Perceived Effects of Customized Avatars in a Multiplatform Virtual Environment on Pain and Anxiety in Hospitalized Children in Hemato-Oncology.

Idiopathic scoliosis is the most prevalent structural spinal deformity in children, characterized by a lateral curvature of the spine exceeding a 10° Cobb angle and the absence of vertebral abnormalities or neuromuscular diseases []. The precise etiology remains unclear, but prevailing ideas suggest a complex origin involving genetic predisposition, impaired proprioception, vestibular dysfunction, hormonal factors, and anomalies in postural regulation []. Among these, sensory system disturbances—including those affecting vision—have gained growing attention as potential contributors to the initiation or progression of spinal curvatures [,]. The function of the visual system in postural regulation is thoroughly established []. The central nervous system sustains spatial orientation, balance, and musculoskeletal alignment by continuously integrating visual input with vestibular and somatosensory signals []. In children and adolescents, whose neurosensory integration is still developing, visual impairments such as myopia, hypermetropia, astigmatism, strabismus, or partial visual deprivation may result in compensatory mechanisms, including asymmetric head positioning, body tilting driven by ocular dominance, or impaired trunk coordination []. These alterations in postural strategy could, over time, affect spinal growth and the progression of curvature []. The concept that idiopathic scoliosis, especially double major idiopathic scoliosis, may be affected by impaired visual input is substantiated by many biomechanical factors []. Double-major idiopathic scoliosis features opposing thoracic and lumbar curvatures, necessitating intricate compensatory alignment to preserve overall sagittal and coronal equilibrium []. Visual feedback is essential in modulating these compensatory adjustments. Any deficit in binocular vision, depth perception, or oculomotor control may disrupt this delicate balance, perhaps encouraging the development of more complex scoliotic patterns [,]. Moreover, asymmetric visual dominance or ocular fixation disorders may be mirrored by corresponding axial deviations or muscle activation imbalances in the trunk [].