Assessment of neurodynamic and hydrodynamic components of somatic dysfunctions of the axial regions of the body in children with scoliosis of various localization

Abstract

Introduction. Scoliotic disease in children is a very common pathology, and adolescent idiopathic scoliosis predominates among it. For planning treatment and assessing its results, functional disorders that accompany scoliotic deformity, including somatic dysfunctions (SD) identified by osteopaths, may be of interest. Regional biomechanical disorders in patients with scoliosis have been studied previously. The most frequently detected diabetes in children with scoliosis was diabetes in the axial regions of the body. According to a number of authors, in some cases, practicing osteopaths underestimate other components of somatic dysfunction, «getting carried away» in treatment only with biomechanical disorders, and this can affect the effectiveness of treatment. This issue undoubtedly requires study and analysis.The aim – to study the features of the neurodynamic and hydrodynamic (rhythmogenic) components of somatic dysfunctions of the axial regions of the body in children with scoliosis of various localizations.Materials and methods. A cross-sectional continuous study was conducted on the basis of the State Budgetary Educational Institution Rehabilitation and Educational Center № 76 of the Department of Labor and Social Protection of the City of Moscow from January to December 2022. 100 children were examined, aged from 12 to 18 years (median 15 years, mean age 15,2+1,5 years), of which 64 were girls and 36 boys. Inclusion criteria: juvenile scoliosis of I–III degree (according to the Cobb method), incomplete skeletal growth according to the Risser test, body mass index no more than 25, absence of pathology of the cardiovascular and respiratory systems in the stage of decompensation, absence of diseases of the nervous system. All patients underwent X-ray examination of the spine in frontal and lateral projections to verify the diagnosis. The Cobb angle was measured and the presence of one or more scoliotic curves was determined. To study the conduction of the respiratory rhythmic impulse (RII) and, to some extent, the active mobility of the main axial regions (thoracic, lumbar and pelvic) in a standing position, the patient took the deepest breath possible with the part on which his palm is located. To assess the neurodynamic component of SD in the above axial regions, a special test was carried out for the coordination of conjugal movements when walking – a test for assessing motor synergies of the pelvis, shoulder girdle and neck. The severity of violations was assessed in points from 1 to 3.Results. The results of a study of active conjugate movements (synergies) in a walking test for the purpose of analyzing the neurodynamic component of DS showed that there are no statistically significant correlations of signs for all localizations of scoliosis. However, it is clear that with cervicothoracic/upper thoracic localization of scoliosis, violations of counterrotation of the eyes and head were most often detected. Disturbances of counterrotation of the head and shoulders were least often detected in lumbar scoliosis, disturbances of counterrotation of the shoulder and pelvic girdles – in cervicothoracic / upper thoracic localization of scoliosis. Impaired performance of DRI and active mobility was most often detected in the region of localization of scoliotic deformity. Impaired mobility of the pelvic region was detected in more than half of the subjects, and most often in children with scoliosis in the lumbar region, but there were no statistically significant differences between the groups. The severity of mobility impairments was assessed in points from 0 to 3, and then the sum of points was calculated for all examined regions for each subject. The correlation between the severity of scoliosis and the total score of impaired mobility of the axial regions is r=0,38, p<0,05.Conclusion. The test proposed by the authors for assessing the neurodynamic and rhythmogenic components of regional somatic dysfunction not only showed its informative value, but also made it possible to identify individual patterns of the combination of organic and functional disorders in patients with scoliosis. At the same time, the data obtained are not enough to recommend the use of these diagnostic tests to develop a treatment strategy for patients. Further research should be aimed at studying the active mobility of the axial regions over time during treatment.