The early detection of adolescent idiopathic scoliosis in three positions using the scoliometer and real time ultrasound: should the prone position also be used?

Abstract

The standing forward bending position is in general use for the early detection of adolescent idiopathic scoliosis. It also reveals humps caused by leg-length inequality and for this reason some workers have advocated using the sitting forward bending position. Most recently the prone position has been evaluated and even recommended. The introduction of B-mode and subsequently real-time ultrasound to measure rib rotation and spinal rotation has involved using the prone position. The numerical description of back humps in scientific studies requires measurements at several levels on the back from T1-S1. This paper utilizes 30 subjects referred by school screening for scoliosis from whom 10-level Scoliometer Angle of Trunk Inclinations (ATIs) were obtained twice in each of three positions--standing forward bending, sitting forward bending and prone. The ATIs were converted to 18 levels and (1) analysed for reproducibility, (2) compared in the three positions, and (3) compared with real-time ultrasound data of rib rotation obtained in the prone position. Several statistical methods are used. The reproducibility is best in the sitting and prone positions. While the prone position produces lower ATI readings, R squared values are significantly higher and Residual Mean Square (RMS) values significantly lower than those for each of the standing and sitting forward bending positions. Though the prone position has clear advantages, it is not advocated in clinical practice for various reasons. More research is needed. The evidence supports the view that the sitting forward bending position has advantages for the early detection of adolescent idiopathic scoliosis.

In this paper the relationship between academic load (the number of modules attempted) and academic performance is investigated in a Scottish and an Australian university. An engagement approach to academic integration is employed, in which there is feedback between load and performance, and in which there is scope for diminishing returns to the study of additional modules onceloads become high. The results indicate that full-time students reduced module load in response to information on academic performance. At the Scottish business school many non-traditional students had taken up opportunities to enter university under the UK government's drive to widenparticipation. In that school load reduction was undertaken at twice the rate of the Australian businessschool. For women, reductions from full-time loads by one or two modules appear rational in that better average marks result. There are indications that status as a widening participation entrant, the learning and assessment environment, the funding regime and rest-of-life demands have influences on load reduction and on academic performance.