The Relationship Between the Shape of the Spine and the Width of Linea Alba in Children Aged 6-9 Years. Case-Control Study.

Introduction: Civilization development coupled with contemporary lifestyle leads to a systematic increase in postural disorders. An analysis of factors that may provoke postural disorders indicates that such a stimulus may be the diastasis of the rectus abdominis muscles. Moreover, abnormal activity of the rectus abdominis muscles may affect balance disorders through reduced spinal stabilization and disturbed body statics. There is an increase in body posture abnormalities between the ages of 6 and 9 related to new school duties. Purpose of the Study: The purpose of the study was to evaluate the relationship between the shape of the spine and the width of the linea alba in children aged 6-9 years. Material and Method: The study was designed to evaluate parameters determining the shape of the spine, and the width of the linea alba in healthy children aged 6-9 years. The study participants were divided into two groups based on the width of the linea alba. The study group with the width of the linea alba >10 mm and the control group with the width of the linea alba ≤ 10 mm. The study group were included 37 children and the control group 24 children. The examination of the linea alba width was performed by a radiology specialist using a linear transducer and SAOTE- My Lab Classc-type ultrasound at rest and during contraction of the rectus abdominis muscles. Parameters describing the shape of the spine were measured using the Diers Formetric 4D system: trunk inclination, trunk imbalance, pelvis tilt, pelvic torsion, kyphotic apex, lordotic apex, kyphotic angle, lordotic angle, rotation angle, trunk torsion, lateral deviation. The obtained results were statistically analyzed using a Paired t test for comparison of differences between the results in the study and control groups and Pearson's test to assess the correlation between the width of the linea alba and parameters describing spinal alignment. Results: In both groups, the parameters describing the shape of the spine did not differ from the norms accepted as typical for the age norm. The only statistically significant difference between the study and control group concerned the trunk inclination, which was negative in the study group, signifying a shift of the entire spine axis backwards beyond the vertical. Conclusions: There is a correlation between the shape of spine and the width of the linea alba in terms of selected parameters determining the body posture in the sagittal plane, which concern: the position of the lumbar lordotic apex, trunk inclination and the depth of the lumbar lordotic angle. The width of the linea alba is not explicitly related to abnormalities of pelvic and spinal alignment in the frontal and transverse planes.

Assessment of Body Posture of Children With Chest Pain.

Objective: An increase in the appearance of chest pain among children is observed globally. The authors present various reasons for their appearance. As can be seen from numerous observations, the majority of cases are not related to the pathology of the circulatory system. Increasingly, studies on the causes of chest pain in children show their association with musculoskeletal disorders. Aim: of the work was assessment of body posture in children with chest pain using the Diers Formetric 4D system. Methods: The study involved a group of 184 female and male children, aged 7-12 years. The study group consisted of 64 patients with chest pain. The children from this group were diagnosed with functional chest pain by a cardiologist. The control group consisted of 120 patients without chest pain. The study included the assessment of body posture using the DIERS Formetric system. Results: The analysis of the results obtained during the study showed that among the children with chest pain, there are statistically significant irregularities in the parameters determining body posture compared to the control group. Comparing the study group with the control group, there is a statistically significant difference in the lateral deviation of VPDM (rms) (mm) (p = 0.001). Both children from the test group aged 9-10 and 11-12 obtained higher results than their peers from the control group. In the group of the youngest children in terms of the lateral deviation of VPDM (rms) (mm), increasing the number of children under study would contribute to significant differences in this variable. In the study group, among children aged 9-10 years, there were also statistically significant abnormalities regarding trunk imbalance and pelvic skewness compared to the children of the same age in the control group. Conclusions: Irregularities in the parameters determining body posture may cause chest pain in children.

Effect of physiotherapy on spinal alignment in children with postural defects.

OBJECTIVES: This paper assesses the effect of neurophysiological rehabilitation in children with postural defects on the depth of thoracic kyphosis, lateral spinal deviation and rotation of spinal motor segments. MATERIAL AND METHODS: A total of 201 patients aged 8-15 years old with a postural defect diagnosed by medical examination were enrolled. The analyzed parameters were determined using the DIERS system before the first therapeutic session and after 4 weeks of therapy. The angle of thoracic kyphosis, lateral deviation of the spine and spinal rotation were assessed. The therapy employed techniques associated with the proprioceptive neuromuscular facilitation (PNF) and Vojta's approaches. The results were analyzed separately for both sexes and for patients rehabilitated solely with Vojta's techniques vs. patients rehabilitated according to combined Vojta's and PNF techniques. The χ2 test was used for statistical analyses, at p < 0.05. RESULTS: There was improvement in the angle of thoracic kyphosis, ranging from 0.14 (among boys with kyphosis < 42°) to 5.47 (among girls with kyphosis ≥ 42°), spinal rotation, from 0.37 (among boys with kyphosis ≥ 42°) to 4.33 (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method), and lateral deviations, ranging from 1.32 mm (among boys with kyphosis < 42°) to 2.99 mm (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method). CONCLUSIONS: Neurophysiological rehabilitation of patients with postural defects produced positive effects by improving the angle of thoracic kyphosis, spinal rotation and lateral deviation of the spine. Children with reduced thoracic kyphosis achieved less improvement in the kyphosis angle, lateral spinal deviation and spinal rotation than children with kyphosis ≥ 42°. The DIERS Formetric System enables precise monitoring of therapeutic outcomes. Int J Occup Med Environ Health. 2019;32(1):25-32.

Efficacy of the use of the McKenzie and Vojta methods to treat discopathy-associated syndromes in the pediatric population.

OBJECTIVES: This paper evaluates the efficacy of using the McKenzie and Vojta methods for patients with low back pain and the use of the DIERS Formetric 4D system as an objective diagnostic tool. MATERIAL AND METHODS: The study enrolled 28 patients aged 15-17 years old. The patients were hospitalized at the Department of Orthopedics and Traumatology of the Swietokrzyskie Center for Pediatrics in Kielce with a diagnosis of back pain associated with a discopathy. The patients were rehabilitated according to the McKenzie and Vojta methods. Assessment by means of the DIERS Formetric system had taken place before the first therapy session and on the day that pain was eliminated to evaluate trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, surface rotation and pelvic obliquity. Pain intensity and change in pain intensity over time were assessed by means of a numerical rating scale. RESULTS: Pain intensity was reduced to 0 over 3-12 days. The study participants demonstrated reduction in anterior trunk inclination of the mean value at 1.83°. The angle of thoracic kyphosis was also reduced by 7.95°. The angle of lordosis increased by 7.6°. The lateral spinal curvature was reduced by 8.92 mm. There was a reduction of 4.64° in trunk torsion. Surface rotation was reduced by 1.61° and pelvic obliquity was reduced by 3.78°. CONCLUSIONS: In discopathic patients, postural parameters comprising trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, vertebral rotation and pelvic obliquity fail to reach Hartzmann's physiological reference ranges. A therapeutic intervention based on the Vojta and McKenzie methods may normalize the posture to physiological reference ranges and is effective in the treatment of patients with back pain. The DIERS system is an objective tool for tracing the effects of therapy in patients with back pain. Int J Occup Med Environ Health. 2019;32(1):33-41.

Managing Toe Walking, a Treatment Side Effect, in a Child With T-Cell Non-Hodgkin's Lymphoma: A Case Report.

Background and Purpose: Children who have survived cancer are at risk of experiencing adverse effects of the cancer or its treatments. One of the adverse effects may be the limitation of ankle dorsiflexion (DF), which may result in "toe walking." Although there is an increasing number of studies in pediatric oncology presenting evidences of different therapeutic interventions to improve DF function, none of these therapeutic interventions has been sufficiently documented. This case report shows the results of non-invasive neurodevelopmental treatment program combined with application of inhibiting casts in a pediatric cancer patient who presented with severe and persistent toe walking. The treatment was aimed to improve DF function and postural and gait pattern and to normalize weight distribution between forefoot and heel. Case Presentation: A 7-year-old girl with T-cell lymphoma, who presented with severe and persistent toe walking, was assessed 10 times over a course of 6 months by both clinical examination (ankle range of motion measurement) and neurophysiological measures (weight distribution between forefoot and hindfoot, postural sway, body posture, and gait). Outcomes: Neurodevelopmental treatment program combined with application of inhibiting casts for 3 months increased passive ankle DF by 10° in both lower limbs, normalized weight distribution between the forefoot and heel in both lower limbs, as well as established a heel-toe walking gait pattern. Improved ankle DF function and normalized postural and gait patterns were maintained in repeated examinations even 3 months after the removal inhibiting casts. Discussion: Early identification of toe walking in the female pediatric patient with T-cell non-Hodgkin's lymphoma and early physiotherapy intervention were beneficial in terms of her body posture and gait pattern development. Non-invasive neurodevelopmental treatment program combined with application of inhibiting casts as described in this study can be useful for managing treatment side effects in pediatric cancer patients.