Adolescent idiopathic scoliosis (AIS) is the most encountered spinal deformity in growing children, which may bring significant impacts on patients’ physical function, appearance, and overall quality of life. A physiatrist plays a crucial role in the early diagnosis of AIS and longitudinal management through continuous care. Contemporary management for AIS is according to the skeletal maturity, the magnitude of the spinal curves, and the risk of progression. For mild curves, therapeutic exercises, particularly physiotherapeutic scoliosis-specific exercises (PSSE), are employed as a conservative approach to improve postural symmetry and reduce the risk of curve progression. Bracing is required for moderate curves from 25 to 45 degrees in skeletally immature cases. Strict compliance with bracing is critical for therapeutic success. In cases that are rapidly progressive or in severe curves exceeding 40 to 45 degrees, spinal fusion surgery is considered the definitive treatment. Recent advancements in non-fusion and motion-preserving techniques provide alternative options to traditional fusion surgery. To protect maximal neurological function, intraoperative neurophysiological monitoring (IONM) is currently the trend for spinal deformity correction surgery. The care for AIS patients is an individualized, multidisciplinary, patient-centered, growth-sensitive approach, aiming to optimize outcomes and minimize long-term complications. This review outlines a comprehensive rehabilitation-oriented strategy for AIS patients from the perspective of a physiatrist, encompassing clinical assessment, conservative management with observation, therapeutic exercises, bracing, and further considerations in referral to spinal surgery.

Objective
To quantify differences in fatigue and disordered sleep between adolescents with cerebral palsy (CP) and their typically developing peers. A secondary aim was to investigate the association between fatigue and disordered sleep in adolescents with CP.
Methods
A convenience sample of 36 youth with CP aged 10–18 years was matched for age and sex with 36 typically developing peers. The Fatigue Impact and Severity Self-Assessment (FISSA), the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue profile, and the Sleep Disturbance Scale for Children (SDSC) were collected.
Results
Higher fatigue was reported in participants with CP than in their typically developing peers based on the FISSA total score (mean paired difference=19.06; 99% confidence interval [CI], 6.06–32.1), the FISSA impact subscale (mean paired difference=11.19; 99% CI, 3.96–18.4), and the FISSA Management and Activity Modification subscale (mean paired difference=7.86; 99% CI, 1.1–14.6). There were no differences between groups in the PROMIS fatigue profile (mean paired difference=1.63; 99% CI, -1.57–4.83) or the SDSC total score (mean paired difference=2.71; 99% CI, -2.93–8.35).
Conclusion
Youth with CP experienced significantly more fatigue than their peers as assessed by a comprehensive measure that considered both general and diagnosis-specific concerns. Sleep did not differ between youth with CP and their typically developing peers. These findings underscore the need to consider the clinical management of fatigue across the lifespan of individuals with CP to prevent the associated deterioration of functional abilities.

Citations

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Objective
To determine the relation of Radiographic Scoring System and Scoliosis Research Society-22 (SRS-22), a revised form of health-related quality-of-life (HRQL) questionnaire in idiopathic adolescent scoliosis patients. Method: A patient group was made up of 41 adolescents who were diagnosed as idiopathic scoliosis. A control group of 17 persons with Cobb's angle ＜10^o was established. To evaluate psychosocial condition, SRS-22 was used to collect the data on both patient and control group. Roentgenographic study was conducted to obtain the Radiographic Deformity Score and evaluate the curve pattern. Results: Pain, self image/appearance, mental health and total score of SRS domains were found to be significantly different between patient and control group (p＜0.05). Radiog raphic Deformity Score was positively correlated with pain and self image of SRS domains (p＜0.05). However, the pattern of curve was found to be not correlated with SRS score. Conclusion: We could evaluate a psychologic condition of idiopathic adolescent scoliosis using Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. The more severe spinal deformity, it had the more negative influence on psychologic conditions in idiopathic adolescent scoliosis patients. Therefore, the clinician who is managing idiopathic adolescent scoliosis patients should consider their psychosocial conditions. (J Korean Acad Rehab Med 2004; 28: 259-264)