Publications

Background: Game-based rehabilitation has been shown to support motor control and muscle activation in children; therefore, video-based gaming may represent a promising rehabilitation approach for targeting scapular muscles.

Objective: To examine the effects of video-based game therapy on scapular muscle activation, strength, and upper extremity performance in children with thoracic hyperkyphosis.

Setting: Randomized controlled trial conducted over 8 weeks.

Participants: Forty-four children with thoracic hyperkyphosis were assigned to a video-based game therapy group (n = 22, mean age 14.4 ± 2.6 years) or a control group (n = 22, mean age 13.2 ± 2.6 years), using stratified block randomization based on age, gender, and Risser sign.

Interventions: The video-based game therapy group received postural education and video-based game therapy under supervision for 8 weeks (3 days/week, 24 sessions), and the control group received only postural education and was waitlisted.

Main Outcome Measurements: Pre- and postintervention assessments included muscle activation (surface electromyography), strength (dynamometer), viscoelastic properties (myotonometer), spinal deformity perception, and upper extremity performance (Medicine Ball Throw Test, Closed Kinetic Chain Upper Extremity Stability Test, Scapular Muscular Endurance Test, and Nelson Hand Reaction Test). Data were analyzed using SPSS 24.0. Two-sided p < .05 was used.

Results: At study end, the video-based game therapy group showed increases in maximal voluntary isometric contraction and dynamic activation of the middle trapezius, lower trapezius, and serratus anterior muscles (p < .001–.048); upper trapezius activation showed no significant between-group differences (p > .05). Muscle strength was higher in video-based game therapy group (p < .001), whereas changes in upper trapezius strength were not significant between groups (p > .05). Muscle tone improved in favor of the video-based game therapy group (p < .05), but stiffness showed no significant between-group differences across most muscles (p > .05). Upper extremity performance also showed significant improvement in video-based game therapy group (p < .001–.05).

Conclusion: Video-based game therapy may enhance scapular muscle activation, strength, and tone, improving upper extremity performance in children with hyperkyphosis. Video-based game therapy demonstrated significant short-term neuromuscular benefits, supporting integration into pediatric postural rehabilitation.

In conclusion, to our knowledge this study is the first randomized controlled trial to design and evaluate the effects of a structured video-based game therapy specifically targeting scapular stabilizers using objective outcomes in pediatric hyperkyphosis. It has highlighted the benefits of an innovative, technology-based approach that enhance participation and adherence to exercise. Although the effects of video-based games on upper extremity performance have generally been investigated in the literature, this study presents pioneering findings by examining the effects on scapular muscle activation in children with thoracic hyperkyphosis. This study makes significant contributions to the literature as the first study to evaluate the effects of video-based game therapy on scapular muscle activation, strength, and muscle tone using objective methods. Additionally, it provides a valuable reference for future clinical applications and research by demonstrating the potential of this treatment method in managing postural hyperkyphosis.