The effect of video-based game therapy on activation of scapular muscles in children with thoracic hyperkyphosis

Introduction: Thoracic hyperkyphosis involves excessive activation of the upper trapezius (UT) and pectoralis major (PM) muscles, coupled with inadequate activation of the middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) muscles. Game-based exercise programs can improve motor control and muscle activation in children, suggesting that video gaming may serve as an effective rehabilitation method for scapular muscles. Aim: The aim is to investigate the effects of video-based game therapy on scapular muscle activation and strength, postural alignment, and upper extremity performance in children with thoracic hyperkyphosis. Method: A total of 44 children diagnosed with thoracic hyperkyphosis were included in the study and randomly assigned to either the intervention group (n=22) or the control group (n=22). The intervention group received postural education and video-based game therapy under physiotherapist supervision for 8 weeks (3 days/week, 24 sessions). The control group received only postural education and was placed on a waiting list for 8 weeks. Pre- and post- intervention assessments included muscle activation using surface electromyography, muscle strength (dynamometer), viscoelastic properties (myotonometer), thoracic curvature (Kyphosis Index and Occiput to Wall Distance), postural analysis, perception of spinal deformity, pain level, and upper extremity performance. Data were analyzed using SPSS 24.0 (p<0.05). Results: At the study's end, significant increases in maximal voluntary isometric contraction values and dynamic muscle activation of the MT, LT, and SA muscles were noted in the intervention group (p<0.05). Muscle strength in these target muscles was significantly higher in the intervention group (p<0.001). Muscle tone also showed significant improvement in favor of the intervention group (p<0.05). However, no significant differences were found between the groups in thoracic curvature and postural parameters (p>0.05). Upper extremity performance improved significantly in the intervention group (p<0.05). Conclusion: Video-based game therapy has demonstrated improvements in the activation, strength, and tone of the MT, LT, and SA muscles, as well as enhancing upper extremity performance in children with thoracic hyperkyphosis. This highlights its potential as a rehabilitation approach for scapular muscle activation. However, further long-term studies are needed to assess its effects on thoracic curvature and postural alignment. Keywords: Electromyography, Exergames, Posture, Scapulothoracic Region