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The five King’s classifications of scoliotic curve [3], illustrated from T1 to L5. a) Classification 1: Double curve of the thoracic and lumbar spine. b) Classificiation 2: Double curve of the thoracic and the lumbar spine with less prominent lumbar curvature. c)  Classification 3: Single primary thoracic curve. d) Classification 4: Long thoracic curve. e) Classification 5: Double thoracic curve. Illustrated using OpenSim [33].

The five King’s classifications of scoliotic curve [3], illustrated from T1 to L5. a) Classification 1: Double curve of the thoracic and lumbar spine. b) Classificiation 2: Double curve of the thoracic and the lumbar spine with less prominent lumbar curvature. c)  Classification 3: Single primary thoracic curve. d) Classification 4: Long thoracic curve. e) Classification 5: Double thoracic curve. Illustrated using OpenSim [33].

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This study uses biomechanical modelling and computational optimization to investigate muscle activation in combination with applied external forces as a treatment for scoliosis. Bracing, which incorporates applied external forces, is the most popular non surgical treatment for scoliosis. Non surgical treatments which make use of muscle activation i...

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... presence of scoliosis is typically defined for Cobb angles greater than 10 degrees. The scoliotic curve may be classified using the widely accepted King's classification scheme which classifies curves into one of five categories, based on the location and shape of the curve on the spine [2], Figure 1. Scoliosis can be treated both surgically and non-surgically. ...

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... The PSSE SRB model is distinguished from other methods by its early intervention (this is the reason why the study group includes children aged 6-9) [42], passive-active correction of scoliosis on the GraviSpine device [43], and the use of neurostimulation massage according to the concept of reflex balance. Inhibiting the development of scoliosis at an early stage by affecting the factors predisposing to its progression [44,45] allows us to achieve other important goals, such as improving neuromotor control, respiratory function, and stability of the joints of the limbs and spine, in order to improve the quality of life in adulthood [7,15,[44][45][46]. ...
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Objectives: Conservative treatment of idiopathic scoliosis is more effective as a result of early diagnosis in conjunction with the use of specific physiotherapy and bracing techniques. Our aim was to investigate the effectiveness of specific physiotherapy developed according to the concept of spinal reflex balance using the GraviSpine device. This study is a retrospective analysis of prospectively collected data. Methods: A total of 199 patients aged 6–17 years, with a mean age of 11.26 ± 3.35 years, including 168 girls (84.4%) and 31 boys (15.6%), out of a total of 830 patients treated for IS at the Scoliosis Treatment Center in 2014–2019 were included in the assessment, which was conducted according to the inclusion and exclusion criteria. The study group was divided into three age groups. Group A subjects were 6–9 years old; group B, 10–12 years old; and group C, 13–17 years old. The mean follow-up time was 28.71 ± 10.98 months. Treatment outcomes were compared, based on changes in the Cobb angle and the angle of trunk rotation before and after treatment, both within the groups and with respect to sex and curvature location, using the Wilcoxon signed-rank test. Cobb angle changes in patients were classified as improvements, stabilizations, or deteriorations according to the SOSORT criteria. Results: A majority of patients improved or stabilized after treatment, with 67%, 71%, and 90% of subjects in groups A, B, and C, respectively, achieving these results. In group C (the oldest children), a statistically significant reduction of −1.84° ± 6.88° (6.31%) in the mean Cobb angle was achieved after treatment. With regard to sex, improvements and stabilizations accounted for 81% of cases in girls and 61% in boys, respectively. With respect to location, statistically significant reductions in the Cobb angle were noted for thoracic and thoracolumbar spines of −2.2° ± 7.54° (10.17%) p = 0.022 and −2.2° ± 6.58° (6.36%) p = 0.049, respectively. A significant reduction in the mean angle of trunk rotation was obtained in the group and in three curvature locations. Conclusions: Based on the presented research findings, the utilization of the GraviSpine device as an adjunct to specific PSSE (physiotherapeutic scoliosis-specific exercises) physiotherapy and bracing in the management of pediatric patients with mild to moderate scoliosis appears to enhance treatment efficacy.
... These findings have valuable implications for spinal health issues in the elderly population. Hence, we propose targeted neuromuscular electrical stimulation therapy for the patient's back muscles, involving the personalized adjustment of stimulation parameters and electrode placement (35). This intervention aims to enhance muscle strength and prevent muscle atrophy with the ultimate goal of effectively promoting functional recovery and improving the quality of life of individuals with DLS. ...
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Background The degeneration and functional decline of paravertebral muscles (PVMs) are reported to be closely linked to the incidence of degenerative lumbar scoliosis (DLS), a spinal deformity of the mature skeleton. However, the functional role and degeneration of PVMs and their relationship to the development of spinal deformities remain controversial. Therefore, the present study analyzed the morphological changes in the PVMs of patients with DLS, and explored the relationship between PVM degeneration and spinal osseous parameters. Methods In this retrospective case-control study, we evaluated the PVM parameters of patients with DLS (n=120) and compared them with patients free of DLS (control group, n=120). The cross-sectional area (CSA) and computed tomography (CT) values of the PVM at the lumbar vertebra 1–5 levels were measured. Further, the lumbar scoliosis Cobb, lumbar lordotic, and apical vertebral rotation angles were measured on CT and radiographs in the DLS group, and the relationship between PVM changes and these factors was analyzed. Results In the control group, the PVM CSA and CT values differed insignificantly between the bilateral sides at all levels (P>0.05). In the DLS group, the CSAs of the multifidus (MF) and erector spinae (ES) were larger on the convex side than the concave side (P>0.05), whereas that of the psoas major (PM) was smaller on the convex side than the concave side (P<0.05). The CT value of the PVM was lower on the convex side at all levels (P<0.05). The CSA and CT values on both sides of the patients were lower in the DLS group than the control group at all levels (P<0.05). Further, the degree of PVM asymmetry at the apical vertebral level was positively correlated with the lumbar scoliosis (P<0.01) and apical vertebral rotation angles (P<0.05), but negatively correlated with the lumbar lordotic angle (P<0.05). Conclusions Asymmetric degeneration of the PVM was observed bilaterally in DLS patients, and the degeneration was more pronounced on the concave side than the convex side. This asymmetrical degeneration was closely associated with the severity of lumbar scoliosis, vertebral rotation, and loss of lumbar lordosis, and a stronger correlation was observed with the MF and ES than with the PM.
... They had normal or healthy weight according to Centers for Disease Control and Prevention (CDC) growth charts for girls which ranged from Body mass index (BMI) for age 85th to 95th percentiles [24]. According to the widely accepted King's classification method, the scoliotic curve was a classification 3 (single primary thoracic curve) [10]. The degree of scoliosis (lateral spine deviation) ranged between 15° and 24°, as determined by the Cobb´s angle, via the use of a plane X ray, from the standing position (stress Xray). ...
Article
Background. Adolescent idiopathic scoliosis (AIS) is a complicated 3D structural spine condition occurring in children aged 10 to skeletal maturity. The study aimed to examine the impact of muscle energy technique and/or myofascial release on adolescent idiopathic scoliosis for large sample. Also, it aimed to compare the muscle energy techniques versus myofascial release on idiopathic scoliosis. Methods. A total of 50 girls with idiopathic non-bony structural scoliosis of the thoracic spine were included in this trial. They were randomly divided into two equal-sized (n = 25 for each group). For three months, group A (Muscle energy technique Group), which received Scientific Exercises Approach to Scoliosis exercises in addition to Muscle energy technique; and group B (Myofascial release Group), which received the same Scientific Exercises Approach to Scoliosis exercises conducted to group A in addition to myofascial release. The primary outcome was a standing radiological evaluation of coronal Cobb´s angle. Results. According to this study's findings, a highly significant difference was discovered in the mean values of Cobb´s angle between pre and post-treatment in muscle energy technique group. When the mean values of Cobb´s angle was compared before and after treatment for myofascial release group, it was reveals a significant change. Conclusions. After treatment for three months, both groups improved significantly, with muscle energy technique group outperforming the myofascial release group by a large margin. So, muscle energy technique was more effective than myofascial release in reducing the abnormal thoracic curvature in adolescent idiopathic scoliosis. Trial registration. The study was registered with Clinicaltrials.gov under the identifier NCT05120089.
... With the aim of strengthening back muscles, transcutaneous electrical nerve stimulation (TENS) has been explored as a potential treatment for scoliosis. While some studies have dismissed electrical stimulation as a viable treatment for scoliosis [42], others have suggested its potential to induce muscle contraction and improve back asymmetry in subjects with scoliosis [21]. Additionally, it has been proposed that TENS can excite muscle spindles or Golgi tendon organs to induce proprioceptive illusions, similar to the approach of mechanical vibration [43]. ...
Article
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Adolescent idiopathic scoliosis (AIS) is a lateral, rotated curvature of the spine. It is a 3-dimensional deformity that arises in otherwise healthy children at or around puberty. AIS is the most common form of scoliosis in the pediatric population. The etiology is multifactorial, including genetic and environmental factors. The incidence is roughly equal between males and females, while there is a higher risk of progression in females. Guidelines for AIS treatment identify three levels of treatment: observation, physiotherapy scoliosis-specific exercises, and braces. In this paper, we carried out a review of the scientific literature about the indication and success rates of the braces provided for free by the National Health Service in Italy (SSN). Despite a general consensus on the efficacy of rigid bracing treatment and its use in AIS, an important heterogeneity about the treatment is present in the scientific literature, demonstrating a high degree of variability. The overall success rate of the braces provided by the SSN is high, suggesting an important therapeutic role in the treatment of AIS. Robust guidelines are needed to ensure uniform and effective treatments.
... Paraspinal muscle stimulation has been proven that it is effective in reducing small spinal curvatures Pan et al. Clinical Biomechanics xxx (xxxx) 105763 (Cobb angle<20°) in the previous study (Curtin and Lowery, 2014;Oliva-Pascual-Vaca et al., 2014). It indicates that the mechanical asymmetry can serve as potential guidance for muscle stimulation treatment in the condition of mild curvature and coronal decompensation after spinal surgery. ...
Article
Background We sought to assess the elasticity change of the paravertebral fascia and muscle in adolescent idiopathic scoliosis patients with Lenke Type 1, 2, or 3 curves after posterior selective fusion surgery. Methods The shear wave elasticity imaging system was used to assess the elasticity of the thoracic paravertebral muscles and fascia both on the concave and convex sides. Three regions of interest, including the apex, upper end, and lower end of the main curve, were tested. Findings Ten female patients, with an average age of 16.6 ± 2.7 years old, were included. The average post-operation follow-up period was 9.0 ± 2.4 months. The Cobb angle was significantly corrected from 63.6 ± 12.0° to 10.7 ± 5.4 degrees (p < 0.05). The length of the trunk increased from 40.4 ± 2.5 cm to 46.0 ± 2.8 (p < 0.05). The elasticity of deep fascia didn't show a significant change post-operation (p > 0.05). The elasticity of the paravertebral muscle on the concave side had a significant increase at the final follow-up (p < 0.05). The elasticity of the paravertebral muscle on the convex side also increased at the upper end (p < 0.05). The elasticity asymmetry of the deep fascia decreased, but the elasticity asymmetry of the paravertebral muscle increased at the upper end of the curve (p < 0.05). Interpretation The paravertebral muscle on the concave side is stiffer after surgery. Elastic asymmetry of paravertebral muscle increased and elastic asymmetry of the deep fascia decreased at the upper end of the curvature. Further study is needed to elucidate the mechanism by which the paravertebral soft tissue responds after surgery.
... Several studies have reported development of scoliosis after latissimus dorsi muscle harvest and have mentioned concerns about the risk of spinal instability, particularly in pediatric patients, but without concrete evidence. [5][6][7][8][9] Few studies have investigated the potential association of latissimus dorsi muscle harvest with postoperative spinal posture. We hypothesized that the harvest of unilateral latissimus dorsi muscle would be associated with changes in spinal posture and subsequent development of scoliosis in the long term. ...
... The potential association between latissimus dorsi muscle function and scoliosis has been commented on frequently. [5][6][7][8][9] The latissimus dorsi muscle has been suggested as one of the main muscles that could affect the severity of scoliosis in patients with preexisting lesions. The findings of our study provide evidence for this long-standing, but still unproven, concern. ...
Article
Background: The latissimus dorsi (LD) muscle originates from the lower thoracic spine with broad attachment and plays a subsidiary role in spinal postural stability. We investigated whether harvesting unilateral LD muscle for breast reconstruction could influence spinal posture in the long-term. Methods: Patients who underwent immediate unilateral breast reconstruction between 2002 and 2010 were reviewed. They were grouped according to reconstruction methods: LD muscle flap and tissue expander/implant. The Cobb angle was assessed twice at each of five different time points (preoperative/postoperative 2, 4, 6, and 8 years) by an independent physician blinded to the reconstruction modality. Postoperative scoliosis was defined as a mean Cobb angle >10° at 8 years postoperatively. The trends of changes in Cobb angle over time and the rate of postoperative scoliosis were compared between reconstruction methods. Results: In total, 153 women were analyzed, including 102 using LD muscle flap and 51 using tissue expander/implant, with a median follow-up of 103.0 months. The LD flap group showed enhanced trends of increasing postoperative Cobb angles as compared with the tissue expander/implant group, and the difference remained significant after adjusting for other variables (p = 0.001). The rate of postoperative scoliosis was significantly higher in the LD flap group than in the control group (p = 0.029). Multivariable analyses revealed that use of the LD flap was associated with a significantly increased rate of postoperative scoliosis. Conclusions: Unilateral LD muscle flap harvest for breast reconstruction might be associated with changes of spinal posture in the long run.
... According to [27,28,29], the two radial muscles FCR and ECR have similar biophysical properties, as well as the two ulnar muscles FCU and ECU, that is, G fcr (z) ≈ G ecr (z), G fcu (z) ≈ G ecu (z). Therefore, we denote the linear contraction dynamics of radius muscles FCR/ECR and ulnar muscles FCU/ECU as G LCD1 (z) and G LCD2 (z) respectively. ...
Article
Wrist motion is produced by a group of muscles acting in a coordinated way. However, existing functional electrical stimulation (FES)-based wrist tremor suppression methods just stimulate one pair of muscles, which can limit the tremor suppression performance and cause muscle fatigue. To address these problems, this article proposes a multimuscle FES-based wrist tremor suppression method by fully considering the properties of wrist motion. First, with the consideration of the mainly involved two pairs of muscles in wrist flexion and extension motion, a multimuscle wrist musculoskeletal model with a Hammerstein structure is developed, and the parameters are identified. Then, a feedback repetitive controller combined with a feedforward linearization controller is proposed for tremor suppression. A frequency-modified inverse repetitive control algorithm and a gradient-based repetitive control algorithm are put forward to regulate the FES level properly. Finally, experiments on both unimpaired subjects and intention tremor patients verify that compared to the existing single-muscle-pair FES-based methods, the proposed methods can substantially improve the performance of tremor suppression and effectively reduce the level of electrical stimulation significantly, thereby reducing muscle fatigue.
... Noting that similar muscle groups have similar linear contraction dynamics [31], we assume that wrist flexor and extensor have similar biophysical properties, that is, G fcr (z) ≈ G ecr (z), which is denoted as G L (z). The rigid body dynamics G RBD (z) is commonly considered to exhibit linear stiffness and damping [32], [33]. The equivalent linear musculoskeletal model can be obtained as following ...
... The relationship among error e(k), reference r(k) and the disturbance d(k) can be written as e(k) = 1 1 + P (z)C(z) r(k) − P (z) 1 + P (z)C(z) d(k). (32) Substituting (8) into (32), the characteristic polynomial of the closed-loop control system is given below, ...
Article
Intention tremor refers to the rhythmic and involuntary contraction and relaxation of muscles with movement toward a target, which is a common sequela of multiple sclerosis and usually occurs in the distal joints of the upper limb. Functional electrical stimulation (FES) is feasible for tremor suppression because of its fewer side effects, low cost, and portability. Most existing FES-based design methods assume that tremor is a single-frequency signal, though it is multifrequency in reality. The idealized simplification will limit the performance of tremor suppression. To address the problem, this article proposes an FES-based multiperiodic repetitive control (MP-RC) scheme to suppress multiple frequency wrist tremors. First, a nonlinear wrist musculoskeletal model with a Hammerstein structure is established. Then, a control strategy combining the model inverse linearization control and MP-RC is proposed for tremor suppression. A frequency-modified inverse RC algorithm and a gradient-based RC algorithm are developed to regulate the FES level. Finally, comparative experiments on four unimpaired participants and an intention tremor patient are conducted to validate the effectiveness of the proposed control schemes. Experimental results show that the MP-RC scheme can suppress tremors by up to 90.52%. Compared with the traditional filter-based feedback controller and the single-periodic repetitive controller, the proposed multiperiodic repetitive controller can achieve an average of 26% and 16% improvement, respectively, in tremor suppression, demonstrating the advantages of the proposed design.
... Electrical paraspinal muscle stimulation has been proven in previous studies that it is effective in reducing spinal curvatures with smaller Cobb angles (< 20°). However, if the Cobb angle in case is larger than 20°, paraspinal muscle stimulation alone would not be effective (Curtin and Lowery, 2014). The results of muscle activation treatment are consistent with previously published (Oliva-Pascual-Vaca et al., 2014) and this current biomechanical studies revealing that paraspinal muscle stiffness do not differ from concave and convex sides in idiopathic scoliosis patients with smaller Cobb angle (11.53°on average), but significant differences can be found in patients with larger curves (66.49°on average). ...
Article
Background: We sought to assess the biomechanical properties of the paravertebral muscles in adolescent idiopathic scoliosis patients with Lenke Type 1, 2, or 3 (Lenke 1-3) curves. Methods: The MyotonPro® and shear wave elasticity imaging system were used to assess the biomechanical features of the thoracic paravertebral muscles on concave and convex side in adolescent idiopathic scoliosis patients with Lenke 1-3 curves. The Cobb angle of the main curve was measured using the anteroposterior whole spine radiograph in the standing position. Findings: A total of 40 adolescent idiopathic scoliosis patients with a mean Cobb angle of 66.49° (SD 32.8°) were included in this study. Muscle tone, stiffness and Deborah number on the concave side was significantly greater than that on the convex side. Relaxation time was significantly longer on the convex side than on the concave side. No statistically significant difference in muscle elasticity was observed between the concave side and the convex side (P > 0.05). Pearson correlation analysis demonstrated that stiffness on the concave side was moderately positively correlated with the Cobb angle (P < 0.05, r = 0.582); the Deborah number on both sides and the relaxation time on the concave side showed a moderate negative correlation with the Cobb angle (P < 0.05, r = -0.632; r = -0.432; r = -0.611). Interpretation: Concave paravertebral muscle tone and stiffness were greater than those on convex side in adolescent idiopathic scoliosis patients. The asymmetric biomechanical characteristics of paravertebral muscles are closely related to the severity of scoliosis.
... On the other hand, the methodology proposed in this study and the corresponding findings can be used for other studies and applications. For example, in the biomechanical modeling of scoliosis correction with externally applied forces [26] , the verification of the curvature variation is essential for the evaluation of the treatment and its effect. Considering that the Cobb method may result in errors greater than 10 ° [1,2,5,19,22] , its use may not to be a good solution. ...