Evaluation of Symmetrical Exercises in Scoliosis by Using Thermal Scanning
, Corina-Maria Gruescu 1, Carmen Sticlaru 1, Elena Sîrbu 2,*, Nicolae-Adrian Jurjiu 2, Ion-Silviu Borozan 1 and Călin Vutan 2Round 1
Reviewer 1 Report
The abstract is not adequate to what was presented in the article. I do not know what the purpose of the work was, because it can be concluded that the authors wanted to advertise the camera. The division of the respondents is unclear. It was probably not a division, but a deliberate selection. The authors write that To the best of our knowledge, this is the first study that assess symmetrical exercises in children with scoliosis by using thermal scanning. Agreed, but can it be assumed to be true? It can be some visual impressions of the authors of the study. What the researchers see in the pictures and what the third person sees. There is a lack of measurable, quantitative data and values. On what basis is it concluded that the muscle tension is asymmetric? Based on what the observer sees? "The use of the thermographic camera as a method of investigation revealed that the symmetrical exercises performed by children with scoliosis can asymmetrically activate the back muscles if they are not corrected by a physiotherapist. Symmetrical exercises can be recommended in home programs only after the subjects know how to perform them correctly and possibly under the supervision of adults who have been trained in advance ". Or maybe the hand of a physiotherapist is enough?What is the scientific problem in this paper?
Author Response
Point 1. The abstract is not adequate to what was presented in the article. I do not know what the purpose of the work was, because it can be concluded that the authors wanted to advertise the camera.
Response 1: The abstract was rephrased. We concluded that: In children without postural deviations, symmetrical exercises activate the muscles equally on the right and left sides of the back. In the case of children with scoliosis, the symmetrical exercises indicated in the rehabilitation programs should be performed only under the supervision of a physiotherapist to properly activate the back muscles.
Point 2. The division of the respondents is unclear. It was probably not a division, but a deliberate selection.
Response 2: The subjects who entered the study were part of the group of children who approached the Ortokinetica VMC Center for postural evaluation between June and August 2021. The children and their parents were informed about the study being organized and only those who wished to participate voluntarily in this study were included. In the control group were included only children who did not show postural deviations in the frontal plane and in the study group were included only children who were diagnosed with mild scoliosis after de evaluation.
The following text was added:
The subjects who entered the study were part of the group of children who approached the Ortokinetica VMC Center for postural evaluation between June and August 2021. Subjects were divided into 2 groups: a control group (only children who did not show postural deviations in the frontal plane) and a study group (only children who were diagnosed with mild scoliosis)
Point 3. The authors write that To the best of our knowledge, this is the first study that assess symmetrical exercises in children with scoliosis by using thermal scanning. Agreed, but can it be assumed to be true? It can be some visual impressions of the authors of the study. What the researchers see in the pictures and what the third person sees. There is a lack of measurable, quantitative data and values. On what basis is it concluded that the muscle tension is asymmetric? Based on what the observer sees? "The use of the thermographic camera as a method of investigation revealed that the symmetrical exercises performed by children with scoliosis can asymmetrically activate the back muscles if they are not corrected by a physiotherapist. Symmetrical exercises can be recommended in home programs only after the subjects know how to perform them correctly and possibly under the supervision of adults who have been trained in advance ". Or maybe the hand of a physiotherapist is enough?
Response 3: The differences are observed by the physiotherapist, who sees differences of colour on the right and left side of the patient’s back. It is assumed as hypothesis that the more intense the muscular activity is, the higher the temperature of the surface gets.
Point 4. What is the scientific problem in this paper?
Response 4: The scientific problem may be stated as follows: is there any difference in the intensity of left and right muscular activity for children with scoliosis during symmetrical exercises? If so, how can the physiotherapist use this information in conducting effective programs of rehabilitation?
Author Response File: 
Author Response.docx
Reviewer 2 Report
The present study is a qualitative analysis of muscle performance during scoliose therapeutic exercise treatment made by thermography imaging. Although this method is interesting, the authors need to justify the exercise selection and support the usefulness of a qualitative analysis in this case, I mean: does this study really support that symmetrical exercises could be more interesting than specific exercise according to curve direction? Are the authors sure that the most updated literature supports the use of the exercise chosen for the treatment of scoliosis? This paper could be suitable but needs from a deep quality improve that authors could perfectly achieve:
Line 48: please include a reference that supports the radiological method as the gold standard for diagnosis.
Line 63: check as there is a double space before “Currently”
Lines 65-69: I consider that both paragraphs could be merged into one.
Line 72: please check the degree symbol
Line 73: there is a space : “wi th” should be “with”
Line 92: I suggest replacing “Subjects studied” by “Participants”
Line 95: authors refer that exercises used are oftenly used in scolisis, but should include some reference to support that or specify where are them used (hospital, clinical guideline, National Health Service of what country…)
103: Specify the recruitment system.
103-120: consider to name this paragraph as “Intervention”, as it looks like a different section.
128: please give more details about how the image capture was taken: height of the camera for example.
Figure 1: it is a pity that no pictures of the real exercises were performed. Consider taking real pictures as the current pictures have not enough quality.
Line 225: remove the first sentence of Discussion, as it is from the template.
Line 231: check the reference, as it doesn’t fit with the topic of the sentence (it is about thermography, not physical exercise).
- Reference 17 is not complete, reference 18 has close to 30 years… consider to include more updated ones as the following scoliosis treatment comparison https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868533/ or 1016/j.rehab.2014.04.003 , which presents the possible influence of vestibular system in idiopathic scoliosis development.
Line 204 and following: Conclusions must answer objectives, so please delete the sentences repeating the purpose of the study and just answer the objectives proposed. Any personal contribution must be stated in Discussion section instead of in Conclusions.
Author Response
Point 1. The present study is a qualitative analysis of muscle performance during scoliose therapeutic exercise treatment made by thermography imaging. Although this method is interesting, the authors need to justify the exercise selection and support the usefulness of a qualitative analysis in this case, I mean: does this study really support that symmetrical exercises could be more interesting than specific exercise according to curve direction? Are the authors sure that the most updated literature supports the use of the exercise chosen for the treatment of scoliosis? This paper could be suitable but needs from a deep quality improve that authors could perfectly achieve.
Response 1. The exercises chosen for the study are not meant to treat scoliosis. They were intentionally chosen symmetrical in order to emphasize the differences in muscular activity for children with scoliosis. The results of the study should help the physiotherapist to plan effective, customized exercises for the treatment. The assessment of intensity in muscular activity is based on differences of colour on the thermal images. The basic hypothesis is that the more intense the muscular activity is, the higher temperature of the area is detected.
Point 2. Line 48: please include a reference that supports the radiological method as the gold standard for diagnosis.
Response 2. Reference included.
Point 3. Line 63: check as there is a double space before “Currently”
Lines 65-69: I consider that both paragraphs could be merged into one.
Line 72: please check the degree symbol
Line 73: there is a space : “wi th” should be “with”
Line 92: I suggest replacing “Subjects studied” by “Participants”
Response 3. Line 63: one space deleted
Lines 65-69: paragraphs merged
Line 72: the symbol of degrees inserted
Line 73: one space deleted
Line 92: replacement made.
Point 4. Line 95: authors refer that exercises used are oftenly used in scolisis, but should include some reference to support that or specify where are them used (hospital, clinical guideline, National Health Service of what country…)
Response 4. The exercises chosen for the study are not often used in scoliosis in hospitals or other institutions. In our experiment, they were intentionally chosen symmetrical in order to emphasize the differences in muscular activity for children with scoliosis.
Point 5. 103: Specify the recruitment system.
Response 5. The recruitment system was described.
Point 6. 128: please give more details about how the image capture was taken: height of the camera for example.
Response 6. The following text was added:
“The images were taken in four sequences: before the exercises, one minute after exercises 1, 2 and 3. The height of the camera was adjusted to the patient’s height, so that the back of the patient to be captured in the field of view.
Thermal imaging proved to be appropriate for complementary investigation, as it is non-invasive and painless for the patient. The images can be taken anywhere, as the apparatus is small, mobile and light. It is easily handled by the therapist and provides instant results.
The information provided by thermal image are qualitative, but quantification would not bring substantial extra information. The thermal image is unique in regard with its intuitive character. No other imaging procedure provides such an easy-to-read result. The therapist can take images at the beginning of the session and during the exercise program and acquire valuable information regarding the efficiency of the exercise.”
Point 7. Figure 1: it is a pity that no pictures of the real exercises were performed. Consider taking real pictures as the current pictures have not enough quality.
Response 7. Images were added.
Point 8. Line 225: remove the first sentence of Discussion, as it is from the template.
Response 8. Deleted.
Point 9. Line 231: check the reference, as it doesn’t fit with the topic of the sentence (it is about thermography, not physical exercise).
Reference 17 is not complete, reference 18 has close to 30 years… consider to include more updated ones as the following scoliosis treatment comparison https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868533/ or 1016/j.rehab.2014.04.003, which presents the possible influence of vestibular system in idiopathic scoliosis development.
Response 9. Line 231: reference corrected.
Reference 17 completed.
Suggested papers included to references and quoted in text.
Point 10. Line 304 and following: Conclusions must answer objectives, so please delete the sentences repeating the purpose of the study and just answer the objectives proposed. Any personal contribution must be stated in Discussion section instead of in Conclusions.
Response 10. Conclusions revised as suggested.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
Point 1. Thank you for rephased the abstract. Now is better.
Point 2. The division of the respondents is more clear.
Point 3.
Authors added inormation, tath it is assumed as hypothesis that the more intense the muscular activity is, the higher the temperature of the surface gets.In my opinion problem and conclussions are not new and not attractive for readers.
Point 4.
This is a popular manuscript with very well-known conclusions.
Reviewer 2 Report
I want to thank the authors for the improvements performed. Despite some minor weak points in the design, I consider the manuscript is suitable for publication.
I would only suggest to remove the old pictures of the exercises, as the new pictures are very representative and enough to understand the exercises used.
Congratulations!
