1	Scoliosis Screening in Schools Training for Health Workers and Volunteers
2	Overview Of Scoliosis Description of scoliosis Myths and facts about scoliosis Types of scoliosis Statistics for the U.S., Georgia and Atlanta area Consequences of untreated scoliosis Treatments for scoliosis
3	What Is Scoliosis?
4	Common Scoliosis Myths Scoliosis is similar to osteoporosis Book bag positions can cause scoliosis Bad posture (sleeping/standing) can cause scoliosis Back pain is an indicator for scoliosis One-sided sports can cause scoliosis A bad mattress can cause scoliosis Carrying heavy objects can cause scoliosis Minor lower limb length inequality can cause scoliosis
5	Scoliosis Facts Scoliosis usually occurs during adolescent growth Scoliosis runs in families Scoliosis affects one in 10 of the adolescent population Minor scoliosis affects girls and boys equally Scoliosis has few physical symptoms, but untreated scoliosis can lead to back pain in the adult Non-progressive curves less than 30 degrees tend not to cause problems
6	Types of Scoliosis Idiopathic: Structural spinal curvature, no established cause More than 80 percent of cases are idiopathic Congenital: Due to bony abnormalities of the spine present at birth Two types: hemivertebrae and non-segmentation Neuromuscular: Caused by a neurological disorder of the central nervous system
7	Most Common Forms 1. Right thoracic 2. Right thorocolumbar 3. Left lumbar 4. Double major-S curve
8	Right Thoracic Curve
9	Right Thorocolumbar Curve
10	Left Lumbar Curve
11	Double Major-S curve
12	Consequences of Untreated Scoliosis in the Adult Due To: Skeletal rigidity Healing capability Surgery complexity Treatment costs
13	Follow-up Protocol for Tertiary Screening 5 to 9 degree curve ® Observe in one year 10 to 14 degree curve ® Observe in six months 15 degrees or more ® Recommend for orthopaedic consultation, depending upon level of skeletal maturity
14	Scoliosis Treatments Observation: if the curve is relatively minor (less than 20 degrees) and the skeleton is close to maturity Brace: worn under the clothes and around the torso and hips, the brace helps hold the spine in place as it grows Surgery: in cases where the curve has progressed past 40 to 45 degrees, surgery may be necessary
15	Scoliosis Exam Issues Environment Privacy Embarrassment Comfort Possible abuse Other possible findings and issues
16	The Scoliosis Examination Your role as a screener The five-step scoliosis examination Helpful screening tips
17	Your Role as a Screener
18	The Five-step Scoliosis Examination Examine the student in the following positions: From the front in a standing position From the front bending toward you From the back in a standing position From the back bending away from you From the side in a bending position
19	Step 1: The Front View Look For: Shoulders level and same height Equal distance between the arm and torso on both sides Even hips
20	The Bending Technique
21	Step 2: Bending From the Front View Answer the following questions: Does one shoulder blade stick up more than the other? Is one side of the torso more rounded than the other? Is one hip higher and more pronounced than the other? Look for lumbar prominence.
22	Step 3: The Back View Look For: Shoulders to be level and the same height Distance between the arm and the torso to be equal on both sides Even hips
23	Step 4: The Bending Away View Look For: Rib prominence Lumbar prominence
24	Step 5: The Side View Look For: Kyphosis: excessive roundness of the back
25	Kyphosis Greater than normal front to back curve A posterior angulation of the spine as evaluated from a side view
26	Lordosis Excessive swayback An anterior angulation of the spine in the sagittal plane Must be careful when diagnosing African-Americans
27	Physical Findings of Scoliosis Examination Shoulder elevation Rib prominence Shoulder/scapular prominence Lumbar prominence Lumbar crease anomalies Long left thorocolumbar curve Pelvic height anomalies Kyphosis Lordosis
28	Shoulder Elevation Most common cause of a false positive diagnosis Must see high thoracic prominence Must have the student bend slowly to observe a high thoracic curve Uneven shoulders can be caused by leg length inequality in an otherwise healthy student
29	Physical Findings Rib Prominence Always refer, unless rib prominence is minimal Can appear in patient with leg length inequality Shoulder/Scapular Prominence Should have a definite rib prominence Can appear in patient with leg length inequality
30	Physical Findings Lumbar Prominence Always refer, unless lumbar prominence is minimal Can appear in patient with leg length inequality Lumbar Crease Flattened Should have a definite lumbar prominence Does appear in patient with leg length inequality
31	Long Left Thorocolumbar Prominence Always needs to be referred Possible indicator of neurological scoliosis, which may include spinal cord tumor
32	Pelvic Height Anomalies Three-quarters of inch or less is acceptable Appears in patients with leg length inequality
33	The Screening Process Volunteering Scheduling Coordinating with teachers Selecting screening areas Making advanced notices Informing students Documenting results Making written referrals Recommending follow-ups
34	Volunteers Essential to successful scoliosis screening Your caring and commitment Proper training Contributing yearly adds to continual training
35	Scheduling Exam Plans Cause as little disruption to school and student schedules as possible Minimize disturbances in the exam area
36	Coordinating with Teachers Teachers need to know the impact of the screening on their students and schedules Inform teachers of any responsibilities they will have during the screening
37	Selecting Screening Areas Your screening area should be: Private Size-dependable Well-lit Have stable, even ground
38	Making Advanced Notices Georgia state law requires: Informing parents at least 10 days prior to exams Letter sent home to parents
39	Informing Students Georgia state law requires: Announce scoliosis screenings at least two to three days prior to exam date Informing students and parents of proper attire Show the Scoli-What? video to students
40	Documenting Results Georgia state law requires proper documentation: Use the screening forms provided Good data helps refine and improve the screening process for the future
41	Making Referrals If you identify a child as positive for scoliosis: Ask medical personnel at screening to re-examine student Final referral decision is the responsibility of medical personnel at screening If needed, inform parents that further evaluation is needed by a tertiary clinic or primary care provider
42	Recommending Follow-ups Medical personnel are responsible for follow-up notification of parents and students Follow-up contact essential: Phone calls Letters Personal contact