Scoliosis Screening

1
Scoliosis Screening
2
Normal Spinal Curvature
There are 4 natural curves in the vertebral
column
3
Linear Spinal Curvatures

• Kyphosis

• Lordosis

Spine curves forward at the waist Swayback
Spine curves backward in the chest
area Roundback
4
Scoliosis

• Sideways curvature of the spine
• Spine turns on its axis like a corkscrew
• Normal spine has a l appearance
• Scoliosis produces an S or C appearance

5
Degrees of Curvature

• Scoliosis is a lateral deviation of the normal
• vertical line of the spine which, when measured
• by an X-ray, is greater than 10 degrees.

MILD
MODERATE
SEVERE
6
Causes for Scoliosis

• Congenital
• Problem with the formation of vertebrae or
• fused ribs during prenatal development
• Present at birth
• Neuromuscular, Connective Tissue Chromosomal
  Abnormalities
• Caused by a neurological disorder of CNS or
  muscular weakness
• Cerebral palsy, Muscular dystrophy, Spina bifida,
  Paralysis
• Marfans Syndrome
• Downs syndrome
• Idiopathic
• Structural spinal curvature with no established
  cause
• Appears in a previously straight spine
• 80-85 of cases

7
Diagnosis

• Physician Physical Exam
• Scoliometer measurements
• X Ray
• MRI

8
Incidence

• Most common onset around puberty growth spurt,
  ages 9-16
• Affects 2-4 of the general population (can
  affect adults, most seen in adolescents)
• Higher incidence in females than males (41)
• Females often have a larger degree of curve
• 20 of individuals with scoliosis, the curve
  continues to progress (especially in females)

9
Screening

• Purpose- to identify the child at risk for
  postural deviation, not to diagnosis
• 704 KAR 4020 (2)(12)- requires 6th 8th grades
  be screened annually.
• The Kentucky Commission for Children with Special
  Health Care Needs recommends school age children
  in grades 5-9 yearly

10
Screening

• Schedule date for screening, training, parent
  permission, follow-up and reports for KDE
• Prior overview with teachers students
• Location for privacy
• Screen males and females separately and
  individually barefooted males without shirts
  on females with blouses on backwards (may
  suggest wearing a bathing suit)
• List all abnormal finding under R for
  rescreening mark those absent for rescreen (with
  parental permission)

11

• Positive findings MUST be re-screened by a health
  professional (this step may be omitted if doctor
  or RN does the initial screening)
• Refer those needing financial assistance for PMD
  evaluation to the Commission for Children with
  Special
• Use criteria for referral to PMD. The PMD should
  complete the referral letter with his/her
  findings and the originals returned placed in
  the students health record
• Students with questionable findings should be
  re-screened in 4-6 months (within the annual
  year)
• Good communication is essential for the parents
  ( Parents should always be notified if their
  child failed the screening
• Resources are available from the National
  Scoliosis Foundation website (http//www.scoliosis
  .org/)

12
Screening Process

• Observe the student walk toward you and then away
• Note leg length discrepancies
• With bare back, have student stand straight, feet
  together and looking straight ahead, with arms at
  his/her side observe for the following

13
Step 1 Front View

• Shoulders should be level
• and at the same height
• Distance between arm and
• torso equal on both sides
• Crest of hips level on
• horizontal plane
• Head straight and centered

Normal
Abnormal
14
Step 2 Back Standing View

• Shoulders should be level and
• the same height
• Distance between arm and
• torso equal on both sides
• Crest of hips level on
• horizontal plane
• Head straight and centered
• Scapula level on both sides

15
Adams Bending Technique

• Feet slightly apart
• Palms together
• Arms outstretched with straight elbows
• Head out
• Bend forward at waist
• Place hands between legs at knee level

16
Step 3 Back Bending Away

• Look For
• Rib prominence
• Lumbar Prominence
• Differences in height of hip
• crests

17
Step 4 Side View

• Look for exaggerated rounding of the back
• Kyphosis

18
Step 5 Bending Front View

• Shoulders level?
• Is one side of torso more
• rounded than the other?
• Look for lumbar prominence

19
Step 6 Side Bends
Ask the student to bend at The waist to each
side Look for S curvatures
20
Results

• Any one of the findings suggests an underlying
  scoliosis curve, which deserves further
  evaluation
• Scoliometer- is a device that provides a way to
  measure the angle of trunk rotation in spinal
  screening, providing objectives guidelines for
  referral. It should be used in conjunction with
  routine screening. Follow manufacturer's
  guidelines.
• Document and notify parents according to school
  policies

21
Referral Criteria

• Used by second screeners as a guide to base
  referrals. If a student has any three of the
  following, the student should be referred to a
  PMD or the Commission for Children with Special
  Health Care Needs
• 1. One shoulder higher than the other
• 2. One scapula more prominent than the other
• 3. Waist folds not even
• 4. Arms not hanging equal distance from the sides
• 5. Pelvis not level
• 6.Unequal symmetry of the upper back, lower back
  or both
• If any one or two of the above are seen,
  re-screen in 6-12 months.
• If the child on forward bent test, has a hump on
  one side that measures less than 7 degrees using
  the scoliometer, re-screen in 6-12 months

22
Scoliosis Treatment

• Treatment is not needed for the vast majority of
  cases
• Observation- minor curvatures (gt20 degrees)
  skeleton is close to maturity exercise may help
  with surrounding muscular strength
• Brace- around torso hips helps hold spine in
  place while it grows can be removed for sports
• Surgery- Major curvatures (lt45 degrees) rapid
  deterioration/progression, generally spinal
  fusion
• General physical therapy/exercises are not
  effective

23
FORMS/INFORMATION

• KDE- Health Services Reference Guide
• Chapter 3- will have the Matrix of Health
  Services and examples of all forms and guidelines
  for screenings, (including scoliosis
  permission), work sheets, vision and hearing
• PHPR Volume I Physical Assessment/Vital Signs