On Saturday the 13th August, 2016, Team #BACS was out to lend a voice to Cerebral Palsy at the Benola 4th National Cerebral Palsy Family Forum held in Lagos, Nigeria. (See Picture)
This brings us to share about this topic today. NEUROMUSCULAR SCOLIOSIS.
Having defined that scoliosis is an abnormal curvature of the spine, Neuromuscular scoliosis is that type of scoliosis that occurs in children with an underlying nerve/muscular condition. Such conditions may be:
- Cerebral Palsy
- Spina Bifida
- Muscular Dystrophy
- Paralysis from spinal cord injury
- Spinal Muscular Atrophy (SMA)
These types of neuromuscular conditions cause muscles to become weak, spastic or paralyzed—and unable to maintain appropriate balance/alignment of the spine and trunk, resulting in spinal curvatures.
Compared with idiopathic scoliosis, neuromuscular scoliosis is much more likely to produce curves that progress, and continue progressing into adulthood. (Curve progression and trunk imbalances are more severe in patients who are not able to walk).
- Children with neuromuscular scoliosis usually do not experience any pain from the condition.
- Most children with neuromuscular scoliosis have poor balance and poor coordination of their trunk, neck, and head.
- Neuromuscular scoliosis can lead to thoracic insufficiency syndrome [inability of the thorax (chest) to support normal breathing and lung growth].
- Seating problems
- Hygiene challenges
Because of the peculiarity of the condition, a multidisciplinary approach is needed in the treatment of neuromuscular scoliosis. The treatment team may include specialists in orthopaedics, pediatrics, pulmonology, neurology, urology, nutrition, and gastroenterology.
Treatment for NMS (neuromuscular scoliosis) will depend on your child’s age and underlying condition, as well as the type and severity of the spinal curve.
Although nonsurgical treatments will not prevent your child’s curve from progressing, they may delay the progression and help improve function and quality of life. Nonsurgical treatments include:
Wheelchair modification. This is the most commonly recommended nonsurgical treatment. If your child has a shifted pelvis that affects balance, his or her wheelchair can be modified to improve posture. These modifications may include custom-molded chair backings and adjustment of the side positioners to help improve balance while sitting.
Bracing. For some patients in wheelchairs, wearing a molded plastic brace around the upper body may be recommended to provide a more stable sitting position and allow for use of the arms and hands. However, bracing will not prevent the progression of NMS curves like it can in idiopathic scoliosis.
For NMS patients who are able to walk, wearing a brace may make them more likely to fall or lose their balance while walking — especially if they have significant muscle weakness, pulmonary problems, or an unsteady gait.
Physical therapy. Specific exercises may help to address your child’s muscular imbalances and improve physical functioning.
Because NMS results from an underlying neuromuscular condition, the underlying condition guides the treatment strategy. Your child’s treatment team will consider several things when determining whether to recommend surgery to control the spinal curve, including how severe the curve is and how much it affects your child’s function. The most common indications for surgery include:
- Curves greater than 50 degrees (in patients who are still growing)
- Curves greater than 50 degrees that have progressed more than 10 degrees (in patients who have reached skeletal maturity)
- Difficulty sitting and functional deterioration
- Problems with heart or lung function
The decision to proceed with surgery in the non-communicative patient is often very difficult and relies on the size of the spinal curve, the impact of the curve on sitting balance, and the care of the patient. Input from the family and/or caregiver is critical in this decision process.
However, at the national forum, the Founder of the Benola Cerebral Palsy initiative shared his experience- his son (who has cerebral palsy) underwent scoliosis surgery some years back. He shared the risks, struggles, and thankfully, eventual success. However, he advised that children with cerebral palsy should not opt for scoliosis surgery except it be very, extremely necessary.
*culled from internet research and some personal notes from author.