# Evaluation of Symmetrical Exercises in Scoliosis by Using Thermal Scanning
## 1 Introduction  
According to the International Scientific Society on Scoliosis, Orthopaedic and Rehabilitation Treatment (SOSORT) definition, scoliosis is a heterogeneous group of conditions that cause changes in the shape and position of the spine, thorax and trunk [1]. Thus, scoliosis can occur as the presence of one or more abnormal curvatures of the vertebral column affecting the spinal alignment in all three dimensions. In scoliosis, the primary curvature is associated in the frontal plane with compensatory curves above and below it in the opposite direction. In addition, to the lateral bending of the spine, rotations of vertebrae in the transverse plane are common. Moreover, scoliosis leads to rib cage deformity if the spinal alterations occur in that zone. Ribs on the convex side move away from each other and bulge posteriorly forming a hump, while ribs on the concave side are pushed laterally and anteriorly. In addition, the vertebral bodies undergo structural changes, becoming wedge-shaped and asymmetrical. Beside clinical examination, a large number of assessment methods have recently been developed in scoliosis. Imaging modalities such as radiography, computed tomography (CT) and magnetic resonance imaging (MRI) are often used in the diagnosis, evaluation,and management of scoliosis. Among these, radiological examination remains the golden method to investigate and assess scoliosis [1]. Unfortunately, all these investigations use radiation and have negative effects on the child's growing body, and therefore new methods were researched. However, there are other possibilities to investigate and to monitor the evolution of scoliosis, but they are not widely used at the moment: Moire topography, computerized raster stereography, optical scanning through system ISIS (Integrated Shape Imaging System), thermography, digital ultrasonic mapping (Zebris Medical GmbH) and three-dimensional mapping through digital image acquisition (InSpeck system) [2; 3]. Thermography, one of the more recent techniques, is used to measure the symmetry or asymmetry in distribution of the skin temperature over selected areas of the body. It is increasingly used in medical applications because it is non-invasive, reliable, non-contact, and painless; the human body is not radiated, and it can be applied without restriction to all categories of patients regardless of age, sex or health status. Thermographic technique is based on the property of bodies to emit radiation in the infrared range. Thermal imaging equipment operates on the principle of conversion of infrared radiation in digital image output signal. Currently, thermography is limited to taking static or dynamic images that seek only local variation and/or temperature over time [4; 5; 6]. Thermography has proven its effectiveness in many pathologies, namely juvenile idiopathic arthritis [7], diabetes [8], scoliosis [9; 10; 11]. In healthy athletes, thermography was used to measure muscle activity in symmetrical or asymmetrical physical training and to predict the best type of effort [12; 13; 14]. Recent work by [PERSON] et al. [15] on thermography in scoliosis has indicated that the areas of the upper body parts (chest, abdomen, back) are much warmer (by about 4 \({}^{\circ}\)C) than the lower parts (thigh, calf) both in healthy children and in scoliosis. They demonstrated that in children with scoliosis, the areas of the body with a significant thermal asymmetry of the surface are the upper back, thighs and calf in the posterior area. Moreover, the size of the thermal asymmetry was significantly correlated with the angle of trunk rotation. Authors concluded that thermography can be used as a complementary tool in screening children with scoliosis. Starting from the observations presented in the literature, we tried to observe in this study how the back muscles act when the movements are performed symmetrically.