The effects of sitting modification and exercises for scoliosis treatments on coronal and sagittal balance of the spine and pelvic obliquity in nonambulatory patients with cerebral palsy and scoliosis: a randomized controlled clinical study

Objective: To determine and compare the efficacy of Sitting Modification (SM) and exercises for scoliosis (ES) treatments on coronal and sagittal balance of the spine, pelvic obliquity and hip subluxation in children between aged 6-15 years with Gross Motor Function Classification System (GMFCS) Level IV-V Cerebral Palsy (CP) and scoliosis. Patients and Methods: A prospective, randomized and controlled study included 29 patients with GMFCS level IV-V CP and scoliosis. The patients were randomly assigned to sitting modification with exercises for scoliosis (SM+ES) group and only exercises for scoliosis (ES) group. In two groups, exercise program was given at least 3 days/week, 1 set/day and 10 repeats in 1 set. The SM+SE group used sitting modification at least 4 hours/day which include a sitting elevation that corrected pelvic obliquity, a thoracal support unit that provides the alignment and control of the spine by pressing the convex side of the curvature with the pads and a hip block that prevent the hip sliding. The patients evaluated at baseline, the first month and third months of treatments. The primary outcome measures were Cobb angle, sagittal parameters of the spine and pelvis (lomber lordosis, thoracal kyphosis, sagittal vertebral axe, pelvic tilt, sacral slope, pelvic incidence) and pelvic obliquity evaluated by using Surgimap® software program. And also the secondary measures included Reimer's Migration Index, Sitting Assessment Scale, Level of Sitting Scale, postural asymmetry, Functional Indipendence Scale for Children (WeeFIM) and parental satisfaction. Results: The mean age of the children who completed the assessments was 10,24±2,72 years. Our results demonstrate that SM+ES treatment was found to be effective in slowing the progression of Cobb angle and hip subluxation, decreasing the angle of pelvic obliquity, correcting sagittal balance of the spine and pelvis, improving upper extremity functions and independence in daily living activities. SM+ES and ES treatments were both ineffective on Thoracal kyphosis, lomber lordosis, pelvic tilt and pelvic incidence angles, postural control and alignment. When the efficacy of two treatment approaches were compared, SM+ES treatment was found to be superior to SE in correcting the sagittal and coronal balance of the spine and pelvis, slowing the hip subluxation progression, improving hand function and increasing social communication. Conclusions: SM+ES treatment were effective on coronal and sagittal balance of the spine and pelvis. In addition to SM+ES approaches was superior to ES treatment in slowing progression of hip subluxation. Our study is important in terms of contributing to the literature because of the small amount of studies showing the effects of the sitting systems on the sagittal balance of the spine and pelvic oblity. Future studies with larger sample and longer follow up period are needed to demonstrate the importance of the sagittal control of thespine and correction of pelvic obliquity. Keywords: Cerebral Palsy, Cobb angle, Pelvic Obliquity, Sagittal Balance, Sitting Modification