PREVALENCE STUDY OF SPINAL DEFORMITIES IN SCHOOL GOING CHILDREN OF THE AGE GROUP OF 6-10 YEARS IN A RURAL AREA

Objective: To identify whether spinal deformities are prevalent in school going children of the age group 6-10 years in a rural area. Methodology: The study involved 100 students between the age group of 6-10 years from a rural area. The participants were assessed for the presence of spinal deformities in the sagittal plane for cervical, thoracic and lumbar spine. Outcome Measure: Flexicurve instrument was used for the purpose of assessment of the spinal deformities. Result: The data revealed that there was 21% of prevalence of forward head posture whereas 20% had decreased cervical curvature. For the thoracic spine, 5% had thoracic hyperkyphosis and 20% had thoracic hypokyphosis whereas for the lumbar spine,

The "gold standard" method that exists as of now is the radiographic method [7] but it entails exposure to undesirable radiation levels, so non-invasive methods have great advantage because of their lower cost, fewer technical problems and the absence of exposure to ionizing radiation. [6] The commonest method which is used to evaluate posture is the visual observation method, since it does not involve any equipment. With this method, quantitative data cannot be obtained, minor postural changes cannot be analyzed and it has a poor inter-rater agreement. All these restrictions discourage the use of this method for research purposes. [7] Among the non-invasive methods is the Flexicurve, a flexible ruler that was first described by Takahashi and Atsumi. [6] The Flexicurve allows measurements in the sagittal plane and can be used in several surroundings and its seen as a cheap and quick evaluation instrument. [6] The Flexicurve instrument can be a screening tool because it is easily available and handy for the school environment. [6] Need for the study:-In the beginning, deviations in normal posture are functional, but due to lack of proper modification, permanent structural changes, especially in the spine, ensue (Popov (Попов), 2006). [1] Many authors stated that starting the conservative management early can prevent the progress of severe deformity and avoid surgery (Focarile, Bonaldi&Giarolo, 1991); (Fernandez-Filiberty, Flinn&Ramires, 1995); (Haher, Merola, Zipnick&Gorup, 1995); (Halm, Castro, Jerosch&Winkelmann, 1995). [1] Awareness about the spinal deformities, its effect on the life of a child and its treatment is necessary. Hence, this study is needed to study the prevalence of spinal deformities in primary school going children in rural area.

Research question:-
Is there any prevalence of spinal deformities in school going children in the age group of 6-10 years in a rural area?

Aim of the study:-
To study the prevalence of spinal deformities in school going children of age group of 6-10 years in a rural area.

Primary objective of the study:-
To identify whether spinal deformities are prevalent in school going children of the age group 6-10 years in a rural area.

Secondary objective of the study:-
To assess the spinal deformities in school going children of the age group of 6-10 years in a rural area. Procedure:-Ethical clearance was obtained from Institutional Ethical Committee of Dr. A.P.J. Abdul Kalam College of Physiotherapy, PIMS-DU. The sample of subjects comprised of 100 children of the age between 6-10 years, out of which 34 were females and 66 were males. It was conducted in 4 schools in Loni, Ahmednagar. The four schools were Pravara Kanya Vidya Mandir School, Pravara Girls New English School, Brilliant Bird School and Zilha Parishad School. Permission was taken from the school to conduct the study. A total of 100 students were selected randomly out of 1375. Written informed consent was taken from the subject's parent or guardian before conducting the study.
The subjects were submitted to a postural evaluation with the help of a flexicurve instrument which provided the flexicurve angles for the cervical, thoracic and lumbar spine. The same protocol was repeated in each evaluation: (1) On the child's bare back, anatomical points which are C0, C1, C2, C7, T1, T2, T12, L1, L5 and S1 were palpated and marked with the help of stickers; (2) the child was in the standing position with normal posture; (3) the child was asked to stay motionless; (4) the Flexicurve was molded to the child's back over the spine; (5) the Flexicurve was removed from the child's back and placed on the graph paper where the curvature was drawn and the anatomical points were marked; and (6) the Flexicurve angle was obtained using Biomec-FLEX free software (www.ufrgs.br/biomec), in which the input data consisted of the co-ordinate values representing the cervical, the thoracic and lumbar curvatures, and the output data consisted of the curvature angles in sagittal plane.

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Outcome Measures:-Flexicurve: It is a device which bends in one plane only and can maintain a fixed shape that can be transferred to paper. The flexicurve is placed over the spinous processes of the cervical, thoracic and lumbar spine and shaped according to these spinal curves. The instrument is carefully removed and traced onto a piece of plain white paper. The convex side of the curve's outline is traced on a piece of poster board. The quantification of the curve can be done by either tangent method or trigonometric method. The flexicurve angle and index showed excellent intra rater(ICC=0.94) and good inter rater(ICC=0.86)reliability. [9] Data analysis and results:-A total of 100 participants were selected from four schools according to the total number of students in a school. The cervical, thoracic and lumbar curvature angles of the participants were obtained. The prevalence of spinal deformities was obtained on the basis of these angles.

Demographic data:
The average age of the participants was 7.61±1.34 years and 66 of them were males and 34 of them were females.  Distribution of participants in angle ranges for cervical curvature.

ISSN: 2320-5407
Int. J. Adv. Res. 8(01), 884-890 888 The graph shows that maximum number of participants have cervical curvature between the ranges 30⁰-34.9⁰ which is followed by the angle ranges between 35⁰-39.9⁰, both of which are included in the normal cervical curvature. The graph shows that maximum number of participants have thoracic curvature between the ranges 35⁰-39.9⁰ which lies within the normal ranges, followed by the number of participants having angle ranges less than 20⁰.

Distribution of participants in angle ranges for thoracic curvature.
889 Graph no. 3:-Distribution of participants in angle ranges for lumbar curvature.
The graph shows that maximum number of participants have lumbar curvature of > 45⁰, followed by the number of participants having angle between the ranges 40⁰-45⁰ both of which are more than the normal values for lumbar curvature.

Discussion:-
This study aimed to identify postural changes that are prevalent in the early ages. The screening covered 100 students aged 6-10 years, 34 girls and 66 boys. The obtained results on the distribution of improper posture and spinal deformities are given in table numbers 1, 2 and 3.
The findings from the study revealed that 59% of the subjects (i.e. 59 out of 100) had normal cervical posture which is between 30⁰-40⁰ [10] . 20% (i.e. 20 out of 100) of the subjects had decreased cervical angles and 21% (i.e. 21 out of 100) of the subjects had increased cervical angle which is forward head. In a study done by Shivani Lalitkumar Verma, Jilani Shaikh, Ranveer Kumar Mahato et al, they have found that the prevalence of Forward head posture is 63% in Vadodara, Gujarat. [11] For the curvature of the thoracic spine, the results showed that 75% of the subjects (i.e. 75 out of 100) had normal thoracic curvature which is between 20⁰-40⁰ [12] . 20% of the subjects (i.e. 20 out of 100) had thoracic angle less than 20⁰ and 5% of the subjects (i.e. 5 out of 100) had increased thoracic angle of more than 40⁰. In a study done by Saša Bubanj, Mladen Živković, Dobrica Živković et al, they found that the prevalence of kyphotic bad body posture was 20.8% in Serbia. [5] The results for the lumbar spine showed that 45% of the subjects (i.e. 45 out of 100) had normal lumbar curvature which is 20⁰-40⁰ [12] . 1% of the subjects (i.e. 1 out of 100) had lumbar angle less than normal and 54% of the subjects (i.e. 54 out of 100) had lumbar angle more than normal which is lumbar hyperlordosis. In the same study mentioned above, they also mentioned that the prevalence of lordotic bad body posture was 24.2% in Serbia. [5] The reasons could be increased amount of time spent on mobile phone, abnormal posture while studying, improper school and housing furniture, incorrect use of heavy bag packs, prolonged time spent in front of television screens and computers. In everyday life there are no precautionary actions against spinal deformations. [1] There is a lack of Distribution of participants in angle ranges for lumbar curvature.
890 physical activity, lack of exercise, irrational nutrition and many other bad habits leading to poor muscle support, obesity, improper posture and spinal deformities. [1] Besides the knowledge about the prevalence of postural change, it is also essential to understand the connection between this prevalence and the environment, in other words, how the daily habits adopted by school children cause postural problems. [3] There is a need to incorporate new public policies in the school environment in order to avoid further progression of the postural changes. Restoration of the practice of creating groups of the correct body posture gymnastics in schools is recommended. [1]