All posts by CHOC Children's

CHOC offers Schroth Method physical therapy treatment for scoliosis

Two CHOC pediatric physical therapists, Ruchi Bagrodia and Adam Shilling, answer questions about the Schroth Method, a physical therapy treatment option for patients with idiopathic scoliosis. The non-invasive approach can improve symptoms and, in some cases, can even prevent the need for surgery. Bagrodia and Shilling are among a limited number of specialists in the nation who are certified in the Schroth Method.

Ruchi Bagrodia and Adam Shilling, Schroth Method-certified physical therapists at CHOC

What do you want referring physicians to know about the Schroth Method?

Schroth is a research-supported, conservative treatment method used for individuals with Adolescent Idiopathic Scoliosis. Treatment is provided by physical therapists who have completed a rigorous nine-day course and obtained a Schroth certification. The goals of Schroth treatment are to improve posture, prevent curve progression, decrease the likelihood for surgery, reduce pain, increase body awareness (proprioception) and strengthen the postural muscles.  

How does Schroth Method differ from traditional physical therapy? What are the benefits?

Traditional physical therapy can be helpful for improving trunk and core strength, range of motion and pain. However, it usually fails to address the three-dimensional changes of the trunk caused by an individual’s unique scoliosis.

With Schroth treatment, each person is guided through specific postural corrections to achieve the most optimal spinal position possible as well as strengthening exercises to maintain this posture during everyday activities. The benefits include improved postural alignment and awareness, a more balanced body position, decreased pain, improved efficiency of breathing and increased trunk and core strength.

Is the Schroth Method a new program?

The Schroth Method was first developed by Katherina Schroth in Germany in the 1920s. In 1968, the Barcelona Scoliosis Physical Therapy School was founded, which follows the original Schroth principles, providing three-dimensional treatment based on breathing and muscle activation. Since then, it has continued to gain attention worldwide due to successful, research-supported outcomes.

Are there certain types or degrees of scoliosis that the Schroth Method is effective for?

A wide range of patients benefit from the Schroth Method. At CHOC, we aim to help patients stop the progression of their curve and avoid surgery. Treatment can also be beneficial for those who have already had surgery to improve strength and body awareness. In addition to looking at curve severity, orthopaedic doctors and Schroth-certified physical therapists will consider the patient’s age and skeletal maturity, as these three factors help indicate likelihood of progression.

What does the Schroth Method entail? Is there a typical course of sessions patients can expect?

The treatment is designed and progressed based on an individual’s specific scoliosis. It involves facilitation techniques for elongation and de-rotation of the spine in different positions, as well as exercises aimed to increase proprioception (body awareness) and strength of postural muscles.

Sessions usually include a brief proprioceptive warm-up followed by postural exercises to promote elongation and de-rotation of the spine in specific areas. Next, the patient is challenged to maintain their newly achieved postural alignment during functional activities and everyday movements, such as getting up off the floor, standing from a chair or climbing stairs.

Most individuals would benefit from attending weekly Schroth Physical Therapy for up to 12 weeks and are also expected to perform a specific home exercise program at least five days per week to achieve best outcomes.

Can the Schroth Method be used in place of traditional physical therapy? Of other scoliosis treatment?

The Schroth Method is specific to treating scoliosis, and not all physical therapists are Schroth Certified. It involves specialized treatment sessions with a physical therapist and supports collaboration with a medical team including the orthopaedic doctor, orthotist and sometimes a psychologist. The Schroth Method is often used in conjunction with bracing when recommended by an orthopaedic doctor. In some cases, it can even prevent the need for spine surgery.

What are the outcomes of Schroth Method treatment? How does it differ from outcomes of other physical therapy methods for scoliosis?

The primary outcome measure for those seeking to avoid surgery is a decrease in Cobb Angle, which is measured on X-rays. Additional outcome measures include self-postural alignment, muscle strength and endurance, balance, shoulder range of motion, height, chest circumference, functional lung volume, pain management and quality of life.

Learn about referrals to CHOC's Orthopaedic Institute

Leprosy antibiotic is safe treatment for M. abscessus infections, CHOC infectious disease team finds

An oral antibiotic used to treat leprosy is safe and well-tolerated in the treatment of children with challenging-to-treat mycobacterium abscessus infections, the CHOC Children’s infectious disease team has found.

In their study, clofazimine was given to 27 patients during an outbreak of odontogenic mycobacterial infections as part of a multidrug regimen. Though clofazimine performed well in test-tube experiments against M. abscessus, reports in children were previously limited.

This group of patients represents the highest number of children to receive clofazimine outside of leprosy treatment settings.

The study findings were published in the July 2019 Journal of the Pediatric Infectious Disease Society. Its authors are CHOC infectious disease specialists Dr. Felice Adler-Shohet; Dr. Jasjit Singh; Dr. Delma Nieves; Dr. Negar Ashouri; and Dr. Antonio Arrieta; as well as Cathy Flores, a CHOC clinical research nurse coordinator, and Tuan Tran, an infectious disease pharmacist at CHOC.

The patients who received the antibiotic were among a large group of children who underwent pulpotomy procedures at a dental practice with a contaminated water system.

CHOC’s team added clofazimine to its original first-line medication regimen after receiving special use approval from the Food and Drug Administration.

An additional benefit of use of clofazimine was the ability to stop use of an intravenous antibiotic given thrice daily that prompted many side effects, the team found.

Learn how to refer a patient to CHOC Children’s infectious disease specialists.

Breastfeeding Roundup: resources to share with families

Breastfeeding offers extensive health benefits for moms and their babies, facilitates bonding and even has financial and environmental benefits. But with it comes challenges that—for some women—leads to an earlier end to breastfeeding than planned.

Below is a list of resources providers can share with breastfeeding patients to help ease worries and frustrations. These articles cover a range of concerns and provide helpful tips for both mom and baby.

Breastfeeding troubleshooting

The excitement of breastfeeding can quickly turn to frustration, discomfort or defeat if issues aren’t dealt with quickly. Encourage breastfeeding patients to get help from the experts, covered in this CHOC Children’s blog about lactation consultants and the CHOC Lactation Services team.

Spanish language breastfeeding resources

The CHOC Lactation Services team presents several useful flyers about breastfeeding for Spanish-speaking patients:

Breastfeeding and milk storage on-the-go

Managing milk when you are separated from your baby: a fact sheet for parents planning a little time away.

This piece from American Academy of Pediatrics (AAP) presents tips for an oft-dreaded scenario for new moms: nursing on an airplane. And with it comes another stressor, storing breast milk safely when flying.

For partners of breastfeeding women

AAP offers a fact sheet for partners of women who are breastfeeding.

What can others do to support a breastfeeding mom? Take a look at this CHOC Children’s blog for ideas.

Click here to learn more about Lactation Services at CHOC.

Four things pediatricians should know about juvenile arthritis

“Arthritis is something elderly people get,” is something Dr. Andrew Shulman, CHOC Children’s pediatric rheumatologist, has heard countless times. People are often surprised to learn that kids — even toddlers — can develop arthritis.

Joint pain can be a bit of a mystery to most people, especially when it comes to young children. With August being Juvenile Arthritis Awareness Month, we looked to Dr. Shulman to learn more about this and other common juvenile joint pain myths he finds most important for pediatricians to recognize and communicate with patients.

Myth 1: All joint pain is arthritis.

False. If joint pain is the primary symptom, chances are it is not arthritis. The most common initial symptoms of arthritis are persistent swelling, redness, stiffness and limited range of motion.

The type of joint pain that is associated with juvenile idiopathic arthritis (or JIA — formerly called juvenile rheumatoid arthritis) is pain in an articular location that is dull, throbbing or sharp and that improves throughout the day with movement. This pain is commonly exacerbated by prolonged sitting, naps and specific tasks, and improves with activity and non-steroidal anti-inflammatory drugs (NSAIDs). Sometimes skin redness is involved.

Myth 2: Arthritis is a precise diagnosis.

False. It is a symptom and a finding, much like a cough is not an official diagnosis. More testing is needed to determine whether or not joint pain is caused by a specific type of arthritis or another rheumatic condition, such as pain from overuse or a neuropathic disorder.

Myth 3: Arthritis is diagnosed with laboratory tests.

False. Labs can be used to characterize arthritis when it is present, but lab work can be totally normal in kids who do have arthritis. Using lab tests alone as a diagnostic tool can lead to a missed diagnosis.

Dr. Shulman urges pediatricians to keep in mind that routine lab work is more useful initially than specialized tests are. “A complete blood count (CBC) with differential, chemistry panel, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) tests present more information and are better initial screening tests than specialized tests such as antibody tests and complement studies,” he says.

Myth 4: Only elderly people get arthritis.

False. The incidence rate of JIA is one to 10 out of 10,000 per year, making it a more common condition among young people than cystic fibrosis, juvenile diabetes and muscular dystrophy combined.

Learn how to refer to a CHOC rheumatologist.

Talking to children after traumatic events: Six resources to share with families

Helping children cope through the aftermath of a traumatic event can be difficult.

Acts of mass violence bring up widespread worry, anxiety, uncertainty and trauma, and it can be overwhelming for parents to know where to start when talking to kids about it.

People often turn to healthcare providers for advice about the best ways to approach tough conversations with young people. The following is a list of helpful resources you can share with families about coping with the complicated feelings after a traumatic event.

Guidelines for helping youth after the recent shootings

This fact sheet by The National Child Traumatic Stress Network (NCTSN) offers guardians tips about helping children after an act of mass violence. It is presented in both English and Spanish versions.

For teens: coping after mass violence

Another NCTSN resource, this handout is tailored to parents of teens and includes information for adolescents on self-care after trauma.

American Psychological Association response to mass shootings in Texas, Ohio

American Psychological Association President Rosie Phillips Davis, PhD, offers an official statement, as well as a helpful list of resources, in the aftermath of mass gun violence.

How to help your child navigate the emotional aftermath of a traumatic event

This CHOC Children’s Blog post presents the five E’s, a clear series of steps parents and guardians can follow when talking to children, alongside a list of additional resources.

Talking to Children About Violence: Tips for Parents and Teachers

The National Association of School Psychologists offers points to emphasize when talking to kids of all ages about violence. Companion flyers are also offered in English, Spanish, Korean, Vietnamese, French, Amharic, Chinese, Portuguese, Somali, Arabic and Kurdish.

Should you talk to young children about tragic events?

This CHOC Children’s Blog post breaks down factors parents should consider before talking to their kid(s) about tragedy, including appropriate approaches by age group.