Help your patients/families understand more about scoliosis treatment and what to expect.
The BSPTS-Rigo Concept is a form of Physiotherapy Scoliosis Specific Exercise (PSSE). The formal definition of PSSE was developed by a scientific society called, the Scientific Society of Scoliosis Orthopedic Rehabilitation and Treatment (SOSORT). PSSE is a name to cover all the different types of scoliosis-specific exercises that are known around the world that have scientific proof of their effectiveness. BSPTS Concept by Rigo is just one of several types of PSSE. The difference between the schools of thought is related to what and how the postural correction is defined and performed by the patient under the Physical Therapist’s direction.
An exercise type must meet the following requirements in order to be an accepted PSSE by SOSORT:
INITIAL TESTING AND EVALUATION
A therapist will do a thorough initial evaluation. If possible, the parent should sit in on the evaluation and ask questions as needed to better understand the process. The following is a list of tests that the BSPTS Concept by Rigo method trained PT may use to develop a treatment plan for your child.
Usual Tests and measures:
TREATMENT PLAN DEVELOPMENT
Once the evaluation is complete the treatment plan and goals are developed based on the medical needs of the patient. The PT will recommend the length, duration, and number of visits the child’s course of treatment will take. After discussing the plan, the patient, family, and PT should all agree on the appropriate goals of treatment. The goals should be patient-specific, measurable, and achievable. After the evaluation is completed and goals are agreed upon, treatment should begin.
Treatment:
Education of the patient and family will be in a style that is understandable and relevant. The program involves self-awareness of the scoliosis posture and strategies to improve the alignment of the patient. It is imperative that the patient is actively involved in the exercises.
Exercise will include BSPTS principles of correction. Most of these beginning exercises are positions to help lengthen and stabilize the trunk. The positions used early in treatment control for the effects of gravity by exercising in anti-gravity positions. Early on in the treatment the patient and family are educated on neutral spinal body mechanics (for example, how people sit to study, stand for band practice, and perform other general daily activities). The body mechanics should be supported with education on why this is important, specifically looking at factors that may increase the risk of progression of scoliosis.
Once the patient can control postures without gravity, he or she will try to work into upright exercise positions with corrected alignment. Eventually, positions become more dynamic and more resistive, and some special exercises may be used. These higher-level exercises are only for the patient who has been training for a significant period of time and/or manages a high capability of postural strength.
Be sure your PT also addresses any pain, making necessary modifications and/or looking for other sources of pain. Pain and other orthopedic conditions should be considered when developing the overall treatment plan.
The ultimate goal is for the patient to be strong enough to be able to control postures during daily life activities with minimal mental or physical effort.
EXPECTATIONS
Your BSPTS Concept by Rigo Schroth-Based Method provider should:
Be sure your PT also addresses any pain, making necessary modifications and/or looking for other sources of pain. Pain and other orthopedic conditions should be considered when developing the treatment plan. Like any other medical training, the quality of the application of the method is not in the control of the school but is in the hands of the PT providing the treatment.
An exercise type must meet the following requirements in order to be an accepted PSSE by SOSORT:
- Autocorrection in 3D.The patient learns how to perform the corrected posture themselves.
- Training in activities of daily living. The patient knows how to correct posture during normal movement patterns in their life activities.
- Stabilization in the corrected position. The patient performs exercises to stabilize the corrected posture both in the clinic and at home.
- Education. The patient and family are educated about scoliosis and what PSSE aims to support.
INITIAL TESTING AND EVALUATION
A therapist will do a thorough initial evaluation. If possible, the parent should sit in on the evaluation and ask questions as needed to better understand the process. The following is a list of tests that the BSPTS Concept by Rigo method trained PT may use to develop a treatment plan for your child.
Usual Tests and measures:
- Adams forward bending test
- Scoliometer (a trunk symmetry measurement tool)
- Postural assessment
- Joint hypermobility (double-jointed)
- Respiratory function
- Health-related quality of life (child’s feelings regarding scoliosis diagnosis)
- Radiological Studies: back view and side view x-rays
- Other standard PT tests as required based on individual needs
TREATMENT PLAN DEVELOPMENT
Once the evaluation is complete the treatment plan and goals are developed based on the medical needs of the patient. The PT will recommend the length, duration, and number of visits the child’s course of treatment will take. After discussing the plan, the patient, family, and PT should all agree on the appropriate goals of treatment. The goals should be patient-specific, measurable, and achievable. After the evaluation is completed and goals are agreed upon, treatment should begin.
Treatment:
Education of the patient and family will be in a style that is understandable and relevant. The program involves self-awareness of the scoliosis posture and strategies to improve the alignment of the patient. It is imperative that the patient is actively involved in the exercises.
Exercise will include BSPTS principles of correction. Most of these beginning exercises are positions to help lengthen and stabilize the trunk. The positions used early in treatment control for the effects of gravity by exercising in anti-gravity positions. Early on in the treatment the patient and family are educated on neutral spinal body mechanics (for example, how people sit to study, stand for band practice, and perform other general daily activities). The body mechanics should be supported with education on why this is important, specifically looking at factors that may increase the risk of progression of scoliosis.
Once the patient can control postures without gravity, he or she will try to work into upright exercise positions with corrected alignment. Eventually, positions become more dynamic and more resistive, and some special exercises may be used. These higher-level exercises are only for the patient who has been training for a significant period of time and/or manages a high capability of postural strength.
Be sure your PT also addresses any pain, making necessary modifications and/or looking for other sources of pain. Pain and other orthopedic conditions should be considered when developing the overall treatment plan.
The ultimate goal is for the patient to be strong enough to be able to control postures during daily life activities with minimal mental or physical effort.
EXPECTATIONS
Your BSPTS Concept by Rigo Schroth-Based Method provider should:
- Follow SOSORT treatment guidelines.
- Be specifically certified in the method.
- Work with a team including the patient, family, orthotist, doctor and, if necessary, a counselor.
- Regularly and individually re-assess the patient doing the exercises, to ensure that the exercises are performed correctly.
- Direct the progression of the exercises as needed to challenge the patient and address any adaptations or changes in the body.
- Help with brace compliance by assisting the patient and family in understanding how to wear and practice moving in the brace.
- Use hands on treatment as needed to assist with the mobility exercise ability.
- Provide spinal stabilization exercises during weaning patient from a brace.
- Provide pre-op preparation, if indicated, with exercises to build flexibility and overall strength.
- Provide PSSE after surgery if pain or functional deficits arise.
Be sure your PT also addresses any pain, making necessary modifications and/or looking for other sources of pain. Pain and other orthopedic conditions should be considered when developing the treatment plan. Like any other medical training, the quality of the application of the method is not in the control of the school but is in the hands of the PT providing the treatment.
QUESTIONS TO HELP SELECT A PHYSICAL THERAPIST
If you are curious about how a certain clinic is running their program you may call any therapist on our physical therapy directory. You can ask questions to learn about details of their program.
Optional questions to ask:
1. How long is each visit?
We recommend 45-60 minutes minimum per session during the initial treatment phase. For follow up visits with trained patients, 30 minutes may suffice. In addition, we understand insurance may limit some visit times. No matter the time spent, we recommend the treatment be provided in full by a scoliosis trained PT, not by a support staff member.
2. Do patients learn the basic program in a group or 1:1 (physical therapist to patient)?
Patients should be trained in their basic program 1:1. Once trained, patients may participate in a group class which can offer social and motivational benefits. We think it is important to also ask yourself if you think your child will learn in a group?
For group training, ask your provider:
a. how many patients are in the group? A group of up to 6 patients is recommended.
b. is your PT trained at the proper level to manage a group? Our school's guidelines recommend therapists be
advanced trained before running groups. (This means "C2" or "L2" in the BSPTS school.)
3. Can you give an example of what a typical visit might look like to us?
A patient should be 1:1 with a licensed PT that has been formally trained in scoliosis through a recognized school such as BSPTS. There should be direct supervision by a scoliosis trained therapist for the entire visit. A patient will learrn scoliosis based exercises in several different positions, and learn posture and functional movement patterns to help stabilze the curve and address any symptoms the patient may be having.
4. Will my child have no more than 1-2 different physical therapists guiding the learning of the BSPTS Concept by Rigo Schroth-based method treatment?
Not all clinics can provide this promise, but research proves that outcomes are best when there is a consistent
provider in the care of a patient.
What your therapist might expect of you:
INSURANCE CONSIDERATIONS
Parents, as healthcare consumers you will need to check with your insurance companies about coverage. Ask your Physical Therapists for the typical codes that are used to bill your insurance company. Once you have these codes, you can call your insurance provider. Below is a list of codes that are typically used when using the BSPTS Concept by Rigo Schroth-based Method. These care standard PT codes that are accepted across the industry for physical therapy.
For the listed codes, each code is used to bill for up to 15 minutes. For instance, if a PT spends 1 hour doing Therapeutic Exercise, that would be billed as 4 units.
CPT code 97110 is a therapeutic procedure, on one or more areas, each lasting 15 minutes. Therapeutic exercisesto develop strength and endurance, range of motion and flexibility. This requires one on one contact.
CPT code 97530 is therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.
CPT code 97112 is therapeutic procedure, on or more areas, is with direct contact with one on one patient, each 15 minutes. Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and /or proprioception for sitting and/or standing activities.
CPT code 97140 is Manual Therapy (mobilization, manipulation, manual lymphatic drainage, manual traction) 1 or more regions, one on one direct contact, each 15 minutes.
If you are curious about how a certain clinic is running their program you may call any therapist on our physical therapy directory. You can ask questions to learn about details of their program.
Optional questions to ask:
1. How long is each visit?
We recommend 45-60 minutes minimum per session during the initial treatment phase. For follow up visits with trained patients, 30 minutes may suffice. In addition, we understand insurance may limit some visit times. No matter the time spent, we recommend the treatment be provided in full by a scoliosis trained PT, not by a support staff member.
2. Do patients learn the basic program in a group or 1:1 (physical therapist to patient)?
Patients should be trained in their basic program 1:1. Once trained, patients may participate in a group class which can offer social and motivational benefits. We think it is important to also ask yourself if you think your child will learn in a group?
For group training, ask your provider:
a. how many patients are in the group? A group of up to 6 patients is recommended.
b. is your PT trained at the proper level to manage a group? Our school's guidelines recommend therapists be
advanced trained before running groups. (This means "C2" or "L2" in the BSPTS school.)
3. Can you give an example of what a typical visit might look like to us?
A patient should be 1:1 with a licensed PT that has been formally trained in scoliosis through a recognized school such as BSPTS. There should be direct supervision by a scoliosis trained therapist for the entire visit. A patient will learrn scoliosis based exercises in several different positions, and learn posture and functional movement patterns to help stabilze the curve and address any symptoms the patient may be having.
4. Will my child have no more than 1-2 different physical therapists guiding the learning of the BSPTS Concept by Rigo Schroth-based method treatment?
Not all clinics can provide this promise, but research proves that outcomes are best when there is a consistent
provider in the care of a patient.
What your therapist might expect of you:
- Regular performance of exercises assigned by PT (frequency, duration and intensity of the exercises based on the person’s risk of progression and other factors)
- Compliance with bracing as directed by the medical team
- Follow up as recommended by the doctor and orthotist
INSURANCE CONSIDERATIONS
Parents, as healthcare consumers you will need to check with your insurance companies about coverage. Ask your Physical Therapists for the typical codes that are used to bill your insurance company. Once you have these codes, you can call your insurance provider. Below is a list of codes that are typically used when using the BSPTS Concept by Rigo Schroth-based Method. These care standard PT codes that are accepted across the industry for physical therapy.
For the listed codes, each code is used to bill for up to 15 minutes. For instance, if a PT spends 1 hour doing Therapeutic Exercise, that would be billed as 4 units.
CPT code 97110 is a therapeutic procedure, on one or more areas, each lasting 15 minutes. Therapeutic exercisesto develop strength and endurance, range of motion and flexibility. This requires one on one contact.
CPT code 97530 is therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.
CPT code 97112 is therapeutic procedure, on or more areas, is with direct contact with one on one patient, each 15 minutes. Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and /or proprioception for sitting and/or standing activities.
CPT code 97140 is Manual Therapy (mobilization, manipulation, manual lymphatic drainage, manual traction) 1 or more regions, one on one direct contact, each 15 minutes.
