The Effect of Video-Based Game Therapy on Activation of Scapular Muscles in Children with Thoracic Hyperkyphosis
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 44
- 试验地点
- 2
- 主要终点
- Posture
研究概览
简要总结
The scapula provides the base of the kinetic chain, which is stabilized by the surrounding muscles. Considering that activating the scapular musculature to stabilize the spine would restore the relationship between body segments, analyzing the scapular muscle activations in the treatment of hyperkyphosis may be a crucial component of an effective therapeutic program.
Video games can be used to stimulate scapular muscles in children with thoracic hyperkyphosis because a game-based exercise program has been observed to increase voluntary motor control in children, thereby promoting selective muscle activation. The purpose of this study is to investigate the impact of video game therapy on the activation of scapular muscles and postural stability in children with thoracic hyperkyphosis, as well as the contribution of these variables to upper extremity performance.
详细描述
Postural hyperkyphosis is a common spine curvature that develops when individuals with inadequate overall muscular strength are continuously exposed to high-intensity external stresses while standing. It is a deformity frequently observed in healthy children and adolescents, but it is often overlooked and can be detected through school examinations. Postural hyperkyphosis has significant effects on a person's overall health, physical performance, and quality of life. When the angle of kyphosis increases, it causes severe health problems, such as sensitivity in the spine, tension, neck, waist, and back discomfort. Untreated hyperkyphosis, which begins in childhood and persists into adulthood, has the potential to increase healthcare costs. It is crucial to control this deformity during childhood and adolescence, given the increase in the incidence of hyperkyphosis due to an increasing reliance on technology and its negative health and economic consequences. In addition to angular correction of the deformity, the entire spine within the kinetic chain should be examined when treating postural hyperkyphosis.
In clinical practice, it is common to convey exercise routines to children as enjoyable activities. In accordance with technological advancements, game-based exercise regimens are now also available as software. In conventional physiotherapy programs, the motivation, willingness to persist, and active participation of children gradually decline. Making it more challenging for the physiotherapist to motivate children to exercise and assure the program's sustainability. Nonetheless, it is vital to maintain enthusiasm throughout this lengthy treatment process, particularly in chronic conditions such as hyperkyphosis.
On the basis of the inclusion and exclusion criteria, individuals diagnosed with thoracic hyperkyphosis who required rehabilitation but did not receive spinal region treatment will be recruited to participate in the study. Random assignment will designate participants to either the study group (video-based game therapy) or the control group (waiting list).
The demographic and clinical characteristics of both groups will be evaluated, along with muscle activation, muscle strength, muscle tone, rigidity, posture, perception of cosmetic deformity, upper extremity performance, physical activity levels, treatment satisfaction, and exercise adherence. The study group volunteers will be required to participate in 24 sessions, three times per week for eight weeks, comprising of games selected at the conclusion of the initial evaluation session. The Nintendo Switch will be used for playing video games. After the initial evaluation, all subjects in the control group will be placed on an eight-week waiting list. At the end of the study, the control group participants will engage in the same exercise regimen.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 7 Years 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Thoracic kyphosis angle (Cobb): ≥40˚- <65˚ on lateral radiograph
- •Age between 7-18 years
排除标准
- •Those with congenital or rigid deformity/anomaly in the spinal area
- •Those who have had major surgery or trauma related to the musculoskeletal system, especially the spinal region
- •Those who received physiotherapeutic intervention in the spinal region in the last 6 months
- •Those who use corsets
- •Having a BMI ≥30
- •Those who are interested in sports in which the upper extremity is regularly used actively (swimming, volleyball, tennis, handball, etc.) Those who have visual problems and are sensitive to light.
- •Those with vestibular problems (Unterberger test positive)
- •Those with hearing problems
- •Those who have difficulty perceiving the given commands
- •Those with systemic diseases (Diabetes, hypothyroidism, infection, malignancy...)
- •Those with neurological disease
- •Those with rheumatic disease in the active phase
结局指标
主要结局
Posture
时间窗: 8 weeks
PostureScreen Mobile software is a valid and reliable application that evaluates the changes in a person's posture. In our study, the evaluation of frontal and sagittal plane posture will be calculated by marking reference points on the photographs taken from the front, back and sides of the patient in the PostureScreen Mobile application.Photographing, positioning and determination of reference points of the participants will be standardized. During the photo shoot, the feet of the participants will be positioned bare and parallel to each other, attention will be paid to the absence of clothing and the bulk of the hair so that the reference points are clear. During the shoot, participants will be asked to keep their arms loose and look straight ahead.
Perception of Spinal Deformity
时间窗: 8 weeks
Perception of spinal deformity will be assessed with the Kyphosis-Specific Spinal Appearance Questionnaire.The Kyphosis Specific Spinal Appearance Questionnaire has been developed to assess appearance in hyperkyphosis patients. The KSAQ included 10 items on a Likert scale (1 to 5) regarding patients' perceptions of appearance, with higher scores indicating worsening deformity and greater kyphosis-specific appearance concern
Muscle Tone and Stiffness
时间窗: 8 weeks
MyotonPRO (Muomeetria Ltd., Tallinn, Estonia) will be used to measure the tone and stiffness of the upper, middle and lower trapezius, pectoralis major and serratus anterior muscles. Myotonometry reflects the viscoelastic properties of the muscle such as tone and stiffness by creating oscillation in the muscle fiber and is an acceptable and reliable method for measuring the mechanical properties of the muscles. In our study, after the participants rest for 5 minutes, the arms will be left relaxed in the sitting position and the measurement will be taken from the most swollen part of the relevant muscles. During the measurement, the test probe of the myotonometer will be placed vertically on the skin surface. The measurement will be started by pushing the probe to the required depth on the skin surface. Whether the required depth has been reached or not will be checked by turning the indicator light on the device from red to green.
Medicine Ball Throwing Test
时间窗: 8 weeks
It will be used to evaluate the explosive power of the upper extremity. Participants will be positioned in a chair without armrests in an upright position with their ankle, knee and hip joints at 90 degrees. He will be asked to grasp the 3 kg medicine ball with both hands and throw it forward over the head without bending his body forward and without flexing his elbows. The first point where the ball touches the ground will be measured from the starting point and the value will be recorded in cm. The test will be repeated three times and the average of the values recorded. The test of the participants will be invalidated and the test will be repeated if they throw the ball down to the level of their neck or make the throw by leaning forward from the trunk.
Muscle Activation
时间窗: 8 weeks
The electrical activity of the muscle during rest and contraction is called electromyogram, and recording this activity is called electromyography (EMG). Superficial EMG (yEMG) is preferred in physiotherapy and rehabilitation researches due to its noninvasive nature, no risk of infection and ease of use. In our study, Noraxon Myosystem (Noraxon Inc., Scottsdale, AZ, USA) yEMG will be used to measure the electrical activity of the upper, middle and lower trapezius, pectoralis major, and serratus anterior muscles. Electrodes will be placed in orientation parallel to the identified muscle fibers as recommended by "Surface ElectroMyoGraphy for the Non-Invasive Assessments of Muscles SENIAM)". Activations of these muscles will be recorded as a percentage of maximum voluntary isometric contraction (%MVIC). In addition, analyzes will be made about fatigue, coactivation and activation time of the muscles.
Satisfaction with Body Image
时间窗: 8 weeks
Since there is no scale specific to hyperkyphosis deformity in the literature that evaluates individuals' own perception of cosmetic deformity, a numerical rating scale with values between 0-10 will be used to evaluate how the perception of cosmetic deformity changes.
Closed Kinetic Chain Upper Extremity Stability Test
时间窗: 4 months
It will be used to evaluate upper extremity strength, endurance and closed kinetic chain. The test will also be performed following the guidelines described by Oliveira et al. During the test, male participants will be placed in the push-up position, and female participants in the modified push-up position (with knee support), on 2 tapes glued to the floor with a distance of 90 cm between the two hands. Participants will be asked to touch the other hand with one hand while maintaining the push-up position for 15 seconds, and the number of reps completed for the right and left will be recorded. The test will be repeated three times and the average of the values recorded. There will be 45-second rest breaks between each test. In the test-retest reliability study of the test in adolescents, the intraclass correlation coefficient (ICC) was found to be 0.68.
Scapular Endurance Test
时间窗: 8 weeks
The endurance of the scapular muscles will be evaluated with the Scapular Muscular Endurance Test. The Scapular Muscular Endurance Test will be performed with the participants facing the wall in a standing position, with the shoulders and elbows in the 90° flexion position. With both scapulae in neutral position, the participant will place the most appropriate length of 10 wooden sticks (18-36 cm) between their elbows and a dynamometer between their hands. While in this position, the participant will be asked to perform external rotation of the shoulder and maintain this force until a load of one kilogram is reached on the dynamometer, and the results will be recorded in seconds. The test will be terminated if the participant is unable to maintain the applied resistance, drops the bar between their elbows, or is unable to maintain 90 degrees of shoulder flexion and becomes unbearable
Reaction time
时间窗: 8 weeks
Nelson Hand Reaction Test will be used to evaluate reaction speed. The test is performed while the subject sits in a chair, placing his hands on the table's edge with the palms facing each other. The little fingers of both hands are in contact with the edge of the table and there is a distance of 30 cm between them. The therapist holds the wooden ruler at the midpoint of the subject's fingers. The ruler is left after the subject gains attention with the therapist's "Ready" command (0.5-2 seconds). The subject holds the ruler by squeezing it between both hands with a horizontal movement as soon as possible. Once the ruler is captured, the reading at the point just above the top edge of the hand is recorded.
次要结局
- Flexicurve Rule(8 weeks)
- The Numerical Rating Scale(8 weeks)
- Demographic and Clinical Characteristics(8 weeks)
- Wall-Occiput Distance Measurement:(8 weeks)
- Muscle Strength(8 weeks)
- Exercise Adaptation(8 weeks)
- Physical Activity Level(8 weeks)
- Treatment Satisfaction(8 weeks)
研究者
Ayse Zengin Alpozgen
Assos. Prof
Istanbul University - Cerrahpasa