Scoliosis Psychic Functions in Patients Treated Conservatively or Operatively

I was contacted by a Dr who is interested in Scoliosis Overcompensation Syndrome, as defined by the author Elisabeth Mina. Dr Ewa Misterska is a psychologist from the Department of Pediatric Orthopaedics, Poznan University of Medical Sciences, Poland. She received her doctor's degree from Characteristics of selected psychic functions in patients treated conservatively or operatively for idiopathic scoliosis. Below is a white paper she has sent me for publication.

Author: Ewa Misterska
Characteristics of selected psychic functions in patients treated conservatively or operatively for adolescent  idiopathic scoliosis.

Department of Pediatric Orthopaedics

Karol Marcinkowski University of Medical Sciences, Poznan

The objective of the paper was to evaluate differences in the functioning of patients with idiopathic scoliosis shortly after taking up various forms of treatment as compared to a group of healthy volunteers. The evaluation concerned the level of social competences and selected aspects of the Carnal Self and features of personality, as well as specific problems occurring in patients with scoliosis. Additionally, it was checked if a correlation exists between the Body Mass Index, size of the Cobb angle before and after performing the surgery, degree of apical vertebral translation, location of the primary curve, % of postoperative correction, scope of instrumentation measured by the vertebrae it covers, duration of bracing (orthosis wearing) measured monthly and daily, and the social competences, dimensions of Corporal Self and features of personality, as well as specific problems characteristic to patients with scoliosis. The evaluation concerned also the internal relations between the variables listed above.

The evaluated group was composed of 104 people, of which 35 were patients subject to conservative treatment (group A), 34 were patients subject to operative treatment who after undergoing the scoliosis correction surgery wore orthoses in the post-operative period (group B). The patients were treated at the Department and Clinic of Children Orthopedics and Traumatology of University of Medical Sciences in Poznań. The third group was composed of 35 healthy girls and was the control group (group C) in the study. The age range for the evaluated group was 12-18 years. Only female patients participated in the study.

In the conservative treatment group orthoses were worn for the minimum time of 12 hours per day for not less than 3 months. The average age of patients was 14.8 years SD 1.4, while the average value of Cobb angle of the primary curve was 27.7 degrees SD 7.5. The average time for which orthoses were worn was 14.9 hours per day SD 3.2 for 16 months SD 11.5. In the examined group thoracic scoliosis prevailed (48.6% of all the patients).

In the group subject to surgical treatment combined with resection of fragments of ribs on the top of rib hump, the patients used the Cheneau orthosis for 3 months following the surgery. The average age of patients was 16.1 years SD 1.4, while the average value of Cobb angle of the primary curve prior to operative treatment was 54.6 degrees SD 9.0 and after the treatment 21.1 degrees SD 9.9. 64.7 % of patients had curves in the thoracic part of the spine. In the examined group, type II scoliosis according to King’s scale prevailed (41.2% of all the patients).

The control group of healthy girls was selected according to the average age and the sex as compared to the groups of patients with scoliosis. Any conditions in the spinal area or other serious diseases confirmed in a clinical examination were an exclusion criterion. The average age was 15.7 years SD 0.4.

All the examined people have filled in: the Personality Test (dimensions: self-criticism, social approach, extraversion, neurotics, maniac disposition, depressive disposition, schizoid disposition, paranoid disposition, vegetative stability); Carnal Self Questionnaire (dimensions: increased and decreased threshold of sensations, interpretation of emotions, physical conditions and sensations in the categories of sense of identity, control of emotions and physical conditions, emotional perception of the body, comfort in a close physical relation and body protection); J-C Scale (exhibition of femininity, acceptance of the body); Social Competences Questionnaire (dimensions: competences that condition effectiveness of behaviors in intimate situations, meaning close interpersonal contacts, in situations of social exhibition and situations that require assertiveness); additionally, patients with scoliosis have filled in the Bad Sobberheim Stress Questionnaire – Deformity (evaluation of the level of stress in patients with scoliosis felt in relation to deformations of their bodies) and Bad Sobberheim Stress Questionnaire - Brace (evaluation of the level of stress in patients wearing braces).

For the radiological examination images made in the standing position with the Ala ossis ilii in the frontal-rear projection were used.  For evaluation of the operatively treated group radiograms were used which had been made before and after the surgery, while in case of the conservatively treated group pre-treatment radiograms were used. In the analysis the following aspects were accounted for: value of the Cobb angle of the scoliosis in the primary curve and the distance (measured in centimeters) of the center of the uppermost vertebra involved from the central vertical spine line described as the degree of translation.  Also the following factors were taken into consideration as the location and the uppermost vertebra of the primary curve, the range of scoliosis, and in case of surgically treated patients also the range of the instrumentation and % of the scoliosis correction.

In the Personality Test, the patients with scoliosis obtained results which prove an average intensification of features tested, i.e. in the range between 25 and 75%. However, the conservatively treated patients may show the tendency for manic or hypomanic behavior, and the operatively treated patients for the neurotic behavior (results close to high: 73% and 74.4 % respectively).

The patients in all study groups do not show any abnormalities in respect of individual dimensions of the Corporal Self, and their results are interpreted as average (Corporal Self Questionnaire) or high (J-C Scale). The patients have a strong sense of identity, accept their bodies and the manner it functions, do not assume any autodestructive actions and take care of their health. The results prove a strong Corporal Self.

In the Social Competences Questionnaire, the patients obtained scores in the range of 4-7 stens, which prove an average level of competences that condition the efficiency of behaviors in close interpersonal contact situations and in social exhibition situations, as well as the efficiency of behaviors in situations that require assertiveness.

The level of stress caused by bracing was average for both conservatively and operationally treated patients (in the range of 9-16 points). Deformations caused a low level of stress (scores in the range of 17-24 points) in conservatively treated patients, a moderated level of stress (scores in the range 9-16 points) in operationally treated patients.

Compared with healthy peers, the patients with scoliosis and the conservatively treated patients had a higher level of self-criticism, but a stronger Corporal Self (relevant statistical differences at the level p<0.05).

Compared with healthy peers, the patients with scoliosis who were subject to operational treatment had a higher level of self-criticism, neurotism, depressiveness, but at the same time also a stronger Corporal Self (relevant statistical differences at the level p<0.05).

The conservatively treated patients, when compared to the operationally treated patients, showed a higher level of maniac disposition, but at the same time a lower level of neurotic disposition and of stress due to bodily deformations  (relevant statistical differences at the level p<0,05).

In reference to the level of functioning of conservatively treated patients important were: age at which their treatment commenced, degree of apical vertebral translation, location and direction of the primary curve, duration of bracing per day and the Body Mass Index; while for the operatively treated patients such relevant factors included: degree of apical vertebral translation prior to the surgery, location and direction of the primary curve, and also the Body Mass Index.

Conclusions:1. Adolescent patients with scoliosis, irrespective of the treatment method applied, show no abnormalities in most of the psychic functions analyzed, as compared to healthy peer group.
2. The issue, which treatment method has a bigger negative influence on the psychic condition of patients with scoliosis, remains undecided. The patients who received conservative treatment showed a higher level of maniac disposition, whilst those treated surgically showed a higher level of neurotic disposition and stress due to bodily deformations.
3. There is a relation between the degree of apical vertebral translation before the operation, Body Mass Index and the psychic and social functioning in the group of patients treated surgically.
4. There is a relation between the degree of apical vertebral translation, Body Mass Index, the period for which orthosis is worn per day, the age at the moment when treatment commences and the psychic and social functioning in the group of patients treated conservatively.

1. Haefeli M, Elfering A, Kilian R, Min K, Boos N. Nonoperative treatment for adolescent idiopathic scoliosis: a 10- to 60-year follow-up with special reference to health-related quality of life. Spine. 2006 Feb 1;31(3):355-66.
2. Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL. Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001 Aug;10(4):278-88.
3. Howe G.W., Geinstein C., Reiss S., Molock K., Bereger K.: Adolescent adjustment to chronic physical disorder - I. Comparing neurological and non-neurological conditions. Journal of Child Psychology and Psychiatry, 1993, 7: 1153-1171.
4. Mrazek D.A.: Chronic Pediatric Illness and Multiple Hospitalization. W: Lewis M (red.): Child and Adolescent Psychiatry. A Comprehensive Textbook. William and Wilkins, Baltimore, 1996.
5. Spirito A., Stark L.J., Gil K.M., Tyc V.L.: Coping with Everyday and Disease-Related Stressors by Chronically Ill Children and Adolescents. J. Am. Acad. Child. Adolesc. Psychiatry, 1995, 34 (3): 283-290.
6. Starfield B., Forrest C.B., Ryan S.A., Riley A.W., Ensminger M.E., Green B.F.: Health Status of Well vs Ill Adolescents. Arch. Pediatr. Adolesc. Med., 1996, 150: 1249-1256.
7. Stein R.E.K., Jessop D.J.: General Issues in the Care of Children with Chronic Physical Conditions. The Pediatric Clinics of North America, 1984, 31 (1): 190-198.
8. Rutter M., Tizard J., Whitmore K.: Education, health and behavior. Longman, London, 1970.
9. Austin J.K., Shelton Smith M., Risinger M.W., McNelis A. M.: Childhood epilepsy and asthma: comparison of quality of life. Epilepsia, 1994, 35 (3): 608-615.
10. Hoare P.: Does illness foster dependency? A study of epileptic and diabetic children. Developmental Medicine and Child Neurology, 1984, 26: 20-24.
11. Fowler M.G., Johnson M.P., Atkinson S.S.: School achievement and absence in children with chronic health conditions. The Journal of Pediatrics, 1985, 106 (4): 683-687.
12. Danielsson AJ. What impact does spinal deformity correction for adolescent idiopathic scoliosis make on quality of life? Spine. 2007 Sep 1;32(19 Suppl):S101-8.
13. Kahanovitz N, Weisser S. The psychological impact of idiopathic scoliosis on the adolescent female . A preliminary  multi-center study. Spine 1989;14:483-5.
14. Clayson D, Luz- Alterman S, Cataletto MM i wsp. Longterm psychological sequelae of surgically versus nonsurgically treated scoliosis. Spine 1987;12:983-6.
15. Sapountzi-Krepia DS, Valavanis J, Panteleakis GP, Zangana DT, Vlachojiannis PC, Sapkas GS. Perceptions of body image, happiness and satisfaction in adolescents wearing a Boston brace for scoliosis treatment. J Adv Nurs. 2001 Sep;35(5):683-90.
16. Lindeman M, Behm K. Cognitive strategies and self-esteem as predictors of brace-wear noncompliance in patients with idiopathic scoliosis and kyphosis. J Pediatr Orthop. 1999 Jul-Aug;19(4):493-9.
17. Tones MJ, Moss ND. The impact of patient self assessment of deformity on HRQL in adults with scoliosis. Scoliosis. 2007 Oct 15;2:14.
18. Payne W, Ogilvie J, Resnick M i wsp. Does Scoliosis Have a psychological impact and Does Gender Make a Difference? Spine 1997;12:1380-1384.
19. Wojnarowska B, Mazur J, Kołoło H, Małkowska M. Zdrowie, zachowania zdrowotne i środowiska społeczne młodzieży w krajach Unii Europejskiej. Wydział Pedagogiczny Uniwersytet Warszawski, Instytut Matki i Dziecka. Warszawa 2005.
20. Marciniak W, Szulc A. Wiktora Degi Ortopedia i Rehabilitacja 2. Wydawnictwo Lekarskie PZWL, Warszawa 2003 str. 68-105.
21. Danielsson AJ, Nachemson AL. Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case-control study. Spine. 2001 Jul 1;26(13):1449-56
22. Steel HH. Rib resection and spine fusion in correction of convex deformity in scoliosis. J Bone Joint Surg Am. 1983 Sep;65(7):920-5.
23. Noonan KJ, Dolan LA, Jacobson WC, Weinstein SL Long-term psychosocial characteristics of patients treated for idiopathic scoliosis. J Pediatr Orthop. 1997 Nov-Dec;17(6):712-7.
24. Brosnan H. Nursing management of the adolescent with idiopathic scoliosis. Nurs Clin North Am. 1991 Mar;26(1):17-31.
25. Głowacki M. Wartość wybranych czynników  prognostycznych w leczeniu operacyjnym skoliozy idiopatycznej. Ośrodek Wydawnictw Naukowych, Poznań 2002.
26. Wilczyński J. Boczne skrzywienia kręgosłupa. Rozpoznanie i korekcja. Część 1, Wszechnica Świętokrzyska, Kielce 2000.
27. Krawczyński M. Dojrzewanie i dorastanie. Problemy i potrzeby zdrowotne i psychospołeczne. Pediatria Polska 1994, 69,(8): 581-587.
28. Offer D., Schonert-Reich K.A., Boxer A.M.: Normal Adolescent Development: Empirical Research Findings. W: Lewis M. (red.), Child and Adolescent Psychiatry: A Comprehensive Textbook. Wiliam and Wilkins, Baltimore, 1996.
29. Żebrowska M. Psychologia dzieci i młodzieży. PWN, Warszawa 1986.
30. Reichel D, Schanz J. Developmental psychological aspects of scoliosis treatment. Pediatr Rehabil. 2003 Jul-Dec;6(3-4):221-5.
31. Weiner I.B.: Zaburzenia psychiczne wieku dorastania. PZWL, Warszawa, 1977.
32. Coleman J.C.: Dojrzewanie. W: Bryant P.E., Colman A.M. (red.): Psychologia rozwojowa. Zysk i S-ka Wydawnictwo, Poznań, 1997.
33. Kaplan H.I., Sadock B.J.: Psychiatria kliniczna. Urban & Partner, Wrocław, 1995.
34. LaMontagne LL, Hepworth JT, Cohen F, Salisbury MH. Adolescent scoliosis: effects of corrective surgery, cognitive-behavioral interventions, and age on activity outcomes. Appl Nurs Res. 2004 Aug;17(3):168-77.
35. Koch KD, Buchanan R, Birch JG, Morton AA, Gatchel RJ, Browne RH. Adolescents undergoing surgery for idiopathic scoliosis: how physical and psychological characteristics relate to patient satisfaction with the cosmetic result. Spine. 2001 Oct 1;26(19):2119-24.
36. Nathan SW.  Coping with disability and the surgical experience: body image of scoliotic female adolescents. 1978 May;17(5):434-40.
37. Havighurst RJ. Developmental Tasks and Education, LONGMAN N.Y. and London, 1981
38. Stępień E., Frączek A.: Przekonania dorastających o czynnikach i zachowaniach szkodliwych dla zdrowia. Alkoholizm i Narkomania, 1991, 8: 83-94.
39. Ziółkowska B. Okres dorastania.Jak rozpoznać ryzyko i jak pomagać? W: Psychologiczne portrety człowieka. Praktyczna psychologia. Gdańskie Wydawnictwo Psychologiczne, Gdańsk 2006 str. 379-422.
40. Kotzer AM. Factors predicting postoperative pain in children and adolescents following spine fusion. Issues Compr Pediatr Nurs. 2000 Apr-Jun;23(2):83-102.
41. Schatzinger LH, Brower EM, Nash CL Jr. The patient with scoliosis. Spinal fusion: emotional stress and adjustment. Am J Nurs. 1979 Sep;79(9):1608-12.
42. Vandal S, Rivard CH, Bradet R. Measuring the compliance behavior of adolescents wearing orthopedic braces. Issues Compr Pediatr Nurs. 1999 Apr-Sep;22(2-3):59-73.
43. Apter A, Morein G, Munitz H, Tyano S, Maoz B, Wijsenbeek H. The psychosocial sequelae of the Milwaukee brace in adolescent girls. Clin Orthop Relat Res. 1978 Mar-Apr;(131):156-9.
44. Gurnham RB. Adolescent compliance with spinal brace wear. Orthop Nurs. 1983 Nov-Dec;2(6):13-7.
45. Myers BA, Friedman SB, Weiner IB. Coping with chronic disability. Psychosocial observations of girls with scoliosis treated with the Milwaukee brace. Am J Dis Child. 1970 Sep;120(3):175-81.
46. Borders C. R. After Bypass. New life, new life-style. The patient’s view. Patient care. 1986 July 15: 65-93.
47. Wickers FC, Bunch WH, Barnett PM. Psychological factors in failure to wear the Milwaukee brace for treatment of idiopathic scoliosis. Clin Orthop Relat Res. 1977 Jul-Aug;(126):62-6.
48. Heckman Schatzinger LA, Nash CL Jr, Drotar DD, Hall TW. Emotional adjustment in scoliosis. Clin Orthop Relat Res. 1977 Jun;(125):145-50.
49. Cattarin, J.A, Thompson, J.K., 1994. A three-year longitudinal  study of body image and eating disorder in adolescent females. Eating Disord 1994: 2:114-25.
50. Stice E , Agras WS. Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behavior Therapy. 1998;29:257–276.
51. Smith FM, Latchford GJ, Hall RM, Dickson RA. Do chronic medical conditions increase the risk of eating disorder? A cross-sectional investigation of eating pathology in adolescent females with scoliosis and diabetes. J Adolesc Health. 2008 Jan;42(1):58-63.
52. Fairburn CG, Shafran R, Cooper Z A cognitive behavioural theory of anorexia nervosa. Behav Res Ther. 1999 Jan;37(1):1-13.
53. Vitousek, K.M. The current status of cognitive behavioural models of anorexia nervosa and bulimia nervosa'' in Salkovskis R et al. Frontiers of cognitive therapy New York: Guillford Press 1996  pp.383-418.
54. Smith FM, Latchford G, Hall RM, Millner PA, Dickson RA. Indications of disordered eating behaviour in adolescent patients with idiopathic scoliosis. J Bone Joint Surg Br. 2002 Apr;84(3):392-4.
55. Alborghetti A, Scimeca G, Costanzo G, Boca S. The prevalence of eating disorders in adolescents with idiopathic scoliosis. Eat Disord. 2008 Jan-Feb;16(1):85-93.
56. Wolska, M. Zaburzenia odżywiania się w perspektywie kulturowej i społecznej. W: B. Józefik (red), Anoreksja i bulimia psychiczna. Wydawnictwo Uniwersytetu Jagiellońskiego  Kraków 1999 str 104-114.
57. Lothman D.J., Pianta R.C.: Role of Child-Mother Interaction in Predicting Competence of Children with Epilepsy. Epilepsia, 1993, 34 (4): 658-669.
58. Cochran T, Nachemson A. Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated with the Milwaukee brace. Spine. 1985 Mar;10(2):127-33.
59. Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL. Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001 Aug;10(4):278-88.
60. Weigert KP, Nygaard LM, Christensen FB, Hansen ES, Bünger C. Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24. Eur Spine J. 2006 Jul;15(7):1108-17.
61. Fällstrom K, Cochran T, Nachemson A. Long-term effects on personality development in patients with adolescent idiopathic scoliosis :influence of type of treatment. Spine 1986;11:756-8.
62. Bunge EM, Juttmann RE, de Kleuver M, van Biezen FC, de Koning HJ; NESCIO group. Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment. Eur Spine J. 2007 Jan;16(1):83-9.
63. MacLean WE, Green NE, Pierre CB i wsp.. Stress and coping with scoliosis: psychological effects on adolescents and their families. J Pediatr Orthop 1989;9:257-61.
64. Olaffson Y, Saraste H, Ahlgren RM. Does bracing affect self-image? A prospective study on 54 patients with adolescent idiopathic scoliosis. Eur Spine J.1999;8:402-405.
65. Braunewell A, Dehe W, Schmitt E, Mentzos S. Psychodynamic aspects of corset treatment in adolescents. Z Orthop Ihre Grenzgeb. 1987 Mar-Apr;125(2):132-4.
66. Koch KD, Buchannan R, Birch JG. Adolescents undergoing surgeryfor idiopathic scoliosis: how physical and psychological characteristics relate to patient satisfaction with the cosmetic results. Spine 2001;26:2119-24
67. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006 Mar 31;1(1):2.
68. Tones M, Moss N, Polly DW Jr. A review of quality of life and psychosocial issues in scoliosis. Spine. 2006 Dec 15;31(26):3027-38.
69. Haher TR, Gorup JM, Shin TM, Homel P, Merola AA, Grogan DP, Pugh L, Lowe TG, Murray M. Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine. 1999 Jul 15;24(14):1435-40.
70. Gratz RR, Papalia-Finlay D. Psychosocial adaptation to wearing the Milwaukee brace for scoliosis. A pilot study of adolescent females and their mothers. J Adolesc Health Care. 1984 Oct;5(4):237-42.
71. Kahanovitz N, Snow B, Pinter I. The comparative results of psychologic testing in scoliosis patients treated with electrical stimulation or bracing. Spine. 1984 Jul-Aug;9(5):442-4.
72. Mirucka B. Kwestionariusz Ja Cielesnego (Skala J-C). Przegląd Psychologiczny 2005: 48 (3):313-329.
73. Sakson-Obada O. Ja cielesne w kontekście traumy i relacji przywiązania. Rozprawa doktorska. Uniwersytet im. Adama Mickiewicza, Poznań, 2007.
74. Kowalik S. Ja cielesne-próba nowego spojrzenia. Polskie Forum Psychologiczne. 2004;8: 5-29.
75. Orbach S. On Eating. Penguin London  2002.
76. Biven, B.M. (1982). The Role of Skin in Normal and Abnormal Development with a Note on the Poet Sylvia Plath. Int. R. Psycho-Anal., 9:205-229.
77. Bronheim H, Strain JJ, Biller HF. Psychiatric aspects of head and neck surgery. Part II: Body image   and psychiatric intervention. Gen Hosp Psychiatry. 1991 Jul;13(4):225-32.
78. Cohen A. Body image in the person with a stoma. J Enterostomal Ther. 1991 Mar-Apr;18(2):68-71.
79. Matczak A. Kwestionariusz Kompetencji Społecznych KKS. Podręcznik. Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego. Warszawa 2001.
80. Steinhausen HC, Stephan H, Schindler-Lembenz HP. Comparative studies of the psychopathology of bronchial asthma and cystic fibrosis   Monatsschr Kinderheilkd. 1983 Mar;131(3):145-9.
81. Perrin EC, Ramsey BK, Sandler HM. Competent kids: children and adolescents with a chronic illness. Child Care Health Dev. 1987 Jan-Feb;13(1):13-32.
82. Pilecka W. Przewlekła choroba somatyczna w życiu i rozwoju dziecka. Problemy psychologiczne. Wydawnictwo Uniwersytetu Jagiellońskiego, Kraków, 2002.
83. Albon J. Parents’ responses to their child’s diagnosis of neurofibromatosis I. Am. J. Med. Genet. 2000; 17: 136-142.
84. North K, Joy P, Yuille D, Cocks N, Mobbs E, McHugh K, de Silva M. Specific learning disability in children with nf type I: significance of MRI abnormalities. Neurol. 1995; 45: 1029-1030.
85. Brzeziński J. Metodologia badań psychologicznych. Wydawnictwo Naukowe PWN. Warszawa 1997.
86. Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M. Natura history of untreated idiopathic scoliosis after skeletal maturity. Spine. 1986 Oct;11(8):784-9.
87. Climent JM, Bago J, Ey A, Perez-Grueso FJ, Izquierdo E. Validity of the Spanish version of the Scoliosis Research Society-22 (SRS-22) Patient Questionnaire. Spine. 2005 Mar 15;30(6):705-9.
88. Dajek E. R. Polska standaryzacja ,,Testu Osobowości” (wersji skróconej Testu Osobowości i Zainteresowań) Ericha Mitteneckera i Waltera Tomana. Wydawnictwo Erda, Warszawa 2006.
89. Lowen A. Duchowość ciała. Jacek Santorski & Co. Warszawa 1991.
90. Andrews, B. Bodily shame as a mediator between abusive experiences and depression. Journal of Abnormal Psychology. 1995;104:277-285.
91. Mirucka B. Typy Ja cielesnego, czyli sposoby doświadczania swojej cielesności przez kobiety. Czasopismo psychologiczne. 2005; 11 (2):157-166.
92. Mirucka B. Przeżywanie własnego ciała przez kobiety z bulimią psychiczną. Roczn. Psychol. 2006; 9: 81-99.
93. James W. The Principles of Psychology. Dover Publications, Inc. New York 1950.
94. Allport G. Osobowość i religia. Warszawa  1988.
95. Botens-Helmus Ch, Klein R, Stephan C. The reliability of the Bad Sobernheim Stress Questionnaire (BSSQbrace) in adolescents with scoliosis during brace treatment
Scoliosis.2006,1:22 doi:10.1186/1748-7161-1-22.
96. D'Andrea LP, Betz RR, Lenke LG, Clements DH, Lowe TG, Merola A, Haher T, Harms J, Huss GK, Blanke K, McGlothlen S. Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis? Spine. 2000 Jul 15;25(14):1795-802.
97. Payne W, Ogilvie J, Resnick M i wsp. Does Scoliosis Have a Psychological Impact and Does Gender Make a Difference? Spine 1997;12:1380-1384.
98. Ugwonali OF, Lomas G, Choe JC, Hyman JE, Lee FY, Vitale MG, Roye DP Jr . Effect of bracing on the quality of life of adolescents with idiopathic scoliosis. Spine J. 2004 May-Jun;4(3):254-60.
99. Vasiliadis E, Grivas TB, Savvidou O, Triantafyllopoulos G. The influence of brace on quality of life of adolescents with idiopathic scoliosis. Stud Health Technol Inform. 2006;123:352.
100. Eliason MJ, Richman LC. Psychological effects of idiopathic adolescent scoliosis. J Dev Behav Pediatr. 1984 Aug;5(4):169-72
101. Matsunaga S, Hayashi K, Naruo T. Psychologic management of brace therpay for patients with idiopathic scoliosis. Spine 2005;30:547-550.
102. Sapountzi-Krepia D, Psychogiou M, Peterson D, Zafiri V, Iordanopoulou E, Michailidou F, Christodoulou A. The experience of brace treatment in children/adolescents with scoliosis. Scoliosis. 2006 May 22;1:8.
103. Newton PO, Parent S, Marks M, Pawelek J. Personal communication on: Prospective evaluation of 50 consecutive scoliosis patients surgically treated with thoracoscopic anterior instrumentation. Spine. 2005 Sep 1;30(17 Suppl):S100-9.
104. Sweet FA, Lenke LG, Bridwell KH, Blanke KM, Whorton J. Prospective radiographic and clinical outcomes and complications of single solid rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis. Spine. 2001 Sep 15;26(18):1956-65.
105. Climent JM, Sánchez J.Impact of the type of brace on the quality of life of Adolescents with Spine Deformities. Spine. 1999 Sep 15;24(18):1903-8.
106. Nachemson A. A long term follow-up study of non-treated scoliosis. Acta Orthop Scand. 1968;39(4):466-76.
107. Frankfort-Nachmias C., Nachmias D.: Metody badawcze w naukach społecznych. Zysk i S-ka Wyd. S.C., Poznań 2001.
108. Piaget J. Rozwój ocen moralnych  dziecka. PWN, Warszawa 1967.
109. Wolańczyk T. Dorastanie a choroba przewlekła – wybrane zagadnienia. Postępy Nauk Medycznych 2006; 6:321-326.
110. McArney E.R.: Social maturation: A challenge for handicaped and chronically ill adolescent. Journal of Adolescent Health Care, 1985, 6: 90-101.
111. Helena Sęk, Lidia Cierpiałkowska (red.) Psychologia kliniczna i psychologia zdrowia. Wybrane zagadnienia. Wydawnictwo Fundacji Humaniora, Poznań 2001.
112. Perrin E.C., Gerrity P.S.: Development of Children with a Chronic Illness. Pediatric Clinics of North America, 1984, 31 (1): 19-31.
113. Samuelsson B, Riccardi VM. Neurofibromatosis in Gothenburg, Sweden. III. Psychiatric and social aspects. Neurofibromatosis. 1989;2(2):84-106.
114. Zöller ME, Rembeck B.A psychiatric 12-year follow-up of adult patients with neurofibromatosis type 1. J Psychiatr Res. 1999 Jan-Feb;33(1):63-8.
115. Johnson NS, Saal HM, Lovell AM, Schorry EK Social and emotional problems in children with neurofibromatosis type 1: evidence and proposed interventions.. J Pediatr. 1999 Jun;134(6):767-72.
116. Kayl AE, Moore BD 3rd, Slopis JM, Jackson EF, Leeds NE. Quantitative morphology of the corpus callosum in children with neurofibromatosis and attention-deficit hyperactivity disorder. J Child Neurol. 2000 Feb;15(2):90-6.
117. Wolkenstein P, Zeller J, Revuz J, Ecosse E, Leplège A. Visibility of neurofibromatosis 1 and psychiatric morbidity. Arch Dermatol. 2003 Jan;139(1):103-4.
118. Cupey S.M., Cohen M.J.: Special considerations for the health care of adolescents with chronic illnesses. Pediatric Clinics of North America, 1984, 31: 211-219.
119. Austin K. Concerns and fears of children with seizures. Clinical Nursing Practice and epilepsy 1993; 1:4-6.
120. Austin J.K., Fraser R.T.: Children with Epilepsy: Their Families and Later Vocational Adjustment. W: Issues in Epilepsy and Quality of Life. Epilepsy Foundation of America, Landover, 1994; 1-8
121. Komender J. Psychospołeczne problemy dzieci chorych na padaczkę i ich rodzin. Praca habilitacyjna. Warszawska Akademia Medyczna, Warszawa, 1988.
122. Daniels D, Moos RH, Billings AG, Miller JJ 3rd. Psychosocial risk and resistance factors among children with chronic illness, healthy siblings, and healthy controls. J Abnorm Child Psychol. 1987 Jun;15(2):295-308.
123. Clarke A. Psychosocial aspects of facial disfigurement: problems, management and the role of a lay-led organization. Psychol Health Med. 1999; 4(2):127-142.
124. Thulbourne T, Gillespie R. The rib hump in idiopathic scoliosis. Measurement, analysis and response to treatment. J Bone Joint Surg Br. 1976 Feb;58(1):64-71
125. Drench ME. Changes in body image secondary to disease and injury. Rehabil Nurs. 1994 Jan-Feb;19(1):31-6.
126. Krueger D. Body self and psychological self. A developmental and clinical integration of disorders of the self. Brunner Mazel, New York 2002.
127. Pruzinsky T. Enhancing quality of life in medical populations: a vision for body image assessment and rehabilitation as standards of care. Body Image. 2004 Jan;1(1):71-81.
128. Lelek A, Bętkowska-Korpała B. Doświadczenie własnego ciała u kobiet z syndromem Dorosłego Dziecka Alkoholoka (DDA)- doniesienie z badań. Psychoterapia. 2008; 4:43-51.
129. Sanders JO, Harrast JJ, Kuklo TR, Polly DW, Bridwell KH, Diab M. Spinal Deformity Study Group. The Spinal Appearance Questionnaire: results of reliability, validity, and responsiveness testing in patients with idiopathic scoliosis. Spine. 2007 Nov 15;32(24):2719-22.
130. Saccomani L, Vercellino F, Rizzo P i wsp. Adolescents with scoliosis: psychological and psychopathological aspects. Minerva Pediatr.1998;50:9-14.
131. Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg Am. 1981 Jun;63(5):702-12.
132. Goldberg MS, Mayo NE, Poitras B, Scott S, Hanley J. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part II: Perception of health, self and body image, and participation in physical activities. Spine. 1994 Jul 15;19(14):1562-72.
133. Smith PL, Donaldson S, Hedden D, Alman B, Howard A, Stephens D, Wright JG. Parents' and patients' perceptions of postoperative appearance in adolescent idiopathic scoliosis. Spine. 2006 Sep 15;31(20):2367-74
134. Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine. 2005 Mar 15;30(6):682-8.
135. Braunewell A, Dehe W, Schmitt E, Mentzos S. Psychodynamic aspects of corset treatment in adolescents. Z Orthop Ihre Grenzgeb. 1987 Mar-Apr;125(2):132-4.
136. Beka A, Dermitzaki I, Christodoulou A, Kapetanos G, Markovitis M, Pournaras J. Children and adolescents with idiopathic scoliosis: emotional reactions, coping mechanisms, and self-esteem. Psychol Rep. 2006 Apr;98(2):477-85.
137. Anderson F.G. Self-concept and coping in adolescents with a physical disability. Issues in Mental    Health. Nursing 1981; 4:257-274.
138. Scoloveno MA, Yarcheski A, Mahon NE. Scoliosis treatment effects on selected variables among adolescents. West J Nurs Res. 1990 Oct;12(5):601-15; discussion 615-8.
139. Freidel K. Psychosocial problems in idiopathic scoliosis. (Berlin:, 1999.
140. Climent JM, Reig A, Sánchez J, Roda C. Construction and validation of specific quality of life instrument with spine defotmities. Spine. 1995 Sep 15;20(18):2006-11.
141. Federico  DJ, Renshaw TS. Results of treatment of idiopathic scoliosis with the Charlston bending orthosis. Spine 1989;14:886-7.
142. Singer T. Investigations on Self-Image of Scoliosis Patients.(Frankfurt:Lang), 1997.
143. Roth M. Body-image structure in chronically sick adolescents. Zeitschrift  für Gesundheitspsychologie, 8th year, vol1/2000, 8-17 (Göttingen: Hogrefe), 2000.
144. Seiffge-Krenke I. Self-Image and Body-Image in chronically Sick and Healthy Adolescents. Zeitschrift  für Gesundheitspsychologie, (Göttingen: Hogrefe), 1996.
145. Clayson D, Levine DB. Adolescent scoliosis patients. Personality patterns and effects of corrective surgery. Clin Orthop Relat Res. 1997;116: 99-102.
146. Bengtsson G, Fällström K, Jansson B, Nachemson A. A psychological and psychiatric investigation of the adjustment of female scoliosis patients. Acta Psychiatr Scand. 1974;50(1):50-9.
147. LaMontagne LL, Hepworth JT, Cohen F. Cognitive-behavioral intervention effects on adolescents’anxiety and pain following spinal fusion surgery. Nurs Res 1993;52:183-90.
148. Matsunaga S, Sakou T, Nozoe S. Psychological effects of brace therapy on patients with idiopathic scoliosis. J Orthop Sci 1997;2:391-5.
149. Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995 Apr;33(4 Suppl):AS264-79.
150. Wolman C, Resnick MD, Harris LJ, Blum RW. Emotional well-being among adolescents with and without chronic conditions. J Adolesc Health. 1994 May;15(3):199-204.
151. Ovromaa E. Psychological evaluation of patients operated for idiopathic scoliosis by the Harrington method . Int J Rehabil Res 1997;21:169-78.
152. Andersen MO, Andersen GR, Thomsen K i wsp. Early weaning might reduce the psychological strain of Boston bracing: a study of 136 patients with adolescent idiopathic scoliosis at 3.5 years after termination of brace treatment. J Pediatr Orthop B 2002;11: 96-99.
153. Vasiliadis E, Grivas TB, Savvidou O, Triantafyllopoulos G. The influence of brace on quality of life of adolescents with idiopathic scoliosis.  Stud Health Technol Inform. 2006;123:352-6.
154. Kotwicki T, Kinel E, Stryła W, Szulc A. Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires. Scoliosis. 2007 Jan 3;2:1
155. Pratt RK, Burwell RG, Cole AA, Webb JK. Patient and parental perception of adolescent idiopathic scoliosis before and after surgery in comparison with surface and radiographic measurements. Spine. 2002 Jul 15;27(14):1543-50
156. Bridwell KH, Shufflebarger HL, Lenke LG, Lowe TG, Betz RR, Bassett GS. Parents' and patients' preferences and concerns in idiopathic adolescent scoliosis: a cross-sectional preoperative analysis. Spine. 2000 Sep 15;25(18):2392-9.
157. Rinella A, Lenke L, Peelle M, Edwards C, Bridwell KH, Sides B. Comparison of SRS questionnaire results submitted by both parents and patients in the operative treatment of idiopathic scoliosis. Spine. 2004 Feb 1;29(3):303-10.
158. Glassman SD, Schwab FJ, Bridwell KH, Ondra SL, Berven S, Lenke LG. The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine. 2007 Jan 1;32(1):93-7.
159. Clayson D, Mahon B, Levine DB. Preoperative personality characteristics as predictors of postoperative physical and psychological patterns in scoliosis. Spine. 1981 Jan-Feb;6(1):9-12.
160. Merola AA, Haher TR, Brkaric M, Panagopoulos G, Mathur S, Kohani O. A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. Spine. 2002 Sep 15;27(18):2046-51.
161. Wilson PL, Newton PO, Wenger DR, Haher T, Merola A, Lenke L, Lowe T, Clements D, Betz R. A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument. Spine. 2002 Sep 15;27(18):2036-40.
162. Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003 Feb 5;289(5):559-67.
163. Newton PO, Parent S, Marks M, Pawelek J. Prospective evaluation of 50 consecutive scoliosis patients surgically treated with thoracoscopic anterior instrumentation. Spine. 2005 Sep 1;30(17 Supl):S100-9.

Popular posts from this blog

Scoliosis and Periods - oh the pain!

Scoliosis and Clothes Shopping

Scoliosis and Memory Foam Mattresses