Bracing in Scoliosis & muscle atrophy (Full Version)

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Mindy -> Bracing in Scoliosis & muscle atrophy (October 22, 2002 9:56:00 AM)

I have a 3 1/2 year old patient whose infantile scoliosis has progressed from 28 to 34 degrees since he started walking in May this year. He is severely hypotonic with a superimposed left hypotonic hemiplegia and resultant significant developmental delay. He has a high thoracic curve which is convex to the right and because of the type of curve and his age, he is at high risk for curve progression with a poor prognosis for conservative management. His orthopaed has put him in a Boston brace for 23 hours a day to try and prevent curve progression until he is at an age were surgery will have a better outcome. My question is this: To what extent will this restrictive brace further weaken his already poor postural muscles and when he no longer wears the brace will the spine collapse even faster due to muscular atrophy? I coud not find anything along these lines on pubmed, prehaps I was not using a good search string. Does anybody have any good ideas in the meantime for home exercises that can be used to maintain postural muscle activity in the brace with a not-so-cooperative 3 year old?



Andrew M. Ball PT PhD -> Re: Bracing in Scoliosis & muscle atrophy (October 22, 2002 1:08:00 PM)

Consider:

E-Stim for muscle activation (TES, NMES, Tandum massage, etc.)

Chiropractic referral

Drew



Mindy -> Re: Bracing in Scoliosis & muscle atrophy (October 22, 2002 9:20:00 PM)

THANKS, BUT THAT DOESN'T ANSWER MY QUESTION re MUSCLE ATROPHY RELATED TO BRACE WEARING



Andrew M. Ball PT PhD -> Re: Bracing in Scoliosis & muscle atrophy (October 23, 2002 6:19:00 AM)

Mindy,

Be aware that not all MEDLINE/Pubmed resources on the internet process search string requests the same way. I’d suggest going to [URL=http://www.medportal.com]www.medportal.com[/URL] and using the following string:

“Immobilization atrophy” AND Cast

This will generate 154 hits, not all of which will be useful to you, but a few will jump out at you such as:

Ansved T. Effects of immobilization on the rat soleus muscle in relation to age.
Acta Physiol Scand. 1995 Jul;154(3):291-302.

Cruz-Martinez A, et al. Quadriceps atrophy after knee traumatisms and immobilization: electrophysiological assessment.
Eur Neurol. 2000;43(2):110-4.

Kannus P, et al. Effects of immobilization and subsequent low- and high-intensity exercise on morphology of rat calf muscles.
Scand J Med Sci Sports. 1998 Jun;8(3):160-71.

Kerkhoffs GM, et al. Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg. 2002 Mar;122(2):102-5.

Thom JM, et al. Effect of 10-day cast immobilization on sarcoplasmic reticulum calcium regulation in humans. Acta Physiol Scand. 2001 Jun;172(2):141-7.

Maxwell LC, et al. Muscle atrophy continues after early cast removal following tendon repair. Anat Rec. 1992 Jul;233(3):376-86.

Qin L, et al. Electrical stimulation prevents immobilization atrophy in skeletal muscle of rabbits. Arch Phys Med Rehabil. 1997 May;78(5):512-7.

Tuukkanen J, et al. The effect of training on the recovery from immobilization-induced bone loss in rats. Acta Physiol Scand. 1992 Aug;145(4):407-11.

The sum total of this and other articles generated leads me to the conclusions that:
1. Muscle atrophy occurs with immobilization.
2. Muscle atrophy is worse with complete immobilization (as opposed to a wrap).
3. Subequent exercise after immobilization is very helpful in restoring to control levels of strength
4. Electrical stimulation, while immobilized, helps to avert the effects of muscle wasting.


You may also want to try the search string:

“Immobilization atrophy” AND Brace

This will yield a far more manageable 46 hits, among them:

Tangsrud SE, et al. Lung function measurements in young children with spinal muscle atrophy; a cross sectional survey on the effect of position and bracing.
Arch Dis Child. 2001 Jun;84(6):521-4.


Exploring the issue of electrical stimulation using the search string:

“Immobilization atrophy” AND cast AND “electrical stimulation”

will yield 9 hits. A few choice ones include:

Arvidsson I, et al. Prevention of quadriceps wasting after immobilization: an evaluation of the effect of electrical stimulation.
Orthopedics. 1986 Nov;9(11):1519-28.

Gibson JN, et al. Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis.
Lancet. 1988 Oct 1;2(8614):767-70.

Chiropractic care? I've not seen any evidence to suggest that it can make a lick of difference in the reduction of scoliosis in children, but unless the DC is question happened to be a freak and/or a Life Graduate, it couldn't hurt.



Andrew M. Ball PT PhD -> Re: Bracing in Scoliosis & muscle atrophy (October 22, 2002 1:08:00 PM)

Consider:

E-Stim for muscle activation (TES, NMES, Tandum massage, etc.)

Chiropractic referral

Drew



Mindy -> Re: Bracing in Scoliosis & muscle atrophy (October 22, 2002 9:20:00 PM)

THANKS, BUT THAT DOESN'T ANSWER MY QUESTION re MUSCLE ATROPHY RELATED TO BRACE WEARING



Andrew M. Ball PT PhD -> Re: Bracing in Scoliosis & muscle atrophy (October 23, 2002 6:19:00 AM)

Mindy,

Be aware that not all MEDLINE/Pubmed resources on the internet process search string requests the same way. I’d suggest going to [URL=http://www.medportal.com]www.medportal.com[/URL] and using the following string:

“Immobilization atrophy” AND Cast

This will generate 154 hits, not all of which will be useful to you, but a few will jump out at you such as:

Ansved T. Effects of immobilization on the rat soleus muscle in relation to age.
Acta Physiol Scand. 1995 Jul;154(3):291-302.

Cruz-Martinez A, et al. Quadriceps atrophy after knee traumatisms and immobilization: electrophysiological assessment.
Eur Neurol. 2000;43(2):110-4.

Kannus P, et al. Effects of immobilization and subsequent low- and high-intensity exercise on morphology of rat calf muscles.
Scand J Med Sci Sports. 1998 Jun;8(3):160-71.

Kerkhoffs GM, et al. Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg. 2002 Mar;122(2):102-5.

Thom JM, et al. Effect of 10-day cast immobilization on sarcoplasmic reticulum calcium regulation in humans. Acta Physiol Scand. 2001 Jun;172(2):141-7.

Maxwell LC, et al. Muscle atrophy continues after early cast removal following tendon repair. Anat Rec. 1992 Jul;233(3):376-86.

Qin L, et al. Electrical stimulation prevents immobilization atrophy in skeletal muscle of rabbits. Arch Phys Med Rehabil. 1997 May;78(5):512-7.

Tuukkanen J, et al. The effect of training on the recovery from immobilization-induced bone loss in rats. Acta Physiol Scand. 1992 Aug;145(4):407-11.

The sum total of this and other articles generated leads me to the conclusions that:
1. Muscle atrophy occurs with immobilization.
2. Muscle atrophy is worse with complete immobilization (as opposed to a wrap).
3. Subequent exercise after immobilization is very helpful in restoring to control levels of strength
4. Electrical stimulation, while immobilized, helps to avert the effects of muscle wasting.


You may also want to try the search string:

“Immobilization atrophy” AND Brace

This will yield a far more manageable 46 hits, among them:

Tangsrud SE, et al. Lung function measurements in young children with spinal muscle atrophy; a cross sectional survey on the effect of position and bracing.
Arch Dis Child. 2001 Jun;84(6):521-4.


Exploring the issue of electrical stimulation using the search string:

“Immobilization atrophy” AND cast AND “electrical stimulation”

will yield 9 hits. A few choice ones include:

Arvidsson I, et al. Prevention of quadriceps wasting after immobilization: an evaluation of the effect of electrical stimulation.
Orthopedics. 1986 Nov;9(11):1519-28.

Gibson JN, et al. Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis.
Lancet. 1988 Oct 1;2(8614):767-70.

Chiropractic care? I've not seen any evidence to suggest that it can make a lick of difference in the reduction of scoliosis in children, but unless the DC is question happened to be a freak and/or a Life Graduate, it couldn't hurt.



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