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The Imaging and Evaluation of Body Posture Defects in Hearing Impaired Children

The Imaging and Evaluation of Body Posture Defects in Hearing Impaired Children The paper presents the use of a diagnostics device Posturometer-S applied to examine body posture in hearing impaired children. 46 subjects from the Primary School for Hard-of-Hearing Children in Wroclaw were examined. The research was conducted through the use of a Posturometer-S, which is an electronic, non-invasive measuring device attached to a computer. It enables not only the imaging and evaluation of frontal and sagittal curves of the spine, but also spinal mobility. Previous research has indicated that incorrect body posture was more often observed in hearing impaired children than in healthy ones. Hence, constant control over body posture in children with hearing loss seems vital. Correct body posture has a great influence on functioning of the entire body. The results obtained by using the Posturometer-S and anthropological measurements helped to determine the types of body posture and postural defects in the examined subjects. The apparatus used in research enabled to determine the occurrence of kyphotic, lordotic and balanced body postures, the results as follows: incorrect kyphotic postures - 10,9% of the subjects, incorrect lordotic postures - 6,4% and incorrect balanced postures - 10,9% of the examined subjects. Correct body postures were observed in 67,4% of the examined children. The most frequent body posture abnormalities were: thoracic scoliosis (19,6%) and shoulder asymmetry (26,1%). Due to the screening tests, some children were referred for further diagnostic evaluation and physiotherapy. KEYWORDS: body posture, postural defects, Posturometer-S, deaf children, hard-ofhearing children Introduction Human senses are used to receive and analyse information from the external environment. Due to this process, a human is able to perceive the reality, picture the world and consciously adapt body functions, such as maintaining body balance, within environmental requirements [1]. Correct body posture as well as balance is crucial for the correct functioning and performance of movements [2]. Hearing impairment in children and youth in general leads to the occurrence of postural defects, changes in psychomotor behaviour and abnormalities in the psychological area [3, 4, 5]. Receiving external impulses in a distorted way has an influence on the deterioration of body posture, control in space and keeping balance. Among the many methods for examining body postures, we can distinguish: visual methods (observation by experienced diagnostician), photography methods, shadowography (with use of silhouette image) and Holland's device [6]. More up-to-date methods are computer-based moiré method and examination with use of Posturometer-S. Some of the older and easier to perform techniques are not precise enough, others are difficult to perform by less experienced staff, and as a result, when such research is conducted by different researchers, a variety of results can be obtained. Some different methods are also very time-consuming, the time needed to obtain results is long and inconclusive. As a whole, this research aimed to determine how often selected types of body posture occurred in hearing impaired children and to evaluate body posture defects in children through the use of the Posturometer-S. Researchers also examined selected parameters of physical development in children with hearing loss. The research was conducted through the use of an original and patented measuring device which enabled the digital depiction of spinal curves and an assessment the type of body posture [7]. The measuring technique applied in this case was not complicated, however, it required good knowledge of anthropometric points on the back. The Posturometer-S is appropriate not only for large-scale research, but also individual diagnostic tests. It enables an instant print out of the obtained picture of a spine along with an evaluation. It also stores data and creates a database which facilitates quick statistical analysis. It is important to observe how often and what type of body posture defects occur in hard-of-hearing children in order to create prophylactic programs and rehabilitation exercises aimed for these groups. Many researchers have proven that body posture is related to the performance of balance features. Thus, body posture defects may result in: balance disorders, the inhibition of response, circulatory disorders and breathing disorders related to chest deformation [8, 9, 10]. Material and Methods The research performed in 2003 included deaf children from the Primary School for Hard-of-Hearing Children in Wroclaw. Diagnostic tests of body posture were conducted in the morning. There were 46 hearing impaired subjects participating in the research, including 16 and 30 in the age of 8-14 years. The scientific term "deaf" was adapted in accordance with terms used by specialists as a superior in surdopedagogy. The term refers to all subjects who suffer from minor or major loss of hearing, including people who are: completely deaf (with deep deafness), partially deaf (with some hearing ability), with impaired hearing and deaf, those who have lost gradually their hearing during their lives but who used to be able to hear [11]. Examined subjects mainly suffered from severe and profound hearing loss from their birth or early childhood. The research was conducted through the use of the Posturometer-S, a specially designed for examining body posture, non-invasive device connected with a computer [7, 12]. The Posturometer-S setup consists of three coupled systems: mechanical; a pointer used to indicate the position of a measured point, electronic; an element which computed the position of the pointer in a three dimensional space, informatique; used to analyse the obtained results. The Posturometer-S setup includes - besides the main device - a platform, which facilitated the stabilization of an examined subject and a computer set (figure 1). Figure 1. Schema of Posturometer-S device (source: M.Stacho). Before the commencement of the examination, the following anthropometrical points needed to be marked on a subject's back: spinous process of vertebrae C7 ­ L5, acromions, infrascapulare and iliospinale posteriori. Next, the subject took a correct, but comfortable position on the platform while the researcher used the pointer to mark all previously determined points (figure 2). Figure 2. The examination of body postures in children with use of Posturometer-S (source: private archive of coauthor - Justyna Andrzejewska). The most important aspect of this research was to properly identify measurement points, all of which was performed by a qualified anthropologist. Another important thing was to monitor whether the subject's body position was comfortable and natural, and furthermore, whether it did not change while measurements were being conducted (i.e. subject not moving). Due to the limited contact with the hearing impaired children, the necessity to repeat measurements on the same subject was quite frequent. After all measurements were taken, researchers used POSTURO software to obtain a 3D image of spinal curves (figure 3). This software evaluates antero-posterior spinal curvature on the basis of the protrusion of the chest kyphosis, the depth of lumbar lordosis and the tilts of separate spinal segments (angles , and ). Increased values of and angles indicated kyphosis while increased and angles indicated lordosis. The software was also used to compute the values of asymmetry for: shoulders, shoulder blades and anterior superior iliac spines. Posturometer-S was used to evaluate body posture in the frontal, sagittal transverse plane. It printed out measuring cards with a picture of a spine and the description of the diagnosis (figure 4). Figure 3. Printscreen of POSTURO software. Figure 4. The printed card with diagnosis and image of spine. On the basis of Wolanski's typology including E. Zeyland-Malawka's modifications [13], three main types of body postures with their sub-types were determined: kyphotic I, kyphotic II, kyphotic III, balanced I, balanced II, balanced III, and lordotic I, lordotic II, lordotic III. The general characteristics of these types are as follows: - Kyphotic ­ flattened chest, shoulder blades which protrude, head located slightly forward (face before the sternum plane), shoulders located at the same plane as back of the neck, middle thoracic kyphosis and small lumbar lordosis; frontal abdominal wall is flat. Advanced kyphotic type is characterized by shoulder blades which distinctly protrude, large thoracic kyphosis, middle lumbar lordosis, and frontal abdominal wall located slightly forward. - Balanced ­ is characterised by a well-shaped thorax with shoulder blades that do not protrude; the head is located directly above the chest, shoulders are located at the same plane as the back of the neck, little thoracic kyphosis and lumbar lordosis, and a flat frontal abdominal wall. Advanced balanced type is characterized by protruding shoulder blades, larger thoracic kyphosis and lordosis and a slightly protruding frontal abdominal wall. - Lordotic - is characterised by the face sticking out in front of the sternum, shoulders being located at the same plane as back part of the neck, slightly flattened chest, slightly protruding shoulder blades, small thoracic kyphosis, middle or large lumbar lordosis, slightly protruding frontal abdominal wall. Advanced lordotic type is characterised by shoulders being located at the front of the neck plane, the upper part of the chest moved back, slightly protruding shoulder blades, middle thoracic kyphosis, large lumbar lordosis, and abdomen protruding abnormally. Among incorrect body postures Zeyland-Malawka distinguished: kyphotic postures type II and III, balanced type III and lordotic types II and III [13]. Those children who displayed such postural defects or also scoliosis and asymmetry were recommended by researchers for further medical diagnostics and rehabilitation. What is more, the analysis included the results of the anthropometric measurements of body mass (measured with certified electronic scales B150L) and height (B-v measurement performed through the use of a Martin's type anthropometer GPM Sieber Wegner Maschinen AG). Both somatic features were used to compute BMI (Body Mass Index). The collected data were analysed through the use of Statistica 9.0 (StatSoft®) and by the application of basic statistical methods (mean, standard deviation, minimum, maximum, and frequency) as well as suitable tests of significance of difference. The distribution of the examined features did not differ from normal distribution. The analysis of variance was used to determine the relationship of BMI values and subject's age with body posture types. For the analysed features the values of Cramer's V coefficient were computed. The Chi2 test was applied to determine the dimorphic differences in the occurrence frequency of the selected types of body posture. The charts presented were created in Microsoft Office Excel 2003. Results The differences observed in the children's body height and mass were due to their age (8-14 years). In comparison to of the same age, the were usually taller and heavier (excluding the short period of pubertal spurt). Greater inter-individual and inter-gender diversification was observed in body mass rather than body height. Figures 5 and 6 present the distribution of body height and mass in the analysed and . The range of BMI values of the subjects was 13-24 kg/m2, excluding one 11-year old boy whose BMI was 29 kg/m2. BODY HEIGHT (B-v) 200,0 BODY HEIGHT [cm] 150,0 100,0 50,0 0,0 7,00 8,00 9,00 10,00 11,00 12,00 13,00 14,00 15,00 AGE [years] Figure 5. Body height of examined hearing impaired children depending on age. BODY MASS 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 BODY MASS [kg] 7,00 8,00 9,00 10,00 11,00 12,00 13,00 14,00 15,00 AGE [years] Figure 6. Body mass of examined hearing impaired children depending on age. The frequencies analysis of selected body posture types revealed that the most frequent type among the examined deaf children was balanced type II (28,3%) and kyphotic type I (21,7%). Types kyphotic I, balanced I and II occurred with the frequency of 10,9% each, while lordotic types I and II occurred with the frequency of 6,5% each. Figure 7 presents the diversification of the frequencies of analised posture types in reference to gender. The dominant types in were: balanced II, balanced I and kyphotic II. The dominant types in were: balanced II and kyphotic I, and next, balanced III. The majority of subjects displayed correct body posture. FREQUENCY OF PARTICULAR BODY POSTURE PERCENTAGE [%] KYPHOTIC I KYPHOTIC II KYPHOTIC III BALANCED I BALANCED II BALANCED III LORDOTIC I LORDOTIC II LORDOTIC III TYPE OF POSTURE Figure 7. Frequency of particular posture types in examined hearing impaired children. The analysis of significance of the difference computed on the basis of the frequency of posture types between the genders (Chi2 test, Fi Yul coefficient, V-Cramer coefficient) did not reveal any significant differences between and . However, some posture types were very rare or did not occur at all. In order to get more information the additional analysis was performed children divided into three groups depending on major posture type (kyphotic, lordotic and balanced). Such analysis was also conducted during the dichotomous division into correct and incorrect body posture. Both genders did not reveal any significant differences in the frequency of the selected body posture types, but it was noticeable that lordotic postures were more often in while kyphotic postures - in (table 1). Table 1. Characteristic of frequencies in body posture types in and with the results of tests of significance of difference. BODY POSTURE TYPES 9 posture types kyphotic 3 posture types 2 posture types balanced lordotic correct incorrect PERCENTAGES 7,494 0,2776 V Cramera or Fi (*) 0,413 Chi2 see figure 7 37,9 % 51,7 % 10,3 % 72,4 % 27,6 % 26,7 % 53,3 % 20,0 % 66,7 % 33,3 % 1,049 0,5919 0,154 0,157 0,6921 - 0,059* Body posture type was not significantly related to BMI of the subjects (ANOVA; F = 0,88; p = 0,4200) and their age (ANOVA; F = 1,03; p = 0,3668), but in examined group of children lordotic postures were characterized by higher BMI values (19,3 +/- 10,1 kg/m2) in comparison with balanced postures (15,3 +/- 7,8 kg/m2) and kyphotic postures (14,9 +/- 4,6 kg/m2). Additionally, the researchers examined the frequency of scoliosis and asymmetry in hearing impaired children. All types of scoliosis were more frequent in , however, percentages of scoliosis did not exceed 20% in none of gender (figure 8). The most common defects were thoracic scoliosis and left-sided scoliosis (occurred mainly in 8-9 year old subjects). Hearing impaired were characterized by more frequent asymmetry of the entire body, asymmetry of shoulders and shoulder blades and rotation of pelvis, comparing deaf (figure 9). Both sexes presented asymmetry of shoulders as the most frequent symmetry incorrectness. The rotation of pelvis was merely left-sided, with one exception, whereas the asymetry of pelvis was not noticed in examined group of children. Dimorphic differences observed in the occurrence of body posture defects mentioned above were not statistically significant. FREQUENCIES OF SCOLIOSIS TYPES 20,0 18,0 PERCENTAGE [%] 16,0 14,0 12,0 10,0 8,0 6,0 4,0 2,0 0,0 GENERAL SCOLIOSIS THORACIC SCOLIOSIS LUMBAR SCOLIOSIS THORACIC-LUMBAR SCOLIOSIS TYPE OF SCOLIOSIS Figure 8. Frequencies of scoliosis in hearing impaired and . FREQUENCY OF PARTICULAR POSTURE DEFECTS 30,0 PERCENTAGES [%] 25,0 20,0 15,0 10,0 5,0 0,0 SHOULDER ASYMMETRY SCAPULA ASYMMETRY BODY ASYMMETRY PELVIS ROTATION TYPE OF ASYMETRY/ROTATION Figure 9. Frequencies of asymmetry and rotation noticed in hearing impaired and . Discussion The morphological structure, the values of body mass and height and the tendencies to alternations of hearing impaired children did not differ from that which is observed in healthy children examined before [14]. Along with age, there was an increase of body mass and height. tend to be slightly taller and heavier than of the same age, excluding the short period of pubertal spurt. The age of the examined children did not have any significant influence on body posture types just as BMI values, but children with lordotic postures had much higher BMI values than the others. Similar tendencies were observed in the previously published research on the correlation of somatic body structure and body posture in children and youth aged 7-12 years [15]. Kyphotic postures were observed in the sompatotypes characterized with dominant ectomorphy components (that is slim), while those with increased endomorphy and mesomorphy (fatty and muscular) were characterized by the balanced and lordotic types [15]. Body posture type was not significant in relation to a child's gender. However, due to previous reports and the diversified number of the gender groups, body posture was analysed separately for and . As gender is a factor which is considered to diversify the occurrence of different types of body posture in adults, the development of antero-posterior spinal curvatures is determined by the dimorphic factor of bone-joint system structure [16, 17]. In the presented study the majority of hearing impaired children displayed correct body posture. The most frequent types observed in were balanced type II and kyphotic type I (30% each), while mostly displayed balanced II (25%), balanced I and kyphotic II (19% each). The occurrence of the lordotic I type in was four times greater than in . Occurrence of the other incorrect posture types was rare. Altogether, incorrect body postures were observed in 27% of and 31% of . When sharing body postures for three main types it was noticed that lordotic postures were two times frequent in than in , while kyphotic type was more often in . In order to compare the results obtained for hearing impaired children and healthy children to those which have been published before, one needs to focus on the methodology used to determine body posture type. Different methods which are being used to examine body postures focus on slightly different elements. The advantage of computer examination conducted with use of the Posturometer-S is a simple research procedure and ability to print an image with diagnosis immediately after research has been conducted. Hence, the Posturometer-S turns out to be useful in both screening and detailed evaluations of individual's body posture. Table 2 presents the comparison of the obtained results with those previously published. The research, through the use of the Posturometer-S, conducted by Wernicka [18] has confirmed a similar frequency of incorrect body posture in deaf as is presented in the paper (about 30%). However, she observed that the number of such body postures in hearing impaired was twice as big. Nevertheless, it is important to note that Wernicka's research was conducted on smaller number of subjects. Wernicka observed that the most frequent body postures in the analysed group were balanced type II for and kyphotic type I for . The comparison of hearing impaired children with healthy children did not reveal any significant differences related to the occurrence of the selected body types. Research conducted by Chromik [19] on body posture of healthy children revealed incorrect body postures in approx. 26-37% (depending on age group: 7-10) and in 30-38% . She also observed that the number of incorrect body postures increases with age in both genders. The most frequent posture types were: kyphotic type I and II, and also balanced type II, but only among . Lordotic types were frequently observed in , while kyphotic types in . Through the use of the Posturometer-S, Walicka-Cupry et al. [20] observed incorrect body postures in 25% of their examined subjects. When conducting the research of this paper, it was not possible to divide children into age groups due to the small number of subjects. The different distribution of the frequency of selected posture types by different researchers may be the result of both different research methods and intensive developmental changes which influence the body posture of a child in analyzed period. However, the pace of development depends solely on the individual subject. The analysis of body postures, such as: scoliosis, asymmetries and rotations in hard-of-hearing children, enabled the determination that the most frequent abnormalities occurring in the examined subjects was thoracic scoliosis (approx. 20% of and 20% of ) and shoulder asymmetry (20% of and 30% of ). Through the use of the Metrecom System, Szczygiel has observed scoliosis in 80% of deaf children [21]. Grabara using the CQ Electronic System photogrammetry method [22] confirmed that body posture defects were more often observed in deaf children, whose results were supported by liwa, who conducted the research through the use of the Posturometer-S [7]. Waliska and Kasperczyk, through the use of visual evaluation, have stated that 40% of their hard-of-hearing subjects displayed posture defects, particularly for [23]. Both Janiszewska et al., who diagnosed body posture defects using the moiré method, and Kaperczyk who used the visual-point method, concluded that abnormalities occur with a frequency of 53-93% (depending on the age group) and are more frequent in younger children (below age of 10) [24]. Scoliosis was observed in Janiszewska's research with the frequency of 7-18% and was the most common for 9-10 year old . In other age grops, it was more often observed in . Thoracic scoliosis was more often observed than lumbar. However, the mentioned above author did not observe any dimorphism in the frequency of asymmetry. Wernicka has observed differences related to the occurrence of asymmetry in healthy and hearing impaired children: asymmetry occurred in 70% of deaf and 30% of deaf in comparison to approx. 10% of healthy children [18]. Table 2. Comparison of published data related to body posture types in and with actual data from presented paper (source: author's own study): KI, KII, KIII ­ kyphotic postures; RI, RII, RIII ­ balanced postures; LI, LII, LIII ­ lordotic postures; table presents data in percentages. As mentioned before, the results of research on body posture can be influence not only by an applied research method, but also by many different factors, such as: the child's living environment, pace of development, and general health condition, and in case of hearing impaired children, degree and type of deafness (e.g. deaf to one/both ears). These factors are examined very rarely due to the small number of subjects. One should know that the examined period of development is characterized by intensive growth in a young body for which pace is different in each subject. It also differs in reference to different body segments, which has an influence on the temporary deterioration of body posture and other abnormalities. That is why the close control of body postures is very important especially in deaf or hearing impaired children, who due to their defects can be more exposed to body posture abnormalities. The results of research such as this contribute to the increase of pressure on suitable conditions of development and prophylaxis programs for children with hearing problems. Conclusion The diversification of body proportions and developmental tendencies observed in deaf children are similar to those observed in healthy children. The most frequent posture types observed in deaf children were balanced type II and kyphotic type I. Incorrect body postures were observed in 28% of and 33% of with hearing impairment. It was noticed that lordotic postures were more frequent in than in , while kyphotic type was more often in , but these differences were not statistically significant. Posture incorrectness were diagnosed in 63% of hearing impaired children; the most frequent were thoracic scoliosis and shoulder asymmetry The body posture types were not significantly related to BMI values of examined children and their age, however, heavier children were characterised by lordotic types, while those slighter by the balanced and kyphotic types. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Bio-Algorithms and Med-Systems de Gruyter

The Imaging and Evaluation of Body Posture Defects in Hearing Impaired Children

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de Gruyter
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Abstract

The paper presents the use of a diagnostics device Posturometer-S applied to examine body posture in hearing impaired children. 46 subjects from the Primary School for Hard-of-Hearing Children in Wroclaw were examined. The research was conducted through the use of a Posturometer-S, which is an electronic, non-invasive measuring device attached to a computer. It enables not only the imaging and evaluation of frontal and sagittal curves of the spine, but also spinal mobility. Previous research has indicated that incorrect body posture was more often observed in hearing impaired children than in healthy ones. Hence, constant control over body posture in children with hearing loss seems vital. Correct body posture has a great influence on functioning of the entire body. The results obtained by using the Posturometer-S and anthropological measurements helped to determine the types of body posture and postural defects in the examined subjects. The apparatus used in research enabled to determine the occurrence of kyphotic, lordotic and balanced body postures, the results as follows: incorrect kyphotic postures - 10,9% of the subjects, incorrect lordotic postures - 6,4% and incorrect balanced postures - 10,9% of the examined subjects. Correct body postures were observed in 67,4% of the examined children. The most frequent body posture abnormalities were: thoracic scoliosis (19,6%) and shoulder asymmetry (26,1%). Due to the screening tests, some children were referred for further diagnostic evaluation and physiotherapy. KEYWORDS: body posture, postural defects, Posturometer-S, deaf children, hard-ofhearing children Introduction Human senses are used to receive and analyse information from the external environment. Due to this process, a human is able to perceive the reality, picture the world and consciously adapt body functions, such as maintaining body balance, within environmental requirements [1]. Correct body posture as well as balance is crucial for the correct functioning and performance of movements [2]. Hearing impairment in children and youth in general leads to the occurrence of postural defects, changes in psychomotor behaviour and abnormalities in the psychological area [3, 4, 5]. Receiving external impulses in a distorted way has an influence on the deterioration of body posture, control in space and keeping balance. Among the many methods for examining body postures, we can distinguish: visual methods (observation by experienced diagnostician), photography methods, shadowography (with use of silhouette image) and Holland's device [6]. More up-to-date methods are computer-based moiré method and examination with use of Posturometer-S. Some of the older and easier to perform techniques are not precise enough, others are difficult to perform by less experienced staff, and as a result, when such research is conducted by different researchers, a variety of results can be obtained. Some different methods are also very time-consuming, the time needed to obtain results is long and inconclusive. As a whole, this research aimed to determine how often selected types of body posture occurred in hearing impaired children and to evaluate body posture defects in children through the use of the Posturometer-S. Researchers also examined selected parameters of physical development in children with hearing loss. The research was conducted through the use of an original and patented measuring device which enabled the digital depiction of spinal curves and an assessment the type of body posture [7]. The measuring technique applied in this case was not complicated, however, it required good knowledge of anthropometric points on the back. The Posturometer-S is appropriate not only for large-scale research, but also individual diagnostic tests. It enables an instant print out of the obtained picture of a spine along with an evaluation. It also stores data and creates a database which facilitates quick statistical analysis. It is important to observe how often and what type of body posture defects occur in hard-of-hearing children in order to create prophylactic programs and rehabilitation exercises aimed for these groups. Many researchers have proven that body posture is related to the performance of balance features. Thus, body posture defects may result in: balance disorders, the inhibition of response, circulatory disorders and breathing disorders related to chest deformation [8, 9, 10]. Material and Methods The research performed in 2003 included deaf children from the Primary School for Hard-of-Hearing Children in Wroclaw. Diagnostic tests of body posture were conducted in the morning. There were 46 hearing impaired subjects participating in the research, including 16 and 30 in the age of 8-14 years. The scientific term "deaf" was adapted in accordance with terms used by specialists as a superior in surdopedagogy. The term refers to all subjects who suffer from minor or major loss of hearing, including people who are: completely deaf (with deep deafness), partially deaf (with some hearing ability), with impaired hearing and deaf, those who have lost gradually their hearing during their lives but who used to be able to hear [11]. Examined subjects mainly suffered from severe and profound hearing loss from their birth or early childhood. The research was conducted through the use of the Posturometer-S, a specially designed for examining body posture, non-invasive device connected with a computer [7, 12]. The Posturometer-S setup consists of three coupled systems: mechanical; a pointer used to indicate the position of a measured point, electronic; an element which computed the position of the pointer in a three dimensional space, informatique; used to analyse the obtained results. The Posturometer-S setup includes - besides the main device - a platform, which facilitated the stabilization of an examined subject and a computer set (figure 1). Figure 1. Schema of Posturometer-S device (source: M.Stacho). Before the commencement of the examination, the following anthropometrical points needed to be marked on a subject's back: spinous process of vertebrae C7 ­ L5, acromions, infrascapulare and iliospinale posteriori. Next, the subject took a correct, but comfortable position on the platform while the researcher used the pointer to mark all previously determined points (figure 2). Figure 2. The examination of body postures in children with use of Posturometer-S (source: private archive of coauthor - Justyna Andrzejewska). The most important aspect of this research was to properly identify measurement points, all of which was performed by a qualified anthropologist. Another important thing was to monitor whether the subject's body position was comfortable and natural, and furthermore, whether it did not change while measurements were being conducted (i.e. subject not moving). Due to the limited contact with the hearing impaired children, the necessity to repeat measurements on the same subject was quite frequent. After all measurements were taken, researchers used POSTURO software to obtain a 3D image of spinal curves (figure 3). This software evaluates antero-posterior spinal curvature on the basis of the protrusion of the chest kyphosis, the depth of lumbar lordosis and the tilts of separate spinal segments (angles , and ). Increased values of and angles indicated kyphosis while increased and angles indicated lordosis. The software was also used to compute the values of asymmetry for: shoulders, shoulder blades and anterior superior iliac spines. Posturometer-S was used to evaluate body posture in the frontal, sagittal transverse plane. It printed out measuring cards with a picture of a spine and the description of the diagnosis (figure 4). Figure 3. Printscreen of POSTURO software. Figure 4. The printed card with diagnosis and image of spine. On the basis of Wolanski's typology including E. Zeyland-Malawka's modifications [13], three main types of body postures with their sub-types were determined: kyphotic I, kyphotic II, kyphotic III, balanced I, balanced II, balanced III, and lordotic I, lordotic II, lordotic III. The general characteristics of these types are as follows: - Kyphotic ­ flattened chest, shoulder blades which protrude, head located slightly forward (face before the sternum plane), shoulders located at the same plane as back of the neck, middle thoracic kyphosis and small lumbar lordosis; frontal abdominal wall is flat. Advanced kyphotic type is characterized by shoulder blades which distinctly protrude, large thoracic kyphosis, middle lumbar lordosis, and frontal abdominal wall located slightly forward. - Balanced ­ is characterised by a well-shaped thorax with shoulder blades that do not protrude; the head is located directly above the chest, shoulders are located at the same plane as the back of the neck, little thoracic kyphosis and lumbar lordosis, and a flat frontal abdominal wall. Advanced balanced type is characterized by protruding shoulder blades, larger thoracic kyphosis and lordosis and a slightly protruding frontal abdominal wall. - Lordotic - is characterised by the face sticking out in front of the sternum, shoulders being located at the same plane as back part of the neck, slightly flattened chest, slightly protruding shoulder blades, small thoracic kyphosis, middle or large lumbar lordosis, slightly protruding frontal abdominal wall. Advanced lordotic type is characterised by shoulders being located at the front of the neck plane, the upper part of the chest moved back, slightly protruding shoulder blades, middle thoracic kyphosis, large lumbar lordosis, and abdomen protruding abnormally. Among incorrect body postures Zeyland-Malawka distinguished: kyphotic postures type II and III, balanced type III and lordotic types II and III [13]. Those children who displayed such postural defects or also scoliosis and asymmetry were recommended by researchers for further medical diagnostics and rehabilitation. What is more, the analysis included the results of the anthropometric measurements of body mass (measured with certified electronic scales B150L) and height (B-v measurement performed through the use of a Martin's type anthropometer GPM Sieber Wegner Maschinen AG). Both somatic features were used to compute BMI (Body Mass Index). The collected data were analysed through the use of Statistica 9.0 (StatSoft®) and by the application of basic statistical methods (mean, standard deviation, minimum, maximum, and frequency) as well as suitable tests of significance of difference. The distribution of the examined features did not differ from normal distribution. The analysis of variance was used to determine the relationship of BMI values and subject's age with body posture types. For the analysed features the values of Cramer's V coefficient were computed. The Chi2 test was applied to determine the dimorphic differences in the occurrence frequency of the selected types of body posture. The charts presented were created in Microsoft Office Excel 2003. Results The differences observed in the children's body height and mass were due to their age (8-14 years). In comparison to of the same age, the were usually taller and heavier (excluding the short period of pubertal spurt). Greater inter-individual and inter-gender diversification was observed in body mass rather than body height. Figures 5 and 6 present the distribution of body height and mass in the analysed and . The range of BMI values of the subjects was 13-24 kg/m2, excluding one 11-year old boy whose BMI was 29 kg/m2. BODY HEIGHT (B-v) 200,0 BODY HEIGHT [cm] 150,0 100,0 50,0 0,0 7,00 8,00 9,00 10,00 11,00 12,00 13,00 14,00 15,00 AGE [years] Figure 5. Body height of examined hearing impaired children depending on age. BODY MASS 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 BODY MASS [kg] 7,00 8,00 9,00 10,00 11,00 12,00 13,00 14,00 15,00 AGE [years] Figure 6. Body mass of examined hearing impaired children depending on age. The frequencies analysis of selected body posture types revealed that the most frequent type among the examined deaf children was balanced type II (28,3%) and kyphotic type I (21,7%). Types kyphotic I, balanced I and II occurred with the frequency of 10,9% each, while lordotic types I and II occurred with the frequency of 6,5% each. Figure 7 presents the diversification of the frequencies of analised posture types in reference to gender. The dominant types in were: balanced II, balanced I and kyphotic II. The dominant types in were: balanced II and kyphotic I, and next, balanced III. The majority of subjects displayed correct body posture. FREQUENCY OF PARTICULAR BODY POSTURE PERCENTAGE [%] KYPHOTIC I KYPHOTIC II KYPHOTIC III BALANCED I BALANCED II BALANCED III LORDOTIC I LORDOTIC II LORDOTIC III TYPE OF POSTURE Figure 7. Frequency of particular posture types in examined hearing impaired children. The analysis of significance of the difference computed on the basis of the frequency of posture types between the genders (Chi2 test, Fi Yul coefficient, V-Cramer coefficient) did not reveal any significant differences between and . However, some posture types were very rare or did not occur at all. In order to get more information the additional analysis was performed children divided into three groups depending on major posture type (kyphotic, lordotic and balanced). Such analysis was also conducted during the dichotomous division into correct and incorrect body posture. Both genders did not reveal any significant differences in the frequency of the selected body posture types, but it was noticeable that lordotic postures were more often in while kyphotic postures - in (table 1). Table 1. Characteristic of frequencies in body posture types in and with the results of tests of significance of difference. BODY POSTURE TYPES 9 posture types kyphotic 3 posture types 2 posture types balanced lordotic correct incorrect PERCENTAGES 7,494 0,2776 V Cramera or Fi (*) 0,413 Chi2 see figure 7 37,9 % 51,7 % 10,3 % 72,4 % 27,6 % 26,7 % 53,3 % 20,0 % 66,7 % 33,3 % 1,049 0,5919 0,154 0,157 0,6921 - 0,059* Body posture type was not significantly related to BMI of the subjects (ANOVA; F = 0,88; p = 0,4200) and their age (ANOVA; F = 1,03; p = 0,3668), but in examined group of children lordotic postures were characterized by higher BMI values (19,3 +/- 10,1 kg/m2) in comparison with balanced postures (15,3 +/- 7,8 kg/m2) and kyphotic postures (14,9 +/- 4,6 kg/m2). Additionally, the researchers examined the frequency of scoliosis and asymmetry in hearing impaired children. All types of scoliosis were more frequent in , however, percentages of scoliosis did not exceed 20% in none of gender (figure 8). The most common defects were thoracic scoliosis and left-sided scoliosis (occurred mainly in 8-9 year old subjects). Hearing impaired were characterized by more frequent asymmetry of the entire body, asymmetry of shoulders and shoulder blades and rotation of pelvis, comparing deaf (figure 9). Both sexes presented asymmetry of shoulders as the most frequent symmetry incorrectness. The rotation of pelvis was merely left-sided, with one exception, whereas the asymetry of pelvis was not noticed in examined group of children. Dimorphic differences observed in the occurrence of body posture defects mentioned above were not statistically significant. FREQUENCIES OF SCOLIOSIS TYPES 20,0 18,0 PERCENTAGE [%] 16,0 14,0 12,0 10,0 8,0 6,0 4,0 2,0 0,0 GENERAL SCOLIOSIS THORACIC SCOLIOSIS LUMBAR SCOLIOSIS THORACIC-LUMBAR SCOLIOSIS TYPE OF SCOLIOSIS Figure 8. Frequencies of scoliosis in hearing impaired and . FREQUENCY OF PARTICULAR POSTURE DEFECTS 30,0 PERCENTAGES [%] 25,0 20,0 15,0 10,0 5,0 0,0 SHOULDER ASYMMETRY SCAPULA ASYMMETRY BODY ASYMMETRY PELVIS ROTATION TYPE OF ASYMETRY/ROTATION Figure 9. Frequencies of asymmetry and rotation noticed in hearing impaired and . Discussion The morphological structure, the values of body mass and height and the tendencies to alternations of hearing impaired children did not differ from that which is observed in healthy children examined before [14]. Along with age, there was an increase of body mass and height. tend to be slightly taller and heavier than of the same age, excluding the short period of pubertal spurt. The age of the examined children did not have any significant influence on body posture types just as BMI values, but children with lordotic postures had much higher BMI values than the others. Similar tendencies were observed in the previously published research on the correlation of somatic body structure and body posture in children and youth aged 7-12 years [15]. Kyphotic postures were observed in the sompatotypes characterized with dominant ectomorphy components (that is slim), while those with increased endomorphy and mesomorphy (fatty and muscular) were characterized by the balanced and lordotic types [15]. Body posture type was not significant in relation to a child's gender. However, due to previous reports and the diversified number of the gender groups, body posture was analysed separately for and . As gender is a factor which is considered to diversify the occurrence of different types of body posture in adults, the development of antero-posterior spinal curvatures is determined by the dimorphic factor of bone-joint system structure [16, 17]. In the presented study the majority of hearing impaired children displayed correct body posture. The most frequent types observed in were balanced type II and kyphotic type I (30% each), while mostly displayed balanced II (25%), balanced I and kyphotic II (19% each). The occurrence of the lordotic I type in was four times greater than in . Occurrence of the other incorrect posture types was rare. Altogether, incorrect body postures were observed in 27% of and 31% of . When sharing body postures for three main types it was noticed that lordotic postures were two times frequent in than in , while kyphotic type was more often in . In order to compare the results obtained for hearing impaired children and healthy children to those which have been published before, one needs to focus on the methodology used to determine body posture type. Different methods which are being used to examine body postures focus on slightly different elements. The advantage of computer examination conducted with use of the Posturometer-S is a simple research procedure and ability to print an image with diagnosis immediately after research has been conducted. Hence, the Posturometer-S turns out to be useful in both screening and detailed evaluations of individual's body posture. Table 2 presents the comparison of the obtained results with those previously published. The research, through the use of the Posturometer-S, conducted by Wernicka [18] has confirmed a similar frequency of incorrect body posture in deaf as is presented in the paper (about 30%). However, she observed that the number of such body postures in hearing impaired was twice as big. Nevertheless, it is important to note that Wernicka's research was conducted on smaller number of subjects. Wernicka observed that the most frequent body postures in the analysed group were balanced type II for and kyphotic type I for . The comparison of hearing impaired children with healthy children did not reveal any significant differences related to the occurrence of the selected body types. Research conducted by Chromik [19] on body posture of healthy children revealed incorrect body postures in approx. 26-37% (depending on age group: 7-10) and in 30-38% . She also observed that the number of incorrect body postures increases with age in both genders. The most frequent posture types were: kyphotic type I and II, and also balanced type II, but only among . Lordotic types were frequently observed in , while kyphotic types in . Through the use of the Posturometer-S, Walicka-Cupry et al. [20] observed incorrect body postures in 25% of their examined subjects. When conducting the research of this paper, it was not possible to divide children into age groups due to the small number of subjects. The different distribution of the frequency of selected posture types by different researchers may be the result of both different research methods and intensive developmental changes which influence the body posture of a child in analyzed period. However, the pace of development depends solely on the individual subject. The analysis of body postures, such as: scoliosis, asymmetries and rotations in hard-of-hearing children, enabled the determination that the most frequent abnormalities occurring in the examined subjects was thoracic scoliosis (approx. 20% of and 20% of ) and shoulder asymmetry (20% of and 30% of ). Through the use of the Metrecom System, Szczygiel has observed scoliosis in 80% of deaf children [21]. Grabara using the CQ Electronic System photogrammetry method [22] confirmed that body posture defects were more often observed in deaf children, whose results were supported by liwa, who conducted the research through the use of the Posturometer-S [7]. Waliska and Kasperczyk, through the use of visual evaluation, have stated that 40% of their hard-of-hearing subjects displayed posture defects, particularly for [23]. Both Janiszewska et al., who diagnosed body posture defects using the moiré method, and Kaperczyk who used the visual-point method, concluded that abnormalities occur with a frequency of 53-93% (depending on the age group) and are more frequent in younger children (below age of 10) [24]. Scoliosis was observed in Janiszewska's research with the frequency of 7-18% and was the most common for 9-10 year old . In other age grops, it was more often observed in . Thoracic scoliosis was more often observed than lumbar. However, the mentioned above author did not observe any dimorphism in the frequency of asymmetry. Wernicka has observed differences related to the occurrence of asymmetry in healthy and hearing impaired children: asymmetry occurred in 70% of deaf and 30% of deaf in comparison to approx. 10% of healthy children [18]. Table 2. Comparison of published data related to body posture types in and with actual data from presented paper (source: author's own study): KI, KII, KIII ­ kyphotic postures; RI, RII, RIII ­ balanced postures; LI, LII, LIII ­ lordotic postures; table presents data in percentages. As mentioned before, the results of research on body posture can be influence not only by an applied research method, but also by many different factors, such as: the child's living environment, pace of development, and general health condition, and in case of hearing impaired children, degree and type of deafness (e.g. deaf to one/both ears). These factors are examined very rarely due to the small number of subjects. One should know that the examined period of development is characterized by intensive growth in a young body for which pace is different in each subject. It also differs in reference to different body segments, which has an influence on the temporary deterioration of body posture and other abnormalities. That is why the close control of body postures is very important especially in deaf or hearing impaired children, who due to their defects can be more exposed to body posture abnormalities. The results of research such as this contribute to the increase of pressure on suitable conditions of development and prophylaxis programs for children with hearing problems. Conclusion The diversification of body proportions and developmental tendencies observed in deaf children are similar to those observed in healthy children. The most frequent posture types observed in deaf children were balanced type II and kyphotic type I. Incorrect body postures were observed in 28% of and 33% of with hearing impairment. It was noticed that lordotic postures were more frequent in than in , while kyphotic type was more often in , but these differences were not statistically significant. Posture incorrectness were diagnosed in 63% of hearing impaired children; the most frequent were thoracic scoliosis and shoulder asymmetry The body posture types were not significantly related to BMI values of examined children and their age, however, heavier children were characterised by lordotic types, while those slighter by the balanced and kyphotic types.

Journal

Bio-Algorithms and Med-Systems – de Gruyter

Published: Jan 1, 2012

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