Scoliosis patient and UCL student Yaning Wu interviewed Dr Nachiappan Chockalingam, a researcher based at Staffordshire University. His most recent work, titled “How does curve type and magnitude affect locomotor function in adolescent females with scoliosis?” is being funded by the BSRF and holds exciting implications for the future of scoliosis monitoring and treatment. Here is a summary of their conversation.

What is this research about and how is it being done?
Dr Chockalingam is studying the biomechanical aspects of scoliosis, or in simple terms, how patients move. His hope is that the results that he and his colleagues report will lead to further understanding of movement patterns and result in new treatment options including surgical techniques and instrumentation.

There is a current gap in our knowledge of gait and its relation to spinal curvature; within the NHS and in health services across the world, gait analysis is commonly used only for children with cerebral palsy and other musculoskeletal disorders. The use of similar techniques with a more common condition will drive the clinical world, including surgeons, physiotherapists, and medical device developers, forward.
Dr Chockalingam’s research focuses on 10 – 16-year-old female patients with all types of adolescent idiopathic scoliosis (AIS) and with a Risser sign of 0-4, meaning that their bones have not reached maturity. He chose to study AIS patients for this project because the condition is the most common type of scoliosis, affecting 80% of those with scoliosis, and it is easier to classify AIS patients into separate groups. His original plan was to obtain data in the USA; Utrecht, the Netherlands; and Cardiff, Wales, but because of the changes brought by COVID-19, he is now shifting to centres in Sweden, Serbia and the UK. The study is both qualitative and quantitative, with initial stages involving a questionnaire being sent out to participants asking them about what activities of daily living (ADLs) are important to them.
ADLs are an important consideration in Dr Chockalingam’s research because of his belief in individualised treatment plans. When determining functional disability, he avoids using standard frameworks to assess the young people he is studying, but will instead use their experiences of physical activity to determine what their greatest needs and difficulties are.

To visualise back movement in the upper and lower thoracic and lumbar regions of the spine Dr Chockalingam and his colleague Dr Tom Shannon used a cluster-based marker approach, a technique developed by their research group to analyse the movement of the back, and Microsoft Kinect, the device used for playing games.

The software that Dr Shannon has developed to use in conjunction with Kinect allows for innovative surface topography assessment that is simpler and less expensive than what is available on the market. They are now testing these kinematics technologies in Serbia and Bulgaria. Whereas previous research only hinted at total range of motion in degrees, Dr Chockalingam’s research can investigate in more detail what happens when segments of the spine (eg, upper thoracic) interact with each other.

What experience does Dr Chockalingam have with conservative and traditional scoliosis management strategies?
Although his primary research interest is not the clinical management of scoliosis, Dr Chockalingam has worked on a Cochrane review of spinal bracing, exercise and surgical intervention and recently has also completed a systematic review on cervical collars. He has collaborated with both spinal fusion surgeons and those practising the innovative technique of VBT (Vertebral Body Tethering), studying the effects of surgery on patients’ range of motion. When asked about the effectiveness of these procedures, he insisted that better patient data are needed for new approaches – only then could we make accurate and representative conclusions.

Why scoliosis?
Although Dr Chockalingam doesn’t have personal experience of scoliosis, he has been studying scoliosis and its related conditions since his PhD years, when he submitted a thesis on the topic. He enjoys this area of research because it is full of unknowns, especially on the biomechanics side, and sees the potential his work has to contribute substantially to improving patient outcomes. In recent years, computing and IT tools used to analyse body movement have rapidly developed, making Dr Chockalingam’s work ever more exciting. He wants to raise the profile of scoliosis research in the biomedical engineering and biomechanics communities because the subject is still relatively unknown and underfunded.

How has COVID-19 changed this research?
Dr Chockalingam’s in-person work has paused during lockdown, and his team are now working virtually. However, he hopes to continue obtaining patient data from early October (2021) sending written questionnaires to study participants in the meantime. There will be a substantial logistical challenge with spinal fusion recipients, who are required to self-isolate for 2 weeks before and after their procedure. This means that Dr Chockalingam must modify his study design – by, for example, measuring patients’ body motion a month before surgery instead of closer to the date as previously planned. Post-fusion measurements should not be affected by these restrictions.

What is in the future?
The eventual aim of this research is to develop patient-specific interventions that don’t come off the shelf. The interventions include spinal instrumentation, bracing, and other technologies that affect range of motion. He is also considering taking the study to low-income and middle-income countries in the global South, whose clinicians can take advantage of affordable technologies to address the treatment gap in their communities.

Yaning would like to thank Dr Nachiappan Chockalingam for having this conversation with her about his intriguing research.