Effect of video-based game therapy on activation of scapular muscles in children with thoracic hyperkyphosis

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.