behavioral training of paraspinal muscles in sitting...

Behavioral Training of Paraspinal Muscles in Sitting Position with Biofeedback for Adolescent Patients with Mild Idiopathic Scoliosis

Garcia Kwok1, Joanne Yip1*, Mei-Chun Cheung2, Kit-Lun Yick1 , Chi-Yung Tse3, Sun-Pui Ng4

1Institute of Textiles and Clothing, The Hong Kong Polytechnic University

2Department of Social Work, The Chinese University of Hong Kong

3Centre for Orthopaedic Surgery, Central, Hong Kong

4Division of Science & Technology, The Hong Kong Community College

CPCE Health Conference 2016

Contents

1. Background

2. Objectives

3. Methodology

4. Result

5. Discussion

6. Q&A

2

1. Background

Cases with a lateral curvature of the spine that measures 10° or

more based on radiographs are regarded as scoliosis (Kane, 1997;

Cassella & Hall, 1999)

Scoliosis can be classified into idiopathic, congenital or secondary

to a neuromuscular disease.(Reamy & Slaky, 2001)

Scoliosis can affect ones’ daily activities and in extreme cases,

even their life (Morgan & Scott, 1956)

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The approximated distribution of the three types of scoliosis is

65% idiopathic; 15% congenital; 10% secondary to a

neuromuscular disease, 10% to other reasons. (Agabegi, 2005; Hewitt, 2011)

Female adolescent ages of 10 to 15 years old were mostly

diagnosed with idiopathic scoliosis. (Dobb & Weinstein, 1999; Roach, 1999)

The rapid growth of the body structure during puberty is one of the

factors that induced the progress of spinal curvature. (James, 1954; Lonstein

& Carlson 1984; Mackenzie, 1922)

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Target Group: Adolescent Idiopathic Scoliosis (AIS) Girls

Studies of electromyography (EMG) assessment indicated AIS

patients have significant differences among paraspinal muscle

regions.(Białek M., et. al., 2007; Chwala W., et. al., 2014)

The asymmetrical paraspinal muscle activity is concluded to be a

contributing factor for the progression of idiopathic scoliosis.

(Avikainen V., et. al., 1999)

Some researchers have helped scoliotic patients to treat their

spinal deformity by using behavioral training. (Birbaumer N., et. al., 1994; Wong M.

S., et. al., 2001)

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2. Objectives

i. Observe the paraspinal muscle activity of patients with

mild AIS during sitting posture.

ii. Train the paraspinal muscles to achieve relatively more

balance as well as a balanced posture with non-

invasive behavioral training via EMG.

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3. Methodology

i. 12 Scoliotic subjects were recruited and examined the spine

curvature by ultrasound imaging system (Scolioscan™).

ii. 12 subjects were divided into three groups according to PUMC

classifications.

iii. EMG posture program by Thought Technology™ EMG devices.

iv. Statistical Analysis by IBM SPSS software 7

• 12 scoliotic subjects were invited to capture lateral 3D spine images through Scolioscan™

• The curve type were identified based on the scan.

• The concave and convex sides of the paraspinal muscle region were identified based on the scan.

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i. Subject Recruitment

The subjects were divided into 3 groups by PUMC classification system.

PUMC Type Ia with a single curve where the thoracic apex is between T2 and T11-12 discs.

PUMC Type Ib with a single curve where the thoracolumbar apex is between T12, T12-L1 discs

PUMC Type IIc with both a thoracic curve and a thoracolumbar/ lumbar curve, where the curve difference is less than 10 °

PUMC Type Ia 9

PUMC Type Ib PUMC Type IIc

ii. PUMC Classification (Qiu et al., 2003)

iii. EMG Posture Training Software

EMG electrodes were placed left and

right of Trapezius, Latissium Dorsi,

Erector Spinae at thoracic region and

Erector Spinae at lumbar region.

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iii. EMG Posture Training Software

Thought Technology BioGraph Infiniti

ver 5.3

EMG Posture Training consisted of

custom EMG channel set and custom

screens for technician and subjects.

The content of the software are

Baseline checking, Posture training

and Training session summary. 11

EMG Baseline Checking

Assessment for the paraspinal muscle of the subjects.

Check the muscle condition in terms of EMG.

The subjects were told to sit 3 minutes in a relax state.

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Interface of the subjects Interface of the technicians

EMG Posture Training Subjects were instructed to perform a suggested sitting posture and maintain

for 5 minutes.

The animation would be moving if the data fitted the requirements.

The aims of the training were narrow the root mean square (RMS) EMG difference between left and right side of the same muscle and reduce the EMG value.

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Interface of the subjects Interface of the technicians

Training Session Summary A summary of the training session was

generated for record.

The RMS EMG value, standard deviation of RMS EMG and absolute RMS EMG difference of the session were shown here.

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Interface of the technicians

Procedure of the Posture Training Session

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Session Summary &

Rest

(3 mins)

Posture Training

(5 mins repeat 5 times)

Rest

(3 mins)

Baseline Checking

(3 mins)

EMG Preparation

(10 mins)

iv. Statistical Analysis by IBM SPSS software

The Mean RMS EMG ratio were calculated. (Chwala W., et. al., 2014)

Student T-test with test value = 1 were carried out.

The result were presented according to subject’s scoliosis PUMC

curve type.

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Concave Convex

1

4. EMG Posture Training Result

17

0

0.5

1

1.5

2

Trapeizus LatissimusDorsi

ErectorSpinae atThoracicRegion

ErectorSpinae atLumbarRegion







2 3 7

Ia Ib IIc

RM

S sE

MG

Rat

io

Tested Muscle Regions

EMG Posture Training Result

Pre-Training Post-Training

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Mean of RMS sEMG

Ratio (p value)

Curve Type N= Muscle Region

Pre-

Training

Post-

Training

Ia 2

Trapeizus 2.82 (0.19) 0.91( 0.40)

Latissimus Dorsi 1.92 (0.18) 1.13 (0.40)

Erector Spinae at Thoracic Region 5.79 (0.19) 1.34 (0.81)

Erector Spinae at Lumbar Region 14.34 (0.50) 1.45 (0.30)

Ib 3

Trapeizus 1.66 (0.63) 1.06 (0.73)




Iic 7

Trapeizus 2.14 (0.15) 0.95 (0.34)




*The data is the mean of RMS sEMG Ratio between the convex and concave side of tested muscle

** The highlighted value represented the it has a trend of significant difference than tested value 1 (1 = EMG value is

identical between convex and concave side)

5. Discussion

During pre-training, for Ib and IIc type subjects, the ratio tends to have a significant

difference with 1 at erector spinae at lumbar region (p= 0.051 & 0.056) This result

shown similar foundings with other scholars. (Białek M., et. al., 2007; Chwala W., et. al., 2014)

After 20 sessions of posture training none of the tested regions had similar trend.

The muscle imbalance could be trained up via behavioral training.

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6. Conclusion

The EMG results obtained prior to the training indicate that there is significant

imbalance in the muscle activity in patients with mild AIS.

The muscle imbalance could be corrected with the use of behavioral training

through biofeedback.

The subjects are able to retain relatively more balanced paraspinal muscle activity

during the training.

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• Białek M., Chwała W., Kotwicki T., & M'hango A. (2007). Decrease of electromyographic activity of concave paraspinal muscles in scoliotic girls

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Q & A Thank you

behavioral training of paraspinal muscles in sitting...

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