The measurement of applied forces during anterior single rod surgical correction of adolescent idiopathic scoliosis

INTRODUCTION. Following anterior thoracoscopic instrumentation and fusion for the treatment of thoracic AIS, implant related complications have been reported as high as 20.8%. Currently the magnitudes of the forces applied to the spine during anterior scoliosis surgery are unknown. The aim of this study was to measure the segmental compressive forces applied during anterior single rod instrumentation in a series of adolescent idiopathic scoliosis patients. METHODS. A force transducer was designed, constructed and retrofitted to a surgical cable compression tool, routinely used to apply segmental compression during anterior scoliosis correction. Transducer output was continuously logged during the compression of each spinal joint, the output at completion converted to an applied compression force using calibration data. The angle between adjacent vertebral body screws was also measured on intra-operative frontal plane fluoroscope images taken both before and after each joint compression. The difference in angle between the two images was calculated as an estimate for the achieved correction at each spinal joint. RESULTS. Force measurements were obtained for 15 scoliosis patients (Aged 11-19 years) with single thoracic curves (Cobb angles 47˚- 67˚). In total, 95 spinal joints were instrumented. The average force applied for a single joint was 540 N (± 229 N)ranging between 88 N and 1018 N. Experimental error in the force measurement, determined from transducer calibration was ± 43 N. A trend for higher forces applied at joints close to the apex of the scoliosis was observed. The average joint correction angle measured by fluoroscope imaging was 4.8˚ (±2.6˚, range 0˚-12.6˚). CONCLUSION. This study has quantified in-vivo, the intra-operative correction forces applied by the surgeon during anterior single rod instrumentation. This data provides a useful contribution towards an improved understanding of the biomechanics of scoliosis correction. In particular, this data will be used as input for developing patient-specific finite element simulations of scoliosis correction surgery.

Young children’s beliefs about including others in their play: Social and moral reasoning about inclusion and exclusion

Previous research has emphasised the importance of active citizenship in the early years for the development of a tolerant and cohesive Australian society. This paper presents findings related to young children’s beliefs about exclusion based on gender and race. The findings draw from a larger study exploring the development of children’s moral and social values and teachers’ beliefs and practices related to teaching for moral development, in the early years of school in Australia. This current study examined reasoning about exclusion in early childhood with children aged 5-8 years. One hundred children from seven schools (Preparatory to Grade 3) answered questions relating to two scenarios in which the children had to make a decision about whether to include others of different gender or race in their play. The majority of children believed that others should be included in their play, regardless of their gender or race. When asked to explain, the children primarily gave reasons related to moral concern and fairness. Children were then asked whether they would continue to include or exclude if their friends (social consensus) or teachers (authority) suggested otherwise. The majority of children maintained their beliefs when beliefs to the contrary were voiced by their peers and teachers. The implications of these responses are discussed.

Early years teachers’ epistemic beliefs and beliefs about children’s moral learning

There is strong political and social interest in values education both internationally and across Australia. Investment in young children is recognised as important for the development of moral values for a cohesive society; however, little is known about early years teachers’ beliefs about moral values teaching and learning. The aim of the current study was to investigate the relationships between Australian early years teachers’ epistemic beliefs and their beliefs about children’s moral learning. Three hundred and seventy-nine teachers completed a survey about their personal epistemic beliefs and their beliefs about children’s moral learning. Results indicated that teachers with more sophisticated epistemic beliefs viewed children as capable of taking responsibility for their own moral learning. Conversely, teachers who held more naive or simplistic personal epistemic beliefs agreed that children need to learn morals through learning the rules for behaviour. Results are discussed in terms of the implications for moral pedagogy in the classroom and teacher professional development. It is suggested that in conjunction with explicitly reflecting on epistemic beliefs, professional development may need to assist teachers to ascertain how their beliefs might relate to their moral pedagogies in order to make any adjustments.

Moral and social development : teachers’ knowledge of learning and teaching strategies in the early years

The intention of the analysis in this paper was to determine, from interviews with eleven early years’ teachers, what knowledge guided their teaching of moral behaviour. Six of the teachers defined moral behaviour in terms of social conventions only. Children’s learning was attributed by five of the teachers to incidental/contextual issues. Nine of the teachers used discussion of issues, in various contexts, as a way of teaching about social and moral issues. The majority of the teachers (n=7) gave the source of their knowledge of pedagogy as practical as opposed to theoretically informed. There was no clear relationship between their definitions, understanding of children’s learning, pedagogy or source of knowledge. Most of the teachers were using discussion, negotiation and reflection to develop the children’s moral and social behaviour. This is probably effective; however, it suggests a strong need for teaching of moral development to be given more prominence and addressed directly in in-service courses so that teachers are clear about their intentions and the most effective ways of achieving them.

Practices for teaching moral values in the early years : a call for a pedagogy of participation

Schools have long been seen as institutions for preparing children for life, both academically and as moral agents in society. In order to become capable, moral citizens, children need to be provided with opportunities to learn moral values. However, little is known about how teachers enact social and moral values programs in the classroom. The aim of this paper is to investigate the practices that Australian early years teachers describe as important for teaching moral values. To investigate early years teachers’ understandings of moral pedagogy, 379 Australian teachers with experience teaching children in the early years were invited to participate in an on-line survey. This paper focuses on responses provided to an open-ended question relating to teaching practices for moral values. The responses were analysed using an interpretive methodology. The results indicate that the most prominent approaches to teaching moral values described by this group of Australian early years teachers were engaging children in moral activities. This was closely followed by teaching practices for transmitting moral values. Engaging children in building meaning and participatory learning for moral values were least often described.

Is the iPhone an accurate and useful tool for the monitoring of spinal deformity?

The progression of spinal deformity is traditionally monitored by spinal surgeons using the Cobb method on hardcopy radiographs with a protractor and pencil. The rotation of the spine and ribcage (rib hump) in scoliosis is measured with a simple hand-held inclinometer (Scoliometer). The iPhone and other smart phones have the capability to accurately sense inclination, and can therefore be used to measure Cobb angles and rib hump angulation. The purpose of this study was to quantify the performance of the iPhone compared to a standard protractor for measuring Cobb angles and the Scoliometer for measuring rib humps. The study concluded that the iPhone is a clinically equivalent measuring tool to the traditional protractor and Scoliometer

Preparing the actor for performance capture

Notions of capture and manipulation infer the existence of an interface that combines performer with system, an interface that separates (or intervenes in) the space between performance, intention and history. It is precisely the effect and provided opportunity of the intermediary device on the practice and craft of the actor, that is particularly examined in this work. Defining the scope of current practice for the contemporary actor is a key construct of this challenge with the most appropriate definition revolving around the pursuit of providing a required mixture of performance and content for live, mediated, framed and variously captured formats that exist in the present day. One of these particular formats is Performance Capture which this paper interrogate in more detail.

Teachers’ and children’s personal epistemologies for moral education : Case studies in early years elementary education

While there is strong interest in teaching values in Australia and internationally there is little focus on young children’s moral values learning in the classroom. Research shows that personal epistemology influences teaching and learning in a range of education contexts, including moral education. This study examines relationships between personal epistemologies (children’s and teachers’), pedagogies, and school contexts for moral learning in two early years classrooms. Interviews with teachers and children and analysis of school policy revealed clear patterns of personal epistemologies and pedagogies within each school. A whole school approach to understanding personal epistemologies and practice for moral values learning is suggested.

Moral and social development: teachers’ knowledge of children’s learning and teaching strategies in the early years

The intention of the analysis in this paper was to determine, from interviews with 11 early years’ teachers, what informed their knowledge of children’s learning and teaching strategies regarding moral development. Overall, the analysis revealed four main categories: definitions of moral behaviour, understanding of children’s learning, pedagogy for moral learning, and the source of knowledge for moral pedagogy. Children’s learning was attributed by five of the teachers to incidental/contextual issues. Nine of the teachers reported using pedagogies that involved discussion of issues, in various contexts, as a way of teaching about social and moral issues. The majority of the teachers (n = 7) described the source of their knowledge of pedagogy as practical/observed as opposed to being theoretically informed. There was no clear relationship between teachers’ definitions, understanding of children’s learning, pedagogy or source of knowledge. These results suggests a strong need for the teaching of moral development to be given more prominence and addressed directly in in-service courses so that teachers are clear about their intentions and the most effective ways of achieving them.

Disputes in Everyday Life : Social and Moral Orders of Children and Young People

"The research presented in this volume has been undertaken in a range of settings and across ages, to display the rich, varied, and complex aspects of children and young people's everyday lives. The papers contribute to understanding children's disputes, framed as forms of social practice, by closely examining children's talk and interaction in disputes to offer insight into how they arrange their social lives within the context of school, home, neighborhood, correctional, and cafe settings. As such, this volume contributes to an emerging body of edited volumes that investigate children and young people's everyday interactions (Cromdal, 2009; Cromdal & Tholander, in press; Gardner & Forrester, 2010; Goodwin & Kyratzis, 2007; Hutchby & Moran-Ellis, 1998). Each paper has been peer reviewed, by respected researchers of the field, in some cases authors of this volume, and revised. We also thank Charlotte Cobb-Moore who so ably assisted in the final preparation of the manuscripts."---publisher website

Investigating the change in three dimensional deformity for idiopathic scoliosis using axially loaded MRI

Background: Adolescent idiopathic scoliosis is a complex three-dimensional deformity, involving a lateral deformity in the coronal plane and axial rotation of the vertebrae in the transverse plane. Gravitational loading plays an important biomechanical role in governing the coronal deformity, however, less is known about how they influence the axial deformity. This study investigates the change in three-dimensional deformity of a series of scoliosis patients due to compressive axial loading. Methods: Magnetic resonance imaging scans were obtained and coronal deformity (measured using the coronal Cobb angle) and axial rotations measured for a group of 18 scoliosis patients (Mean major Cobb angle was 43.4 o). Each patient was scanned in an unloaded and loaded condition while compressive loads equivalent to 50% body mass were applied using a custom developed compressive device. Findings: The mean increase in major Cobb angle due to compressive loading was 7.4 o (SD 3.5 o). The most axially rotated vertebra was observed at the apex of the structural curve and the largest average intravertebral rotations were observed toward the limits of the coronal deformity. A level-wise comparison showed no significant difference between the average loaded and unloaded vertebral axial rotations (intra-observer error = 2.56 o) or intravertebral rotations at each spinal level. Interpretation: This study suggests that the biomechanical effects of axial loading primarily influence the coronal deformity, with no significant change in vertebral axial rotation or intravertebral rotation observed between the unloaded and loaded condition. However, the magnitude of changes in vertebral rotation with compressive loading may have been too small to detect given the resolution of the current technique.

Secondary curve behavior in Lenke Type 1C adolescent idiopathic scoliosis after thoracoscopic selective anterior thoracic fusion

Study Design. Analysis of a case series of 24 Lenke 1C adolescent idiopathic scoliosis (AIS) patients receiving selective thoracoscopic anterior scoliosis correction. Objective. To report the behaviour of the compensatory lumbar curve in a group of Lenke IC AIS patients following thoracoscopic anterior scoliosis correction, and to compare the results of this study with previously published data. Summary of Background Data. Several prior studies have reported spontaneous lumbar curve correction for both anterior and posterior selective fusion in Lenke 1C/King-Moe II patients; however to our knowledge no previous studies have reported outcomes of thoracoscopic anterior correction for this curve type. Methods. All AIS patients with a curve classification of Lenke 1C and a minimum of 24 months follow-up were retrieved from a consecutive series of 190 AIS patients who underwent thoracoscopic anterior instrumented fusion. Cobb angles of the major curve, instrumented levels, compensatory lumbar curve, and T5-T12 kyphosis were recorded, as well as coronal spinal balance, T1 tilt angle and shoulder balance. All radiographic parameters were measured before surgery and at 2, 6, 12 and 24 months after surgery. Results. Twenty-four female patients with right thoracic curves had a mean thoracic Cobb angle of 53.0° before surgery, decreasing to 24.9° two years after surgery. The mean lumbar compensatory Cobb angle was 43.5° before surgery, spontaneously correcting to 25.4° two years after surgery, indicating balance between the thoracic and lumbar scoliotic curves. The lumbar correction achieved (41.8%) compares favourably to previous studies. Conclusions. Selective thoracoscopic anterior fusion allows spontaneous lumbar curve correction and achieves coronal balance of main thoracic and compensatory lumbar curves, good cosmesis and patient satisfaction. Correction and balance are maintained 24 months after surgery.

The effect of intraoperative force on scoliosis correction at the apex : a biomechanical investigation

Adolescent idiopathic scoliosis (AIS) is a complex 3D deformity of the spine, which may require surgical correction in severe cases. Computer models of the spine provide a potentially powerful tool to virtually ‘test’ various surgical scenarios prior to surgery. Using patient-specific computer models of seven AIS patients who had undergone a single rod anterior procedure, we have recently found that the majority of the deformity correction occurs at the apical joint or the joint immediately cephalic to the apex. In the current paper, we investigate the biomechanics of the apical joint for these patients using clinically measured intra-operative compressive forces applied during implant placement. The aim of this study is to determine a relationship between the compressive joint force applied intra-operatively and the achievable deformity correction at the apical joint.

Is the iPhone a useful clinical tool to monitor spinal deformity patients?

The progression of spinal deformity is traditionally monitored on hard copy radiographs using the Cobb method with a protractor and pencil. The rotation of the spine and ribcage (rib hump) in scoliosis is measured with a hand-held inclinometer/Scoliometer. The iPhone and other smart phones, can accurately sense inclination, and can therefore be used to measure Cobb angles and rib hump angulation. The purpose of this study was to quantify the performance of the iPhone compared to the standard protractor (Cobb angles) and the Scoliometer (rib hump).

CT and X-Ray analysis of sagittal curve changes following thoracoscopic anterior scoliosis surgery

Normal thoracic kyphosis Cobb angle for T5-T12 is most commonly reported as a range of 20-40º [1]. Patients with adolescent idiopathic scoliosis (AIS) exhibit a reduced thoracic kyphosis or hypokyphosis [2] accompanying the coronal and rotary distortion components. As a result, surgical restoration of the thoracic kyphosis while maintaining lumbar lordosis and overall sagittal balance is a critical aspect of achieving good clinical outcomes in AIS patients. Previous studies report an increase in thoracic kyphosis after anterior surgical approaches [3] and a flattening of sagittal contours following posterior approaches [4]. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality and are the subject of analysis in this study.