Scoliosis Awareness Month: Casting for Scoliosis

Scoliosis Awareness Month: Casting for Scoliosis

by | Jun 27, 2018 | Scoliosis & Spine

Casting is a form of treatment for scoliosis and is used to prevent the curve from getting larger when children are young and growing rapidly. The cast works like a brace to control curve progression, but cannot be removed. Casts can be used when doctors are unable to control curve progression with a brace. As with a brace, when the cast is removed, the curve will still be present. Our goal is to keep the curve from getting larger.

Your child will be admitted to the hospital the day before or on the morning of each cast application. Your child will be given general anesthesia and will be asleep in the casting room before the doctor applies the cast. Gentle traction is used to correct the scoliosis curve as much as possible. The doctor applies a T-shirt liner and soft padding to protect the skin before the cast is applied. The cast will have holes (or “windows”) to allow the stomach to expand for eating and to allow plenty of room for breathing.

Your child will be able to go home either the same day the cast is applied or the day after. This cast may have an impact on your child’s balance and walking. Close supervision is important to prevent injuries from falls. Your child will adjust to the cast in a few days.

It is important for the cast to remain dry. If your child wears diapers, you will have to tuck the diaper under the cast at the hips. Your child will not be able to take a regular bath or shower while wearing a scoliosis cast. You will have to sponge-bathe your child during this time, as water will ruin the cast and can damage your child’s skin under the cast. Because of your child’s rapid growth, the cast will have to be changed every two to three months for up to one year. 

How to care for your child’s scoliosis cast:

  • Keep the cast as clean and dry as possible at all times to prevent skin breakdown and damage to the cast.
  • Give your child a sponge bath daily and wash all areas of skin not under the cast. Never give a bath or shower in the cast.
  • If itching is a problem you may use a hair dryer on cool setting to blow into the cast. You can also use distractions, such as games, music, reading, video games or counting to distract your child.
  • Never put anything in the cast to scratch the skin, as this can cause a sore or infection. You can pull the T-shirt liner up and down to relieve itching.
  • Never use powder inside the cast, as it may clump and irritate the skin. Do not use oil or lotion under or around the edges of the cast.
  • Never permit a child around a pool with a cast on or allow him/her to ride in a boat.
  • Do not allow your child to play in sand or dirt.
  • It is OK to draw on your child’s cast or put stickers on it. Be creative. Have fun with the cast.
  • You will be given a cast care book before you go home. The nurse will give you further instructions and waterproof tape and moleskin for cast edges to use at home as needed.

Call Scottish Rite Hospital:

  • If the cast is too tight.
  • If your child has decreased movement or sensation (tingling) in arms or legs.
  • If you notice skin breakdown.
  • If the cast cracks or breaks.
  • If you notice the cast position has changed.
  • If you notice a foul odor (beyond body odor). This can indicate a wound under the cast.
  • If an object (such as a toy, rocks, fork, etc.) gets into the cast and cannot be removed. This can cause a pressure wound under the cast.
  • If the cast is causing pain.

Summer Colors Artist Spotlights: Part IV

by | Jun 27, 2018 | Events

Summer Colors, now in its 10th year, was an idea born out of passion for both art and the patients of Texas Scottish Rite Hospital for Children. Founded in 2009 by Jenny and Loren Koziol and Jill and Dupree Scovell, this silent art auction raises awareness about the hospital, while also exposing the Dallas community to up and coming local artists. Each year, local artists donate original pieces of art to be featured in the auction, with all the proceeds benefiting our hospital. Over the next few weeks, we will be introducing you to all of the artists. This year’s event will be held on Thursday, July 26, at Scottish Rite Hospital. Additional information and tickets can be found at scottishritehospital.org/summercolors

 

JENNY GRUMBLES KOZIOL

Dallas entrepreneur, Jenny Grumbles, obtained her degree in journalism and studio art from Southern Methodist University in 2002.  Her work-life is threefold; artist, shop-owner, and buyer for A&E’s hit series, Storage Wars Texas.  Jenny’s paintings have been sold in galleries and shops throughout Georgia, Texas, and California.  She is the proprietor to her very own vintage home furnishings shop, Uptown Country Home. 

Since realizing her passion in painting in 1994, she has created an impressionist style with loose brush strokes and an emphasis on light and color. There is never black on her palette. Her subject matter includes everything from children on the beach, home interiors, florals, and commissioned work. Jenny attributes much of her success to her mentor, the renowned Claudia Hartley of Arizona, and to gallery owner, Anne Irwin, of Atlanta. 


Jenny also spends much of her time searching for treasures to recycle, repurpose, and repaint for sale in her shop. 

In addition to her shop and artwork, Jenny has a passion for politics and major league baseball. 

Jenny’s main aspiration is to make the world a better place through political advocacy, creative art and home decor, because she truly believes, whether it’s the whole world, or a little cottage in Dallas, home is where the heart is.

HELEN GREEN

Helen Green’s work was described by a local Dallas store as “simplistic beauty with light and airy colors that will add a touch of summer to any room”. Raised in Boerne, Texas under her mom’s easel, Helen has developed her graceful style, which has caught the attention of area stores, cafes and followers on Facebook site called GraceFilledNestTumblr.com

Her education began at the University of Texas but chose to graduate at the Art Institute of Dallas. She left the stressful corporate world environment after beginning her career in a high-end specialty store in the visual communications department and ending as a senior art director for a national retailer. Now she finds true joy and peace as a stay at home mom with her precious 6-year-old daughter where she takes time to paint in her studio.

 

She also has mini art camps from home to encourage children to find joy in painting during a 2 hour sessions. Each with devotion, inspiration and snacks. They leave with their painted canvases and a smile! Facebook site called “Grace Filled Nest Mini Art Camps” 

Sweetly rooted in her faith, Helen is moved daily by the beauty that she sees in the world through the eyes of the LORD. It’s amazing the following that she is blessed with in like-minded people and others that recognize a still small voice in her work.

LAURA RUNGE

I am a Texas native and earned a BA in Journalism from Baylor University. After many years in the corporate world, I took the leap of faith to pursue my lifelong passion as a self-taught artist. I am now a full time, working artist and dedicate my days to painting and searching for creative avenues in everything I do.

My passions are creating and inspiring, and I wake up each day in hopes of combining the two in every endeavor. I paint in acrylics, often combining stains and metallic leafs and powders into my pieces. I am drawn to objects that reflect movement, and this is incorporated into my works. Finding beauty in unusual objects and places, I use unconventional tools and techniques to create imaginative, one-of-a-kind works of art. My goal is to create a painting for the buyer that will add flair and a special dimension to the space where it will reside.

Madison Slusher

Madison has been a jewelry designer since 2006 and newly developed abstractpainter.

Madison’s inspiration is knowing that someone will treasure my art as much as she does and bring them joy!

Abigail Law

In 7th grade, I was diagnosed with Scoliosis and became a patient here at TSRHC. I had to wear a back brace for 20 hours a day for most of 7th and 8th grade. On the last week of 8th grade, I underwent Scoliosis surgery with Dr. Sucato. I will forever be grateful for the angels here at Scottish Rite and I decided that I wanted to give back. I have been holding my own Art Show annually since the year of my surgery. My 3rd annual Art Show was on May 11 at Christy M Boutique in Snider Plaza which benefited the hospital. I do this because It’s my own way of giving back to the place that has given me so much. I’m honored to be a part of Summer Colors! It gives me another opportunity to show my love and respect for Scottish Rite.

HEATHER GALLAGHER

I am a mom of three beautiful children, a wife, a sister, a daughter, and a friend to many. I have lived in Texas my whole life and North Texas for most of that. I work for locally based non-profit ambulance service Careflite. I am a paramedic and enjoy taking care of my patients and their families. I paint as a hobby. I never really considered myself and artist, but I truly enjoy creating art, so I guess that makes me one

I love seeing what colors work together, and never really know what is going to end up on the canvas. I love abstract art, as it can mean many different things to many different people. I love blues and greens, and fluid movement. I take inspiration from my children’s drawings and paintings that they make because they are truly random and beautiful.

Matt Esparza

Matt Esparza is a Dallas based visual artist, film maker and photographer. As a graduate of Oral Roberts University (ORU), in Tulsa, Oklahoma, Matt obtained a degree in Art Graphic Design, with a concentration in Video. He was also a key player on the ORU Men’s Soccer team, and went on to train with professional clubs in Brazil. As a gifted artist, Matt has displayed and sold works across the United States, including Dallas, Fort Worth, Tulsa, New York and Los Angeles. After living in L.A. for a year, and apprenticing under highly respected artist, Andy Anh Ha, Matt relocated to Dallas in 2012 to establish his studio.Matt is continually getting inspiration from the world around him, drawing equally from urban and rural textures, international travels, and famous artists.

The artists who have most influenced him include: Jackson Pollock, Jean- Michel Basquiat, Andy Warhol, Gerhard Richter, Georges Mathieu and Franz Kline. His main source of inspiration,however, is his faith in God, and the effect that has had on his life.

Matt is a highly travelled individual and has visited over 18 countries in the past 10 years. He has recently returned from an 8 month sabbatical in which he lived and travelled around the world and visited 12 different countries including, India, Jordan, Lebanon, Uganda, Vietnam, Myanmar, Ecuador, Hong Kong, Costa Rica and Mexico. Esparza’s preferred medium is a variety of acrylic and oils, on board, with regular use of polymers, spray paints, stains, epoxy resin and sheet metal. When Esparza is not painting or traveling the world filming, he is busy volunteering at his church, enjoying local eats, working out, dancing or enjoying the outdoors.

KRISTIN O’KEEFE

B.A. in art from Hastings College in Hastings, NE. I’m a jack of all trades and a master of none. 

Inspired by ordinary moments, rainy days, and quietness.

Rachel Nash

Rachel Nash is an artist and art therapist. She recieved her undergraduate degree from Southern Methodist University and her Masters from The Scho ol of the Art Institute of Chicago.

Rachel is drawn to color, she loves mixing paint and seeks to create colors that are found in nature. She is also drawn to people and human nature, a common theme she explores in her work.

BRITTNEY WELLS

I have been painting and drawing since I was 5 years old. I am a former patient of TSRH. I received my BFA in graphic design from Texas A&M University-Commerce in 2010. I will paint or draw on anything that will hold paint. The world is my canvas, from walls (murals) to shoes to printing t-shirts to paint on making my own canvases; I’m blessed to say I do it all!

I get my inspiration from everyday life and sometimes even my dreams. Most times I’ll let my imagination run wild on a canvas.

#SRHaccess Facebook LIVE Recap: Scoliosis FAQs

#SRHaccess Facebook LIVE Recap: Scoliosis FAQs

by | Jun 22, 2018 | Scoliosis & Spine

In honor of Scoliosis Awareness Month, clinical manager Jennifer Bowden, R.N., joined us on Facebook LIVE to discuss the most frequently asked questions about scoliosis. Below is a recap of the conversation.

Watch the live segment. 

What is the difference between an ambulatory care and inpatient nurse?

  • An ambulatory care nurse, also known as clinic nurse, is the nurse a patient will see when he or she has a clinic visit.
  • An inpatient nurse takes care of the patient once out of surgery.

At an initial appointment for scoliosis, what can a patient expect? 

  • The patient is seen by their doctor and clinic nurse. They could also be evaluated by a physician’s assistant or fellow/resident.
  • If the patient does not have X-rays on file, it is possible that they may be sent to radiology to have those taken.
  • The doctor will complete a clinical exam to check for scoliosis.
  • Depending on the outcome of the clinical exam, X-rays are checked if there are concerns regarding a potential curve in the back.
  • The doctor will give the patient a time frame of when he or she needs to come back for another visit.

Scoliosis Surgery 
Who do the parents contact if they have questions about surgery?

  • Clinic nurse
  • Families are encouraged to call with any questions they may have at any time.
  • Our staff encourage parents/patients to write down any and all questions.

While a patient is in surgery, where does the parent/guardian wait?

  • Patient will be assigned a room on the inpatient unit – parents can wait in that room.
  • Surgery waiting area is on the 4th floor – quiet and away from hustle and bustle
  • Cafeteria – on the C level by the A elevators
  • While the patient is in surgery, the parent/guardian must stay inside the hospital at all times.
  • Each parent/guardian is given a pager to be notified/updated regarding the progress of the surgery.

Most common updates during surgery

  • It takes about an hour to get the patient prepped before surgery actually begins.
  • The parent/guardian is updated when the surgery actually begins.
  • Updates come every one to two hours
  • Parents are notified when the patient is being closed up.
  • When the surgery is complete, the surgeon will call and speak to the parent.

What does the admission process for spine surgery look like?

  • Most spine patients check into the hospital the day before surgery.
  • Labs and X-rays are taken, if needed
  • Clinical photos are taken so that the patient can remember what he or she looked like before the surgery.
  • The patient and their family are able to meet their care team:
    • Inpatient nurse
    • If needed, a child life specialist and physical/occupational therapist
    • OR nurse
    • Anesthesiologist

What happens after surgery?

  • The patient will be in recovery (PACU) for half an hour to an hour or longer.
  • Once the patient is awake and the breathing tube is removed, the parents are called to see their child in recovery.
  • Parents are escorted to the patient’s room and the recovery nurse will take the patient to their room.
  • Recovery nurse will give the inpatient nurse a report on the child.

Who is the patient seeing after surgery?

  • Inpatient nurse
  • Patient care techs
  • Doctors
  • Residents and fellows

Pain management after surgery

  • Education on pain takes place before surgery
  • Really sore and still after surgery – the nurse teaches the patient how to assess their pain

Will the patient wake up during surgery?

  • No, the patient is fully asleep during surgery.
  • Anesthesia is given to the patient to keep them asleep
  • The patient’s spinal cord wil be monitored throughout the duration of the surgery.

Movement after surgery

  • Physical or occupational therapy can be part of the process after surgery, if needed.
  • Nurses help patients get out of bed.
  • The nurse will teach the patient how to roll over, prop themselves up and turn over.
  • The care taker at home will also be taught how to help the patient get out of bed and move around safely.

Going home after surgery

  • Pain is under control
  • Incision looks good
  • Patient is up and moving
  • Eating and drinking – no vomiting
  • Bowel movement in the hospital – biggest problem after this surgery is constipation and gut issues

The drive home from the hospital: Is there a certain set up needed in the car? 

  • Every patient is different
  • Take pain medication close to when departing the hospital
  • Most patients like to recline in the car seat versus sitting up straight.
  • The nurse will help the patient down to the car and will make sure they are safely situated inside the car.
  • Every hour to two hours, we recommend the patient to get up and move/change positions.

Specific bed set up at home

  • No restrictions on the bed setup at home
  • If the bed is upstairs, recommend sleeping somewhere downstairs
  • No hospital bed is necessary
  • Some patients like being in a recliner, instead of lying flat

Incision care

  • Nurses educate parent/guardian on how to change the dressing covering the incision.
  • No creams or lotions on the incision until told by your doctor.
  • A nurse will provide the parent with supplies to change the dressing.
  • No soaking the incision, showers only – do not want the incision under water because it could cause an infection
  • After shower, remove the dressing, pat area dry and then apply a new dressing

Will the patient have a scar from surgery?

  • Yes, a long and thin scar down the middle of their back.
  • If well taken care of, it will flatten out and look like a faint pencil mark down the middle of the patient’s back.
  • For at least two years after surgery, it is recommended that the scar be covered with sunscreen or a shirt when out in the sun.

Summer Colors Artist Spotlights: Part III

by | Jun 20, 2018 | Events

Summer Colors, now in its 10th year, was an idea born out of passion for both art and the patients of Texas Scottish Rite Hospital for Children. Founded in 2009 by Jenny and Loren Koziol and Jill and Dupree Scovell, this silent art auction raises awareness about the hospital, while also exposing the Dallas community to up and coming local artists. Each year, local artists donate original pieces of art to be featured in the auction, with all the proceeds benefiting our hospital. Over the next few weeks, we will be introducing you to all of the artists. This year’s event will be held on Thursday, July 26, at Scottish Rite Hospital. Additional information and tickets can be found at scottishritehospital.org/summercolors

CAROLINE QUISENBERRY

Constantly in need of a “creative outlet”, I would often find new project and hobbies to test drive. The day I was introduced to jewelry, jewelry design, and a paintbrush was the day I realized I could put my biggest passions of creative design, the arts, and crafting into a tangible product to give back to the world. 

My personal relationship with design has evolved into a love and passion I incorporate into every aspect of my life, both personally and professionally. Throughout my professional life, I have broadened my creative abilities through even planning, jewelry designs, painting, branding, business development, client relations, and marketing. Alongside my professional life, I have grown my design skills through my jewelry and painting business, CLQ Designs. 

CLQ Designs offers custom jewelry design, jewelry redesign, and abstract acrylic paintings, while catering to the client’s style, need and budget! CLQ Designs offers the best of both worlds – unique handcrafted jewelry and art sure to make you and your home the statement piece at your next event and a price point that won’t send you running for the hills! I want my clients to be able to call me on a random Tuesday and ask if I can design them something new because they need to “spoil” themselves. 

Since childhood, my creativity and passion for design has fueled my drive to explore new experiences, learn new skill sets, and cultivate meaningful relationships. For me, the most exciting and rewarding part of CLQ Designs is knowing that I am not limited to what I can learn, design and create. I love getting together with my clients to get our creative wheels turning together in order to design their one of a kind piece from CLQ Designs. I love the challenge of design and thrive off creativity (I can’t get enough of it!). 

CHRISTI MERIL

Christi Meril has been creating mixed media art filled with simple and connectable images since 2006. She has devoted herself as an artist to create images that speak to the eye and heart of the beholder. Her artwork is filled with modern yet timeless pieces full of life, self-reflection and love.

Over the years, her work has appeared in ArtHouse Dallas, The Thrift Studio, Dallas, The Dallas Flea, The Jewish Art Fest of Dallas, Arts and Tarts, open shows at the 500X Gallery and sold locally. She is also found in personal collections from California to New York and abroad. Christi resides in Dallas, Texas with her husband, two daughters, two standard poodles and English bulldog.

JOANNE “JOJO” HERDA

Rocket scientist turned self-taught abstract artist utilizing a blend of the analytical mind and artistic passion to create harmonious balance of color on canvas with compassion and diligence. Artwork is created for the individual collector, clients of leading interior design and non-profit organizations. JoJo was honored to be named a Fashion Group Internal of Dallas 2016 Rising Star Nominee in Art. 
 
JoJo’s artwork inspiration is drawn from life experiences, 80’s flare, and the color found in everyday objects. 
 

MEGAN ADAMS BROOKS

Inspired by patterns and textures in the natural world, Megan Adams Brooks creates abstract paintings on silk that reflect the beauty found throughout nature. Brooks began painting interior scapes on canvas early in her career. It was through depicting the fabrics and patterns in a room that she discovered her fascination with fabrics, which led her to designing custom textiles. From there, Brooks found her true passion for the silk medium. Painting on silk, similar to watercolor, provides many opportunities for unexpected challenges and happy accidents. The process is time-sensitive, multi-layered and endlessly inventive. Brooks’ unique method of self-expression fulfills her unending obsession to create. 

Brooks’ work has been exhibited at Art Basel in Miami and McKinney Avenue Contemporary (The MAC) at 3120 McKinney Ave, Dallas, TX. Her work hangs in public and private collections, nationally and internationally. Brooks holds a Bachelor’s of Fine Art degree in painting and drawing from Southern Methodist University and a Master’s of Fine Art degree from the University of North Texas. She lives and works in Dallas, TX.

LORI CUSICK

In 2002, Lori decided to follow her life’s passion and recommitted herself to painting. At this time, she first engaged in plein air painting. “The challenges presented by painting nature while being part of that nature have taught me a tremendous amount about studying light and manipulating paint.” The one constant through her paintings: her energetic spontaneous brushstroke, applying paint with a confident contemporary approach.

Lori resides in Dallas, a long way from the mountains of New York where she was born and raised. She attended Pratt Institute in Brooklyn, earning a bachelor’s degree in Fine Art. Over the following years, Lori successfully pursued a career as a commercial artist designing for advertising agencies and running her own design studio. She is currently Design Director for the award-winning Private Clubsmagazine. You see the influence of her commercial career in her exciting compositions … silhouettes of the world.
 
Lori’s inspired by nature and the ever changing light.

 

CHARLSIE DOAN

I am a self-taught landscape artist, primarily using oils and sometimes watercolors.
Inspiration: My inspirations are the colors of the sky. My grandparents live on a farm in rural New Mexico, and I love being there because the sky is so wide and huge that it is possible to see everything, the stars, the clouds, the sunrises, and the sunsets. I especially love the vibrant oranges and reds of sunset, and these are the colors that you can see most in my paintings.

Fran Di Giacomo

Artist, Author, Speaker

1970 was a pivotal year for Fran Di Giacomo; she found two passions – her husband and her art.  She pursued her passion for art by studying with living masters, including Paul Leveille, David Leffel, and a unique opportunity at Scottsdale Artist School with Howard Terpning. 

Striving to establish her career in oil painting, Fran Di Giacomo found herself most excited by the methods and concepts of the Dutch masters.  “I focused on seeking out living masters to study with.  Perfecting the drama of light, shadow, and mystery has been a constant theme.  Fad and fashion will ebb and flow, but classical realism is endless and enduring.”  Her paintings are represented by galleries in several states, and are in demand for their lush colors and dramatic lighting.

Today her portraits are renowned, and her still life paintings are in great demand for their lush colors and dramatic lighting.  Her portraits include private collectors, precious children, sports figures such as Dallas Cowboys’ Emmitt Smith and Mavericks’ Dirk Nowitzki, and dignitaries such as Former Supreme Court Chief Justice Warren E. Burger and President George W.Bush.  

She has been published in books, magazines, and newspapers, as well as Who’s Who in American Art and Who’s Who of American Women, and The Best of Portrait Painting.   In today’s fast-paced world, our senses are constantly assaulted. When you behold a Di Giacomo painting, you return to the world of quiet elegance.   

Fran is represented by Southwest Gallery in Dallas, and Gallerie Amsterdam in Carmel. She is a member of Associated Creative Artists and Oil Painters of America.  

Michelle Elwazir

The interplay of natural and man-made geometric forms and textures is a unifying theme in Michelle Elwazir’s photographic work. She has always been amazed and surprised by the beauty of nature.  The subjects of artistic observation, interpretation, and discipline surrounded her from an early age.  Her fascination with color and texture as well as the urge to fix her observations artistically was informed by her childhood surrounded by the art and sculpture of her artist parents (her mother is a sculptor of exotic pottery and her father is a watercolorist and sculptor).  

Michelle has a bachelor’s degree in biology and a master’s in education development. Her projects have included commercial fashion and product photography, portraiture, and abstract art photography.  She has taught photography related workshops at the Dallas Center for Photography.   

Meagan Johnson

Lil’ d Dog Works is operated by Meagan Johnson in Denton, TX. Meagan has been teaching art in Dallas for 6 years and is the Artist in Residence at the Scottish Rite Hospital for Children.

Meagan’s private business began as a pet portrait artist doing commissions for close friends. Since then she has completed works that span a large variety of subject matter working with acrylics, watercolors, colored pencils, and inks. Meagan’s style incorporates vibrant colors, expressive lines, and fun compositions to create unique works of art with the client in mind.

Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis

by | Jun 18, 2018 | Scoliosis & Spine

Article originally published by staff orthopedist Amy L. McIntosh, M.D., in first quarter, 2018 issue of Pediatric Society of Greater Dallas newsletter. 
What is scoliosis?
Scoliosis is a rotation in the spinal column that creates a “C”-shaped single curve or an “S”-shaped double curve, when viewed from behind (Figure 1). Some cases worsen with time and can result in serious problems such as abnormal appearance in posture, increasing back pain as one ages, and in the worst cases, interference with heart and lung function. Idiopathic (no underlying cause) scoliosis occurs in 2 to 3% of the adolescent population, usually affecting young people between the ages of 10 to 16. Scoliosis onset is usually earlier in girls than in boys—generally, ages 10 to 14 for girls and 12 to 16 for boys.


Figure 1

When should I screen patients for adolescent idiopathic scoliosis (AIS)?
Scoliosis screening is designed to identify adolescents with abnormal spinal curvature. Screening can detect scoliosis at an early stage, when the curve is mild. Most curves can be treated without surgery if detected before becoming too severe. Therefore, early detection is the key to controlling spinal deformities. Ideally, spinal screening should be conducted as a part of the annual examination for females at age 10 and 12 years, and males once at age 13 or 14 years. Signs to watch for include (see Figure 2):

  • One shoulder higher than the other. One shoulder blade higher or more prominent than the other
  • One hip higher than the other.
  • Space between arms and body greater on one side.
  • Leaning to one side.
  • Head not centered directly above the pelvis.
  • When bending forward, thoracic rib prominence or lumbar fullness that is asymmetric to the opposite side. (+ Adams forward bend test) (Figure 3)​

If any of these signs are present, then the child should be referred to a pediatric orthopedic surgeon. Texas Scottish Rite Hospital for Children has a low dose X-ray machine (EOS) that obtains high quality images with significantly less radiation exposure to the patient. For that reason, please do not obtain X-rays. Just refer the patient if clinical signs of scoliosis are apparent on physical exam. The orthopedic surgeon will obtain standing, full length (posterior-anterior and lateral) spine X-rays to measure the cobb angle in both the frontal and sagittal planes. The Cobb angle measurement and the skeletal maturity of the child will determine the treatment.
What are the treatment options for AIS?
Observation:
Routine rescreening or observation by the physician is a form of treatment for mild curves (11-20 degrees). This observation period consists of regular clinical exams and spine X-rays throughout the rapid growth years of adolescence until the spine is mature. It is important to note that more than 90 percent of patients with scoliosis require no treatment other than observation. 

Brace: 
For curves greater than 20 degrees in patients that are still growing rapidly, a brace is prescribed. The brace can prevent the curve from progressing and may eliminate the need for spinal surgery. However, the brace cannot correct the curve that already exists. Bracing is generally recommended for curves between 20 to 40 degrees in adolescent patients with significant growth remaining. The main factor in achieving a high rate of bracing success is the number of hours a day that the brace is worn. Various spinal orthoses are available, with the most common being a Thoracolumbo Sacral Orthosis (TLSO). The TLSO is named by the areas it is designed to stabilize: the thoracic, lumbar and sacral parts of the spine. It is cosmetically acceptable as it can be covered well by clothing. Wearing a brace is not an easy treatment for an adolescent. Even covered by clothing, it is hot, hard and can make the student feel self-conscious. Getting into a daily routine of wearing the brace while participating in activities helps with compliance, which is key to successful treatment.

Surgery: 
Some patients present with severe spinal deformity, and other patients scoliosis worsens despite compliant brace wear.  In these specific patients, surgery can reduce a portion of the curve and prevent it from increasing in the future. Usually, surgery is reserved for adolescents and pre-adolescents who already have a curve of 45 to 50 degrees or more. The most common surgical procedure is a posterior spinal fusion with instrumentation and bone graft.

This type of surgery involves attaching rods to the spinal column to help straighten it. The bone graft between the affected vertebrae encourages fusion to prevent further progression of the curve. Instrumentation refers to the various rods, screws, hooks or wires that are used to hold the spine in the corrected position while the bone fusion occurs. The instrumentation is rarely removed. Following surgery, the fused section is no longer flexible. The average hospital stay is about two to three days, and the student can usually return to school in approximately four weeks. During the first six months after surgery, some limits will be placed on strenuous physical activity. After this healing phase, the surgeon will usually release the patient for all activities, including competitive, low-contact sports.
Does physical therapy help treat scoliosis?
The Schroth method is a nonsurgical option for scoliosis treatment. It uses exercises customized for each patient to return the curved spine to a more natural position. The goal of Schroth exercises is to de-rotate, elongate and stabilize the spine in a three-dimensional plane. This is achieved through physical therapy that focuses on:

  • Restoring muscular symmetry and alignment of posture
  • Breathing into the concave side of the body
  • Teaching you to be aware of your posture

This approach to scoliosis treatment was developed by Katharina Schroth and further popularized by her daughter Christa. Born in Germany in the late 1800s, Katharina Schroth had scoliosis that was unsuccessfully treated with bracing. She developed her own breathing technique and exercises to manage her scoliosis. She and her daughter opened a clinic, where they treated more than 150 patients at a time.
A Schroth-trained physical therapist or specialist should guide you in learning this program. The duration of this treatment varies and the patient is expected to continue exercises at home to keep scoliosis in check.

Scottish Rite Hospital is currently investigating the use of Schroth physical therapy alone and combined with brace treatment for patients with mild scoliotic curves.

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