Postural Screening Program

Background

• The Massachusetts Department of Public Health has promoted postural screening in schools since 1971

• In 1980, regulation changes required all school systems to begin providing screenings in grades5-9– Covers the years in which adolescents experience the

most rapid growth, and in which signs of curvature most often appear

Program Goal• Designed to detect possible early signs of spinal

problems that require further medical evaluation– Scoliosis (lateral curvature)– Kyphosis (front to back curvature)

• The Postural Screening program is intended as a supplement to primary health care– It does not provide a medical diagnosis

Postural Defects• Scoliosis refers to a curvature of the spine• Adolescent Idiopathic Scoliosis (AIP) is the most common type

– First signs often appear in early adolescence– Generally painless and may go unnoticed– Causes unknown; thought to be multifactorial (age, gender, genetics)

• Poor posture does not cause scoliosis/kyphosis or affect the progress of the curve

• In most cases, the curvature is mild and does not progress. Treatment will most likely include:– careful monitoring by a physician – exercises

• Severe curvature may require treatment with a brace or surgery• If severe curvatures are untreated, may result in the following:

– physical deformity– arthritic symptoms– heart and lung disorders– mobility issues

Screening Process• Initial screenings will be conducted by the Physical Education staff

– Location: Girls and Boys High School locker rooms– Girls and boys screened separately– Students screened by staff of same gender– Screened individually in private– Observation ONLY– Clothing considerations:

• Girls should wear a bathing suit top or athletic bra• Boys will remove shirt

• Students with positive findings will be referred to the nurse for a second screening

• May recommend further medical evaluation– Parent/guardian notified– Does not mean the student has scoliosis– Screening is not intended to diagnose; designed to detect possible early signs

of spinal problems

Postural Observation

• During the screening, posture is evaluated in 5 views

• Standing position: front, back, side• Adams Forward Bending Test: front, side– Student bends forward until the back is parallel to

the floor (bend to about knee level)• Feet together• Knees straight• Hands together (palm-to-palm)• Head down (tuck chin)

Evaluation Criteria

• Several things are evaluated:– Head centered over the body– Shoulders/shoulder blades equal– Hips equal– Equal gaps between arms and torso when

standing– Spine straight

Final Thoughts / Questions

• Don’t be embarrassed– We are not looking at “you”– Compartmentalized evaluation

• Humans are “Perfectly Imperfect”– Positive findings do not necessarily mean there is

a problem– Did you know? The dominant shoulder is typically

lower than the non-dominant• Questions

ResourcesMassachusetts Department of Public Health. (1996). Postural Screening Manual. Boston, MA.

http://www.mass.gov/eohhs/docs/dph/com-health/school/psmanual04.pdf

Northeastern University. (2013). Postural Screening. School Based Screening and ReferralDecision Making. Boston, MA: Denise Lotufo, PT, DPT, OCS, CSCI, CMT. http://neushi.org

Presentation prepared by Jennifer Greiner, RNFebruary 2014