Effects of Telerehabilitation-based Motor Imagery and Exercise Combination in Individuals With Postural Kyphosis: A Randomized Controlled Trial

Overview

Objective: Kyphosis is one of the most common postural problems. It is defined as a thoracic curvature that exceeds normal limits. The Cobb angle, also known as the kyphosis index, can be used to determine the degree of this curvature. Motor imagery (MI) is defined as visualising movement in the mind without actually moving. Studies have shown that similar brain regions are activated during motor imagery and actual movement. regions are activated during motor imagery and actual movement. Most of the information about motor imagery training has been obtained from studies of stroke patients, and the physical effects of motor imagery training have been examined in these studies. However, there has been no study in which motor imagery, which is mostly performed by neurological stroke groups or athletes, is used for treatment of postural disorders. In this context, this study aims to examine the effect of tele-rehabilitation-based motor imagery training on kyphotic angle, pain, depression and quality of life in individuals with posture disorders. Materials and methods: Young adults with postural kyphosis who are studying at Istanbul University-Cerrahpaşa Faculty of Health Sciences will be included in the randomised controlled, single-blind, prospective study. Participants will be randomly divided into two groups: an exercise group (Group 1) and an exercise + motor imagery group (Group 2). The presence of kyphosis in participants will be evaluated by measuring the Flexruler kyphosis index and wall-occiput distance. Posture will be evaluated using the New York Posture Analysis and pain using a visual pain scale. Depression will be assessed using the Beck Depression Scale. assessment will be evaluated using the Beck Depression Scale; quality of life will be evaluated using the SRS-22; and motor imagery will be evaluated. ability will be evaluated using the Turkish version of the Movement Visualisation Questionnaire-3 (MIQ-3). SPSS (Statistical Package for the Social Sciences) Sciences) statistical program (SPSS 21.0) will be used to analyse the obtained data, with p\<0.05 being significant.

The term "posture" is derived from the notion of assuming an upright bodily position, specifically standing. The concept of "body language" refers to the position, alignment, and order of the body parts. The American Academy of Orthopaedic Surgeons (AAOS) defines good posture as a state of muscular and skeletal balance that protects the body from injury and progressive deformities by ensuring that the body structures are aligned in the most appropriate position. Postural disorders are the result of a disruption to this equilibrium. Kyphosis is a prevalent postural issue. A curvature of the thoracic wall that exceeds the standard measurement is referred to as kyphosis. The degree of this curvature of the thoracic wall can be determined by the Cobb angle or kyphosis index. A kyphosis index greater than 13, as determined by the Flexruler, is classified as hyperkyphosis. Thoracic hyperkyphosis is categorised into three distinct types: postural kyphosis, Scheuermann disease, and forms that develop due to congenital deformities. Postural hyperkyphosis is the most prevalent form of kyphosis. Postural hyperkyphosis is characterised by a spinal curvature that occurs in response to external forces, resulting from weakness of the muscles that are effective in the upright position. This curvature of the spine is not rigid, and when patients are asked to stand up straight, the existing curvature can usually be corrected by the patient themselves. Motor imagery (MI) is defined as the visualisation of a movement in the mind without the execution of the movement itself. Research has demonstrated that analogous regions of the brain are stimulated during the process of motor imagery and physical movement. It has been established that individuals can enhance their motor abilities, including lifting weights, playing the piano, and performing surgical procedures, by repeatedly visualising the same movement.The results of this study indicate that motor imagery facilitates motor learning by enhancing synaptic connections in an activity-dependent manner. A review of the extant literature reveals that the participants in studies conducted with healthy individuals are predominantly athletes and musicians. It has been demonstrated that athletes and musicians frequently utilise motor imagery in conjunction with physical training to enhance a variety of skills. The objective of this approach is to enhance performance, alleviate anxiety, and augment body image and self-confidence through its utilisation as a pre-performance rehearsal in athletes. Motor imagery has been demonstrated to be a valuable tool in the domains of motor learning and rehabilitation, particularly in the context of neurological diseases such as stroke, spinal cord injury, and Parkinson's disease. The utilisation of motor imagery in conjunction with physical therapy for stroke patients has been demonstrated to be efficacious in enhancing upper limb function, ambulatory ability, and the patient's capacity to resume daily activities. Despite the paucity of research conducted on individuals with spinal cord injury, it has been posited that motor imagery exerts an indirect influence on motor performance, rather than exerting a direct effect. Instead, it has been hypothesised that motor imagery enhances the function of non-paralyzed muscles. A study conducted on patients suffering from stroke, multiple sclerosis and traumatic brain injury demonstrated that the utilisation of motor imagery in conjunction with physical therapy regimens can yield a favourable impact on functional task performance. In the course of a review of postoperative studies in the literature, Newsome et al. demonstrated the efficacy of motor imagery in reducing the loss of wrist flexion/extension strength that may occur after short-term muscle immobilisation. A number of studies have indicated that motor imagery training in patients who have been immobilised for a short time after anterior cruciate ligament injury is effective in reducing pain, loss of muscle strength, and anxiety, and may improve functional recovery. The preponderance of information regarding motor imagery training has been derived from studies conducted on stroke patients, with a predominant focus on the physical effects of motor imagery training employed in these studies. To the best of the author's knowledge, there have been no studies conducted on the use of motor imagery in the treatment of postural disorders. To date, such studies have been mainly conducted on neurological stroke groups or athletes. Telerehabilitation can be defined as a developing method that aims to provide rehabilitation to patients and clinicians by reducing barriers such as distance, time, and cost using information and communication technology. Telerehabilitation facilitates the provision of rehabilitation services to patients who would otherwise be unable to access them due to geographical, economic or physical limitations. In this context, the objective of the present study was to examine the impact of telerehabilitation motor imagery training on posture, pain, depression, and quality of life, with a view to addressing the existing lacunae in the extant literature on the subject.