SCOLIOSIS SCOLIOSIS

SCREENINGSCREENING

FOR FOR

ARKANSAS SCHOOLARKANSAS SCHOOL

CHILDRENCHILDREN

The planning committee & faculty attest that no relevant financial, professional or personal conflict of interest exists, nor was sponsorship of commercial support obtained, in the preparation or presentation of this educational activity.

ObjectivesObjectivesParticipants will be able to:Participants will be able to:

• Explain why scoliosis screening is necessary.Explain why scoliosis screening is necessary.

• Identify the 9 steps of Scoliosis Screening. Identify the 9 steps of Scoliosis Screening.

• Demonstrate how to perform the first two Demonstrate how to perform the first two stages of scoliosis screening. stages of scoliosis screening.

• Differentiate between a normal spine and Differentiate between a normal spine and scoliosis and the recommendation for referral. scoliosis and the recommendation for referral.

• Describe the documentation standards for the Describe the documentation standards for the Scoliosis Program.Scoliosis Program.

• Explore diagnostic and treatment options Explore diagnostic and treatment options available. available.

• Identify financial and medical resources for Identify financial and medical resources for referrals. referrals.

ADH Rules and ADH Rules and

Regulations For Regulations For

Scoliosis ScreeningScoliosis ScreeningEffective as of November 1, Effective as of November 1,

20072007

I. Purpose I. Purpose

• Scoliosis is lateral curvature of the spine, resembling an S-curve or a C-curve.

• Idiopathic Scoliosis accounts for 85% of all scoliosis cases.

• Condition detected in children between ages of 10 and 15 years.

• Girls affected more often than boys.

• About 2 in 100 people have a mild form of scoliosis.

I. Purpose Cont.I. Purpose Cont.

• Scoliosis can be relatively easily detected by performing a 30 second scoliosis screen.

• Early detection and treatment can help prevent physical and emotional disability.

• Rules and Regulations provide a method to assure all school age children are screened for scoliosis and necessary referrals for medical follow-up are made.

II. Authority: II. Authority:

It’s the Law!It’s the Law!

Arkansas Act 95 of 1989 and Act 41 of Arkansas Act 95 of 1989 and Act 41 of 1987 requires that Arkansas Children 1987 requires that Arkansas Children be screened for scoliosis in selected be screened for scoliosis in selected grades. Rules and regulations grades. Rules and regulations implementing the act were adopted by implementing the act were adopted by the Arkansas Department of Health the Arkansas Department of Health and filed in 1998 and and filed in 1998 and revised in revised in November of 2007November of 2007..

III. DefinitionsIII. Definitions

• Certified Instructors:Certified Instructors: Individuals Individuals

who train the screeners. These shall who train the screeners. These shall

be licensed health practitioners who be licensed health practitioners who

have successfully completed the have successfully completed the

Arkansas Department of Health Arkansas Department of Health

Instructor Training Course in Instructor Training Course in

Scoliosis Screening.Scoliosis Screening.

III. Continued DefinitionsIII. Continued Definitions

• Screeners: Screeners: Individuals who perform the Individuals who perform the

actual scoliosis screening. These shall be actual scoliosis screening. These shall be

licensed physicians, individuals who have licensed physicians, individuals who have

been trained to perform scoliosis screening been trained to perform scoliosis screening

by a Certified Scoliosis Screening Instructor, by a Certified Scoliosis Screening Instructor,

or individuals who can document or individuals who can document

completion of a scoliosis screening completion of a scoliosis screening

workshop within the past five years and workshop within the past five years and

demonstrate competence to a Certified demonstrate competence to a Certified

Scoliosis Screening Instructor.Scoliosis Screening Instructor.

III. Continued DefinitionsIII. Continued Definitions

• Scoliometer: An instrument that measures the degree of rotation of a deformity of the back found on a routine scoliosis screening.

III. Continued DefinitionsIII. Continued Definitions

• Scoliosis Screening Procedure: The procedure used to examine a child for scoliosis. It consists of evaluating the child in six positions. The forward bend technique is included in three of these positions.

III. Continued DefinitionsIII. Continued Definitions

• Forward Bend Technique: A

technique used to determine the

presence or absence of an

abnormality of the spine. It involves

observing the person being screened

from the rear, front, and side while

the person is bending forward.

• Scoliosis

from Greek:

skoliōsis

meaning

from

skolios,

"crooked"

III. Continued DefinitionsIII. Continued Definitions

IV. Responsibility:IV. Responsibility:

• Who must institute and maintain a Who must institute and maintain a

continuing scoliosis screening continuing scoliosis screening

program:program:

• Public elementary and secondary Public elementary and secondary

schoolsschools

• Institutions supported by state funds Institutions supported by state funds

providing education to minor childrenproviding education to minor children

• Private institutions providing education Private institutions providing education

to minor childrento minor children

IV. Responsibility:IV. Responsibility:

• Rules and RegulationsRules and Regulations

• Arkansas State Board of Health Arkansas State Board of Health

• Training ProgramTraining Program

• Arkansas Department of Health Arkansas Department of Health

provides an Instructor Training provides an Instructor Training

Course in Scoliosis Screening.Course in Scoliosis Screening.

V. Screening ProgramV. Screening Program

• QualificationsQualifications

• Licensed physiciansLicensed physicians

• Individuals trained by a Certified Individuals trained by a Certified

Scoliosis Screening InstructorScoliosis Screening Instructor

• Individuals providing documentation of Individuals providing documentation of

successful completion of a Scoliosis successful completion of a Scoliosis

Screening Workshop within the past five Screening Workshop within the past five

years and can demonstrate competence years and can demonstrate competence

to a Certified Scoliosis Instructor.to a Certified Scoliosis Instructor.

V. Screening Program Cont.V. Screening Program Cont.

• Guidelines for Screening:Guidelines for Screening:

• Girls- 6Girls- 6thth and 8 and 8thth grades grades

• Boys- 8Boys- 8thth grades grades

V. Screening Program Cont.V. Screening Program Cont.

• Screening Procedure Screening Procedure (five (five stages)stages)

11stst Stage-Scoliosis Screening Stage-Scoliosis Screening ProcedureProcedure

22ndnd Stage-Scoliometer Stage-Scoliometer

33rdrd Stage-Recommendation for Stage-Recommendation for ReferralReferral

44thth Stage-Referral System Stage-Referral System

55thth Stage-Follow-Up Stage-Follow-Up

V. Screening Program Cont.V. Screening Program Cont.

•Recommendation for ReferralRecommendation for Referral

•Referrals are made on students with Referrals are made on students with

an abnormal screening and/or an abnormal screening and/or

scoliometer reading of scoliometer reading of >> 7 7°.°.

•It is recommended that scoliometer It is recommended that scoliometer

readings of readings of >>8° be referred to an 8° be referred to an

orthopedist.orthopedist.

V. Screening Program Cont.V. Screening Program Cont.

• Referral SystemReferral System

• Certified Scoliosis Screening Instructor or School Certified Scoliosis Screening Instructor or School Health Nurse shall contact the parents of a child Health Nurse shall contact the parents of a child who fails the screening by letter, telephone call, who fails the screening by letter, telephone call, or in person to:or in person to:

11. explain the findings. explain the findings

2. define and discuss scoliosis2. define and discuss scoliosis

3. discuss the need for referral to a licensed 3. discuss the need for referral to a licensed physicianphysician

• The School shall provide a Scoliosis Screening The School shall provide a Scoliosis Screening Report to the parent to take to the licensed Report to the parent to take to the licensed physician.physician.

V. Screening Program Cont.V. Screening Program Cont.

• Follow-UpFollow-Up

• Reschedule absent students for screening Reschedule absent students for screening

within 90 days of missed screening.within 90 days of missed screening.

• Reasons for all exclusions must be Reasons for all exclusions must be

documented.documented.

• Students referred to a physician for scoliosis Students referred to a physician for scoliosis

screening failure, and then fail to see screening failure, and then fail to see

physician require a second contact by mail, physician require a second contact by mail,

telephone or in person at least one additional telephone or in person at least one additional

time to discuss importance of follow-uptime to discuss importance of follow-up

VI. Training ProgramVI. Training Program

•Certified Scoliosis Screening Certified Scoliosis Screening

Instructors must be recertified every Instructors must be recertified every

five years.five years.

VII. Confidentiality of InformationVII. Confidentiality of Information

VIII. Notification of ScreeningVIII. Notification of Screening

•At least seven days prior to scoliosis At least seven days prior to scoliosis

screenings parents must be notified.screenings parents must be notified.

IX.IX. Exclusions to ScreeningExclusions to Screening

• Act 41 of 1987 states that "no child shall be screened if its parent or guardian objects to the screening in writing stating as the basis of the objection that it is contrary to the parent's or guardian's religious beliefs.“

X. Quality AssuranceX. Quality Assurance

The Arkansas Department of Education The Arkansas Department of Education

shall collect statistics on Scoliosis shall collect statistics on Scoliosis

Screening activities in the state. The Screening activities in the state. The

following information shall be reported following information shall be reported

annually:annually:

1. the target population eligible for 1. the target population eligible for

screeningscreening

2. the number of children screened2. the number of children screened

3. the number of children referred3. the number of children referred

4. the number of children seen by a 4. the number of children seen by a

physicianphysician

5. the number of children diagnosed with 5. the number of children diagnosed with

scoliosis scoliosis by a physician by a physician

THE NINE “P’s”THE NINE “P’s”

Purpose Planning Population

Personnel Preparation Place

Permission Procedure Paperwork

PURPOSEPURPOSE(First “P”)(First “P”)

• Early detection to prevent further Early detection to prevent further

damagedamage

• Detection of other abnormalitiesDetection of other abnormalities

o Child AbuseChild Abuse

o Acanthosis NigricansAcanthosis Nigricans

Suspected Child AbuseSuspected Child Abuse

• Child Abuse as defined by Child Abuse as defined by Arkansas code 12-

12-503

• Do School Nurses report child abuse? Do School Nurses report child abuse?

• Reporting the suspected child abuse.Reporting the suspected child abuse.

• Failure to report suspected abuse.Failure to report suspected abuse.

AbuseAbuse can be physical or sexual. It

includes non-accidental physical injury,

shaking a baby, tying a child up, and

giving or exposing a child to alcohol or

other drugs.

Reasonable and moderate discipline (such

as spanking) is generally not considered

abuse as long as it does not cause injury

more serious than transient pain or minor

temporary marks and is administered by a

parent or guardian.

Arkansas code 12-12-503

Reporting Suspected Child Reporting Suspected Child AbuseAbuse

School Nurses are Mandated School Nurses are Mandated ReportersReporters

Child Abuse HotlineChild Abuse Hotline 1.800.482.59641.800.482.5964

Failure to Report Suspected Failure to Report Suspected AbuseAbuse

Class C misdemeanor; willful Class C misdemeanor; willful

failure to report: civilly liable for failure to report: civilly liable for

all damages proximately caused all damages proximately caused

by that failure.by that failure.

Acanthosis Nigricans/NeckAcanthosis Nigricans/Neck

Acanthosis Nigricans/Under Acanthosis Nigricans/Under ArmArm

Acanthosis Nigricans/HandAcanthosis Nigricans/Hand

PLANNINGPLANNING(Second “P”)(Second “P”)

• This is the most important “P”This is the most important “P”

• Get organizedGet organized

• Determine date and site then scheduleDetermine date and site then schedule

• Recruit helpRecruit help

• Notify parents at least 7 days priorNotify parents at least 7 days prior

• Remind students one day prior to screeningRemind students one day prior to screening

• Set up roomSet up room

POPULATIONPOPULATION(Third “P”)(Third “P”)

This changed in November 2007This changed in November 2007

• Girls are to be screened in the 6Girls are to be screened in the 6thth and and

88thth grades only. grades only.

• Boys are to be screened in the 8Boys are to be screened in the 8thth grade grade

• This includes public and private schools.This includes public and private schools.

PERSONNELPERSONNEL(Fourth “P”)(Fourth “P”)

• Certified Scoliosis ScreenerCertified Scoliosis Screener

• PhysiciansPhysicians

• VolunteersVolunteers

PREPARATIONPREPARATION(Fifth “P”)(Fifth “P”)

• Inform School StaffInform School Staff

• Dates, times and locationsDates, times and locations

• Ensure Screeners are either Certified Ensure Screeners are either Certified

or a Physicianor a Physician

• Train volunteersTrain volunteers

• Inform StudentsInform Students

PLACEPLACE(Sixth “P”)(Sixth “P”)

• Ensure PrivacyEnsure Privacy

• Screen boys and girls separatelyScreen boys and girls separately

• Good lighting essentialGood lighting essential

PERMISSIONPERMISSION(Seventh “P”)(Seventh “P”)

• Parental notification at least 7 days Parental notification at least 7 days

prior to screeningprior to screening

Act 41 of 1987Act 41 of 1987 states that "no child shall be states that "no child shall be

screened if its parent or guardian objects to screened if its parent or guardian objects to

the screening the screening in in writingwriting stating as the basis stating as the basis

of the objection that it is contrary to the of the objection that it is contrary to the

parent's or guardian's religious beliefs."parent's or guardian's religious beliefs."

PROCEDUREPROCEDURE(Eighth “P”)(Eighth “P”)

• Screener seated or standingScreener seated or standing

• Student should be 4-6 feet awayStudent should be 4-6 feet away

• Student’s feet two to three inches Student’s feet two to three inches

apart, knees straight and arms apart, knees straight and arms

hanging loose at sidehanging loose at side

PROCEDURE - Stage 1PROCEDURE - Stage 1

Position 1-Student facing front to Position 1-Student facing front to screenerscreener

Position 2-Student bends forward slowlyPosition 2-Student bends forward slowly Position 3-Student facing to sidePosition 3-Student facing to side Position 4-Student bends forward slowlyPosition 4-Student bends forward slowly Position 5-Student’s back to screenerPosition 5-Student’s back to screener Position 6-Student bends forward slowlyPosition 6-Student bends forward slowly

PROCEDURE - Stage 2PROCEDURE - Stage 2

• The second phase of screening requires The second phase of screening requires

use of the scoliometer.use of the scoliometer.

• Student is in position 6 with back to Student is in position 6 with back to

screener bending forward slowly with screener bending forward slowly with

hands together as if diving.hands together as if diving.

• When using a scoliometer, referralWhen using a scoliometer, referral is is

made on students exhibiting unequal made on students exhibiting unequal

lumbar or thoracic areas of lumbar or thoracic areas of ≥ 7≥ 7 degrees degrees

or greater.or greater.

NORMAL SPINENORMAL SPINE

Four main areas:Four main areas:

Cervical (neck)Cervical (neck)

Thoracic (chest)Thoracic (chest)

Lumbar (small of Lumbar (small of back)back)

Sacral (lower spine)Sacral (lower spine)

Three Types of Spinal Curves:

• KyphosisKyphosis-slight -slight curvature is curvature is normal.normal.

• LordoisLordois-slight -slight curvature is curvature is normal.normal.

• ScoliosisScoliosis-lateral -lateral curvature is curvature is never normal.never normal.

ScoliosisScoliosis::• Abnormal lateral Abnormal lateral

curvature of the spine curvature of the spine

of 10of 10°° or more. or more.

• Rotation in the spinal Rotation in the spinal

column creates a side column creates a side

to side, to side, ““SS”” shaped shaped

curve when viewed curve when viewed

from behind. from behind.

STRUCTURAL SCOLIOSISSTRUCTURAL SCOLIOSIS

• Idiopathic – 85%Idiopathic – 85%

• CongenitalCongenital

• Neuromuscular-CP, Neuromuscular-CP,

MDMD

FUNCTIONAL SCOLIOSISFUNCTIONAL SCOLIOSIS

A structurally A structurally

normal spine that normal spine that

appears to have a appears to have a

lateral curve lateral curve

(scoliosis).(scoliosis).

Kyphosis:Kyphosis:

An abnormal increase An abnormal increase

in normal kyphotic in normal kyphotic

(posterior) curvature (posterior) curvature

of the thoracic spine of the thoracic spine

which can result in a which can result in a

noticeable round back noticeable round back

deformity. deformity.

Lordosis:Lordosis:

An abnormal An abnormal increase in normal increase in normal lordotic (anterior) lordotic (anterior) curvature of the curvature of the lumbar spine. lumbar spine.

This can lead to a This can lead to a noticeable "sway-noticeable "sway-back“ back“ appearance. appearance.

Lordosis:Lordosis:

EQUIPMENTEQUIPMENT

TREATMENT OPTIONSTREATMENT OPTIONS

• ObservationObservation

Periodic medical examinations and Periodic medical examinations and

x-raysx-rays

• BracingBracing

• SurgerySurgery

PERIODIC EXAMINATIONSPERIODIC EXAMINATIONS

• X-RAYSX-RAYS

PERIODIC EXAMINATIONSPERIODIC EXAMINATIONS

• Risser SignRisser Sign

Skeletal maturity can be assessed by Skeletal maturity can be assessed by

the Risser signthe Risser sign

BRACING……thenBRACING……then

BRACINGBRACINGMilwaukee BraceMilwaukee Brace

BRACINGBRACING

BRACING…..nowBRACING…..now

BRACING…..nowBRACING…..now

SURGERYSURGERY

Vertebral Body Stapling (VBS)Vertebral Body Stapling (VBS)

Application of metal staples to the front of the spine.

Staples are inserted

between two vertebral bodies, which squeezes the growth plates and slows the growth of

that side of the spine.

PAPERWORKPAPERWORK(Ninth “P”)(Ninth “P”)

Make written referrals and Make written referrals and

follow-up as indicatedfollow-up as indicated

Complete School Scoliosis Complete School Scoliosis

Screening Annual Summary in Screening Annual Summary in

APSCN.APSCN.

19

Parent Notification of Scoliosis Screening

Dear Parent, During the next few weeks a scoliosis screening program will be conducted to screen children for

scoliosis in school.

Scoliosis is a sideways curving of the spine, resembling an S – curve or C – curve. Eighty-five

percent of the time scoliosis has no known cause and tends to run in families. This type of

scoliosis first develops between the ages of 10 –15 years and occurs more often in girls than

boys. If scoliosis is detected early, treatment can be started and almost all of the curving can be

prevented.

The procedure for screening is a simple one in which the child’s back is observed as he/she

stands upright and as he/she bends forward. To observe this condition, each child will be asked

to remove their shirt or blouse (girls may wear bra or bathing suit top with an open back). The

screening will be conducted in privacy with only student and examiner present.

Any curvature or “back hump” that is noticed during the screening may indicate the need for

further studies. If a problem is found, you will be notified. We will recommend that you take your

child to a physician of your choice for an evaluation.

We encourage all students to participate in this program. If you do not want your child screened

please let us know in writing by three days before the screening date. Phone calls will not be

accepted. If your child is currently under treatment for a back problem, please let us know in

writing.

A. Head

A. Head B. Shoulder

B. Shoulder C. Scapula

Address: C. Waist D. Waist

D. Hips E. Hips

Screener: 1 3 5

Grade:

Class:

Student Name M/F DOB 2 4 6

FILLING OUT THE SPINAL SCREENING WORKSHEET

It is important that the screener include as much information as possible about His/Her findings for easy reference in the rescreening.

Adapted from the Texas department of Health, Bureau of Matenal & Child Health , Child Health division, December 1985

The pictures on the spinal screening worksheet represent the positions in which the student is viewed by the Screener. The front, back, and side views each have several areas of focus. Each area has a letter designation. Use these letters on the worksh

SPINAL SCREENING WORKSHEET

Res

cree

ning

D

ate:

S

cree

ner:

Und

er C

urre

nt M

edic

al T

reat

men

t

Confirm Findings

Y/N

School:

Dat

e F

amily

Con

tact

ed

Dat

e R

efer

red

for

Exa

m:

Dia

gnos

is &

tre

atm

ent

Rep

ort

Dat

e R

ecei

ved:

Follow-up

Nee

ds S

choo

l Fol

low

-up:

Y

es/N

o

22

Parent Notification - Scoliosis Screening Follow-up Needed

Dear Parent, This letter is in regards to the scoliosis screening your child received

on at .

A trained screener checked your child’s back and has recommended further evaluation by a physician of

your choice.

We would like to emphasize that this is just a screening. A complete examination by a physician is

recommended to determine if there is a problem. We urge you to contact a physician within the next two

weeks.

The Division of Children’s Medical Services (CMS), Department of Human Services may offer financial

assistance for this evaluation when needed. Parents must apply for CMS prior to obtaining the medical

evaluation. Contact your School Nurse for more information about this program.

Sincerely,

School Nurse

Dear Doctor: In accordance with Act 41 of 1987 and Act 95 of 1989 our school has conducted an annual scoliosis-screening program for detection of postural deformities such as scoliosis and kyphosis. The purpose of the screening program is to recognize deformities in their earliest stages so that progression can be prevented. Through scoliosis screening, this student has been observed to have variations consistent with either R/L thoracic scoliosis, lumbar scoliosis, or kyphosis. Please review the findings and, if your examination concurs with the screener’s, an appropriate X-ray of the spine should be obtained to establish the diagnosis. It is important that a standard technique be used in getting the X-ray. It is recommended that a single STANDING AP X-ray of the spine be obtained. A 14 x 17-inch film is acceptable if the top of the film is at the level of the shoulders and the tube is centered on the center of the cassette. The child must be standing straight and not be in a slouch position. If a kyphosis has been suspected, than a STANDING lateral film, using the same technique, should be obtained. In order that our school make required reports it is necessary to receive follow-up information from you. Please complete the following information and return this form to the school. Thank you, School Nurse, Scoliosis Screening Program Student Name: X-Ray Shows: DISPOSITION: Signed by M.D. Date: Please return to Nurse:

Scoliosis Tracking and Annual Scoliosis Tracking and Annual

Scoliosis Summary ReportingScoliosis Summary Reporting

is completed on APSCN.is completed on APSCN.

REFERRALSREFERRALS

Children’s Services (formerly known as Children’s Services (formerly known as Children’s Medical Services) Children’s Medical Services) Department of Human ServicesDepartment of Human Services Donaghey Plaza SouthDonaghey Plaza South P.O. Box 1437 Slot 526P.O. Box 1437 Slot 526 Little Rock, AR 72203-1437Little Rock, AR 72203-1437 (Nancy Holder, Program Manager)(Nancy Holder, Program Manager)

Toll Free (800) 482-5850-ext.-22277 Toll Free (800) 482-5850-ext.-22277 or (501) 682-2277or (501) 682-2277

REFERRALSREFERRALS

Shriners Hospitals for ChildrenShriners Hospitals for Children(Shreveport or St. Louis)(Shreveport or St. Louis)

Contact local club/representative for Contact local club/representative for applicationapplication

Scimitar Shrine Temple – Little Rock 501-565-Scimitar Shrine Temple – Little Rock 501-565-59925992

Shrine 1-800-237-5055Shrine 1-800-237-5055

REFERRALSREFERRALS

Shriners Hospitals for ChildrenShriners Hospitals for Children Less than 18 year oldLess than 18 year old Copy of Immunizations and Birth CertificateCopy of Immunizations and Birth Certificate Letter of referral from PCPLetter of referral from PCP 3 pictures of child’s problem – ex. X-rays, 3 pictures of child’s problem – ex. X-rays,

CT,MRICT,MRI

RESOURCESRESOURCES

http://medstat.med.utah.edu/scoliosishttp://medstat.med.utah.edu/scoliosis http://srs.orghttp://srs.org http://www.tdh.state.tx.ushttp://www.tdh.state.tx.us www.orthopaedics-scoliosis.comwww.orthopaedics-scoliosis.com www.consultingorthopedists.comwww.consultingorthopedists.com http://www.rad.washington.edu/mskbook/http://www.rad.washington.edu/mskbook/

scoliosis.htmlscoliosis.html Individual Healthcare Plans for School Nurses Individual Healthcare Plans for School Nurses

(2005)(2005)

The New School Nurse Handbook The New School Nurse Handbook (3rd Edition)(3rd Edition)

School Nursing: A Comprehensive TextSchool Nursing: A Comprehensive Text (5 (5thth Edition)Edition)

FAQ’sFAQ’s

1. A lack of calcium will not cause scoliosis.

2. Poor posture does not cause scoliosis.

3. Carrying a heavy book bag does not cause scoliosis.

4. Scoliosis is not usually painful in adolescence, but can become so in adulthood.

5. Braces do not make the spine straight.

6. Smoking does interfere with bone healing.

More FAQsMore FAQs

7. The metal implant (spinal instrumentation) does not activate the metal detectors at airports, does not rust, and is not subject to rejection by the body.

8. Surgery does not interfere with normal childbearing.

9. Spinal deformities are not contagious.

10. At present, there is no known prevention for spinal deformities.

More FAQ’sMore FAQ’s

• Spinal Deformities-Scoliosis Spinal Deformities-Scoliosis Screening VideoScreening Video

• 15 Minutes15 Minutes

Scoliosis Screening for Early DetectionGillette Children’s Specialty Healthcare & The Minnesota Spine Center

PRACTICUMPRACTICUM

• Pair up and practice the procedurePair up and practice the procedure

• Document findings on the proper Document findings on the proper

formsforms

• Skills Check-offSkills Check-off

THE ENDTHE END