Protocol Template for RT Interventions
Title:
/ Schroth exercises for adolescents with scoliosis.Purpose(write the purpose from the client perspective, e.g., what is the client expected to gain from this intervention?): / By being part of this program, you will hopefully be able to see a degree change in the curve of your spine. The spinal curvature is predicted to change anywhere from two to five degrees, which can lead to a better quality of life. Improvement in the appearance of the spine, postural control, prevention of curve progression, decreased pain, and an increase in back endurance can also result from being part of this program. At the end of all the session you should be able to take what you learned and put the exercises into use, in the future when needed, if pain continues to be a major problem.
Brief Description (brief overview of the intervention): / The program works on all three planes of the spine, side-to-side, front to back and longitudinally. The goal of the exercises is to move the body in an opposite direction of the spine curvature and retrain the brain to accept the proper body alignment.Schroth exercises are standardized exercises, for the treatment of scoliosis. Exercises are individualized on a prescription basis, ensuring each patient is using the best exercises for them. Schroth exercise prescriptions are determined by curve type with specific exercises designed to target different aspects of the spinal curve, and different areas of the body, intensity of exercises are gradually increased based on patient capacity. Performance is evaluated using the proposed checklist, which asks if the participant’s job was adequate or not, if so the next exercise in the prescription is attempted; otherwise, the participant tries the easier exercise. Exercises are to be increased from gravity assisted postural shifts to dynamic postural shifts against gravity.
Staff
Requirements(how many staff with what qualifications; staff to client ratio): / Staffers who are leading the program must be a Schroth-certified therapist and must know how to use the prescription algorithms accurately, to ensure each patient is prescribed the best exercises for them. Staff will first meet 1:1 with participants, to teach them about the exercises they will be using throughout the program and about what the Schroth program and its benefits. When it comes to the weekly group sessions, the program should be run with at least two members of the staff. It has been successful to have one staffer running the program up front for everyone, and one staffer assisting the participants who may need additional help perform the movements.
Entrance Requirements(how are clients placed in this intervention; are there referrals?): / All participants must be between the ages of 10 to 18 years old to be eligible for enrollment in this program. Individuals must have a spinal curve ranging from 10 to 45 degrees in severity. If a patient wears or does not wear a back brace is not taken into consideration for this program since it will neither positively or negatively affect the progress. Although not much research has been done using these exercises after surgery, a few studies do indicate that it can be helpful in the long run, so participants can either have had the spinal correction surgery or not.
Exit
Requirements(under what conditions do clients complete the intervention goals or when are they discharged?): / Compliance in the program will be monitored with a logbook, which is kept by staff and clients. The staff's logbook will indicate if the exercise was performed with enough accuracy, to move on to the next task to keep a record of how far the client was able to go within the program. The client's logbook will be for their at-home sessions, where they will write down which exercises they did, for how long, and if they had any problems while doing them. Clients are required to attend each of the weekly sessions, failure to show at the weekly sessions will result in no longer be part of the program. Clients will also be required to do their daily at home exercises, at least five of the seven days throughout the week. Their logbook will be shown to the staff at the weekly sessions to demonstrate compliance with the home regiment. At the end of the six months, if the client has complied with all the requirements and if the staff agrees the patient will be discharged from the program.
Group Size(minimum and maximum): / The program will run with 15 people. The participants are determined by who needs the program most at this time. The group can be larger or smaller if necessary and if there are appropriate staff and resources to accommodate the change in number. Since each participant needs to go to individual sessions, before the group ones, smaller groups are more time efficient.
Duration(how many sessions for how long over how many weeks, or is it a one-time intervention): / This program is an ongoing treatment, over a matter of several months. This program will last for six months. This treatment has had the most success adhering to a six-month program since is enables the patients to learn more exercises. Participants will have five individual visits to learn the exercises, and about the program followed by weekly-supervised group sessions of one hour each, with daily home exercises prescribed specifically for them. Home workouts should last for a total of at least 45 minutes per day, for at least five days out of the week.
Safety Considerations(detailed safety information for client involvement/engagement): / It is extremely important to know which participants have had corrective surgery or not prior to this treatment program. The surgery often entails spinal fusion and or inserting metal into the spine, which can increase their pain. We do not want agitate the spine too much after surgery, or put the patient in harm by causing, even more, pain with the program. One should also keep in mind, the position of the curve; center curves are likely to get worse over time, so patients with this curve may be in more pain than others. Muscle spasms and uneven waists, are common problems that come with scoliosis and can cause problems and or pain, during this program, it is vital to keep this all in mind to ensure the safety of all involved and that the program is run to its best ability.
Facility and Equipment(describe specific facility and equipment requirements): / Not much is needed to run this program. This program will be done in in the rec/gym of a hospital. The majority of the exercises do not require any equipment; the few that do need equipment are simple items to find such as a ball that is both big enough and durable enough to support each participant’s weight. Another important piece of equipment is a wall bar, which is similar to an upright ladder that attaches to a wall allowing different levels for the patient to stretch to and grab on to for balance and various exercises.
Methods(detailed step-by-step procedures for client involvement in each session, including any warm-up or transition activity at beginning of each session, main learning content, closing or ending transitions. If multiple sessions are involved, explain the methods of each session): / Patients will first complete five initial individual visits to learn about the schroth program, and some of the exercises they will be using during this program. During one of the introductorymeetings, the patient will be evaluated. To be assessed, the patient will sit on a ball; this tests balance and posture. While sitting on the ball, look to see is the patient is leaning to one side or the other; this is also a good time to examine their spinal curve. The CTRS will also evaluate the patient by examiningthe shoulder alignment, hip alignment, and the degree of their curve. They will then follow up by doing 1-hour weekly-supervised group sessions before the course starts they will show the CTRS their logbook, and mention any problems or concerns that arose during the home sessions. The weekly sessions will consist of many exercises the four most used will be Pelvis Movement, Breathing, Bench Tilt, and muscle tension.
First we will work on pelvis position/movement. A properly aligned pelvis the starting point treatment, a misaligned pelvis results in an unnatural spine position that encourages spinal deterioration. Place a horizontal wall bar against a wall, at door top height and making sure it is securely fastened to a wall. Have the patient Stand with their left side against the bar and lift their left arm overhead to hold onto the bar, Keeping their right hand free. While having them breathe deeply, have them gently rotate their spinal column and pelvis in the opposite direction of your curvature. You have to assist them turn and make sure to do it slowly not all at one time. Have them hold this position for 10 seconds then slowly release their grip from the bar and return to the standing position. Relax 10 seconds. Repeat this exercise five times.
Breathing correctly plays an essential role in Schroth exercises. The correct breathing can lengthen and widen the rib area and can help fill the concave side, firm surrounding muscles, return twisted vertebrae to the proper position, reverse improper pelvic positioning and elongate the spine. Have the patient stand to face a wall bar. Have them lift both hands overhead and grab the top of the bar. Instruct them to breathe in deeply and hold three seconds while slowly going into a squatting position. As they slowly exhale instruct them to return to the original position (standing). Relax 10 seconds. Repeat this exercise three times.
Bench Tilt exercises lengthen the patient's neck and spine. Have the patient stand with their left side perpendicular to a chair, feet shoulder-width apart. The patient should hold onto the seat with their left hand. Have the patient Slowly tilt their body to the left, gently bending their elbow as you distribute weight between the left arm and leg. Have them place their right arm against their right side, having them lift their right foot off the floor and point their toe up. Instruct them to slowly raise their right arm out to the side to shoulder level and rotate their arm, so the palm faces upward. Gently place weight on their left arm, and have them straighten their elbow while raising their left shoulder. Have them gently tilt their neck to the left, which lengthens it. Make sure to Remind them to breathe deeply throughout this exercise. Hold this position for 10 seconds having them slowly return to the standing position. Relax 10 seconds. Repeat this exercise five times.
Lastly, the patient will Tense their trunk muscles isometrically, to strengthen weak muscles and preserve the corrected posture. Make sure to Remind them to breathe deeply throughout this exercise. Hold this position for 10 seconds having them slowly return to the standing position. Relax 10 seconds. Repeat this exercise five times.
Outcomes are recorded, at base- line, three and six months. The staff is also supposed to record sessions in a logbook they will indicate in the log if the patient properly did the exercises and if they should move on to the harder exercises or go back to the easier one.
Possible Client Objectives or Outcomes(what are the intended client outcomes from engaging in this intervention? What are they supposed to be able to do at the end): / At the end of the program, there are many things we should expect to see in the participants. The biggest change expected is a degree change in the curve of the spine. The degree is predicted to change anywhere from two to five degrees; more significant changes are expected with longer and more extensive treatment. Improvement in appearance, postural control, prevention of curve progression, and an increase in back endurance can also be seen with this program. Pain is another significant change expected and is expected to drop between .05 and three points on a pain scale At the end of all the session participants should be able to take what they learned and implement the exercises in the future if needed.
References(references relate to the intervention content, research or theoretical evidence for the use of this RT intervention): / Floman, Y., Burnei, G., Gavriliu, S., Anekstein, Y., Straticiuc, S., Tunyogi-Csapo, M. (2015). Surgical management of moderate adolescent idiopathic scoliosis with ApiFix®: a short peri- apical fixation followed by post-operative curve reduction with exercises. Scoliosis (17487161), 10(1), 1-6.
Hagit, B. (2013). A preliminary report on applying the Schroth method principle after surgical fusion for scoliosis in a 23-year-old female with adolescent idiopathic scoliosis: a case report. Scoliosis (17487161), 8(Suppl 2), O9-O10.
Kuru, T., Yeldan, İ., Dereli, E. E., Özdinçler, A. R., Dikici, F., & Çolak, İ. (2016). The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clinical Rehabilitation, 30(2), 181-190.
Negrini, A., Negrini, M. G., Donzelli, S., Romano, M., Zaina, F., & Negrini, S. (2015). Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study. Scoliosis (17487161), 10(1), 1-7.
Parent, E. C., Schreiber, S., Hedden, D., Moreau, M., Hill, D., & Watkins, E. (2013). The effect of a 6-month Schroth exercise program: a pilot study using subjects as their own controls. Scoliosis (17487161), 8(Suppl 2), O45-O46.
Schreiber, S., Parent, E. C., Hedden, D. M., Moreau, M., Hill, D., & Watkins, E. M. (2013). The effects of a 6-month Schroth intervention for Adolescent Idiopathic Scoliosis (AIS): preliminary analysis of an ongoing randomized controlled trial. Scoliosis (17487161), 8(Suppl 2), O44-O45.
Schreiber, S., Parent, E. C., Hedden, D. M., Watkins, E. M., Hill, D. L., Moreau, M., Mahood, J. K. (2013). Feasibility and three months preliminary results of an RCT on the effect of Schroth exercises in adolescent idiopathic scoliosis (AIS). Scoliosis (17487161), 8(Suppl 1), O21-O22.