Basic Body Awareness Therapy (BBAT) and Corrective Exercise for Adolescent Hyperkyphosis

The Effects of Basic Body Awareness Therapy Added to a Corrective Exercise Program on Body Image, Self-Esteem, and Posture in Adolescents With Postural Hyperkyphosis

This study is designed as a randomized controlled trial to evaluate the additional benefits of Basic Body Awareness Therapy (BBAT) when combined with a corrective exercise program for adolescents with postural hyperkyphosis. Postural hyperkyphosis, defined as a thoracic kyphosis angle of 40 degrees or greater, often leads to physical misalignments and psychosocial issues such as decreased self-esteem and poor body image during adolescence. Participants will be randomly assigned to either Group A (Experimental) or Group B (Control) using a stratified block randomization method. Both groups will participate in a 12-week intervention consisting of supervised Schroth corrective exercises performed twice weekly. Group A will additionally receive one session per week of BBAT, a physiotherapy method focusing on movement quality, mental awareness, and the integration of physical and mental self-awareness through lying, sitting, standing, and walking exercises. Group B will receive Autogenic Training, a systematic relaxation technique, as an active control. Assessments will be conducted at baseline and at the end of the 12-week program. The primary outcome measures include body awareness (Body Awareness Questionnaire), aesthetic perception of the spine (Kyphosis Specific Spinal Appearance Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), and digital posture analysis (PostureScreen Mobile). Secondary outcomes involve clinical measurements of kyphosis (Flexicurve and Wall-Occiput Distance), dynamic and static balance (Y-Balance Test and Single-Leg Stance Test), thoracic joint position sense, health-related quality of life (SRS-30), and pain intensity (Numeric Pain Rating Scale). The study aims to provide a comprehensive understanding of how mindfulness and movement awareness can enhance traditional physical rehabilitation for spinal postural disorders.

This study is a randomized controlled trial designed to evaluate the impact of integrating Basic Body Awareness Therapy (BBAT) into a corrective exercise protocol for adolescents with postural hyperkyphosis. Postural hyperkyphosis is defined in this study as a thoracic kyphosis angle of 40 degrees or greater. The research explores how this combined approach affects physical posture as well as psychosocial variables like body image and self-esteem. Participants will be randomly assigned to either the experimental group (Group A) or the control group (Group B) using stratified block randomization based on age and gender. Both groups will undergo a 12-week intervention consisting of supervised Schroth corrective exercises performed twice weekly in a clinical setting. Group A will receive an additional weekly session of BBAT. This intervention focuses on movement quality and the integration of mental and physical self-awareness through a series of lying, sitting, standing, and walking exercises. Group B will serve as the active control group and will receive Autogenic Training, which is a systematic relaxation technique, in addition to their corrective exercises. Evaluations will be performed at baseline and after the 12-week intervention period. Clinical assessments include digital posture analysis via PostureScreen Mobile and measurement of the thoracic kyphosis angle using the Flexicurve method and Wall-Occiput Distance. Dynamic and static balance will be assessed using the Y-Balance Test and the Single-Leg Stance Test. Furthermore, the study will measure thoracic joint position sense through active repositioning tests. Psychosocial and quality-of-life data will be gathered using the Body Awareness Questionnaire, the Kyphosis Specific Spinal Appearance Questionnaire, the Rosenberg Self-Esteem Scale, and the SRS-30 questionnaire.

Inclusion Criteria:

• Adolescents aged between 10 and 18 years.
• Diagnosis of postural hyperkyphosis confirmed by a thoracic kyphosis angle of 40 degrees or greater.

Exclusion Criteria:

• Diagnosis of congenital or rigid spinal deformities, such as Scheuermann's kyphosis.
• History of major spinal surgery, severe spinal trauma, or significant orthopedic conditions.
• Presence of diagnosed neurological or vestibular diseases that may affect balance or movement.
• Use of spinal braces or other corrective orthotic devices during the study period.
• Having received formal physiotherapy or a structured exercise program for posture within the last 6 months.