# \"Scoliosis 3D\"-A Virtual-Reality-Based Methodology Aiming to Examine AIS Females' Body Image
## 1 Introduction  
Adolescent idiopathic scoliosis (AIS) is one of the most frequently occurring deformities of organ motion, with a prevalence of 2-3% in children and adolescents [1]. AIS is characterized by a three-dimensional deformity which occurs across three planes: frontal (lateral bend), sagittal (physiological deformation resulting in thoracic kyphosis and lumbar lordosis) and transverse (associated with the rotation and translation of vertebrae) [1]. Scoliosis progression tends to occur more frequently in girls and, therefore, girls need treatment more often than boys [1]. Scoliosis with a high Cobb angle can result in the reduction of a patient's physical capacity, neurological disorders and, in extreme cases, in cardio-respiratory failure and premature death [1]. Additionally, trunk deformity in AIS is a significant cosmetic, psychological, and social problem, particularly in cases of trunk decompensation and rib hump, especially of a high angle [1, 2, 3, 4, 5]. A steadily increasing angle of curvature of up to a 45-50 degree Cobb angle, neurological disorders and pain are indications for operative treatment, as are, in some cases, aesthetic reasons connected to rib hump or lumbar curve [1]. In particular, individuals with progressive idiopathic scoliosis may have several pronounced body deformities, including scapular and rib prominence, uneven shoulders, and an asymmetric waistline. Accordingto some authors, these deformities can significantly influence personality traits, levels of self-esteem, and self and body image which, among others, are decisive factors affecting the quality of life of adolescent patients [6; 7; 8; 9]. Specifically, [PERSON] et al. [9] indicated greater back-related body-image disturbances in patients with scoliosis compared with healthy controls. In the view of challenges related to the need for objective measurement of body representation, some modern techniques, such as virtual-reality (VR) tasks might offer a unique method for eliciting state-variable fluctuations in body satisfaction and associated behaviors by allowing near-perfect control over environmental factors. VR has been used to study social behaviors toward, e.g., stigmatized groups; for example, researchers have measured interpersonal distance as an indicator of participants' level of stigmatization toward avatars who are perceived to be HIV-positive [10; 11]. Furthermore, one study recently investigated the use of virtual embodiment to reduce self-criticism in a non-clinical sample of young women, suggesting that VR may show promise as a tool to reduce the detrimental effects of self-stigmatization among members of marginalized groups, including people with visual body deformities [12]. To the best of our knowledge, this would be the first study to create biometric avatars in VR to investigate changes within body representation in AIS. The concept of VR tasks is modeled after the design of [PERSON] et al. [13], with our original modification dedicated to AIS patients. This innovative method would allow realistic manipulation of avatar body shape and the investigation of perception of other bodies in a well-controlled environment. Moreover, as this field of research develops, it would be important to consider how virtual interactions and avatar embodiment, among other factors, may influence body-shape perception within a virtual setting. Developing a nuanced understanding of the perception of the silhouette, in the context of virtual spaces, incorporating such themes as embodiment, interaction with avatars, and one's self-perspective in VR, may allow the development of universal, disseminable virtual interventions to improve body satisfaction in the future. VR-related analyses can enable a better description and understanding of the somatic-disease mechanism influencing adolescent patients and the treatment and intervention methods applied.