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Weight distribution in the sitting position in patients with paralytic scoliosis: pre- and postoperative evaluation
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. (Landstinget i Östergötland; Centre for Public Health Sciences; Centre for Public Health Sciences; Folkhälsovetenskapligt centrum; Folkhälsovetenskapligt centrum)
2002 (English)In: European spine journal, ISSN 0940-6719, Vol. 11, no 2, 94-99 p.Article in journal (Refereed) Published
Abstract [en]

Patients with paralytic scoliosis spend most of their time in the sitting position. The spinal deformity, pelvic obliquity and uneven weight distribution on the seating surface necessitates frequent seating adaptations in the wheelchair. In this prospective study, 45 wheelchair-bound patients were evaluated preoperatively and 43 postoperatively. The pre- and postoperative evaluation was done by an independent observer. Surgical correction was performed between 1993 and 1996. Assessments included sitting balance on a box; number of seating supports in the wheelchair; weight distribution on the seating surface, measured with a computerized EMED system; Cobb angle; hip dislocation; mediolateral translation of T1 and of the apex vertebra with reference to a perpendicular line drawn upwards from the spinal process of S1; and pelvic obliquity from a line drawn between the most proximal points in the iliac crests. X-rays for the measurement of Cobb angle and pelvic obliquity were performed in sitting position. Reference values for normal weight distribution on the seating surface were obtained for 27 normal subjects and revealed a mean value of 59% of weight supported on one side. A stepwise regression analysis on the preoperative results showed that pelvic obliquity and thoracolumbar/lumbar spinal imbalance explained weight distribution on the seating surface (R2=0.45). There were significant improvements in all variables except in sitting balance and imbalance of T1, 1 year postoperatively. When dividing the material into two subgroups, the results showed no significant difference in any of the assessed parameters of the scoliosis, pelvic obliquity, or sitting position between individuals with even (50-59% on one side) and those with uneven (60-100% on one side) weight distribution postoperatively. The results of the assessment showed a significant improvement after surgical correction, but the majority still had pelvic obliquity and uneven weight distribution in a sitting position. The weight distribution on the seating surface preoperatively was explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity, with R2 = 0.45. There were no significant differences in any variables in comparisons between individuals with even weight distribution and those with uneven weight distribution. For the group with even weight distribution, however, the mean pelvic obliquity was 6° and in the group with uneven weight distribution the mean pelvic obliquity was 12°. Attention to seating surface and adjustment of seating position is needed for patients with paralytic scoliosis.

Place, publisher, year, edition, pages
2002. Vol. 11, no 2, 94-99 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13734DOI: 10.1007/s00586-001-0373-7OAI: oai:DiVA.org:liu-13734DiVA: diva2:21223
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2009-08-19
In thesis
1. Pre- and postoperative evaluation of function and activity in patients with paralytic scoliosis
Open this publication in new window or tab >>Pre- and postoperative evaluation of function and activity in patients with paralytic scoliosis
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis evaluates surgical correction in patients with paralytic scoliosis with emphasis on function and activity. The thesis includes four studies of 100 consecutive patients preoperatively evaluated and surgically corrected between 1992 and 1996 at Linköping University Hospital. Eighteen different diagnoses were represented. The postoperative follow-ups were at one year and in average seven years. Six patients dropped out during the first year and twelve during the long-term follow-up period. The assessments included general information, lung function, and measurements of radiographs, function and activity - seating posture, ADL, pain, care and need for rest. The patients or relatives view on the effects of surgery were evaluated in follow-up questionnaires.

The preoperative results of the 100 patients described a heterogeneous group in terms of function and activity. Even when the patients were grouped into subgroups according to the Scoliosis Research Society classification, they remained heterogeneous. In patients who could understand verbal instructions assessments that needed co-operation could be used and in those who could not understand verbal instructions, assessments relied more heavily on measures of function and level of dependence. Preoperative results of weight distribution on the seating surface were explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity R2=0.45 (n=45).

The one-year follow-up of 94 patients showed improvements in angle of scoliosis, sitting balance, weight distribution to the seating surface, seating supports in the wheelchair, time needed for rest. The results in subgroups were almost the same as in the whole group. The subjective results for patients or relatives in the follow-up questionnaire showed a positive outcome of surgery. In the comparison between the one-year follow-up and the long-term follow-up there were further improvements in sitting balance, ADL, and care given, but the angle of scoliosis was increased. These results were in line with patients’ and relatives’ assessments in the follow-up questionnaire and in the open-ended questions.

Due to the heterogeneity of patients with paralytic scoliosis, irrespective of disorder, it is important to focus on different subgroups with regards to the patients’ total situation. The surgically corrected and stabilised spine resulted in the strength to keep the body upright with improvements in function, activity and possibilities to belong in social activities. Further improvements were shown between the one-year follow-up and the long-term follow-up. It is recommended that patients who have been surgically corrected for paralytic scoliosis are followed for more than one year.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 59 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 748
Keyword
Activities of daily living, disability evaluation, paralysis, complications, physiopathology, scoliosis complications, etiology, physiopathology, surgery, posture, treatment outcome, wheelchairs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5236 (URN)91-7373-191-9 (ISBN)
Public defence
2002-11-01, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2012-01-25Bibliographically approved

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Larsson, Eva-LenaAaro, StigNormelli, HelenaÖberg, Birgitta

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Health, Activity, CareFaculty of Health SciencesOrthopaedics and Sports Medicine Department of Orthopaedics LinköpingDepartment of Clinical and Experimental MedicinePhysiotherapy
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