Rabu, 27 Februari 2013

hosting dan domain


Hosting



Hosting merupakan sebuah space atau ruang yang digunakan untuk menyimpan file-file yang ada hubungannya dengan website kita, seperti file HTML, file PHP, file musik, file video, ataupun gambar. Hosting dapat juga diibaratkan sebagai Flash disk atau Hard disk, dimana alat tersebut berfungsi sebagai media penyimpan semua file dan data yang ada di komputer kita.

Domain



Domain adalah nama unik yang diberikan untuk mengidentifikasi nama server komputer seperti web server atau email server di internet. Unik disini berarti nama situs anda hanya andalah pemiliknya di internet. Contohnya google.com. Apakah ada situs lain selain google yang namanya sama? Tentu saja tidak ada. Nama google di internet hanya satu. Tidak seperti nama manusia, bisa jadi nama wita ada banyak orang yang menggunakannya bukan. Tentu saja.
Jadi domain adalah identitas anda di Internet

Sedikit tentang teori domain. Sebenarnya, domain itu sendiri adalah alat pengingat untuk mempermudah manusia dalam mengakses komputer di internet. Dalam dunia jaringan komputer, dikenal dengan nomor ip. Nah sebenarnya itulah kode yang digunakan komputer untuk mengakses suatu situs. Contoh nomor ip diinternet adalah 203.30.236.154. Itu hanya baru satu situs. Bayangkan bila anda bekerja pada beberapa situs yang berbeda. Tentu akan susah mengingat angka-angka tersebut bukan. Maka dari itulah dibuat fasilitas domain. Bila diumpamakan lagi, domain itu bagaikan buku telepon pada sebuah handphone. Orang-orang tentu lebih mengingat nama dibandingkan nomor telepon bila hendak ingin menghubungi seseorang.
Top Level Domain (TLD)

TLD merupakan sebuah extension atau akhiran dari suatu nama domain. Ada 2 kelompok utama dalam TLD, yakni country code top-level domains (ccTLD) dan generic top-level domains (gTLD). Country code top-level domains (ccTLD) merupakan sebuah level domain tertinggi yang didasarkan pada kode negara seperti .id, .us, .ca, .ru, dan masih banyak lainnya. Sedangkan generic top-level domains (gTLD) merupakan sebuah level domain tertinggi yang digunakan secara umum seperti .com, .mil, .net, .gov, .edu, .asia, .info ,.org dan masih banyak lainnya. Hingga tahun 2010, terdapat lebih dari 21 gTLD dan 250 ccTLD.

Second Level Domain (SLD)

Second Level Domain merupakan nama domain yang ada di sebelah kiri TLD. Agar Anda tidak menjadi bingung, saya akan memberikan contohnya, jembelisme.com . Nah, kata jembelisme ini merupakan Second Level Domain (SLD), sedangkan .com merupakan Top Level Domain (TLD).

Lower Level Domain

Lower Level Domain merupakan nama domain yang ada di sebelah kiri SLD. Lower Level Domain dapat dibagi lagi menjadi Third Level Domain, Fourth Level Domain, Fifth Level Domain, dan seterusnya. Namun hal ini sangat jarang. Kebanyakan nama domain hanya sampai SLD saja.

sumber http://gmedia.net.id/faq/view/2/Apa-Itu-Hosting-dan-Domain

pengertian dan beda webside dan blog


1. Website



    Website adalah kumpulan dari halaman-halaman situs atau link yang terangkum dalam sebuah domain atau subdomain yang tempatnya berada dalam World Wide Web (WWW).
Website atau situs juga dapat diartikan sebagai kumpulan halaman yang menampilkan informasi data teks, data gambar diam atau gerak, data animasi, suara, video dan atau gabungan dari semuanya, baik yang bersifat statis maupun dinamis yang membentuk satu rangkaian bangunan yang saling terkait dimana masing-masing dihubungkan dengan jaringan-jaringan halaman (hyperlink).
Secara garis besar website dibagi menjadi 2 model : Website Statis dan Website Dinamik.
Website Statis (isi informasi website tetap, jarang berubah, dan isi informasinya hanya searah  dari pemilik website). Sedangkan Website Dinamis (isi informasi website selalu berubah-ubah, dan isi informasinya interaktif dua arah berasal dari pemilik dan pengguna website, jadi ada hubungan timbal balik).
Biasanya Website menggunakan Domain dan Hosting berbayar jadi siapkan modal yang cukup jika ingin  membuat website.

2. Blog



Blog merupakan singkatan dari web log adalah bentuk aplikasi web yang menyerupai tulisan-tulisan (yang dimuat sebagai posting) pada sebuah halaman web umum. Tulisan-tulisan ini seringkali dimuat dalam urut terbalik (isi terbaru dahulu baru kemudian diikuti isi yang lebih lama), meskipun tidak selamanya demikian. Situs web seperti ini biasanya dapat diakses oleh semua pengguna Internet sesuai dengan topik dan tujuan dari si pengguna blog tersebut.


Media blog pertama kali dipopulerkan oleh Blogger.com, yang dimiliki oleh PyraLab sebelum akhirnya PyraLab diakuisi oleh Google.Com pada akhir tahun 2002 yang lalu. Semenjak itu, banyak terdapat aplikasi-aplikasi yang bersifat sumber terbuka yang diperuntukkan kepada perkembangan para penulis blog tersebut. Kebanyakan blog menggunakan subdomain, contohnya(kupunyailmu.blogspot.com)ada embel-embel "blogspot"nya jika anda membuat blog dari blogger. Sedangkan Hostingnya gratis, karena sudah disediakan sama Blogger dan tentunya "unlimited".
yang pasti blog merupakan bagian dari website tapi belum tentu Website merupakan blog
dengan perkembangan dan inovasi  dari para Blogger (pengelola blog) terkadang sulit juga membedakan antara website dengan blog, tapi gambarannya senagai berikut:

1.       Pengelola: Kalau website biasanya yang punya perusahaan atau milik badan bersama, sedangkan blog milik perorangan.
2.       Letak isi: Kalau Website berupa halaman, sedangkan Blog isi yang baru akan menimpa atau menggantikan yang lama.
3.       Halaman: Website-->Terdiri dari page dengan link untuk mengakses, Blog berupa CSS (Cascading style Sheet) yaitu sistem halaman bergulir.
4.       Alamat: Website-->Domain dan Hosting berbayar, Blog-->Sifatnya gratis
5.       Template: Website-->Variatif sesuai dengan keahlian si pembuat website, Blog-->Menggunakan template yang sudah disediakan.
6.       Tujuan: Website--> Komersil, sarana promosi, Blog-->Tempat menyalurkan ide, krease, aspirasi
Perbedaan yang saya utarakan diatas sebenarnya tidak mutlak dan baku tapi bersifat keumuman saja

sumber : http://www.kupunyailmu.com/2012/05/perbedaan-website-dengan-blog.html

Selasa, 26 Februari 2013

ebook


Buku elektronik
Buku elektronik (disingkat Buku-e) atau buku digital adalah versi elektronik dari buku. Jika buku pada umumnya terdiri dari kumpulan kertas yang dapat berisikan teks atau gambar, maka buku elektronik berisikan informasi digital yang juga dapat berwujud teks atau gambar. Dewasa ini buku elektronik diminati karena ukurannya yang kecil bila dibandingkan dengan buku, dan juga umumnya memiliki fitur pencarian, sehingga kata-kata dalam buku elektronik dapat dengan cepat dicari dan ditemukan. Isinya hampir sama dengan buku cetak konvensional, namun e-book dibuat dan diterbitkan secara digital. Kamus Bahasa Inggris Oxford mendefinisikan e-book sebagai "sebuah versi elektronik dari buku cetak," tetapi e-book bisa dan memang ada tanpa versi cetak. E-book ini biasanya dibaca pada perangkat keras yang memang termasuk salah satu perangkat e-book. Komputer pribadi (PC), notebook/laptop, dan beberapa telepon seluler (handphone) juga dapat digunakan untuk membaca e-book.

Sejarah ebook
Di antara buku-buku versi e-book yang umum, pertama kali ada yang dikenal dengan nama: Proyek Gutenberg. Proyek ini dimulai oleh Michael S. Hart pada tahun 1971. Sebuah implementasi awal e-book adalah prototipe desktop untuk komputer notebook yang dibuat, bernama Dynabook, pada tahun 1970 di PARC. Dynabook menjadi komputer umum yang khusus digunakan untuk kebutuhan membaca pribadi, termasuk membaca buku. Ide serupa diungkapkan pada saat yang sama waktu oleh Paul Drucker.
Pada awalnya, e-book ditulis untuk kalangan khusus dan khalayak terbatas. Hal ini dimaksudkan untuk dibaca hanya oleh kelompok-kelompok kepentingan kecil dalam lingkup tertentu, misalnya kaum akademis di kampus. Ruang lingkup materi pelajaran dari buku-buku e-termasuk pedoman teknis untuk hardware, teknik manufaktur, dan mata pelajaran lain. Pada tahun 1990, fasilitas media dalam internet mengalami perkembangna dengan dapat dibuatnya program untuk mentransfer file elektronik sehingga jauh lebih mudah, termasuk e-book.



Format buku elektronik
Terdapat berbagai format buku elektronik yang banyak digunakan. Popularitas umumnya bergantung pada ketersediaan berbagai buku elektronik dalam format tersebut dan mudahnya piranti lunak yang digunakan untuk membaca jenis format tersebut diperoleh.Teks polos, PDF, JPEG, LIT, HTML, Format Open Electronic Book Package
Jenis e-Book yang lebih kompleks dan memerlukan rancangan yang lebih cermat misalnya pada Microsoft Encarta dan Encylopedia Britannica yang merupakan eksiklopedi dalam format multimedia. e-Book dengan format multimedia tidak saja berisi teks dan gambar tapi juga berisi suara, movie, dan unsur multimedia lainnya.
Seiring dengan perkembangan e-book, seperti yang telah di utarakan sebelumnya, Kehadiran e-Book semakin diperkuat oleh kehadiran e-Book Reader, dimana e-Book Reader merupakan alat pembaca atau dalam ungkapan lain untuk menikmati sebuah karya e-Book diperlukan alat untuk membacanya. Nah, alat untuk membaca sebuah karya yang terdapat dalam e-Book diperlukan sebuah alat yang di sebut sebagai e-Book Reader. perangkat e-book reader pun mulai banyak bermunculan. Namun belum satupun e-book reader yang bisa menampilkan semua versi e-book, berwarna dan mampu memainkan file multimedia
e-Book Reader telah banyak perusahaan yang telah mengeluarkannya seperti misalnya iPad besutan Apple, Kindle besutan Amazon, Nook besutan Barnes dan Noble, dan masih banyak yang lainnya. Sejauh ini, e-Book Reader dibagi dalam dua jenis yakni reader dan Tablet PC. Reader Apple Ipad seperti Kindle, Nook dan Sony Reader mengandalkan teknologi e-ink. Kelebihan dari teknologi tersebut adalah ketika sebuah e-Book dibuka maka tampilannya hampir mirip terlihat seperti kertas dan hasilnya tidak mengakibatkan silau di mata pada saat membacanya, karena ketika membaca e-Book tersebut layaknya seperti membaca sebuah kertas atau buku cetak seperti pada umumnya. Teknologi e-ink telah di adopsi oleh beberapa perangkat e-Book Reader.




E-book Sebagai Sumber Pembelajaran
E-book membantu pendidik dalam mengefektifkan dan mengefisienkan waktu pembelajaran. Pendidik repot jika harus membawa banyak buku bacaan dalam bentuk fisiknya yang berat. E-book yang berupa data digital sangat mudah untuk dibawa dalam banyak file, sehingga pendidik tidak kehabisan bahan belajar untuk peserta didik.
E-book juga media belajar yang interaktif dalam penyampaian informasi karena dapat ditampilkan ilustrasi multimedia. E-book memberikan dampak yang luar biasa pada kemajuan teknologi dalam pendidikan. Bagi seorang pendidik sangat terbantu dengan adanya E-book dengan berbagai kemudahannya. Pendidik akan lebih mudah mencari sumber materi pelajaran, menambah referensi sumber belajar. Pendidik tidak perlu beranjak dari tempat satu ketempat lainnya yang membuang waktu dan energi, karena E-book bisa didapatkan dari situs web, hanya perlu duduk dan seaching dengan akses internet. E-book bisa diteriakan sebagai seorang Hero untuk keberhasilan pendidik mengajar karena efisien dan efektif.
Bagi peserta didik E-book juga sangat membantu untuk proses belajar diluar kelas atau dirumah. Peserta didik yang memiliki akses internet di rumah bisa mengunduh E-book dari situs atau bisa juga cari akses internet gratis di area hotspot. Karakteristik peserta didik yang haus akan pengetahuan menjadikan materi yang disampaikan pendidik itu kurang, bisa dianalogikan sayur tanpa garam. E-book berperan sebagai penunjang materi tambahan pengetahuan, E-book menjadi garam dalam sayur. Pengetahuan peserta didik akan lebih kompleks dari pemanfaatan E-book.

Kelebihan ebook
·         Buku digital jauh lebih praktis dan ringan jika dibandingkan dengan buku tradisional.
·         E-book dapat disimpan dalam waktu yang lama dengan sedikit kemungkinan mengalami kerusakan.
·         E-book dapat didistribusikan dengan cepat dan mudah, dengan memanfaatkan jaringan internet.
·         Format E-book kini dapat dibaca dengan mudah, dengan munculnya berbagai piranti portabel yang khusus dibuat untuk mempermudah proses membaca (E-book reader).
·         Keberadaan E-book akan mengurangi biaya dan sumber daya yang dibutuhkan untuk membuat buku tradisional, seperti kertas dan tinta.
·         E-book cenderung lebih murah jika dibandingkan dengan buku tradisional.
·         Dapat dikomersilkan dan lebih murah.

Kekurangan ebook
·         Ketergantungan akan sumberdaya listrik .
·         Piranti  pembaca yang masih mahal dan dapat rusak.
·         Rentannya dokumen-dokumen E-book terhadap aktivitas yang dilakukan pembaca.
·         Banyaknya program yang harus diingat, mengingat format yang ada semakin bertambah.
·         Masalah hak cipta. 


Senin, 25 Februari 2013

jurnal fisioterapi

Chiropractic and pilates therapy for the treatment of adult scoliosis☆
Charles L. Blum,
DC Private practice of chiropractic, Santa Monica, Calif.
Received 11 March 1999; received in revised form 12 May 1999



Abstract
Objective: To describe the use of Pilates therapy and sacro-occipital technique in the management of a 39-year-old woman with scoliosis who had undergone spinal fusion many years earlier. Clinical Features: The patient had progressive severe low back pain that had worsened over the years after her surgery and had prevented her from activities such as carrying her son or equipment necessary for her job as a photographer. Intervention and Outcome: The patient was provided a series of Pilates exercises used to overcome her chronic habituation and muscle weakness. Although this therapy went on for some time, she did begin to stabilize and increase physical activity. At present, she is no longer limited in her physical activity, although she still exhibits some symptoms from her scoliosis. Conclusion: The addition of Pilates therapy can be useful to care for patients with chronic low back pain and deconditioning. (J Manipulative Physiol Ther 2002;25:e3)
 

Introduction
Surgical intervention for adult scoliosis carries risk.1, 2, 3 The obvious question is, does the benefit outweigh the possible side effects of surgery? “The decision to proceed with surgical treatment … must be based on a thorough understanding of the anticipated benefits from surgical treatment and results that can be less desirable than the original condition.”2 Complications of surgery on an adult patient with scoliosis are relatively common, occurring from 30% to 53% of the time.4, 5, 6, 7, 8, 9 Patients with scoliosis are at risk with epidural anesthesia.1, 10 Complications as serious as a subdural hematoma have been reported, which in one case resulted in paraplegia.1 Nonoperative treatment is best suited to those adults with mild pain or older patients for whom surgery is not prudent.11

Chiropractic procedures have been shown to be helpful in the treatment of scoliosis.12, 13, 14, 15, 16, 17, 18, 19 In one study, it was determined that “chiropractic spinal manipulation offers a possible treatment method for aiding in the reduction and correction of scoliosis.”19 With chiropractic treatment, mechanical stability is considered, applying engineering principals to understand buckling and critical loading. By examining the factors of spine slenderness and flexibility and strength of the trunk muscles and applying this understanding to curve mechanics and the biomechanics of scoliosis, the chiropractor has a rationale for the treatment of mild lateral curves.14 Another study suggested that chiropractic procedures may also have a favorable long-term effect of preventing reoccurrence of back pain and on retarding curve progression.12 Because of the serious sequelae associated with surgery, conservative methods such as chiropractic, especially if they offer relief, are viable and necessary options.

Case report
A 39-year-old woman had sequelae caused by a long-term history of severe scoliosis. The patient had a 2-year-old adopted son (she was not able to carry a pregnancy because of her scoliosis), and the process of holding him and trying to play with him caused excruciating pain. She had been working as a photographer, but the carrying of cameras and the pain and discomfort that followed made working prohibitive.

In 1974 the patient underwent a spinal fusion of T9 through L4. The surgeons report noted that the incision was made from T9 down to L4. The spinous processes from T9 down to L4 were identified and split with a knife. Subperiosteal dissection of spinous process, lamina, and zygapophyseal joints was performed involving 9 lumbar and dorsal segments. The spinous process was split with the osteotome, and a facet fusion was performed with a gouge. An initial cut was made into the superior facet, and cartilage was removed with a small gouge. The second cut was made in the lamina just below this, and the spicule of bone was brought up dorsally and imbricated into the facet. The spinous process was cut with a gouge, and fish scale pieces were overlapped. The identical procedure was performed from T9 to L4 so that the entire dorsal lumbar spine was cut and imbricated. Bone grafts were removed from the right posterior iliac crest, and strips of cortical cancellous bone were removed. The bone was placed around the apex of the curve on the concave side to act as a bone graft.

Twenty years after her surgery, the patient's condition had continually worsened, until the fear of being confined to a wheelchair directed her to pursue active treatment. In early 1995 she began treatment and evaluation with a prominent orthopedist because of significant pain she was experiencing in the cervical and upper thoracic region. The orthopedist stated in his report on January 3, 1996, that he recommended a “strengthening program that is designed to produce proper muscular control and support for her spine with her scoliosis and severe radicular components which is the only hope that she has nonoperatively. The alternative is a spinal fusion of her cervical and thoracic spine and there is quite severe potential chance for complications. The estimated cost of the spinal fusion is $150,000.00.” He recommended extensive testing, including a scan, EMG, nerve conduction studies, and myelogram.

The patient underwent all the all of the tests that were recommended but needed to be hospitalized after the lumbar puncture for the myelogram for approximately 10 days. The tests essentially revealed that the patient's condition was worsening. By October 1996, simple activities such as bending down to pick up her son's toys were now prohibitive, and most of her activities were largely limited. Because of her fear of surgery, she continued with the physical therapy recommended by her orthopedist even though she was not seeing any progress.

When the patient came to my office in November 1996, she had essentially exhausted what she considered all her possible options, and believed that she could do no worse with chiropractic care. She was seen and evaluated, and a course of treatment ensued. The treatments were spaced initially 1 to 2 times a week for 6 to 8 weeks. Although she was making progress, symptomatically, there would be a gradual regression during the period between treatments. Specific exercises were given to her to aid in her recovery; however, because of her chronic habituation and facilitation, it was extremely difficult for her to isolate specific muscle groups and stretch or strengthen the weakened or fixated joints. As a result of these findings, the patient was referred to a Pilates trainer specializing in exercises for patients with scoliosis.

As treatment continued, the patient's ability to begin to use her body in a balance manner allowed her to proceed with her Pilates exercises. Although her progress was slow initially, 1 year after commencement of chiropractic treatment, she was beginning to stabilize and increase her physical activity. By the beginning of 1999 she was only being seen at the office for flare-ups, which consisted of approximately 5 to 10 office visits per year. The patient was continuing with her Pilates exercises and would see her Pilates trainer periodically to ensure that she was exercising with proper placement.

She now can infrequently carry her son, who is now 5 years old, and although she still exhibits symptoms of her scoliosis, she is not limited by her condition at this time. Her condition is consistently improving as of the last office visit.

Discussion
An effective method of treating patients with scoliosis is sacro occipital technique (SOT), which was developed by M.B. DeJarnette, a chiropractor and osteopath.

SOT orthopedic block placement
One method, called “orthopedic block techniques,”20, 21 uses wedges or blocks placed in specific positions to “derotate” the spine and rib cage of the patient with scoliosis. DeJarnette noted that this type of orthopedic block technique approach is extremely valuable in multiple rotations because it permits proper muscle conformation as the correction is being made, and the correction is made without force and therefore without trauma. Blocks can be positioned under the pelvis, rib cage, and clavicles with the patient in either the prone or supine position. With the patient lying supine or prone, elevations of the pelvis, lumbar, thoracic spine, or rib cage is noted. Placement of blocks or wedges is determined by SOT protocol, essentially creating balance in the pelvis and rib cage by way of block placement as specific reflex points are monitored. As the musculature and fascia relax as a result of the block placement, reflex points and aspects of the body distal to the block placement also relax.

Cranial manipulation
Because of the multiple interrelationships between the pelvis and cranium,22 it is common to see cranial restriction in patients with scoliosis. An evaluation of the cranial bone dynamics is often necessary. A good overview of the dural membranes in the cranium can be obtained by performing sphenobasilar ranges of motion.

Flexion/extension
With the patient lying in a supine position, and the examiner at the head of the table, the doctor will contact bilaterally the greater wings of the sphenoid with his/her thumbs while the occiput rests in the fingertips of both hands. As the head is held gently, a subtle force is initiated in the direction of flexion. Flexion occurs when the doctor draws the greater wings of the sphenoid and the occiput caudalward toward the patient's feet. The sphenobasilar movement is monitored and allowed to return to a neutral position where at that point the sphenoid and occiput are gently directed into an extension position. Extension occurs when the doctor draws the greater wings of the sphenoid and occiput toward the cranial vertex.

Side-bending rotation
Side-bending rotation in the sphenobasilar joint occurs when there is an approximation between the greater wing of the sphenoid and the occiput on the ipsilateral side. On the contralateral side, there is a lengthening between the greater wing of the sphenoid and occiput. As this convexity or bulge occurs, inferior rotation of the cranium will also occur on that side. The side-bending disturbance of the sphenobasilar junction is named by the side of the convexity. Therefore the lengthened distance between the sphenoid and occiput ipsilaterally with its caudal rotation along an anteroposterior axis on the right side would be termed a right side–bending distortion.


Trapezius fibers
DeJarnette25 also found a relationship between the trapezius muscle and the thoracolumbar spine. The trapezius muscle arises from the medial third of the superior nuchal line at the external occipital protuberance and continues its attachment along the nuchal ligament until the spinous process of C7/T1. The trapezius continues along the spinous processes, also attaching to the supraspinous ligaments, of all 12 thoracic vertebra. The lateral connections of the muscle insert at the lateral third of the clavicle, medial border of the acromion, and the superior lip of the crest of the scapular spine.26 DeJarnette25 found a group of 7 myofascial fibers along the trapezius muscles located bilaterally from T1 to the acromion process. There is a direct relationship between one or more of these fibers when swollen and specific thoracolumbar vertebra. DeJarnette25 postulated a relationship between the thoracolumbar vertebral pedicles, the temperature-sensitive spinothalamic tract and the trapezius muscle fibers. Correcting the malpositions of the specific vertebra balances and reduces tension in the fiber that affects the entire trapezius muscle, specifically its connection along the nuchal ligament with its attachment to the occiput.25

Pilates exercise methods
A complex method of exercise rehabilitation was developed by Joseph Pilates in 1923. “The Pilates Method of Physical and Mental Conditioning provides thorough training to improve strength, flexibility, and postural awareness. Its philosophy integrates the mind with the musculoskeletal system. Although Pilates has traditionally been used by dancers, the method is becoming more popular for use throughout general physical therapy practice.”37, 38, 39, 40, 41, 42, 43, 44, 45Exercise therapies have been shown to be effective tools in combating the progression and sometimes improving the condition of idiopathic scoliosis.46, 47 Pilates' focus of maintaining a balance in the use of the musculoskeletal system throughout movements are the ideal physiotherapeutic exercises for the patient with scoliosis.

It is theorized that scoliosis-related injuries may cause, or may occur, as a result of imbalances of the body and preferred patterns of movement. One weak or misaligned area may result in a propensity to overcompensate or overdevelop another area. Pilates conditioning works toward a rebalancing of musculature.37, 38, 39, 40, 41, 42, 43, 44, 45 The symmetrical nature of the Pilates exercise technique and apparatus (reformer)42 makes the Pilates method an excellent rehabilitative therapeutic agent with patients who experience imbalances in use as a result of scoliosis.

Practitioners teaching Pilates therapy can be certified. The certification process is quite extensive and involves years of study of anatomy and kinesiology along with at least 2 years of apprenticeship and assistant instructing. There are also both written and practical examinations required for the certification. One Pilates teaching facility, “The Pilates Studio”, (New York, NY) has an extensive teacher certification program that involves years of supervised teaching, studies in anatomy and kinesiology, written, oral, and practical examinations, as well as yearly recertification through continuing education courses.
Treatment
Treatment for the patient discussed here consisted of sacro occipital technique and “fascial unwinding” techniques. When patients with scoliosis are treated, a balance between structure and function must be determined. Then a balance between structure and function must be attained. Treatment focused on creating a release of the patient's “fascial makeup,” which encased her spine, thoracic cage, and cranium. Although I was concerned about her scoliosis and imbalance, my focus was to unwind the 3-dimensional “scoliotic spiral” that her body presented.

Lower extremities and pelvis
The patient exhibited a pattern that affected her from head to toes. Treatment was focused on her whole body dynamics and fascial patterning. Initially it was noted that her right lower extremity was externally rotated. This was initially treated with SOT's iliofemoral technique, which is a method that is designed to release a chronic contracture of the hip external rotators at their insertion at the greater trochanter. When this condition persisted, evaluation of the right knee, ankle, and foot revealed a continuation of the facial “twisting” with a posterior fibula and lateralization of the talus with the calcaneus presenting medially and in “hyper” inversion. The fibula and talus were adjusted to correct their position and the foot and ankle were taped in a neutral position, to decrease the persistent ankle inversion.

Lumbar/cervical relationship
With regard to her spine, the patient had a longstanding rotation of the L2 spinous to the left and T8/9 to the right, creating a significant rib cage distortion. This was present even though the patient had fusion from T9 to L4. Her lumbar paravertebral musculature was notably decreased on the right with increased height of the paravertebral musculature noted on the left in the prone and standing postures.

With SOT's R+C therapy, sensitivity was noted at the patient's left C4 transverse process, and an orthopedic block was placed under her right ilium, between the anterior superior iliac spineand greater trochanter. This placement restricts pelvic bone rotation and elevates the right side of the pelvis and engages the right paravertebral musculature. As the right paravertebral muscles contract as a result of this block position, the fascia and musculature (iliopsoas and quadratus lumborum muscles) surrounding the rotated L2 “unwinds,” and sensitivity at the C4 transverse process decreases or is eliminated. Pressure to the left of the L2 spinous process rotating to the right assists the process of relaxation and neutralization of the reflex at the C4 transverse process. The procedure can take anywhere from 2 minutes to 20 minutes depending on the chronicity of the patient's condition.

Cervical relaxation
With specific “sutural technique”48 cervical preparatory procedures, the cervical fascia is relaxed, with various techniques used to release any platysma, scalenus, sternocleidomastoid fixation, and the deeper posterior vertebral musculature of the cervicothoracic, cervical and suboccipital regions. After relaxation of the cervical myofascial a procedure called “cervical stairstep” was used. This procedure will localize and correct “loosened motor units” of the cervical vertebra. DeJarnette recommends using a treatment called the “figure eight,” which he described as the “ideal cervical technique as it involves no violent motions or thrusting forces, rather a gentle controlled motion to reset the processes of the loosened cervical motor units.” The “resetting of the vertebra” involves a mechanical repositioning of the vertebra, normalizing any limitations in ranges of motion during stairstep range of motion testing.49

Cranial bone/meningeal “unwinding”
Often, in patients with scoliosis who have had surgery fixating parts of their spine, a “build up” of tension can be palpated in the cranial aponeurosis and meningeal structures. Sutural technique involves a step-by-step method of analyzing myofascial and cranial sutural fixation with procedures to gently relax and unwind any sutural or meningeal restrictions. Often, when the patient's cranial base is affected, a procedure entitled “sphenobasilar range of motion technique” is used to effectively determine the magnitude of cranial base fixation and subsequently can be used to release this fixation.

Pilates rehabilitative exercises: Precision of alignment, breath, and body placement
Although various Pilates exercises were used, the following gives an example of the exercise methodology and relationship to a patient with scoliosis. Only 2 of the many exercises are described: (1) the prone latissimus dorsi pulls with twist and (2) the side leg lift.

The patient had significant spinous vertebral rotation in her mid thoracic region, convexity of the curve toward the right with apex of the curve at T8/9. The prone latissimus dorsi pulls with twist exercise was modified for the patient to create an exercise to address this asymmetry. In the lumbar region the patient had significant spinous vertebral rotation with convexity of the curve to the left and apex of the curve at L2/3. The side leg lift was modified regarding repetitions to address the decreased muscle mass of the right lumbar paravertebral musculature.

Prone latissimus dorsi pulls with twist
This exercise was modified for this patient and was not performed the same on both sides because of the vertebral spinous rotation in the mid thoracic region. To address the asymmetry a “twist” or upper body rotation to the right was added when the ipsilateral right arm was used, whereas no “twist” when using on the left arm. This exercise is performed on alternating sides through 3 to 5 repetitions.

The exercise begins with the patient lying on his or her stomach with a small pillow under the abdomen to reduce any lumbar lordosis. Both arms are straightened and extended above the head.

Right side
Keeping the neck relaxed, have the patient lift the head and arms approximately 10 degrees off the floor. The patient breathes in and then while slowly exhaling, reaches, extending outward, with the right arm and in unison rotates the neck 90 degrees toward the right while slowly describing a semicircular arc toward the right hip with the right arm. The patient then slowly returns the arm and head to the starting position (held 10 degrees off floor) as they inhale. Then have the patient lower their head and arms, so that the forehead and arms touch the floor.

Left side
The exercise varies on the left side because the head and arm do not lift off the floor. The patient breathes in and then while slowly exhaling, she reaches, extending outward, with the left arm, while slowly describing a semicircular arc toward the left hip with the left arm. At a few inches from the left hip the arm makes a pulsing action (3 times), abducting and adducting, to activate the left latissimus dorsi, trapezius muscles, and adjacent musculature to encourage strengthening of the left mid thoracic paravertebral muscles. After the 3 pulses the left arm is replaced in a semicircular arc to its starting position, extended over the head. Sometimes a light weight (3 pounds) can be used on this left side procedure.



Side leg lift
This exercise relieved tension in the patient's upper trapezius musculature and was modified by performing greater repetitions (5 repetitions on “weaker” side versus 3 repetitions on “stronger” side) on the side of weaker or less muscle development in the lumbar paravertebral musculature.

Side leg lifts are performed with the patient on their side with a pillow under their head in a neutral position, without any lateral flexion. Alignment of the body is essential, keeping the head, shoulders, hips, knees, and feet in a “perfect” line. (1) Initially have the patient breath in and then exhale, engaging the abdominal muscles without altering pelvic position. (2) Then have the patient reach the superior leg “out” of the hip without contracting the ipsilateral quadratus lumborum muscle nor having the superior hip and costal margins approximate themselves. (3) The superior leg is then lifted approximately 10 to 20 degrees and held for 3 seconds before gradually replaced to the starting position as the patient breaths in. All motions are fluid, gradual, with emphasis on precise body placement.

Conclusion
Pilates-type exercises are essential whether the patient chooses a surgical or conservative route of care. It appears from the research performed at the Katharina Schroth Hospital that exercises focused on balancing spinal curvatures and the associated muscles in conjunction with chiropractic/cranial therapy have been successful options to surgical intervention.

Much of the research in scoliosis intervention is focused on whether the curves are reduced and whether the spine appears to be “straighter.” What is difficult to measure, to some degree, is the ability of the fascia to allow for motion in various positions. Sometimes there will be a “freeness” in the fascia but that will not be found by increases of range of motion. This means that the skeletal structure might still have a fixed anatomic structure, but the fascia and musculature will not. Wolfe's law notes that as stress is applied to osseous structure the trabecular pattern will modify or reconfigure itself to the amount, direction, and location of the stress by increased localized bone mass. Because osseous structure is constantly responding to stress, a balanced nonfixated myofascial structure is theorized to create a 3-dimensional template by which a scoliosis might reconfigure over time, measured in years.

Another theory regarding releasing of the myofascial structure in patients with scoliosis relates to Hiltons law. Hilton's law states that the motor nerve to a muscle tends to give a branch of supply to the joint, which the muscle moves and another branch to the skin over the joint.26 The neural intercommunication might also help the osseous reorganization of the patient with scoliosis as their muscles act in a more “balanced” manner.

The ultimate result of treatment is to determine whether the patient has decreased pain and increased function. It is imperative that chiropractic, in conjunction with exercise modalities such as Pilates, team together to formulate studies on the efficacy of cotreatment for patients with scoliosis. Greater communication and education of our fellow health care practitioners is necessary, so that many forms of care are available for patients with scoliosis, and surgery is the last resort after other conservative methods have been exhausted.

http://www.jmptonline.org/article/S0161-4754(02)93254-9/fulltext