Improvement in Scoliotic Children
Marc J. Lamantia D.C., D.A.C.N.B., Gary Deutchman D.C., Charles Bagley M.D.
Keywords: Scoliosis, Truncal bracing, Electronystagmography, oculomotor function
, as well as vestibulo-cerebellar2
, and brainstem abnormalities3,4,5
long been identified as a co-morbidity to Idiopathic Scoliosis (ISc).
Both vestibular and oculomotor deficits have been identified in the scoliosis population.6
Video Electronystamography (ENG) sub-testing of oculomotor function allows for the
assessment of subtle abnormalities in brainstem and cerebellar systems, even when gross
neurological testing is negative.7
Three case studies are presented here, all which were diagnosed with ISc. Various ENG
subtests were performed to assess oculomotor function both in and out of a truncal
scoliosis brace. Three brace types were studied, the Wilmington, the SpineCor, and the
Progressive O & P.
It is well accepted that truncal bracing causes changes in spinal posture. The resultant
activation of muscle spindle and joint mechanoreceptors causes ipsilateral afferent
stimulation of cerebellar pathways. Our study has shown a correlation linking truncal
bracing and improved oculomotor function in a scoliosis population.
The role of the cerebellum in both smooth pursuits and saccadic function has been
Studies done by Keller,8
Buttner and Straube9
implicate midline cerebellar structures,
especially the oculomotor vermis and caudal fastigial nuclei (CFN), as the control center
of saccade size. Other studies reported saccadic dysmetria as a common feature of
degenerative cerebellar disease10
Cerebellar damage disrupts saccades in humans11
Anatomical andrecording studies to date indicate that there are two parts of
the cerebellar nuclei that participate in saccades: the caudal fastigial nucleus (CFN), also
called the fastigial oculomotor region, and the ventrolateral corner of the posterior
interpositus nucleus (VPIN).13
Smooth pursuit abnormalities associated with cerebellar deficits were first identified by
Westheimer and Blair in 197314
and Zee et al. in 198115
In 1989, O'Beirne J, and Goldberg et al. reported findings of smooth pursuit dysfunction
in seven subjects with either idiopathic or congenital scoliosis.16
Human subjects with pathology of the cerebellum showed defects in the generation of
pursuit eye movements17,18,19
Based on the anatomic projections to the cerebellum from areas within the pons that are
concerned with pursuit,20,21,22
and the effects of focal lesions within the cerebellum of
monkeys, two specific regions of the cerebellar cortex have been implicated in the control
of pursuit:the cerebellar flocculus, paraflocculus,23
and the dorsal and posterior cerebellar
vermis including lobules VI, VII24
, as well as the uvula.25
Furthermore, lesions within the portion of the fastigial nucleus that receives projections
from Purkinje cells of the dorsal vermis, the so-called fastigial oculomotor region (FOR),
also affect pursuit.26
Recently, the ventrolateral portion of the posterior interposed nucleus27
and the lateral
have also been implicated in pursuit.
It is apparent that many areas of the cerebellum contribute to smooth pursuits, saccades
and optokinetic pursuits. Our study was not designed to unravel the precise contributions
of the cerebellum to oculomotor function, but rather to show that truncal bracing causes
improvement in global cerebellar function. This was objectively measured through the
use of ENG testing.
Of course it has also been well studied that lesions of the cerebellum such as Arnold
Chiari Malformation, as well as cranio-cervical junction abnormalities as seen with
syrinx, are involved in ISc.
Materials and Methods
Study Design- Three (3) Pediatric Case Studies of patients with Scoliosis were tested for
oculomotor function utilizing Video Electronystagmography (ENG). The Studies were
performed with the subjects both “in” and “out”, of their scoliosis brace. The following
tests were completed; Saccade testing (Speed/Latency/Accuracy) was recorded and
measured for a random stimulus in all participants, and a Fixed stimulus recording was
made in two (2) of the participants, Optokinetic gain at 30 degrees per second (d/s), and
Sinusoidal Smooth pursuit gain at 0.1 hertz (hz), 0.2hz, and 0.4hz were recorded and
Objectives- The purpose of this study is to better understand the central neurological
affects of truncal bracing on brainstem and cerebellar function as objectified by
Methods- The patients were evaluated utilizing Micromedical Video
Electronystagmography (ENG); with infrared video capture and pupillary tracking
Spectrum Software. All recordings were taken of the left eye, with three (3) channels.
Testing was performed with the patient in a seated position thirty nine (39) inches from a
computer controlled stimulus light bar. Testing was performed in a random order with
regards to braced vs. non-braced.
Data Acquisition and analysis
The reliability of oculomotor testing was found to be good in studies performed both by
Ettinger U, and Kumari V, et al. at the Institute of Psychiatry, University of London.
Participant 1; a 13 year old female, previously diagnosed with ISc, Ehler Danlos
syndrome, and a Superior Oblique Palsy of the left eye.
Initial Fixed saccade testing was performed out of the brace for this patient. The
waveforms were recorded and analyzed (Figure 1). Left sided saccade speed showed
slowing, and hypometric in regards to accuracy. The findings were consistently
reproduced over multiple attempts.
The patient was immediately re-testing with her customized Progressive O &P truncal
brace fastened. The waveforms and results (Figure 2) revealed normometric results in
speed, accuracy and latency of saccades. Random Saccade testing was also performed
for Participant 1. The “out of brace” results (Figure 3) revealed slowing of saccades
bilaterally, hypometria on left sided saccades, and bilateral increases in latency.
“In brace” results (Figure 4) were recorded to show normometric findings in bilateral
speed, accuracy and latency of saccades.
Optokinetic waveforms are presented in (Figures 5 and 6). Gain calculation on left sided
pursuits improved from 0.58 to 0.88 when tested “out” then “in” the truncal brace ; right
sided pursuits improved from 0.88 to 1.03 when tested “out then “in” the truncal brace.
Sinsoidal Smooth Pursuit testing was done first “out” of the brace. The findings revealed
hypometric gain calculations of 0.68, 0.62, and 0.61 at 0.1hz, 0.2hz, and 0.4hz
respectively. Testing “in” the truncal brace revealed normometric results in gain at all
frequencies (0.99, 0.96, and 1.01).
Participant 2; an 11 year old female, fitted with the SpineCor brace.
Optokinetic testing “out” of the truncal brace was performed first. Results showed
hypometric gain calculations of 0.52 and 0.49 on left and right pursuits respectively.
Subsequent “In” truncal brace results showed a improved gain calculations of 0.81 and
0.73 on left and right pursuits respectively.
Random saccade testing “out” of the truncal brace was performed initially. Testing
revealed slowing of all saccade attempts. “In” truncal brace testing revealed
normometric speed on all saccade attempts.
Sinusoidal Smooth Pursuit testing “out” of the truncal brace exposed a gain of 0.83, 0.83,
and 0.77 at 0.1hz, 0.2.hz, 0.4hz respectively. “In” truncal brace testing revealed
normometric gain calculations of 0.97, 0.96, and 0.94 respectively.
Participant 3; a 13 year old female fitted with the Wilmington Brace.
Optokinetic testing “out” of the truncal brace revealed gaze difficulties and diminished
pursuit abilities bilaterally. A gain calculation was unavailable due to the saccadic
intrusuions and gaze difficulties. “In” truncal brace testing revealed a dramatic change in
gaze and pursuit abilities. The gain was calculated as 0.76 and 0.42 right and left
respectively. All other measures were normal during both “out” and “in” brace testing.
Raw data results revealed a significant improvement in all measures of Saccade
performance, (acc-8%-30%, lat-25% sp-100%>275 d/s), Sinusoidal gain increases (20%-
40%) and optokinetic gain increases in performance (30%-60%) during the “In” truncal
Truncal bracing of scoliotic patients causes changes in spinal postures, and immediate
changes in oculomotor function in the cases studied. These findings indicate abnormal
spinal curvatures associated with Idiopathic scoliosis are linked with deficits of
oculomotor function, and can be reversed with truncal brace correction. Further research
in this area may give objective evidence that the success of bracing in scoliosis is due to a
central neurological rehabilitation achieved through spinal postural support and
Further study is required to determine if improvements of oculomotor function can be
associated with changes is abnormal curvatures of the spine found in Idiopathic scoliosis.
Further study is also required on somatic stimulations effect on oculomotor function is
If a correlation is made between improved ocular control and a reduction of spinal
curvatures, further study may identify oculomotor rehabilitation techniques that are
valuable in scoliosis rehabilitation. Specific somatic stimulations have been shown to
cause improvements in oculomotor function. Chiropractic adjustments, as well as
unilateral upper limb girdle stimulation, have both been shown to improve abnormal eye
Waveforms and results of Participant 1 Fixed Saccade testing (out of brace)
Figure 2 Waveforms and results of Participant 1 Fixed Saccade testing (in the brace)
Figure 3 - results of Participant 1 on random saccade testing out of the brace
Results of Participant 1 on random saccade testing in the brace
Figure 5 Optokinetic responses Out of brace Left / Right
Figure 6 Optokinetic responses In Brace Left / Right
Figure 7. Sinusoidal smooth pursuit results (out of brace)
Gain Asymmetry Phase
Figure 8. Sinusoidal Smooth pursuits results (In brace)
Gain Asymmetry Phase
Participant 2 Out of Brace Optokinetic pursuits
Participant 2 In Brace Optokinetic pursuits
Participant 2 out of brace saccade results
Participant 2 In brace saccade results
Participant 2 Smooth pursuits in brace
Participant 2 Smooth Purusits Out of brace
Figure 13- Participant 3 Optokinetic pursuits
Figure 14- Participant 3 Optokinetic pursuit waveforms
Left “Out of brace” Right “Out of brace”
Left “In brace” Right “In brace
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