The Centers for Medicare & Medicaid Services (CMS) regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). In total, CLIA covers approximately 320,000 laboratory entities. The Division of Clinical Laboratory Improvement & Quality, within the Quality, Safety & Oversight Group, under the Center for Clinical Standards and Quality (CCSQ) has the responsibility for implementing the CLIA Program.
the book with no pictures pdf 17
Katharina Schroth, born February 22nd 1894 in Dresden Germany, was suffering from a moderate scoliosis herself and underwent treatment with a steel brace at the age of 16 years before she decided to develop a more functional approach of treatment for herself.
From 1921 this new form of treatment with specific postural correction, correction of breathing patterns and correction of postural perception was performed with rehabilitation times of 3 months in her own little institute in Meissen and in the late 30's and early 40's she was supported by her daughter, Christa Schroth.
The history of the Schroth method is a history involving the professional work of three generations. The initiation of the programme was the result of Katharina Schroths studies (Additional file 1 and 2), in part a development from studying her own body, her own spinal function and the corrective movements possible. Mirror monitoring plays an important role in the original Schroth programme so as to allow synchronizing the corrective movement and the postural perception with the visual input (Figure 2). As breathing and its functional correction played an important role, her first pamphlet focused on breathing in general [3] and later on also describing the importance of postural perception by the patient and its improvement with the help of specific correction exercises [4, 5].
Patient with a large thoracic curvature exercising on her own in front of a mirror. Mirror monitoring plays an important role in the original Schroth programme so as to allow synchronizing the corrective movement and the postural perception with the visual input [12]. [Historical picture from the picture database of Christa Lehnert-Schroth, Meissen 1944].
In the 70's Christa Lehnert-Schroth further developed the method and introduced a simple classification, which is still used today by physiotherapists (Figure 3). Additionally, she discovered the importance of the lumbosacral (counter-) curve (4th Curve) for pattern specific postural correction and described all this in her book, which was first published in 1973 and is now available in the 7th edition [6]. This historically important book is also available in English and Korean [7].
The original classification according to Lehnert-Schroth. On the left the Three Curve Pattern with the shoulder, thoracic and lumbo-pelvic block deviated against each other in the frontal plane and also rotated against each other. On the right the Four Curve Pattern with a separation of the lumbo-pelvic block into a lumbar and a pelvic block deviated against each other in frontal plane and also rotated against each other. Per definition: the pelvic block symbolises the lumbosacral counter curve and this curve is defined as the 4th Curve [12].
Katharina Schroth, born February 22nd 1894 in Dresden Germany, was suffering from a moderate scoliosis herself and underwent treatment with a steel brace at the age of 16 before she decided to develop a more functional approach of treatment for herself (1910).
From 1921 on this new form of treatment with specific postural correction, correction of breathing and correction of postural perception was performed with rehabilitation times of three to sometime six months in her own little institute in Meissen (Figure 4, 5) and from the late 30's she was supported by her daughter, Christa Schroth (Figure 6, 7).
A group of patients with large curvatures exercising in the garden of the little institute run by Katharina Schroth in the 30's in Meissen. [Historical picture from the picture database of Christa Lehnert-Schroth].
Another typical patient with a large curvature as treated in Katharina Schroth's institute. [Historical picture from the picture database of Christa Lehnert-Schroth, Gottleuba 1950, second Schroth institute, East Germany].
A small group of patients with large curvatures exercising in front of mirrors to allow the monitoring of the progress of correction. [Historical picture from the picture database of Christa Lehnert-Schroth, Meissen 1944].
Besides individual exercises, also with passive manual correction by a therapist, a group setting was established allowing the treatment of patients with similar curve patterns in one group (Figure 11).
The institute had a large garden and a little hut with some helpful tools for individal and group treatment. Most of the treatment was carried out in the garden, fresh air and sunrays increased the patient's general health at a time where people were not used to exposing their skin to the sun or indeed to other people (Figure 12).
After World War II Katharina Schroth was forced to leave her little institute in Meissen. Before she went to the West she was employed by the state to offer her services together with her daughter in a medical centre at Gottleuba during the early 50's.
After World War II, Katharina Schroth and her daughter moved to West Germany to open a new little institute in Sobernheim in the early 60's, which constantly grew to a clinic with sometimes more than 150 in-patients treated as a rule for 6 weeks (Figure 14 and 15). After her divorce from her first husband, Ernst Weiss, Christa Schroth married Adalbert Lehnert, who helped her to build up this new centre and who was also involved in the treatment of patients (Figure 16).
Adalbert Lehnert and Christa Lehnert-Schroth treating a patient with significant rib hump together in the early 70's in the new institute in Sobernheim. [Historical picture from the picture database of Christa Lehnert-Schroth].
In the 70's a series of investigations were carried out with respect to vital capacity improvements and improvement of cardiopulmonary function contributing to the acknowledgement of the method at some universities [13, 14].
More patients with curvature angles of less than 40 and typical flatback deformities were treated, but there was no real development towards a systematical correction of the sagittal profile. While the original programme was for thoracic curves exceeding 80 with trunk rotations and rib humps leading to a more kyphotic inclination of the trunk, the moderate curvatures were addressed quite well in the frontal and coronal plane, but the sagittal profile was still underestimated. The only correction of a thoracic flatback was through rotational breathing while the starting positions of the exercises was still with both arms in elevation increasing the flatback deformity (Figure 17 and 18).
Most of the studies were cohort studies in a pre-/postintervention design and there were no mid- or long-term follow-ups. Nevertheless, huge numbers of patients were investigated. 794 Patients were investigated with the ECG showing that even signs of manifest right cardiac strain were reduced highly significantly after an in-patient rehabilitation of 6 weeks using the Schroth programme [20]. More than 800 Patients were material for the study on vital capacity and rib mobility published in Spine 1991 [21], the material in the study on muscle activity reductions after intensive rehabilitation consisted of more than 300 patients [22].
The only mid-term study with a follow-up of more than a 30 months period was the one with the cohort treated between 1989 and 1991 first published in the English language in 1997 [18], which was the basis for our prospective controlled trial published in 2003 [19].
During the 90's there was some development with respect to the correction of thoracolumbar curves including the derotational effect of the psoas muscle. More and more exercises were performed in horizontal positions with as many corrective tools as possible, surely not available during the patients' home programmes (Figure 19).
Typical treatment in the Asklepios centre in Bad Sobernheim with very many tools not available at home, lying on the floor not using the automated postural correction by using the corrective postural reflex activation [12].
In the 80's the author performed an analysis of the different aspects of the original Schroth method [25]. One of the most important factors of the original Schroth method was the automated precorrection of the deformity with the help of postural reflex activity in certain asymmetric upright starting positions. The exercise began precorrected with the help of postural reflex activity in upright asymmetric starting positions and the exercise itself increased this precorrection (Figure 20).
The programme was getting more complex and complicated during the 90's, but a clear direction of development was no longer visible. While brace treatment constantly developed and improved, the exercise programme lost its effectiveness compared to other centres after the Katharina Schroth Klinik was taken over by Asklepios in 1995. The groups of sometimes 15-16 patients were too big for significant gains and with only one therapist.
The same programme was also performed at that time in the Elena Salva Institute in Barcelona under the supervision of Dr. Manuel Rigo. Together with the author he improved many parts of the original programme according to the latest knowledge throughout the 90's.
He also offered more intensive courses with groups of 10 patients and two or three therapists at the same time and was able to achieve significant postural improvements also exceeding the margins of technical error measured with the help of the Formetric system [26, 27]. While Dr. Rigo's patients only received half of the treatment time than those patients in the Asklepios centre, they clearly had better outcomes with a similar program compared to the results published 1999 [28] not exceeding the technical error [29]. 2ff7e9595c
Comments