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Uvod: Najpogostejša strukturna deformacija hrbtenice je skolioza. Pri nekaterih pacientih je mogoče določiti osnovni vzrok skolioze, vendar pa vzrok pri večini skolioz ni znan. Izraz idiopatska skolioza se nanaša na paciente, pri katerih ne najdemo jasnega vzroka bolezni. Adolescentna idiopatska skolioza je najpogostejša idiopatska skolioza, ki jo diagnosticiramo kadar je Cobbov kot na rentgenskem posnetku večji od 10°. Dejavniki ki napovedujejo povečanje patološke krivine hrbtenice so: zrelost (kronološka starost, menarha, skeletna zrelost, Risserjev znak), velikost, tip in lokacija krivine. Cilj konservativnega kot tudi operativnega zdravljenja skolioze je preprečiti napredovanje ukrivljenosti hrbtenice. Kot pomemben del konservativnega zdravljenja so se izkazale tudi stabilizacijske vaje, ki se pogosto uporabljajo pri zdravljenju adolescentne idiopatske skolioze. Namen: Namen diplomskega dela je, na podlagi pregleda strokovne in znanstvene literature, ugotoviti učinkovitost stabilizacijskih vaj pri pacientih z adolescentno idiopatsko skoliozo. Metode dela: Raziskave so bile izbrane v elektronski podatkovni zbirki PubMed s ključnimi besedami »adolescent scoliosis AND stabilization exercise«. Izbrane so bile raziskave, ki so ustrezale sledečim vključitvenim merilom: članki s prosto dostopnim celotnim besedilom, raziskave, ki so bile objavljene po letu 2012, randomizirane kontrolirane raziskave, raziskave, v katerih so ocenjevali učinkovitost stabilizacijskih vaj pri pacientih z adolescentno idiopatsko skoliozo. Rezultati: V pregled literature je bilo vključenih pet raziskav. V štirih raziskavah je bila učinkovitost stabilizacijske vadbe primerjana z drugo obliko vadbe (za skoliozo specifične fizioterapevtske vaje, vaje za osnovno zavedanje telesa, Schroth pristop), v eni raziskavi pa sta bili primerjani nadzorovana, vodena stabilizacijska vadba s strani strokovnjaka in nenadzorovana stabilizacijska vadba, izvajana samostojno v domačem okolju. V večini izbranih raziskav so ugotovili statistično značilno izboljšanje rezultatov meritev rotacije trupa s skolimetrom, Cobbovega kota, intenzitete bolečine, kakovosti življenja, vizualnega in haptičnega zaznavanja, zaznavanja položaja telesa, subjektivne zaznave deformacije trupa in izboljšanje periferne mišične moči. Večinoma so bile v teh raziskavah ugotovljene statistično značilne izboljšave znotraj posameznih intervencijskih skupin. Vse raziskave pa niso pokazale statistično značilnih razlik med različnimi vadbenimi pristopi, zato je potrebno nadaljnje raziskovanje. Razprava in zaključek: Rezultati pregledanih raziskav kažejo, da ima stabilizacijska vadba pozitivne učinke pri zmanjševanju intenzitete bolečine, povezane s skoliozo, preprečuje napredovanja skolioze, zmanjša asimetrijo in deformacijo hrbtenice ter vpliva na kakovost življenja posameznika s skoliozo. V prihodnjih raziskavah bi bilo potrebno upoštevati naslednja priporočila: vključiti večje število preiskovancev, daljše vadbene programe, uporabiti enotna merilna orodja za vrednotenje rezultatov in spremljati dolgoročne vplive vadbe. Introduction: Scoliosis is the most common structural deformity of the spine. In some patients, the underlying cause of scoliosis can be determined, but the cause of most scoliosis is unknown. Idiopathic scoliosis refers to patients in whom no clear cause of the disease is found. Adolescent idiopathic scoliosis is the most common idiopathic scoliosis and is diagnosed when the Cobb angle on the radiograph is greater than 10⁰. Factors predictive of increase in the pathological curvature of the spine are: maturity (chronological age, menarche, skeletal maturity, Risser sign), size, type and location of curvature. The aim of conservative as well as operative treatment of scoliosis is to prevent the progression of spinal curvature. Stabilisation exercises, which are commonly used in the treatment of adolescent idiopathic scoliosis, have proven to be an important part of conservative treatment. Purpose: The aim of this diploma work is to determine the effectiveness of stabilisation exercises in patients with adolescent idiopathic scoliosis based on a review of the literature. Methods: Studies were selected if they met the following inclusion criteria: articles with freely available full text, studies published after 2012, randomised controlled trials, studies evaluating the effectiveness of stabilisation exercises in patients with adolescent idiopathic scoliosis. Results: Five studies were included in the literature review. Four studies compared the effectiveness of stabilisation exercise with another form of exercise (Scientific Exercises Approach to Scoliosis, basic body awareness therapy, Schroth exercises) and one study compared supervised, guided stabilisation exercise with unsupervised stabilisation exercise performed independently in the home environment. Most studies found statistically significant results within-group differences for measures of trunk rotation with a scoliometer, Cobb angle, pain intensity, quality of life, visual and haptic perception, body position perception, subjective perception of trunk deformity, peripheral muscle strength. However, not all studies showed the same statistically significant differences between the different exercise approaches, so further investigation is needed. Discussion and conclusion: The results of reviewed research suggest that stabilisation exercise has positive effects in reducing the intensity of pain associated with scoliosis, preventing scoliosis progression, reducing asymmetry and spinal deformity, and affects on the quality of life of individuals with scoliosis. Future research should consider the following recommendations: include a larger number of subjects, longer exercise programmes, use uniform measurement tools to evaluate the results and monitor the long-term effects of exercise.

Uvod: Hrbtenica omogoča telesu gibljivost trupa in glave, prav tako pa mu daje oporo, ravnotežje in pokončno držo. Pri človeku ima v sagitalni ravnini obliko črke S, v frontalni ravnini pri vzravnanem telesu pa je ravna. V prsnem in križničnem delu je izbočena nazaj, v ledvenem in vratnem delu pa naprej. Raznovrstne deformacije in bolezenski procesi pa lahko privedejo do stranske ukrivljenosti hrbtenice ali skolioze. Danes jo opredeljujemo kot tridimenzionalno torzijsko deformacijo hrbtenice in trupa, ki povzroči lateralni odklon v frontalni ravnini, aksialno rotacijo v horizontalni ravnini in spremembo sagitalnega profila. Idiopatskih skolioz je 80 %, ostalih 20 % pa sekundarnih. Zdravljenje skolioze lahko poteka operativno oziroma konzervativno. Namen: Namen diplomskega dela je raziskati vplive konzervativnega in operativnega zdravljenja za paciente v odrasli dobi. Metode dela: V diplomskem delu je bila uporabljena deskriptivna metoda s pregledom domače in tuje literature pri primerjavi med ortotičnim in operativnim zdravljenjem pri pacientih z AIS. Analizirali smo tri vprašalnike ter na podlagi pregledanega sestavili anketo, s katero smo anonimno anketirali odrasle paciente z adolescentno idiopatsko skoliozo. Rezultati: Anketni vprašalnik je sestavljen iz osnovnih podatkov, ki zajemajo starost in spol preiskovancev ter šestnajst vprašanj o velikosti krivine hrbtenice pred in po zdravljenju AIS, bolečini, težavah z dihanjem ter vrstah zdravljenja. V raziskavi je sodelovalo 71 oseb, od tega je bilo 63 žensk in 8 moških. Povprečna starost preiskovancev je bila 39,1 let. Razprava in sklep: Med pregledom rezultatov ankete smo ugotovili, da je bila večina preiskovancev zdravljenih konzervativno, nekaj pa tudi operativno. Preiskovanci so navajali močne bolečine in težave z dihanjem predvsem ob večjem fizičnem naporu. Prišli smo do spoznanja, da se zdravstveno stanje pacientov s starostjo slabša, prav tako pa smo opazili, da delež pacientov z AIS ne pozna velikosti ukrivljenosti svoje hrbtenice. Introduction: The spine enables the movement of the torso and head, as well providing it with support, balance and an upright posture. The sagittal plane of the human spine is the shape of an 'S', whereas the frontal plane of an upright corpus is straight. It is extruded backwards at the height of the chest and sacrum, intruded at the kidneys and neck. Various deformations and illnesses can also lead to a lateral deformation of the spine or scoliosis. Today this condition is classified as a three-dimensional torsional deformation of the spine, caused by a lateral deviation of the frontal plane, axial rotation of the horizontal plane, implicitly, the change of the sagittal profile. The total of 80 % of all cases are recognized as idiopathic scoliosis, with the other 20 % being secondary. Treatment of this condition can be surgical or conservative. Purpose: The intent of the diploma thesis is to research the impacts of both conservative and surgical treatment methods on adult patients. Methods: The literature review of domestic and foreign literature was conducted. Comparisons of orthotic and operative treatments on patients with AIS were of primary focus in the source material. We analyzed three questionnaires and based on the review we compiled a survey with which we will anonymously survey adult patients with adolescent idiopathic scoliosis. Results: The survey questionnaire consists of basic data, which are gender and age and sixteen questions, which were all related to the curvature of spine before and after treatment of AIS, pain, breathing problems and form of treatment. In total, 71 people participated in the survey, 63 of which were women and 8 participants were men. The average age of participants was 39.1 years. Discussion and conclusion: Upon analysis it was determined that most subjects were treated conservatively, only a few were treated operatively. Subjects reported of severe pain and difficult breathing, especially with increased physical exertion. It can be observed that the health status of patients deteriorates with age. The data also show that a number of patients with AIS are not aware of the extent of their spinal curvature.

Uvod: Korekcijska spinalna ortoza je pomembna in jo priporočajo pri zdravljenju skeletno nezrelih najstnikov z AIS ter pri tistih, ki imajo krivino 25°- 40° po Cobbu. Lyon ortoza ali nastavljiva modularna-večdelna ortoza se uporablja že več kot 60 let. Razvile so se tri nivojske različice teh ortoz te so torakalna, torakolumbalna in lumbalna Lyon ortoza. Ta ortoza omogoča zdravljenje vseh krivin, odstopajočih od normale, razen primarne visoke torakalne krivine, za katero priporočimo Milwaukee ortozo. ART ortoza je nova asimetrična, iz trdnega polikarbonata, torzijska ortoza, izdelana z dvema asimetričnima lateralnima polikarbonatnima deloma, ki sta na sredini povezana z navpično tračnico iz kovine. Cilj ART ortoze ni le dobiti ravno hrbtenico, temveč poravnati obliko trupa, nastalo zaradi skolioze. Ta korekcija je mogoča le, če vretenca niso deformirana, v nasprotnem primeru želimo poudariti popravek asimetrije pritiska na telesa vretenc. Namen: Namen diplomskega dela je predstaviti Lyon in ART korekcijski spinalni ortozi s pomočjo pregleda strokovne literature. Predstaviti želimo zgodovinski razvoj ortoz, njihovo funkcijo, indikacije in kontraindikacije, učinkovitost delovanja na uporabnika in primerjavo rezultatov. Metode dela: V diplomskem delu je bila uporabljena deskriptivna metoda dela s pregledom domače in tuje literature s področja spinalne ortotike, bolj natančno Lyon in ART korekcijskih ortoz. Literaturo smo iskali na spletnih portalih COBISS in DiKUL ter v bibliografskih podatkovnih bazah Google Učenjak, MEDLINE, CINAHL in PubMed. Rezultati: Nekatere študije kažejo dobre rezultate ART ortoze za takojšnje zmanjšanje skolioze, nato pa se trend ohranja še 6 mesecev in eno leto po začetnem nošenju. Torej novi koncepti in prvi rezultati ART ortoze, ki so definirani kot spremenjena ali "nova" Lyon ortoza, potrjujejo, da lahko ta ortoza popolnoma zamenja antigravitacijski korekcijski mavec in staro Lyon ortozo. Zmanjšanje Cobbovega kota po enem letu zagotovo tudi ni končni rezultat zdravljenja (2 leti po odstavitvi ortoze), čeprav nekateri avtorji v tem trenutku kot napovedno mero uporabljajo njegovo zmanjšanje. Razprava in zaključek: Uporaba ortoze pri konzervativnem zdravljenju AIS ima pomembno vlogo, katere cilj je preprečitev nastanka deformacije pri kostno nezrelih mladostnikih in posledično težav v odraslem obdobju. Pri kakovosti posameznih ortoz se mnenja avtorjev razlikujejo, zato je narejenih več raziskav o učinkovitosti le teh. Pri uporabi Lyon ortoz je konzervativno zdravljenje dokazano kot zelo učinkovito. Ambulantno izvajanje korekcije skolioz z antigravitacijskim mavcem in Lyon ortozami je bilo finančno ugodno in otroku omogočalo nemoten pouk. Za nov način izdelave ortoze se strokovnjaki odločajo zaradi izboljšanja kakovosti, predvsem pa zaradi zadovoljstva pacientov, saj s tem pripomorejo k njihovemu boljšemu počutju med izdelavo kot tudi nošenjem ortoze in čim hitrejšemu okrevanju. Učinkovito ortotično zdravljenje ima velik pomen pri pacientovem poteku bolezni. Potrebno je izbrati pravilno vrsto ortoze, saj jo pacient uporablja večji del dneva in močno vpliva na kvaliteto njegovega življenja. Introduction: The correctional spinal orthosis is a very important and recommended tool for treating adolescents with under developed bone structures. It is mostly used for treating younger people with AIS and for people with a 25° to 40° scoliosis according to Cobb. The Lyon orthosis or the modular-multi-part adjustable orthosis has been used for over 60 years. It has developed into 3 subcategories: the thoracic, thoracolumbal and lumbal Lyon orthoses. The Lyon orthosis can be used for treating all kinds of scoliosis (deviating from the normal values). The ART orthosis is a new asymmetric orthosis made from hard polycarbonate. It is a torsional orthosis made from two asymmetric polycarbonate lateral parts that are connected to each other through the middle with a vertical metal track. The goal of the ART orthosis is not only to straighten the spine but also to correct the shape of the body caused by the scoliosis called the scoliosis correction. The purpose: The purpose of the thesis is to present the Lyon and ART correctional spinal orthosis based on professional literature. The orthoses will be described according to their development, function, indications, contraindications and efficiency with the comparison of the results. Methods: Work method is based on the literature review. The review of domestic and foreign literature on spinal orthotics, with special emphasis on the Lyon and ART orthoses was conducted. The literature was searched in COBISS and DiKUL platforms and bibliographic databases such as Google Scholar, MEDLINE, CINAHL and PubMed. Results: Some studies point to the results of ART orthosis for the immediate reduction of scoliosis, and then the trend is maintained for another 6 months within one year of wearing. Therefore the new concepts and the first results of ART orthosis, defined as altered or "new" Lyon orthosis, confirm that the antigravitation plaster cast and the old Lyon orthosis can be replaced. Angular reduction in the first year is also certainly not the final result of the treatment (2 years after the removal of orthosis), therefore further studies are needed. Conclusion: The use of the orthosis in conservative AIS treatment has a significant role. The goal is to prevent a deformity in adolescents with bone structures not yet fully developed, thereby preventing further problems in adulthood. The opinions of authors differ regarding the quality of different kinds of orthosis. Therefore, various researches about the efficiency of different kinds of orthosis were conducted. It has been proven that conservative treatment is very successful when using the Lyon orthosis. Clinical scoliosis correction with a antigravitation plaster cast and a Lyon orthosis is an inexpensive way of treating scoliosis and it allows children to continue their education. The improved orthosis was decided upon due to higher quality, the added comfort during the manufacture and wearing and faster rehabilitation. Efficient orthotic treatment has an important role in the development of the medical condition. The correct orthosis should be selected since it is worn up to 23h a day and it effects the quality of patient’s life.