Effects of Global Postural Reeducation on Forward Head Posture

Study Overview
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Brief Summary
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This study aims at investigating the effects of application of a twelve sessions of Global Postural Re-education Technique (GPR) on Craniovertebral angle (CVA), functional abilities, stability of sense of position, cognitive abilities and treatment satisfaction.

Detailed Description
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A sample of 36 participants with a CVA less than 50 degrees will be randomly assigned to one of the two groups either receiving global postural reeducation added to traditional Kendall exercises or a group that receives Kendall Exercises only. Treatment sessions will be continued for a total of 12 sessions with a rate of 2-3 sessions per week. The effect of these two treatments will be assessed by various variables including: forward head angle via photogrammetry and Kinovea App, functional abilities via neck disability index, stability of sense of position by Cervical Range of Motion instrument (CROM) ,cognitive abilities via Stroop and Montreal Cognitive Assessment (MOCA) tests and agreeability of treatment techniques via treatment satisfaction scale.

Official Title
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Effect of Global Postural Reeducation on Functional Abilities, Stability of Sense of Position, Cognitive Abilities and Treatment Satisfaction in Patients With Forward Head Posture

Conditions
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Forward Head Posture

Intervention / Treatment
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* Other: Global Postural Re-education
* Other: Kendall exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients suffering from forward head Posture (CVA 50-40 degrees) All subjects are medically stable and do not suffer from any other diseases which might affect the trial results. Patients willing and able to participate in this treatment program. At least a moderate user of English. Exclusion Criteria: History of whiplash injury. Patients who have undergone spinal surgeries or spinal fixations. Patients with a neurologic deficit in their upper limbs, such as hypertonia, hypotonia, hyporeflexia, absence of reflex, and vertebral instability. Patient undergone other physical therapy program in the last three months.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: GPR<br>participants in this group receive global postural reeducation technique+ Kendall exercises | Other: Global Postural Re-education<br>* treatment techniques include corrective exercises both local and global to correct forward head posture. first session will be to educate participants the treatment sequence. This will be a session of Kendall exercises as described below. This will followed be performing GPR techniques of Anterior Chain stretch in the supine frog like position for 20 minutes followed by posterior chain stretch against the wall for another 20 minutes. This is repeated in the first 6 sessions. Staring from the seventh session the time of holding each position is decreased to 15 minutes and a third position (standing against the wall) is introduced and performed for 15 minutes. Starting from the eighth session a forth position of sitting on the floor position is introduced and performed for another 15 minutes. total of a session will then take a bout 90 minutes.<br>|
| Active Comparator: Kendall<br>Kendall exercises | Other: Kendall exercises<br>* exercises that correct upper crossed syndrome: Treatment sequence will be: a) Strengthen deep Cervical Flexors via Chin tucks. Repetition will be 15 times repeated for 3 sets. (b) Stretching the cervical extensors. This is held for 1 minute and repeated 5 times. (c) Strengthening shoulder retraction. Repetition will be 15 times repeated for 3 sets. (d) Stretching the pectoralis muscle. This is held for 1 minute and repeated 5 times.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| craniovertebral angle | the angle formed between a horizontal line and a line extending from ear meatus and C7 | 12 sessions with a rate of 2-3 sessions/week taking a 4-6 weeks /patient (according to patient's timetable) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck disability index | a scale that tests the effect of treatment on functional abilities of patients. | 12 sessions with a rate of 2-3 sessions/week taking a 4-6 weeks /patient (according to patient's timetable) | 
| Proprioceptive stability test | By utilizing CROM testing the patients' sense of location precision | 12 sessions with a rate of 2-3 sessions/week taking a 4-6 weeks /patient (according to patient's timetable) | 
| Stroop test | a word- color test to measure cognitive abilities of patients | 12 sessions with a rate of 2-3 sessions/week taking a 4-6 weeks /patient (according to patient's timetable) | 
| MOCA test | a series of questions that enable to measure cognitive abilities of patients | 12 sessions with a rate of 2-3 sessions/week taking a 4-6 weeks /patient (according to patient's timetable) | 
| Treatment satisfaction scale | a scale measuring the satisfaction and agreeability of the treatment according to patients' perspective | 12 sessions with a rate of 2-3 sessions/week taking a 4-6 weeks /patient (according to patient's timetable) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Forward Head Posture, Global Postural Re-education, Kendall Exercises, Rounded Shoulders, Postural Correction