Video-Based Game Therapy in Thoracic Hyperkyphosis

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Thoracic kyphosis angle (Cobb): ≥40˚- \<65˚ on lateral radiograph
* Age between 7-18 years

Exclusion Criteria:

* 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