Investigation of the Effect of Thoracic Kyphosis Proprioception

The Body Sensation Assessment is a procedure designed to evaluate the physical sensations experienced by the subject. The assessor will then proceed to touch the T4, T5 and T6 spinous processes with a monofilament. The Semmes-Weinstein monofilament kit will be employed for the purpose of sensory evaluation. The monofilament is applied at an angle of 90°C until the tip of the monofilament is curled. The areas to be tested are maintained in contact with the monofilament for a period of 1.5 seconds, after which the monofilament is removed from the skin. Subsequently, the participant is queried as to whether they perceive the sensation and is requested to provide feedback as to whether they do or do not feel it. In the monofilament kit, starting from 2.83 and continuing up to 6.65, the initial filament, 2.83, was tested. If the participant did not perceive it, the next higher level, the thicker filament, was then evaluated.

The sole of the foot is tested at four sites: the heel, medial arch, lateral arch and first metatarsal. The heel position was determined to be the centre of the heel at 15% of the sole length. The medial arch position is located at 15% of the arch width from the medial border. The lateral arch is defined as the projection of the medial arch. The first metatarsal position is marked at 15% of the metatarsal width from the lateral and medial borders, respectively.

For the dorsum of the foot, a region was delineated with the proximal boundary at 15% of the length from the lateral malleoli to the fibular head and the distal boundary at 75% of the length from the lateral malleoli to the fifth metatarsal. The dorsum test sites included a proximal, middle and distal region, each marked at a distance of 10%, 50% and 90% from the proximal border of the reference region, respectively. The Semmes-Weinstein monofilament kit will be employed for the purpose of sensory evaluation.

The baseline brand digital goniometer (Baseline 10044E Digital Absolute + Axis Goniometer 10044E SKU: CM10044E) can be utilised for the measurement of joint position sense. The participants are blindfolded in order to prevent visual notifications. For the measurement of plantarflexion and dorsiflexion, the pivot point of the digital goniometer is placed 1.5 cm below the lateral malleolus. The fixed arm is parallel to the longitudinal axis of the fibula and aligned with the fibular head, while the mobile arm is parallel to the longitudinal axis of the fifth metatarsal. Participants are asked to perform 10° dorsiflexion, 10° and 20° plantarflexion. Individuals are instructed to actively perform the desired target angles, sense the position of the ankle for three seconds, and then return to the starting position. Individuals are then asked to repeat the target angle, and the measurement is taken in this position.

Cervical position sense can be evaluated by utilising a laser pointer mounted on a lightweight headband. The subject is seated in a relaxed position with their knees and hips at 90° angles, their hands placed on their knees, in front of a sheet of paper containing a coordinate plane of A2 size and 40 cm in diameter at a distance of 90 cm, positioned at eye level. The participants are requested to focus on the natural resting head position and the origin for a period of three seconds. Subsequently, the participants are instructed to perform flexion, extension, and right-left rotation movements with their eyes closed, pausing for three seconds after each position. Subsequently, the participants are instructed to attempt to return to the initial focused position as much as possible. The point at which the participant perceives the laser beam to have reached the focal starting point is marked. The procedure should be repeated three times, and the mean value should be recorded.

A postural assessment will be conducted using the PostureScreen Mobile application. PostureScreen Mobile represents a pioneering application for the rapid assessment of posture. It has been demonstrated to be both valid and reliable. A camera, mounted on a tripod at shoulder height, was used to photograph the subject in lateral posture while standing in a comfortable, natural position. The angles corresponding to the photograph were then calculated. The craniovertebral angle (CVA) is the angle between the line joining the tragus of the ear to C7 and the horizontal line at C7. The shoulder angle (SA) is defined as the angle between the line joining C7 to the acromion process and the horizontal line at the acromion process. The sagittal head angle (SHA) is the angle between the line joining the tragus of the ear to the canthus of the eye and the horizontal line at the tragus.

The Kyphosis Specific Spine Appearance Questionnaire (KSAQ), adapted into Turkish, will be used to assess the perception of postural appearance. The KSAQ is a reliable and valid patient-reported outcome tool to assess individual perception of various aspects of kyphotic deformity and appearance in young patients with kyphosis. The KSAQ is a 10-item questionnaire based on a five-point Likert scale ranging from 1 to 5, with 1 being not true; 2, somewhat true; 3, true; 4, very true; and 5, completely true. For the Kyphosis Specific Spine Appearance Questionnaire, the mean of the responses is used to obtain a total score. It is related to patients' perception of appearance, with higher scores indicating worsening of the deformity.