Pediatric Scoliosis OMT Module

American College of Osteopathic Pediatricians

Robert Hostoffer, DO,FACOP, FAAP

edited by Eric Hegybeli, DO, FACOP

Background:

Andrew Taylor Still, was born in Virginia in 1828, the son of a Methodist minister and physician. At an early age, Still decided to follow in his father's footsteps as a physician. After studying medicine and serving an apprenticeship under his father, Still became a licensed M.D. in the state of Missouri. Later, in the early 1860's, he completed additional coursework at the College of Physicians and Surgeons in Kansas City, Missouri. He went on to serve as a surgeon in the Union Army during the Civil War.

Background:

After the Civil War and following the death of three of his children from spinal meningitis in 1864, Still concluded that the orthodox medical practices of his day were frequently ineffective, and sometimes harmful. He devoted the next ten years of his life to studying the human body and finding better ways to treat disease.

Background:

His research and clinical observations led him to believe that the musculoskeletal system played a vital role in health and disease and that the body contained all of the elements needed to maintain health, if properly stimulated. Still believed that by correcting problems in the body's structure, through the use of manual techniques now known as osteopathic manipulative treatment, the body's ability to function and to heal itself could be greatly improved. He also promoted the idea of preventive medicine and endorsed the philosophy that physicians should focus on treating the whole patient, rather than just the disease.

http://www.aacom.org/OM/history.html

Toddler and Children OMT

Classification of Scolosis

Nonstructural scoliosis – postural scoliosis – compensatory scoliosis

Transient Structural Scoliosis

– sciatic scoliosis – hysterical scoliosis> – inflammatory scoliosis

Structural Scolosis

– idiopathic (70 - 80 % of all cases) – congenital – neuromuscular

poliomyelitis cerebral palsy syringomyelia muscular dystrophy amyotonia congenita Friedreich's ataxia

– neurofibromatosis – mesenchymal disorders

Marfan's syndrome Morquio's syndrome rheumatoid arthritis osteogenesis imperfecta certain dwarves

– trauma fractures irradiation surgery

Types of Curves

Cobb’s Angle

Vertebral Maturation

Maturation of iliac crest

Osteopathic Considerations

Type II (non-neutral) mechanics occur at the transitional areas between the spinal curves

In scoliosis, flexed vertebral dysfunctions are typically found in the lumbar region; extended dysfunctions in the thoracic region

Scoliosis usually is not secondary to a short leg

Osteopathic Considerations - Treatment

*Infantile scoliosis can be treated fairly effectively by addressing the occiput (usually with cranial), cervicothoracic and sacroiliac areas

*Treatment of older patients is focused on mobilizing restricted areas with OMT, stretching tightened tissues on the convex side, strengthening weak muscles on the concave side and correcting posture

Shoulder Leveling

Demonstrate the procedure on patient in front of director

Scapular leveling

Demonstrate the procedure on patient in front of director

Pelvic Leveling

Demonstrate the procedure on patient in front of director

Spinal Inspection

Demonstrate the procedure on patient in front of director

Bending Test

Demonstrate the procedure on patient in front of director

Innervation TableInnervation TableOrgan/System Parasympathetic Sympathetic Ant.

Chapman'sPost.

Chapman's

EENT Cr Nerves (III, VII, IX, X)

T1-T4 T1-4, 2nd ICS

Suboccipital

Heart Vagus (CN X) T1-T4 T1-4 on L, T2-3

T3 sp process

Respiratory Vagus (CN X) T2-T7 3rd & 4th ICS T3-5 sp process

Esophagus Vagus (CN X) T2-T8 --- ---

Foregut Vagus (CN X) T5-T9 (Greater Splanchnic) --- ---

Stomach Vagus (CN X) T5-T9 (Greater Splanchnic) 5th-6th ICS on L

T6-7 on L

Liver Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 5 on R T5-6

Gallbladder Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 6 on R T6

Spleen Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 7 on L T7

Pancreas Vagus (CN X) T5-T9 (Greater Splanchnic), T9-T12 (Lesser Splanchnic)

Rib 7 on R T7

Midgut Vagus (CN X) Thoracic Splanchnics (Lesser)

--- ---

Small Intestine Vagus (CN X) T9-T11 (Lesser Splanchnic) Ribs 9-11 T8-10

Appendix    T12 Tip of 12th Rib

T11-12 on R

Hindgut Pelvic Splanchnics (S2-4)

Lumbar (Least) Splanchnics --- ---

Ascending Colon  Vagus (CN X) T9-T11 (Lesser Splanchnic) R Femur @ hip

T10-11

Transverse Colon  Vagus (CN X) T9-T11 (Lesser Splanchnic) Near Knees ---

Descending Colon Pelvic Splanchnic (S2-4)

Least Splanchnic L Femur @ hip

T12-L2

Colon & Rectum Pelvic Splanchnics (S2-4)

T8-L2 --- ---

Print out the answer sheet to use with the following questions.

Circle the correct answer and review with director:

Question1: A, B, C, D, E. Question2: A, B, C, D, E. Question3: A, B, C, D, E.

Question:

1. Inflammatory Scoliosis is considered a:

A. Transient scoliosis

B. Structural

C. Idiopathic

D. Neurogenic

E. NonStructural

2. All of the following are causes of structural scoliosis except:

A. Wedge vertabrae

B. Hemivertebrae

C. Congenital Bar

D. Block vertebra

E. Circular wedge

3. All are curves found in scoliosis except:

A. Thoracic curve

B Cervico/thoracic curve

C. Lumbar curve

D. Double major curve

E. Thoraco/lumbar curve

Certificate of Completion

I, _________________________, successfully completed the Pediatric OMT Module on __ __ 20__

Signatures: Pediatric Resident ____________________ Pediatric Residency Director____________

( Please print and give to program director.)

Congratulations