know, home of the newly wed and the nearly dead ;-)

ISR covers a lot of territory. Application can be found as a non-surgical choice or post surgical choice when pain remains an issue. It will be interesting to see how its future unfolds. In the end if there were only one center in every major city in the country ... there would still be more than enough work to go around ... I think. And finances would have to become creative (like mine).

Bty ... excellent equestrian history above.

[mamamax]

Just a little horsin' around :-)

Sharing a ride ...

http://www.youtube.com/watch?v=kWJ-p_1OGz8

[mamamax]

OMG ... now that is what I call sharing a ride. Awesome side by side and excellent commentary you offered. Smart Rattle Snake is a dead ringer for one of my late sister's horses: Rattler's Bobbie. Quite a show this one, loved the switch they made mid program. You know, I had to give up riding many years ago, no great loss to the world as sister was the show quality rider - but I to miss it. Thanking both you and Dr. Weiss for the recent visuals, helps me live vicariously :-)

[mamamax]

Meet the Competition

*faints*

ok ... Dr. Weiss comes out of the closet - meet the rock star!

http://www.youtube.com/watch?v=TD_JsDtopR0

http://www.youtube.com/watch?v=XtUCzrRN52k

http://www.youtube.com/watch?v=q6k4xlWj2BE

... Scary - What next?

[SandyC]

Mamamax
Scary is an understatement. I would not leave a daughter alone in the same room with this guy
SandyC

[Ballet Mom]

Hi mamamax!

I clicked on the first link and my immediate reaction was "Yikes! What does he think this is doing to his credibility?"

And then I watched a bit of the second two links and I actually changed my opinion a bit. I actually think that all these girls in a group dancing, wearing their braces out in the open with their "cool" doctor (to them at that age) is probably helping them get through their bracing. And anything that helps, is great in my book.

[Confusedmom]

OMG!!!

This guy is really freaking me out. I do agree that helping girls with their self-asteem, making them feel pretty, etc., is good. But let's leave that to parents and friends.

These videos make it appear like this middle-aged man is basically hot for teen (and young teen!) girls with scoliosis. He is even touching some of them in a couple of spots--and definitely caressing the braces and calling the girls "pretty" and "sexy."

Seriously, if I knew anything more about this man I would not only not let a daughter near him, but I would having the local authorities check him out.

Freaked out, disgusted and a little scared.

Evelyn

[hdugger]

You know, if he has *this* much free time, maybe he could publish some research results.

[mariaf]

OMG!!!

This guy is really freaking me out. I do agree that helping girls with their self-asteem, making them feel pretty, etc., is good. But let's leave that to parents and friends.

These videos make it appear like this middle-aged man is basically hot for teen (and young teen!) girls with scoliosis. He is even touching some of them in a couple of spots--and definitely caressing the braces and calling the girls "pretty" and "sexy."

Seriously, if I knew anything more about this man I would not only not let a daughter near him, but I would having the local authorities check him out.

Freaked out, disgusted and a little scared.

Evelyn

What she said!

[Pooka1]

You know, if he has *this* much free time, maybe he could publish some research results.

Don't be silly.

[mamamax]

Weiss Film Festival - Critique

The man has artistic talent - no denying that. Plays guitar, writes song, music, and choreographs ... started out as a physical therapist, became a surgeon - oversaw the operations at the German Schroth clinic for decades - writes prolifically (and scientifically), is an accomplished equestrian ... guess we could call him a genius, perhaps even a contemporary renaissance man.

By itself, video #1 is quite good and speaks well of his artistic talents. Videos #2 & 3: made in the 90's, obviously for in-house use to inspire motivation towards bracing compliance. A good idea. The content however is questionable, especially as it now appears uploaded to a venue that can be seen worldwide. Parents and patients who do not have any previous knowledge of the man - may be offended by the sexual undertones in these two videos. And that is not good. I'm not passing judgment, just making some observations.

I stumbled across these while viewing some other Spinecor bashing videos done by the good doctor. As you may suspect, this doesn't sit all that well with me - but I do know the history, and so - I am not necessarily surprised. What did surprise me was his need to negatively comment on another practitioner's posted video - yet he will remove from his videos, and ban posters who leave comments that even remotely question his method, or the "facts" that he posts. His "Spinecor Failures" series begs the question - has he developed a failure free brace? We wait for the literature.

As Dr. Weiss(Schroth), leaves the clinic (for reasons surrounded in secrecy), goes into private practice, and uses the tools of technology to promote himself - I would hope that he be aware of these things and use them constructively to better polish his image. Although, quite frankly he may not care about that, finding constructive criticism as flies buzzing around his head in need of swatting. The plight of the genius, not always seeing as the rest of the world sees.

I have been a bit guilty of hero worship of this man. And now I must ask: Genius or madman? We wait and watch, how ironic ... we shall see.

And as I wait for his newest literature - part of me hopes to see him do a Steve Martin/King Tut Tribute - would be tres cool.