COMPUTERISED SYSTEM FOR EVALUATION OF

ASYMMETRY OF POSTURAL PARAMETER

COEFFICIENTS IN SCOLIOSES

Andrzej Dyszkiewicz, Zygmunt Wróbel

Institute of Computer Science, Silesia University

Department of Biomedical Computer Systems, ul. Będzińska 39, 41 – 200 Sosnowiec, Poland

Józef Opara

Rehabilitation Department University of Physical Education, Katowice, Poland

Keywords: Scoliosis asymmetry coefficients, lung asymmetry factor, breath asymmetry factor, pelvic asymmetry factor

foot asymmetry factor.

Abstract: The work presents a clinical outline of stature defects and scoliosis as well as the contemporary

methodology behind the thorax, spine and leg bone radiogram measurements. In order to increase the

repeatability of the results and to create computer records which support monitoring records of scoliosis, an

algorithm for the process of radiological image was developed. It automatises the time consuming process

of measuring and processing data by the doctor. The image processing is initiated by an interactive

procedure where key points of biological structures are marked with a cursor. Other measurements are done

automatically. The algorithm is also an attempt to use the author’s modification for measuring the geometry

of the spine and thorax, which increases precision when compared to the methods by Cobb, Fergusson and

Gruca. Results of radioplan-metric investigations compared with a system for analysing the trajectory of

respiratory motion and the asymmetry weight distribution system in the foot have been presented. A

mathematical analysis of thorax and bone radiogram geometry combined with the results of thorax

trajectory movement enable the creation of individual patient symmetry indices with a description of the

monitoring process of the disease.

1 INTRODUCTION

Side curvatures of the spine are a huge individual

and social problem. The frequency in which this

problem occurs is different in various populations

and alternates between 3-15% of children and young

people. During the last several years there has been a

clearly increasing tendency in the number of people

suffering from this disease. Scoliosis is a severe

impediment of posture, which is accompanied by

secondary alterations in the blood circulation and in

the respiratory system. The alteration of the

aforementioned systems leads to the limitation of the

general efficiency of the patient. Finally it can cause

early disabilities and can also shorten one’s life.

Be advised that papers in a technically unsuitable

form will be returned for retyping. After returned the

manuscript must be appropriately modified. The

three-dimensional body system in the standing

position, which functions as a biomechanism with a

wide range of freedom, protects against gravitation

in the conditions of unstable equilibrium, and it

should be considered in a dynamic sense. As a

starting point it is necessary to consider the degree in

which the body’s physiology in terms of bones,

joints and ligaments has been fulfilled. The correct

build of the skeleton, passive stabilisation and

proper movement in the range of individual

elements, are essential. These elements create

merely potential possibilities of taking on and

maintaining the correct posture, however its image

depends on the function and efficiency of the central

nervous system. Currently it is claimed that

assuming and sustaining the correct position is the

same motion task as any other movement activity.

277

Dyszkiewicz A., Wróbel Z. and Opara J. (2008).

COMPUTERISED SYSTEM FOR EVALUATION OF ASYMMETRY OF POSTURAL PARAMETER COEFFICIENTS IN SCOLIOSES.

In Proceedings of the First International Conference on Bio-inspired Systems and Signal Processing, pages 277-280

DOI: 10.5220/0001067802770280

 SciTePress

Producing and establishing a proper unconditioned

co-ordination reflex requires even millions of

conditions to be fulfilled; however the quality of

created habits depends on conscious action and

inborn predispositions. Gradually worked out, more

simple movement abilities create a base for the

following predispositions, which are built-in into

more complex movement patterns. An established

system of individual segments of the body, as well

as balance do not form a static condition, but one

that oscillates around the balance point, with a

tendency to optimisation. Secondary disturbance of

posture control is caused by a slightly different

mechanism. It is probable that as a result of

disturbance of brain functions, deviation of posture

from the pattern recognised as a correct can occur. It

should be noticed that while comparing the results of

the application of advanced technology with a

system of a few relatively connected simple methods

supplemented by computer techniques, a

significantly higher acuteness and peculiarity, than

in the case of expensive novelties is achieved.

Taking into account the unfavourable financial

realities of Polish science there is a growing interest

concerning the low-outlay adaptations of more

simple methods. A system of mathematical

correlation between different methods, which

describe a chosen phenomenon, uncovers a new

multidimensional space of description, characterised

by a higher level of specificity.

One of the methods used in many centres as

a parameter, which monitors the development of

scoliosis, is the spirometer experiment.

Unfortunately, from the bioengineering point of

view it can be noticed that the two lung spaces

coupled by an angle of scoliosis are the source of an

averaged volumetric parameter and can be described

as a compensatory structure. The increase in the

value of the angle of scoliosis leads to a decrease of

volumetric space on the chord site and a

proportional increase of volume on the curve site.

Proportions are preserved best with a slight

scoliosis, which does not exceed 15-18

. In such a

situation equilibrium is established. The pressure of

the lung is compensated by the emphysema of the

second lung. During the increase in the angle of

scoliosis the summative volumetric parameter

decreases. Therefore, cases where a spirometric

parameter represents an angle of scoliosis the case is

usually so advanced that it should be treated

surgically. The non-invasive character of simple

postural-metric methods and precision of

planimetric radiography are connected by a method,

which consists of a multi-segmental system for

evaluating the trajectory of thorax movement. A

system of tapes and transducers braiding the thorax

enables the estimation of movement in all of its

areas. Based on the knowledge of motion

biomechanics’ index values which are dependant on

the scoliosis angle, rib movement and activity of

respiration muscles, a quantified body symmetry

image can be obtained. Clinical cases linked with the

occurrence of certain movement asymmetries can be

induced through various illness mechanisms such as

limb shortening, shoulder syndrome and the like.

The application of an integrated system, which

evaluates the basic parameters of geometry of the

thorax by the planimetric method and repeated bio-

engineering (Dyszkiewicz at all 1999) and

spirometry provide effective and credible

supervision in every stage of the disease. The image

is made at the beginning of research. An analysis of

the images of a patient’s body carried out by means

of a neural net implemented into the computer

provides geometry (mainly symmetry) indicators of

selected parameters. Based on these parameters the

parameters of a three-dimensional trajectory of the

respiratory system are compared. Monitoring the

capacity of expiration in scoliosis is of a particular

diagnostic importance when the parameter values

fail to increase proportionally to age. This happens

when a limiting value of scoliosis is achieved which

is qualified to surgical treatment.

2 THE AIM OF THE STUDY

The aim of this compilation is to find a practical

application of contemporary measurement methods

of the side curvature of the spine to construct a

practical algorithm and easy to use multipart

software. The following questions were posed:

1. Does using methods

(LAF, PAF, FAF, CA, FA, GA, LCC)

make it possible to differentiate between the

parameters of healthy and scoliotic people ?

2. Are the new, planimetric coefficients LAF,

PAF, FAF (in scoliosis) well correlated with

the traditional, measurement systems CA, FA,

(Cobb, Fergusson, Gruca)

3. Are the planimetric coefficients LAF, PAF,

FAF, CA, FA, GA (in scoliosis) better

correlated with the traditional, spirometry test

LCC or breath asymmetry analysing system

(produces breath asymmetry factor BAF) ?

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2.1 Group of Patients

Patients suffering from thorax and spine trauma,

hypertension, collagen and asthmatic disease,

diabetes, taking vascular medication, having

frostbites and after injury to upper extremity were

excluded from the study. The examinations were

carried out in the following group of patients: (1)

Examined group (A)

- consisted of 16 women,

average age 32,9±4,6 years and 9 men aged 34,7±6,3

years, with right-thorax scoliosis. (2) Control group

(B) - consisted of patients with normal spine (treated

in hospital for gastric illness), 15 women and 9 men,

average age 35,7±5,8 years

2.2 Methods

In the first part the measurement algorithm conducts

geometrical measurements according to Cobb’s and

Ferguson’s recommendation. In the second part the

author’s own modification of the process is used. It

is based on measuring the torsion and angle of

scoliosis on the level of every vertebra with results

projected on two vertical charts placed on both sides

of the radiogram (Dyszkiewicz at all. 2001) The

proposed method enables a partial observation of

scoliosis on the background of averaging

parameters. The analyser of the radiograms works

with a spirometer and a device to evaluate the

trajectory of the respiratory system in the thorax.

The obtained multi-parameter of patients after long-

term observations significantly helps to achieve a

more accurate evaluation of the progression or

regression of a disease (fig. 2, 3).

Figure 1: Expert program automatically detecting bone

modification in scoliosis: (1) vertebrae torsion angle modo

Gruca, Cobb, Fergusson, (2) cuneiform vertebrae

deformations, (3) geometry and bone density distribution,

(4) hip geometry, (5) sacro-iliac joint geometry.

The researchers used a prototypical diagnostic

device, consisting of 4 elastic tapes embracing the

chest, connected with converters of the path and an

analogue-digital converter enabling the transmission

of data through a parallel port to the “respiratory

path” software which made it possible to monitor the

oscillatory motion of the right and left lungs.

2.3 Results

Results of investigations (asymmetry coefficients

CA, FA, GA, LAF, BAF, PAF, FAF, LCC) included

in tab. 1. Patients described by asymmetry

coefficients CA, FA, GA, LAF, BAF, PAF, FAF,

LCC) show completely different values in group of

sick patients (A) and in control group (B). While

analysing table 1 we can clearly notice that in

scoliosis the level of asymmetry of newly inserted

coefficients LAF, BAF, PAF and FAF is

comparative with coefficients based on Cobb’s,

Fergusson’s, and Gruca’s methods and clearly

higher than the coefficient based on the LCC breath

volume of lungs. Moreover, it can be observed that

LCC in group (A) is much different from the value

in the group of healthy people (B).

Figure 2: Asymmetry area of lungs measurement.

Figure 3: Graphs of ungs area.

COMPUTERISED SYSTEM FOR EVALUATION OF ASYMMETRY OF POSTURAL PARAMETER COEFFICIENTS

IN SCOLIOSES

279

Table 1: Asymmetry coefficients.

Cobb

angle

Fergusson

angle

Gruca

Angle

lung

asymmetry

factor

LAF

breath

asymmetry

factor

BAF

pelvic

asymmetry

factor

PAF

foot

asymmety

factor

FAF

lungs

capacity

coefficient

LCC

Group A

(n=25)

0,684

± 0,175

0,616

± 0,168

0,651

± 0,181

0,752

± 0,121

0,711

± 0,176

0,764

± 0,193

0,694

± 0,185

0,876

± 0,214

Grop B

(n=24)

0,973

± 0,181

0,955

± 0, 114

0,949

± 0,136

0,813

± 0,164

0,922

± 0,178

0,875

± 0,187

0,935

± 0,135

0,821

± 0,189

CA (A - B) P < 0,01 GA (A - B) P < o,o1 BAF (A - B) P < 0,01

FA (A - B) P < 0,01 LAF (A - B) P < 0,05 PAF (A – B) P < 0,05

FAF (A – B) P < 0,01 LCC (A – B) P < 0,5

Table 2: Correlation table of Fergusson angle with Cobb angle, Gruca angle and FAF, BAF, PAF, LAF, LCC in decreasing

relation.

3 CONCLUSIONS

1. The methods

(LAF, PAF, FAF, CA, FA, GA, LCC)

used

this investigation

make it possible to clearly

differentiate between the parameters of healthy

and scoliotic people

2. New, planimetric coefficients LAF., PAF, FAF

(in scoliosis) have good correlations with

traditional measurement systems CA, FA, GA

(Cobb, Fergusson, Gruca)(tab. 2).

3. The planimetric coefficients LAF, PAF, FAF,

CA, FA, GA (in scoliosis) have better

correlations with breath asymmetry analysing

factor BAF in comparison with traditional,

spirometry test LCC

(tab. 2).

4 DISCUSSION

The contemporary diagnosis and monitoring of the

evolution of scoliosis in cheap screening evaluation

is based on a physical test assisted with plumb-line,

measure tape and a goniometer. Tests of averaged

spirometric parameters, which have been

administered for many years, have pointed to a

phenomenon where the loss of capacity of one lung,

which is the result of hypopnoe, is counteracted by

hyperpnoea of the other lung often leading to tests

producing normal values. It is often only after the

angle of curvature passes the 30’ mark that evident

pathology is registered. Displaying a child on an x-

ray, with the aim to determine a single angle of

curvature seems very controversial. The main aim of

this work was to expand the range of methods used

for defining patients with scoliosis by adding to the

already known methods CA, FA and GA – the new

planimetric coefficients of the chest LAF, pelvis

PAF, load decay of the foot test FAF and breathing

track BAF. These tests were carried out on a small

group of patients and have to be treated tentatively;

nevertheless it is possible to notice a significant

difference in the results between sick group (A) and

control group (B). The correlation between CA, FA,

GA / LAF, PAF and CA, FA, GA / FAF, BAF was

also very good and clearly higher from the

correlation with the traditional spirometric test

which produced a result of only 0.41.The study

results distinctly recommend inserting some extra

LAF and PAF determinants to estimate standard

radiological photos and to expand their range by a

simple FAF podoscopic test and breath asymmetry

analyses system estimating BAF. It can be clearly

seen that an assessment of the breath asymmetry

truck of the chest reveals more sensitivity than a

traditional evaluation of the breath-volume.

REFERENCES

Dyszkiewicz A, Sapota G, Imielski K. Perspectivy

automatizace plynule menitelne zateze pro krcni

trakci. Rehab Fizik Lek 1999,4(6), 119

Dyszkiewicz A, Kuna J, Koprowski R, Wróbel Z.

Simplified analysis of spine thermovision picture in

diagnostics of scoliosis. Acta Bioeng Biomech 2001, 1,93.

FA/CA FA/GA FA/FAF FA/BAF FA/PAF FA/LAF FA/LCC

Gr. A (n=20) 0,93 0,915 0,89 0,81 0,76 0,72 0,41

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