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Nighttime Bracing Coupled with Physiotherapeutic Scoliosis-specific Exercises Can Reduce Adolescent Spinal Curves

Nighttime Bracing Coupled with Physiotherapeutic Scoliosis-specific Exercises Can Reduce Adolescent Spinal Curves

by | May 17, 2023 | Research & Innovation

Scoliosis is one of the most common pediatric orthopedic conditions and presents very differently depending on the patient. Research into nonoperative treatment methods has shown promising results for using a Providence or nighttime brace in addition to physiotherapeutic scoliosis-specific exercises (PSSE).

Scottish Rite for Children pediatric orthopedic surgeon Amy L. McIntosh, M.D., and a  team of physical therapists, orthotists, and others conducted this prospective comparative study to evaluate the effectiveness of PSSE in skeletally immature patients with adolescent idiopathic scoliosis treated with nighttime bracing (PSSE group) compared with the standard of care of nighttime bracing alone (control group). Their findings were published in the Journal of Pediatric Orthopaedics in the article “The Addition of Daytime Physiotherapeutic Scoliosis-Specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression.”

Skeletally immature patients with adolescent idiopathic scoliosis (AIS) who have moderate curves are treated with thoracolumbosacral orthoses, which are designed for nighttime wear. The effectiveness of PSSE in addition to nighttime bracing compared with nighttime bracing alone was unknown. Patients in this study met the following inclusion criteria: diagnosis of AIS, Providence brace treatment, ages 10 to 16 years, thoracolumbar or lumbar primary curve <35 degrees, Risser stage 0, and females <1-year postmenarchal.

Patients in this group completed at least eight hours of one-on-one outpatient physical therapy sessions from a Schroth-based (Barcelona Scoliosis Physical Therapy School) certified physical therapist. All patients participated in Schroth therapy at Scottish Rite for Children and were given a standardized exercise prescription algorithm. They also committed to performing a home exercise program for a minimum of 15 minutes a day, five days a week, for at least one year. They were encouraged to maintain a corrective posture throughout the day during activities of daily living.

The primary outcome measures were curve magnitude of the primary curve and the rate of curve progression. Curve magnitude was digitally measured using the Cobb method, and baseline curves averaged 25 degrees, which is at the lowest bracing threshold recommended by the Scoliosis Research Society. These patients either presented with a Cobb  angle ≥ 25 degrees or had demonstrated curve progression to a Cobb angle ≥ 25 degrees.

Both groups demonstrated positive results, 22% of curves improved at skeletal maturity, and only 9% required surgery. However, the PSSE group had no change in curve magnitude at the final visit compared with curve progression in the control group (1 vs. 7 degrees, P<0.01). Furthermore, the PSSE group had a lower rate of curve progression >5 degrees at the final visit (14% vs. 43%, P<0.01). The PSSE group also had less conversion to full-time bracing after 1 year (5% vs. 24%, P=0.046), but the differences were no longer significant at the final visit (14% vs. 27%).

Their research confirms that Schroth-based physical therapy, in conjunction with wearing a brace at night, reduces curve progression after one year and at skeletal maturity. This information is helpful to patients and their families experiencing scoliosis and could be used as an encouragement for compliance with the treatment.

Learn more about scoliosis and orthopedic research.

Get to Know our Staff: Lori Wendt, Center for Dyslexia

Get to Know our Staff: Lori Wendt, Center for Dyslexia

by | May 15, 2023 | Spotlight

What is your job title/your role at Scottish Rite for Children?
Dyslexia marketing and outreach associate

What do you do on a daily basis or what sort of duties do you have at work?
I have the privilege of representing Scottish Rite by marketing our new curricula. I do this by organizing exhibit space and presenting at conferences. I also assist with training for our curricula,Build and Bridges.

What was your first job? What path did you take to get here or what led you to Scottish Rite? How long have you worked here? 
My first job was at a store that sold different flavors of popcorn. I taught first grade and then worked for HIT Entertainment where I was responsible for the educational content and outreach for Barney & Friends,Thomas the Tank Engine, Angelina Ballerina and Bob the Builder on PBS. I returned to teaching and then started here at Scottish Rite one year ago!

What do you enjoy most about Scottish Rite? 
The positive energy and sense of hope are what I enjoy most about Scottish Rite.

Tell us something about your job that others might not already know? 
This job has brought my life full circle. My children were both diagnosed here with dyslexia. Now that they are 19 and 22, I see every day what a difference intervention makes. It makes me so proud to be part of the Center for Dyslexia!

Where is the most interesting place you’ve been? 
My husband and I took our four kids to Austria. We went to the most amazing, unique restaurant! You had to walk up a mountain to get there and then you rode a sled down after dinner. It was an amazing experience!

What is your favorite game or sport to watch and play? 
I love to watch football! My football-loving dad had three daughters, so we all grew up watching football with him!

If you could only eat one meal for the rest of your life, what would it be? 
Queso!

What’s one fun fact about yourself?
I am married to the voice of Barney the Dinosaur! I loved working with Barney so much that I married him!

What to Expect When Visiting the Rheumatology Clinic

What to Expect When Visiting the Rheumatology Clinic

by | May 12, 2023 | Rheumatology

The Rheumatology team treats children with conditions that can cause inflammation in many different parts of the body. Some of these conditions include juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis, vasculitis and scleroderma to name a few. The clinic includes a multidisciplinary team who work together to provide the best care. The Rheumatology team includes:
  • Doctors
  • Nurse practitioners
  • Nurses
  • Pediatric psychologists
  • Physical therapists
  • Occupational therapists
  • Child Life specialists
  • Dietitians
  • Clerks and medical assistants
The doctor who staffs the clinic is a board-certified pediatric rheumatologist. This doctor is a pediatrician with special training in treating arthritis and related conditions. You may also meet with fellows who are doctors finishing their specialized training. Services available for patients seen in our Rheumatology Clinic in Dallas and Frisco:
  • Infusion therapy
  • Digital X-ray and advanced imaging
  • Family Services and Child Life specialists
  • Physical and Occupational Therapy
  • Orthotics
  • Lab Services
  • Psychologists
What to expect at your appointment: After checking in, a staff member will greet, weigh and measure the child. Then, you will be escorted to an exam room to meet the care team. What to bring:
  • Although we have disposable shorts available for our patients’ use, your child may feel more comfortable by bringing a pair of their own.
  • Please bring your child’s immunization record.
  • Also, please bring any pertinent medical records, all medications your child is taking in original bottles or a list of your child’s medications.
Who you will see: Prior to meeting the rheumatologist, your child may be seen by a nurse, medical student, resident, fellow or advance practice nurse. The rheumatologist may have a physical therapist, occupational therapist and/or dietitian see your child during the same visit. Please understand that this visit may be lengthy. Sometimes it takes more than one visit to make a final diagnosis. What you need to do We are specialists in pediatric rheumatology. It is very important for you to maintain a relationship with your pediatrician or family practitioner to meet all other health care needs and provide routine care. If you need help finding a doctor in your area, please call our Family Services department at 214-559-7490 or 469-515-7191. Learn more about our Rheumatology department.
An Affirmation of Independence

An Affirmation of Independence

by | May 8, 2023 | Pediatric Developmental Disabilities

Published in Rite Up, 2023 – Issue 1. 

I’m brave. I’m strong. I’m beautiful. I’m perfect — just the way God made me,” says 8-year-old Jordynn, of Crowley, with her mother, DeAdriene. Together, they practice daily affirmations. “Because of Jordynn’s condition, she is different,” DeAdriene says. “When you’re different, it can be a confidence killer. I want her to be the best version of herself that she can be.”
 
Jordynn was born at 30 weeks and spent six weeks in the NICU. At her 12-month appointment, she could not sit up or walk. Her pediatrician said not to worry about walking until she was 18 months old. “At 18 months, Jordynn still wasn’t sitting up,” DeAdriene says. “We’d have to prop her up in a corner.”

A month later, Jordynn was diagnosed with cerebral palsy, a neurological disorder that affects a person’s ability to move. Jordynn’s condition was caused by periventricular leukomalacia, a type of brain injury that is common in very premature babies. In Jordynn’s case, it affected her legs the most. “When we found out, it was really hard,” DeAdriene says. “We were seeing all these doctors, and they said she would never walk independently.”

Jordynn began wearing leg braces, and at age 3, received a gait trainer — an assistive device similar to a walker that supports a child’s mobility. For long distances, she used a wheelchair. As Jordynn grew, she began taking steps on her own, but she could not put her right foot flat on the ground. “The position of her foot was horrible,” DeAdriene says. “Her braces had stopped working because her muscles were so tight.”

DeAdriene had heard about a surgery that she thought could help. When Jordynn was 5, she was referred to Scottish Rite for Children where they sought advice from a team of cerebral palsy experts, including Lane Wimberly, M.D., medical director of movement science and pediatric orthopedic surgeon, and Fabiola I. Reyes, M.D., pediatric physical medicine and rehabilitation physician.

Jordynn underwent a thorough evaluation, including a gait analysis in Scottish Rite’s Movement Science Lab. The analysis measured Jordynn’s walking ability, which aided in designing a customized treatment plan. Through surgery, Dr. Wimberly lengthened her Achilles tendon and hamstring to get her foot into a neutral position. Over the next year, Jordynn regained strength through physical therapy and home exercises. During that time, Dr. Reyes provided tone management by prescribing medication to relieve Jordynn’s muscle spasms, which completely resolved her pain.

“Scottish Rite has exceeded our expectations,” DeAdriene says. “Jordynn is not only walking, she’s running around with her friends. She’s even on the dance team at school!” “Jordynn is happy and active,” Dr. Reyes says, “and that is our ultimate goal for our patients.”

Read the full issue.

Healio Orthopedics Today: Arthroscopic Meniscus Repair

Healio Orthopedics Today: Arthroscopic Meniscus Repair

by | May 7, 2023 | Press Coverage, Sports Medicine

In a prospective multicenter study, Medical Director of Clinical Research Henry B. Ellis, M.D., and colleagues used the Clavien-Dindo classification system to identify complications among more than 2,000 arthroscopic meniscus repairs in pediatric patients. Presented at the 2023 Arthroscopy Association of North America Annual Meeting, research showed that pediatric patients with an isolated meniscus repair had a complication rate of 14.25% and the team found no statistical cause for the failed meniscal repairs. Read the full article on Healio Orthopedics Today.