Neuromuscular Scoliosis

In general, it has been noted that the greater the neuromuscular abnormalities within an individual, the greater the likelihood and severity of scoliosis.

Incidence of scoliosis:

• 25% of Cerebral palsy (2 limbs involved)
• 40 % of Prader Willi syndrome
• 60% of girls with Rett syndrome
• 67% of Spinal muscle atrophy
• 60% of Myelopdysplasia (lower lumber)
• 80% of Cerebral palsy (4 limbs involved)
• 90% of males with Duchene Muscular Dystrophy
• 63 – 100 % of Friedreich’s Ataxia
• 100% of Myelopdysplasia (thoracic level)
• 100% of traumatic paralysis (<10years)

Neuromuscular scoliosis usually develops early in life and can progress rapidly through growth and in adulthood. Curve progression is especially rapid once the individual becomes non-ambulant (averaging 10° in Cobb angle/year) and usually curves extend to involve most of the thoracic and lumbar spine. Sustained mal-alignment may rapidly decrease the flexibility of the spine, affecting movement potential, rib mobility and lung function.

Non-operative treatments of neuromuscular scoliosis include bracing and physiotherapy. Bracing may be prescribed for curves.

As neuromuscular scoliosis tends to progress quite rapidly, often physiotherapy is aimed at halting or slowing down the progression rate with the view of delaying or avoiding surgery. In cases where surgery is decided upon/required, physiotherapy is often used as an interim measure to limit the consequences of the scoliosis such as impairment of rib cage mobility and respiratory function (which subsequently may benefit future surgical outcomes (Vaille & Mary, 2013) and to prevent/minimise the onset of associated contractures (Ferrai et al., 2010).

Flow on benefits of physiotherapy may extend to the individuals quality of life such as with improved balance, mobility, strength, posture, comfort and fatigue levels.

24 hour management of posture is a key focus of treatment. Management will depend on multiple factors such as severity of the scoliosis, skeletal maturity, pain and complexity of comorbidities. Thorough assessment is therefore vital.

Treatment may include:

• Stretching and manual facilitation towards better postural alignment
• Specific exercises to maintain movement/flexibility/strength
• Functional movement exercises
• Postural education
• Education regarding condition and needs
  Joint goal setting
• Management of neuromuscular scoliosis involves thorough knowledge and assessment of the presenting condition.