Apparatus for Passive Correction.

Kl. Side-hanging (Fig. 160). - The reclining board, a, of the apparatus is movable round an axis in its upper edge, and can be placed at various angles of inclination. There is a scale graduated in centimetres of which the zero point is on the inner edge of the padded wooden cross-piece, b, the scale showing the distance from this edge. The section of wall-bar, c, can be placed at various distances from the cross-piece. In using this apparatus for scoliosis the patient is placed on the reclining board, which is at first horizontal, on his convex side, in a side-lying position, so that the maximum point of the curvature is directly over the cross-piece. The position is held in the following way : - With the arm of the upper concave side the patient grasps the movable wall-bar, which is so placed that the arm is fully stretched. The arm of the convex side is stretched downward and grasps another bar in the lower section which is immovable. The head rests on a cushion made in saddle form. When the reclining board is lowered (as in the diagram) the spine is flexed over the cross-piece and a correction of the scoliosis thus effected. To prevent too great a compression of the chest the patient lies turned obliquely upward so that the pressure is diagonal, a position which corrects also any "bulging" of the ribs. The slant of the board determines the effect produced by the apparatus. Beginning with a slight slant, it can be increased as the patient becomes accustomed to the procedure. The patient remains lying, or more correctly hanging, from three to five or ten minutes at a time. The procedure is repeated two or three times during each daily treatment, with other movements between.

Fig. 160.

Fig. 161.

The apparatus may also be used for kyphosis. The patient lies on his back with the kyphotic curve over the cross-piece. Both arms are stretched upward and backward, grasping the movable wall-bar. Generally the board can be slanted as much as in scoliosis.

Fig. 161 gives an example of the use of the measurement diagram in connection with the apparatus (Kl).* The picture represents a patient with right dorsal scoliosis lying on the apparatus. In the diagram the scale on the left side, the standing scale, is carried down to zero at the footboard. The patient's legs are represented by two dotted lines parallel with the above scale. As will be seen, the maximum of the curve is directly over the cross-piece, b, the body is supposed to lie on the board, a, which is afterwards lowered in the direction of the arrow, and the patient is prevented from falling in the way already described. From the picture it will be seen that the zero, 0, of the apparatus scale must be placed exactly over number 123 of the fixed scale. This gives the distance which should exist from zero to the sole of the patient's foot. This is done by placing the patient in a lying position with the upper edge of the heels resting over number 123 of the scale when the legs are well stretched. All these figures are marked on the prescription and tell the assistant how to place the patient so that one may be sure of obtaining the desired effect. The prescription will read thus : - Kl. Right, 123, 25 to 45 (gives the slant).

* The picture, like all that follow, represents a case where the spinal line is the true index to the position of the vertebral column.

K2. Side-lying with Pressure (Fig. 162). - The apparatus consists of a rectangular board resting on four feet, of which one half is an upholstered reclining board, a, which can be raised at one end (the foot end) round an axis fixed to the other end, and may be fixed at different slopes. It also has a scale showing the distance from this axis. The other half has two or three cushions, b and c, which can be placed at different distances from the axis and at various heights from the frame. The furthest cushion, b, is square and is meant to support the head; the other, c, is smaller and meant for the trunk, while the legs from the iliac crests downward rest on the board, a. The patient lies on one side, as in Kl, turned obliquely upward, with the maximum deviation of the lateral curve resting on the trunk cushion. By its own weight the trunk is flexed over the supporting cushion and the curve is thus corrected. The strength of the pressure depends on the height at which the cushion is placed. It should begin at 6 to 8 cm. above the level of the reclining board and be gradually increased as required. The patient continues lying from five to ten minutes at a time.

Fig. 162.

The apparatus is used for lumbar curves, and is then more effective than Kl, which cannot affect the spine so low down. It is, moreover, difficult with mere side pressure to correct the curvature between the lower lumbar vertebrae and the pelvis. The pelvis should in this case be made to rotate round its sagittal axis when the lower part of the spine is fixed; this can be done by K2. When the patient has been placed in the position described, the foot-piece of the board on which the legs and the pelvis rest is raised, the pressure of the trunk cushion preventing the lumbar vertebrae from moving out of position.