## 4 Discussion
Moreover, smartphone-based applications offer dynamic feedback and facilitate long-term monitoring, capturing variations in head posture across different scenarios. For instance, by integrating features such as data visualization, telemedicine compatibility, and patient education modules, these tools can support a multidisciplinary approach to AHP management and provide adjustments to treatment plans, complementing existing methods and expanding access to effective care. The second aim of this study was to detect and quantify potential limitations in cervical ROM in individuals with AHP compared to age-matched healthy controls. Using the MoCap system, significant differences (\(p<0.05\)) were observed in the head flexion angles between individuals with AHP and healthy controls. The AHP of ocular origin is a multifaceted issue involving ocular, musculoskeletal, and neurological factors. In this study, the increase in terms of cervical ROM in the frontal plane is likely linked to the compensatory mechanisms adopted by individuals with AHP to optimize visual input. For example, children with nystagmus may adopt a \"null position\", tilting the head to reduce involuntary eye movements and enhance visual focus [56]. Similarly, patients with superior oblique palsy often tilt their heads toward the affected side to maintain binocular vision [57]. Moreover, research suggests that ocular causes of AHP often allow for greater neck mobility compared to non-ocular causes, which may result in restricted neck movements due to muscular or orthopaedic issues. This distinction is critical, as prolonged AHP can lead to secondary musculoskeletal complications, including cervical muscle imbalances and reduced neck mobility over time [58; 59; 60]. These findings underscore the importance of a multidisciplinary approach involving ophthalmology, neurology, and physical therapy to address the interplay between ocular conditions and neck posture effectively. While the study's findings are promising, they should be interpreted cautiously due to the small sample size (i.e., n = 15 for the AHP group), which may reduce the generalizability of the results and introduce potential bias. Including a larger cohort would enhance the validity of the findings and strengthen the statistical analysis. Moreover, the severity of AHP was not categorized in this study, which could also impact the findings since AHP might present with varying degrees of compensatory posturing. Taking these aspects into consideration, future research should include large cohorts and categorize patients by specific diagnoses (e.g., strabismus and nystagmus) to provide additional insights into variations in AHP. For instance, patients with strabismus often exhibit head rotation, while those with nystagmus show head inclination. Incorporating variables such as chin-up and chin-down angles and assessing head postures before and after visual correction could further clarify the impact of AHP on posture and dynamics. Exploring these factors would enhance the development of targeted interventions to improve outcomes for patients with AHP. Furthermore, a larger dataset would provide the opportunity to enable subgroup analysis and also incorporate orthodontic assessments into the results, allowing for a more thorough analysis of the potential relationship between malocclusions and AHP. Finally, while the current study provides a snapshot of head posture measurements, the long-term reliability of these tools (particularly smartphone-based applications like eyeTilt) remains to be explored. Longitudinal studies would be beneficial to assess whether the observed measurements are consistent over time and to determine how changes in head posture might evolve with the treatment or progression of AHP. Moreover, future studies should incorporate inter-rater and intra-rater reliability tests to evaluate the consistency of smartphone-based measurements across different raters and over time.