Biomechanical Study of the Schroth Exercise on Improving the Muscle Activities and Dynamic Balance Control in Adolescent Idiopathic Scoliosis

• Main Authors: Yi-Ju Lu, 陸奕儒
• Other Authors: Sai-Wei Yang
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/pkc7d9

碩士 === 國立陽明大學 === 生物醫學工程學系 === 106 === Scoliosis is a progressive illness that is divided into two major categories of non-idiopathic and idiopathic. According to the World Medical Association, about 5% of 11-18 years old teenagers suffer from scoliosis. The incidence of boys and girls is about 1:3, but the risk of adolescent girls worsens from 20 degrees to 40 degrees 7 times larger than boys. In Taiwan, about 3% of high school students (400/15,000) suffer from scoliosis, which is mainly girls. Researches have shown that the increase in the Cobb’s angle is most obvious in the fast growing period, and the chance of increasing the Cobb’s angle after the puberty is low. If the Cobb’s angle exceed over 50 degrees, the Cobb’s angle may continue to increase even the growing of height is stop. In addition to the appearance of the unsightly, due to the deformation of the bone and central and peripheral spinal nerve compression are likely to cause pain and muscle weakness. The larger Cobb’s angle with the bending and rotation of the thoracolumbar spine and the rib deformation of the chest compression that cause the heart and lungs and internal organs leading to autonomic nervous disorders such as breathing, cardiopulmonary, and even life-threatening. Some studies had shown that scoliosis patients excepted wearing a suitable brace for a long time, enhanced rehabilitation exercises such as Schroth exercise can reduce the Cobb's angle. Some studies had shown that most of the scoliosis patients only have little improvement in the Cobb's angle, but the muscle activation time is longer. However, there is no scientific experimental design, and the research of using motion control, dynamic posture control and muscle strength before and after the rehabilitation exercise. Therefore, this study used evaluation equipment including: Biodex constant velocity dynamometer, Myoton muscle tone measuring instrument, Delsys myoelectric signal meter, Vicon crossing-obstacle gait analysis and other equipment to explore the scoliosis patients before and after Schroth exercise. The differences in the isometric and Isokinetic joint torques, EMG activities, motion control, and dynamic posture control between scoliosis groups and normal groups were analyzed. Mann-Whitney U test two groups differences and Wilcoxon matched-paires Signed-Rank test the treatment of Schroth exercise and significant differences are set as 0.05. The study recruited 5 patients with Adolescent idiopathic scoliosis whose Cobb’s angle were between 17o to 45o and set as the exercise group (4 S type, 1 C type) and 9 healthy adolescents for the control group. The exercise group was specially trained by the same physical rehabilitation therapist in the Schroth exercise class, 60 minutes per week, for 12 weeks, and then introduced to the Yang-Ming University Rehabilitation Laboratory for evaluation. The pre-test to post-test period must be continued at home for at least 30 minutes of rehabilitation exercise per day. The results showed that the C type patient’s Cobb’s angle decreased from 26o to 18o, about 30% after the exercise time which was 30 minutes per day and 53 days (1590 minutes). The S type patients' exercise time were 600~6720 minutes, the average angle is 33.25o in the pre-test, and the post-test is 34.75o. It was nearly no improvement for S type patients. The result showed that the Inferior paraspinous muscle has a better improvement after Schroth exercise. In muscle power, the calf muscle power increased after Schroth method treatment, but had to notice the Scoliosis patient’s antagonistic muscle ratio of the ankle joint. It may cause the patients to get muscle injury. The trunk muscle power decreased to completed the isokinetic activity more easily and the trunk muscle strength increased significantly after Schroth method treatment. In dynamic postural balance control, regardless of the scoliosis patients trained by Schroth method or not, they were still weaker than the normal group. But the scoliosis patients who were trained by Schroth method are still greater than the scoliosis patients who aren’t. The comparison was categorized by the scoliosis type, namely C type and S type. In muscle power, the C type had better exercise treatments than the S type but the S type still had exercise treatment after Schroth exercise. In dynamic postural balance control, the 3D twisting of the musculoskeletal system of scoliosis might prompt the pelvis and trunk compensation and benefits dynamic postural balance control for the S type subjects. It was the reason which cause the S type had better dynamic postural balance control abilities than the C type, but the S type still worse than normal group. The C type had better exercise treatments than the S type but the S type still had exercise treatment after Schroth exercise. In our research we could find out if Cobb’s angle was not significantly improved, using muscle strength, muscle power and dynamic postural balance control to be the evaluation standard still had better effects in calf muscle、trunk muscle and dynamic postural balance control abilities after Schroth method treatment, especially for the C type scoliosis patients.