Rajiv Gandhi University of Health Sciences Karnataka

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                             KARNATAKA, BANGALORE

                                           ANNEXURE II


1   Name of the Candidate and Address           SHILPI SEN
                                                C/o Mr. S.R SARTHI
                                                H.No: 8 S G Palya, C V Raman Nagar
                                                Bangalore- 560093

2   Name of the Institution                     Florence College of Physiotherapy
3   Course of Study and Subject                 Master of Physiotherapy (Pediatrics)
4   Date of Admission to the Course             29.05.2010
5   Title of the Topic:
                           INDIAN SCHOOL CHILDREN”

6   Brief Resume of the Intended Work:
    6.1 Need of the Study:
                School age children are faced with the daily responsibility of transporting a variety
    of items to, from and around school. There has been growing concern among health care
    professionals, parents and educators that back packs are damaging the back.6 Moreover, external
    forces such as carrying load may also influence the growth, development and maintenance of
    alignment of the human body. There is widely held belief that repeated carrying of loads, such as
    school backpacks, places additional stress on rapidly growing adolescent spinal structure,
    making them prone to postural change.12
                In children daily physical stresses associated with carrying heavy backpacks causes
    significant forward lean of head and trunk12 and it is assumed that daily intermittent abnormal
    postural adaptation could result in pain and disability in children.17
               Studying postural responses to load will help us to understand the impact of carrying
    backpacks on children.12 The studies done by the other researchers proved that carrying heavy
    backpack load led to “forward head position”.1 These changes in alignment of neck can produce
    strain on cervical junction and imbalance muscle performance in the upper quarter of the body
    which can cause pain in cervical upper thoracic and shoulder region.17 When load is positioned

posterior to the body in the form of backpack it changes posture because of changes in centre of
gravity. The body tries to keep centre of gravity between the feet, so with a backpack, the trunk
is in a more forward position, placing abnormal forces on spine. Load carried in a backpack
shifts centre of gravity behind the body, in order to compensate, the centre of gravity of body
plus the load is moved back over the base of support; the feet. This is accomplished by either
leaning forward at the ankle or hip or inclining the head; the rigidity of postural muscles
controlling these adjustments increases to support the load.12
            It is necessary to investigate the postural response of cervical spine and shoulder to
back pack load in static and dynamic activities which may benefit to school going children.
Thus arises the need of this study, which provides us with information about the average weight
a child has to carry to school. Therefore if preventive measures can be introduced now with the
regard to safe load carriage in the school students, it will help to protect young people while they
are still developing, but will also ensure that the principles they learn now are carried through to
work place as adults.12

6.2 Review of Literatures:
     Mayank Mohan (2006): Effect of backpack loading on cervical and shoulder posture in
Indian school children. Study determined that carrying a back pack weight 10% of body weight
appeared to be too heavy to maintain standing posture for school children.

    M Ramprasad (2009): Effect of backpack weight on postural angles in preadolescent
children. Carrying a back pack more than 10% of body weight is associated with increased
incidence of pain in neck and back.

    Chansirinukor W et al (2001): Effects of backpacks on students: measurement of cervical
and shoulder posture. Study is to determine whether the weight of the back pack, its position on
the spine or time carried affected adolescents cervical and shoulder posture. Study revealed that
both backpack weight and time carried influenced cervical and shoulder posture.

    Chi-Kin Cheung et al (1999) performed research on the effect of load carriage on gait
pattern and trunk posture in school children. It also determined the upper limits for the

appropriate weight of children’s schoolbags. This study indicated that significant changes in gait
pattern and trunk posture were observed when the loads were increased from 15% to 20% of
body weight. Load carrying causes significant changes on the gait pattern and trunk posture of
school children.

    Pascoe DD et al (1997) investigated on influence of carrying book bags on gait cycle and
posture of youths. It is concluded that the daily physical stresses associated with carrying book
bags on one shoulder significantly alters the posture and gait of youth.

    Sharifah Alwiah Syed Abdurrahman (2009): A preliminary studies on the effect of
varying backpack loads on trunk inclination during level walking. The study showed that
carrying heavy load of 15% to 20% of body weight during level dynamic activities include a
significant increase in trunk inclination angle for children aged 6 years old.

    Goodgold S (2002): Backpack use in children. Effects of backpack load and task demand on
trunk forward lean. Study made on concerns raised by parents and professionals that children
carrying heavy loads are justified however the relationship between heavy carry load and back
pain needs further elucidation.

   Kruse RW et al (2002) studied on backpack use as a risk factor in children’s back pain.
Statistically significant associations were found between back pain and backpack use, female
gender, body mass index, general health, physical functioning, and bodily pain.

   Dr. Amaal H.Ebrahim (2007) did a comparative study of static and dynamic balance of
school age children with and without backpack. The study indicates that there were no
significant difference in static and dynamic balance between boys and girls during age of 6 to 12
years with or without carrying backpack of 15% of body weight except the reaction time without
carrying backpack.

6.3 Objectives of the Study:
The objectives of the study are:
      To find out the effect of backpack load on cervical and shoulder posture during static
      To find out the effect of backpack load on cervical and shoulder posture during dynamic
      To compare the effect of backpack load on cervical and shoulder posture during static
       and dynamic activities.

Null Hypothesis:
      There may not be a significant effect of back pack load on cervical and shoulder posture
       during static and dynamic activities.

Alternative Hypothesis:
      There may be a significant effect of back pack load on cervical and shoulder posture
       during static and dynamic activities.

7   Materials and methods:
    7.1 Source of Data:
           Subjects for the study will be taken from children schools in Bangalore.

    7.2 Methods of Collecting Data:
            Measurement scale (Beurer scale, accurate to be within 0.1kg to 120kg).

    7.2.1 Sample size and sampling Method:
            A total of 30 subjects will be selected on the basis of Simple random sampling method.

    7.2.2 Research Design and statistical tools
           This study is a comparative design involving the analysis between static and dynamic
    activities with back pack load on cervical and shoulder posture of school age children.

    7.2.3 Population
           The population of the study will include both boys and girls of school children in

    7.2.4 Selection Criteria

    1. Inclusion Criteria:
          Boys and girls between 6 to 7 years.
          Without any kind of major cervical and shoulder disability.

    2. Exclusion criteria:
          Subjects below 6 and above 7 years.
          Subjects with Cervical instability, dislocations prolapsed intervertebral disc, infections,
           tumors in cervical and shoulder region.
          Children with neurological deficit, mental illness.
          Children with physical disability like polio etc.

7.2.5 Materials used:
      Digital camera.
      Marker.
      Pencil, Pen, Paper.
      School bag.

7.3 Intervention to be conducted on participants (Methodology):
(I) Ethical Clearance :
       Ethical permission for the study will be obtained from two schools. A written consent
will be taken from each subject who participates in the study.
(II) Methodology:
        We will be recruiting healthy boys and girls between ages 6 to 7 from schools of
Bangalore city. Each child’s body weight, height, and school bag weight will be measured. Boys
with height range from (42-44 inch) and weight range from (46.2-50.6 lbs) and girls’ height is
(41-43 inch) and weight (46.2-50.6 lbs) will be incorporated in study. Student will be weighed
with and without their bags on one set of calibrated electronic scale (Beurer scale, accurate to be
within 0.1kg to 120 kg). One school bag will be used for all the experimental conditions. The
school bag will have two adjustable padded shoulder straps, two compartments and no waist or
chest compression strand and size of backpack will be 12-13” in height and 7” in width.
        A range of weight which will be 10% of the body weight will be implemented as their
respective backpack loads. One Panasonic 10 mega pixel digital camera will be used to take still
photographs of subject’s sagital posture. Tripod stand with a spirit meter level will be used for
monitoring the camera. Measures of cervical and shoulder posture will be calculated from digital
photographs using the digitizing software (Image tool UTHCSA, University of Texas Health
service Centre, San Antonio).
        The photographic measurement will be obtained in morning to minimize the fatigue and
diurnal variation in subjects. With subject in standing position, adhesive photo reflective
markers will be placed on the right sided lateral landmarks which includes:
          External canthus of the right eye.
          Right tragus.

           Spinous process C7.
           Midpoint between greater tuberosity of humerus and posterior aspect of acromion of
        Subjects will be then asked to stand comfortably with their arms by their side in normal
standing posture without backpack. The subjects will look directly ahead. Camera will be placed
two meters from the subject’s right side. Photograph will be taken within 5 seconds of assuming
the position.
        The photographs of the subjects were taken in specific order:
           Without backpack static activity.
           With 10% of body weight static activity.
           With 10% of body weight dynamic activity.
        The length of the straps of school bag will be adjusted prior to loading to place the center
of bag approximately at mid back level. Subjects will be encouraged to relax and move about
each photograph.
        In this students will perform three dynamic activities with 10% of body weight school
bag prior to being photographed: Walking, Stair climbing, Running.
        Photographs will be analyzed by digital software image Tool UTHCSA (University of
Texas Health service Centre, San Antonio).

8   List of References:
       1. Chansirinukor W, Wilson D, Grimmer K, et al. Effects of backpacks on students:
           measurement of cervical and shoulder posture. Aust J Physiother 2001; 47: 110-116.
       2. Cheung CK, Hong Y. changes of posture with backpack weight and floor walking in
           children.      Department   of     Sports    Science     and     Physical    Education.
       3. Daniel HK, Monica LY, Alexander CK, Andrew D Jack CY, Fiana YD, et al. The
           effect of backpack load on the gait of normal adolescent girls. Ergonomics 2005; 48:
       4. Goodgold S, Corcoran M, Gamache D, et al. backpack use in children. Pediatr Phys
           Ther 2002; 14: 122-131.
       5. Goodgold S., Mohr K., Samant A., Parke T., Burns T. and Gardner L., 2002. Effects
           of backpack load and task demand on trunk forward lean: Pilot findings on two boys,
           Work, 18, pp.213-220.
       6. Iyer SR. Musculoskeletal pain in school children. In: Proceedings of the International
           Ergonomics Association 2000; Human Factors Ergonomics Society; Congress, pp.
           5.419–5.422. Washington, DC: 2000.
       7. Kinoshita, H. 1985, effect of different loads and carrying systems on selected
           biomechanical parameters describing walking gait. Ergonomics, 28, 1347-1362.
       8. Knapik J, Harman E and Reynolds K (1996): Load carriage using packs: a review of
           physiological, biomechanical and medical aspects. Applied ergonomics 27: 207-216.
       9. Kruse RW, Sheir-Neiss GI, Rahman T, Jacobsen L, Pelli J. Backpack use as a risk
           factor in children’s back pain. Presented at the American Academy of Orthopaedic
           Surgeons Annual Meeting; 2002; Dallas, TX. Poster No. 264.
       10. Lafond D, Martin D, Normand MC, Harrison DE. Postural development in school
           children - A cross sectional study. BMC Chiropractic Osteopathy 2007; 15: 1.9.
       11. M.Ramprasad, Jeba Alias And AK Raghuveer. Effect of backpack weight on
           Postural angles in preadolescent children. Indian pediat 2010; 47:575-580.
       12. Mayank M, Upendar S, Nishat Q. Effect of backpack loading on cervical and shoulder
           posture in Indian school children. Indian J Physiotherapy Occupational Therapy 2006; 1:

13. McKvoy MP, Grimmer K. Reliability of upright posture measurements in primary
   school children. BMC Musculoskeletal Disorders 2005; 6: 35.
14. Marsh AB, Diponio L, YamakawaRoberts Marsh AB, Diponio L, Yamakawa K,
   Khurana S, Haig AJ. Changes in posture and perceived exertion in adolescents wearing
   backpacks with and without abdominal supports. Am J Phys Med Rehabil 2006; 85:
   509- 515.
15. Pascoe DD, Pascoe DE, Wang YT, Shim D-M, Kim CK. Influence of carrying book
   bags on gait cycle and posture of youths. Ergonomics. 1997;40:631-641.
16. Penha PJ, Joao SMA, Casarotto RA, Amino CJ Penteado DC. Postural assessment of
   girls between 7-10 years of age. Clinics (Sao Paulo) 2005; 60: 9-14.16.
17. Voll HJ, Klimt F. On strain in children caused by carrying schoolbags. (From
   Diebeanspruchung des kindes durch die schultasche: translated by Theodridis D).
   Offentliche Gesundheitswesen 1977; 39: 369-378. [German].

9   Signature of the Candidate    :

10 Remarks of the Guide           :

11 Name and Designation of
    ( in Block Letters)

    11.1 Guide                    :

    11.2 Signature                :

    11.3 Co-Guide (if any)        :

    11.4 Signature                :

    11.5 Head of the Department   :

    11.6 Signature                :

12 12.1 Remarks of the Chairman
        & Principal               :

    12.2 Signature                :