Introduction in the ISST – Concept

ISST – Training Institute

The ISST-Training Institute was founded in 2016 by Axel Hennes and makes great efforts to provide adequate solutions for continued vocational training for relevant professional groups for conservative scoliosis treatment especially physical therapists and orthopedic technicians (in cooperation with Human Study).
The institute offers international training courses worldwide in more than 20 countries in the English language or translated in the local language.

Basic elements of ISST training according Asklepios – Katharina Schroth

Information

Scoliosis patients need to have information about the disease to help themselves to develop pro-active coping strategies. Such information should include a calculation of the risk of progression even when it is difficult to assess accurately the risk of progression for immature children with scoliosis <25°Cobb.
To interrupt the circular process of scoliosis progression, the main therapeutic aspect is to reduce the asymmetric loading on the spine and its effects for the body statics and the postural and structural adaptations before the end of skeletal maturity.

Trained and experienced experts

PTs and physicians should have specific knowledge about radiological and clinical assessment, pathomechanism of scoliosis, documentation and scoliosis management regarding postural aspects, implementation of specific exercises, specific mobilization, and if necessary high standard braces. Because of the long term aspect of the treatment, therapists and patients must develop a special trustful relationship.
A standardized teaching process including physical examination, functional classification, documentation for therapists as well as for patients leads to an individual therapy plan followed by clearly defined follow-up evaluations.

Multidisciplinary team

The multidisciplinary team consisting of scoliosis diagnostic and treatment experienced medical doctors, orthopedic technicians, and physical therapists, and their communication and clinical reasoning, is a clear recommendation from the SOSORT guidelines (2016) for the treatment and management of idiopathic scoliosis.

A team approach focusing on scoliosis patients and their families is able to enhance compliance and the development of effective coping strategies and allows good adherence with braces and exercises.

For this reason, ISST-Training institute offers vocational training schemes for all members of the multidisciplinary team. A new approach are courses for medical doctors interested in the management of idiopathic scoliosis. For more information please read Courses for doctors.

Treatment

Specific scoliosis treatment (Asklepios Katharina Schroth), individual (out-patient by certified Schroth therapists), and possibly in groups (in-patient at the Asklepios clinic, Germany) is based on the above mentioned standardized teaching and clinical-reasoning management.
Conservative scoliosis treatment is targeting towards deceleration or prevention of progression to avoid bracing in cases with a low risk of progression and most important preventing surgery.
Treatment also includes teaching and planning scoliosis specific exercises and breathing techniques following the principles of Schroth Posture Variations to enable and encourage patients to perform a home-exercise program and achieve postural changes in activities of daily living. The intensity of the treatment program has to be individually tailored to the exercise capacity of the patients and the inherent risk of progression. Specific passive-assistive and active mobilization techniques are mandatory in case of structural-functional limitations.
Motivation, compliance, commitment, and discipline of the patients are following a deep understanding and the recognition of the main focus on long term postural changes.
Therapists should be able to accompany patients sometimes for months, years even lifelong.

Goals and main objectives

  • Avoidance of surgery
  • Deceleration or prevention of further progression
  • Stabilization of spinal corrections in three dimensions
  • Increase of chest mobility and respiratory function
  • Trunk symmetry – cosmetic improvements
  • Postural awareness and control of postural changes
  • Home exercise program (HEP)
  • Support regarding brace treatment – compliance – cosmetic
  • Pain relief
  • Help for self-help, self-competence, development of coping strategies

Standardized specific physical therapy

Positioning: Passive corrections for each Schroth “Body Block” up to the structural limits.
Corrective Breathing: Mobilization of the concavities by intrinsic forces.
In-brace exercises:  Designed to improve the starting position for the Schroth home-exercise-program for beginners.
Specific Mobilization: Focusing on the apical segments of a curve, or soft tissues within the concavities.
3D exercises: Typical Schroth exercises try to achieve 3D corrections. Preparatory exercises could have specific goals.
Home exercise program: Essential tool to affect ADL and to prolong and intensify the correction effects

ISST – Schroth Results (1, 2, 3, 4, 5, 6)

Ref.:
1. Schreiber S, Parent EC, Moez EK, Hedden DM, Hill D, Moreau MJ, et al. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis. 2015;10(24):1–12
2. Schreiber S. Schroth Exercises for Adolescent Idiopathic Scoliosis – Reliability, A Randomized Controlled Trial and Clinical Significance. Scoliosisjournal 2014.
3. Kuru T, Yeldan İ, Dereli EE, Özdinçler AR, Dikici F, Çolak İ. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil. 2016 Feb;30(2):181–90
4. Weiss HR, Weiss G, Petermann F, Incidence of progression in idiopathic scoliosis patients treated with SIR: an age and sex-matched controlled study. Pediatric Rehab., 6(1) 23-30,2003.
5. Ottmann S, Kose N. Yakut Y, The efficacy of Schroth´s 3-dimensional exercise therapy in the treatment of idiopathic scoliosis in Turkey. Saudi Med J. 26(9)  1429-1435, 2005
6. Hennes A, Goodall D, Rehabilitation (SIR) in patients with spinal deformities – Description and results. J: Physiotherapy Theory and Practice, 2009

Spine-Concept Sobernheim (SC)

Spine Concept Sobernheim is a multidisciplinary cooperation of experts with extensive experience in scoliosis and kyphosis field under the leadership of Asklepios. These skilled and creative experts, forming a strong team consisting of medical doctors, orthopedic technicians (Sanomed), and Schroth therapists, and ensure optimal and efficient conditions for patient care (1).

The basic principles of SC in the realm of braces and orthopedic technical solutions
were presented by Mr.Heinen OT and Mr.Rexing OT in May 2015 at the annual SOSORT-meeting (Society on Scoliosis Orthopedic and Rehabilitation Treatment) in Wiesbaden, Germany.
Also involved in the brace development was Mr. Steffan MD the former medical director of the Asklepios Katharina Schroth clinic. Since 2016 he is in charge of the medical out-patient spine center (MVZ-Sobernheim) with the focus on individual client-centered conservative treatment of scoliosis and kyphosis.
Physical therapy scoliosis specific exercises in combination with effective brace treatment was contributed by Mr. Hennes PT the former head of the physical therapy department of the Asklepios clinic, international senior Schroth instructor, and founder of the ISST-Training Institute.
The Asklepios Katharina Schroth Clinic in Bad Sobernheim, Germany with its medical director Dr. Zabar and a highly specialized team of Schroth therapists provides intensive three to five weeks in-patient highly specific Schroth rehab-programs for scoliosis, kyphosis, and other spinal deformities.
The treatment approach consists of four to six hours of group sessions with additional individual functional training for about 180 to 200 patients.

SC-Concept – Goals and Principles

The primary goal of SC is a highly appropriated conservative out-patient treatment approach for patients affected with scoliosis and kyphosis provided by the already mentioned team of medical, technical, and therapeutic experts.
Standardization of internal processes and procedures in the care of patients together with continuously reviewing and challenging these measures are typical features in an evidence-based and quality management principles following approach.
The documentation of the results with modern technical devices like EOS, MRI, Formetric, and full-body scan enables a comparison with other concepts and builds the fundaments and prerequisites for the development of internal guidelines contributing to the existing common guidelines.
The combination of effective brace treatment (Sanomed-Brace) and specific brace-related physical exercises (Schroth) enhance the efficacy of conservative scoliosis therapy (2).

An international survey of scoliosis experts (SOSORT-Guidelines 2011) resulted in the recommendation for the development of expert teams and treatment centers in scoliosis and kyphosis patient care. Further expertise and quality standards for processes and procedures, provided by the professional core team, were defined (1).

Ref.:

  1. Negrini S, et.al.: 2016 SOSORT guidelines: orthopedic and rehabilitation treatment of idiopathic scoliosis during growth; Scoliosis and Spinal Disorders (2018) 13:3
  2. Kwan K, et.al., Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis: results from a preliminary study—SOSORT Award 2017 Winner Scoliosis and Spinal Disorders (2017) 12:32