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Most people are unaware of the scope of traumatic brain injury (TBI) or its overwhelming nature. According to the Florida Department of Health, a traumatic brain injury[1] (TBI) is caused by a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. The Center for Disease Control[1] (CDC)estimates that as many as 5.3 million Americans are living with brain injuries at any given time, and a significant head injury occurs about every 21 seconds.
The Brain Injury Association[1] of America (BIAA) leads the nation in observing Brain Injury Awareness Month by conducting an awareness campaign in March each year. According to the Centers for Disease Control[1] and Prevention, as many as 1.4 million Americans suffer a brain injury on an annual basis.
The National Institute of Neurological Disorders [1] and Stroke (NINDS) describes Traumatic brain injury (TBI) as a form of acquired brain injury that occurs when a sudden trauma causes damage to the brain. The Brain Injury Association[1] of America provides, that brain injury is unpredictable in its consequences as it affects who we are, the way we think, act, and feel. ABOUT USDolman Law Group, is a Clearwater-based personal injury law firm serving residents in Pinellas County, Hillsborough County, Manatee County, Sarasota County, Pasco County, and the entire state of Florida. Renato de Souza Melo1, Polyanna Waleska Amorim da Silva2, Licia Vasconcelos Carvalho da Silva3, Carla Fabiana da Silva Toscano4. Introduction: Posture is determined by the performance of the visual, somatosensory and vestibular systems.
It keeps us alive through breathing, circulation, digestion, hormones, and the immune system. In 2010, about 2.5 million emergency department visits, hospitalizations or deaths were associated with traumatic brain injury (TBI). A concussion is a mild traumatic brain injury (TBI) that usually occurs after a blow to the head. Brain injuries can be caused by anything from a car accident to a fall in the shower to a sports-related accident at school. Post-traumatic headache[1] (PTH) is defined by the International Headache Society as a headache developing within seven days of the injury or after regaining consciousness. Founded in 2009 by President and Managing Partner Matthew Dolman, Esq., Dolman Law Group, is not your typical settlement mill firm running cheesy television commercials.
Anatomical relationships between manubrium, plica mallearis, incus and footplate are shown. Children with hearing loss can present problems in their posture or postural control, enabling postural deviations and alterations to appear in their vertebral column, possibly provoked by a hypoactivity of the vestibular system as a result of deafness. The period between birth and the end of the first year of life is deemed to be one of the most significant for a child's neuropsychomotor development (2). Through the brain, we experience emotion and express ourselves.  The human brain can even store more information than all the libraries in the world.
Concussions can be caused by any number of causes including car accidents, falls, as well as sport-related injuries. Otosclerosis, clinical, bilateral, with bony ankylosis of stapes and obliteration of round window2. Objective: To evaluate the posture of the vertebral column in children and teenagers with hearing loss at school age, taking into consideration the sample gender and age. A great event in children's development is the evolution of postural control, since latents increase their possibilities of exploration and interaction with the environment to an extent that they start to stabilize their head around the 3rd month of life (3).
Studies to date have documented that anywhere from 30-90% of individuals who sustain a TBI develop post-traumatic headache. Method: A descriptive and prospective study was performed at both Duque de Caxias School and Rotary Rehabilitation and Special Education Center in Caruaru - Pernambuco. Next, an improvement in the postural control is noticed, since between the 6th and 7th months many latents are already capable of sitting for a short period with a support of their arms (4).

44 students aged between 7-17 years old, out of whom 22 were female and 22 were male, with hearing loss were evaluated. The study was developed by way of a postural evaluation, using a symmetrograph, marking specific anatomical points with stickers placed over polystyrene balls and fixed with double-sided adhesive tape. In the situation of proper postural alignment, the musculoskeletal structures are balanced, and, therefore, lesions or deformities are less likely to occur (6). Results:The results showed that all of the individuals evaluated in this study presented some kind of postural alteration in their vertebral column.
The main sources of sensorial information for the postural control to satisfactorily work are the visual, somatosensory and vestibular systems (8). Conclusion: It has been concluded that children and teenagers with hearing loss are exposed to postural alteration in their vertebral column.
This labyrinth of information on each sensorial system occurs on a selective basis, thus increasing the relevance of a more useful system and reducing the relevance of that or those systems, which are less useful to maintain and regulate posture (9, 10).According to HORAK & MACPHERSON (11), the postural control system identifies the sensorial information coming from the three sensorial channels and produces effective motor responses so that the desired position is reached or maintained.
Such a condition can be associated with a number of factors comprising unfavorable ergonomics of the school environment, bad postural habits and impairment of the vestibular system by virtue of the hearing loss. If one of the sensorial channels does not provide the proper sensorial information, the working dynamics of the postural system can be altered. In this case, the postural control system does not seem to have a coherent and stable relation between sensorial information and motor action and, therefore, the motor development can be impacted, just like in children with hearing loss.The vestibular system is an organ with double function, in which the cochlea is responsible for hearing and the vestibule is responsible for regulating the postural control and equilibrium (12). The ability of hearing, however, is actually a secondary characteristic, being the primary responsibility of the hearing organ to maintain and regulate the postural control and equilibrium (13). As a result of the anatomic proximity to the structures responsible for the hearing and vestibular functions, it is normal to find associated alterations in both systems, therefore, it is reasonable to assume that many deaf children have vestibular problems simultaneously with their hearing loss (14). Moreover, studies show that hypoactivity of the vestibular system is a frequent finding in otoneurological evaluations on children with hearing loss, creating vestibular disorders in these children (15, 16, 17).Accordingly, it is assumed that children with hearing loss can develop postural strategies to overcome or compensate their equilibrium difficulties, by selecting a certain posture for purposes of attaining a higher corporal stability, and they can therefore develop postural alterations in their vertebral column.
For purposes of data acquisition, volunteers were submitted to a postural evaluation of the vertebral column individually performed by physiotherapists, by using a symmetrograph and mark of specific anatomic points, being photographed next, according to criteria proposed by KENDALL, MCCREARY & PROVANCE (6), POLITANO (19) and KISNER & COLBI (20).
Such criteria allow postural alterations and deviations in the vertebral column to be evaluated and identified, such as scoliosis, thoracic hyperkyphosis, hyperlordosis in the cervical column and lumbar column.For purposes of postural evaluation, the student was put in the orthostatic position, barefooted, in front of Cerci® symmetrograph at a 20-cm distance from the wall, wearing bath clothes (short for boys and a short and a top for girls), having specific anatomic points marked with Pimaco colored adhesives, placed over 1-cm diameter polystyrene balls and fixed with Cremer double-sided adhesive tape. The procedures consisted of digital palpation of the transverse processes of the evaluated student' vertebral column in the cranium-caudal direction. Evaluators instructed the volunteers to raise one arm when digital palpation would cause pain and this way the painful symptomatology has been reported in the evaluated students' vertebral column by this study.Orientations prior to examination, postural evaluation and evaluation of pain were previously explained by the researchers to volunteers by way of the Brazilian Language of Signs (BLS), since one of the researchers is a BLS interpreter. The data was organized and described with the help of Packstage Statistical Science (SPSS) Software, version 11.5, and the results were expressed in frequency percentage. With respect to pain distribution between the genders, male students complained more about pains in their vertebral column (45%) more than female students (27%) (Graphics 3 and 4).Graphic 1. When analyzing the types of postural alterations observed among the students of this study, scoliosis was the most observed kind of alteration (84.1%), and it was more prominent in 7-14-year-old male. The results achieved with regard to scoliosis in this study were superior to studies where they evaluated the posture of hearing students that utilized the same methodology of this study.
FORNAZARI (23), who studied the prevalence of scoliosis in 655 students without hearing loss, at the same age group of this study, found scoliosis in 26% of the evaluated samples; the author believes that the postural alterations may be associated with factors related to school environment. The authors concluded that scoliosis can be associated with the prevailing factor whether the student is right-handed or left-handed, what could cause a more accentuated muscular hypertrophy and an elevation in the shoulder on the dominating side, or by the frequent use of school backpacks, in an operational way in case supporting it in only one shoulder.
Contrary to BIASOTTO & GODOY GOMES (24)'s study, SANTOS et al (25)'s study, which also evaluated the posture of students without hearing loss aged between 6-12, of both genders, found thoracic hyperkyphosis in 9.1% of their samples.
Corroborating with this data, VASCONCELOS et al (22) report that lumbar hyperlordosis was the second most predominant alteration between the students with hearing loss evaluated in their study, it was observed in 50% of the samples, equally distributed between the genders (50%), being most frequent in the age group between 7-12. Likewise, BIASOTTO & GODOY GOMES (24) reported that lumbar hyperlordosis was also the least predominant alteration between the students without hearing loss in their study, with an occurrence of 42.4%.
SANTOS et al (25) report that the incidence of lumbar hyperlordosis in their study evaluating students without hearing loss was 26.3%, with the highest indexes being in the age group between 9 and 13.

According to DETSCH & CANDOTTI (28), until the nine years of age, lumbar hyperlordosis is considered normal in the infantile motor development, since there is not a postural stability yet, what could create a search for the corporal equilibrium by abdominal protrusion and anterior pelvic inclination.Besides the factors associated with the environment and school ergonomics, another important fact that could enable postural deviations to appear in the students evaluated in this study are GUILDER & HOPKINS (29), who evaluated children with hearing loss by rotating stimulation and they found results of the diverse labyrinthic examinations, thus affirming that children with hearing loss frequently showed a hypoactivity of the vestibular system.
The authors still stressed that vestibular hypoactivity is more observed in children with deep and severe hearing loss.
These results confirm ALCOHOLADO (30)'s study, evaluating 7 children with hearing loss by computed vectoelectronystagmograph, observed that 6 children had a response of hypoexcitability of the vestibular system.
The author still suggests that any patient with a hearing loss diagnosis, apart from age and gender, must be submitted to vestibular examinations, even when vertigo and dizziness are not present.For SHUMWAY-COOK & WOOLLACOTT (31), the most critical period for the postural control development is between 4 and 6 years of age. Sensorial organization in this stage consists of the ability of the central nervous system to select, supply and combine the vestibular, visual and proprioceptive stimuli, providing thus the proper postural orientation. Such an affirmation seems to justify the results of this study, where children with hearing loss showed postural alterations in their vertebral column, from childhood to adolescence, what makes us suggest that it is possible that the teenagers in this study can have adopted inadequate postural standard in their childhood and that, without any information, specific treatment and interventions, these compensating postures would remain year after year leading to a final condition with musculoskeletal maturation in adult age.
By analyzing the occurrence of the painful symptomatology in the students evaluated in this study, 36.4% complained about pains in their vertebral column during digital palpation performed by the physiotherapists.
Male gender showed a higher occurrence of pain in the vertebral column (45%) than female gender, with an incidence of 27%. In this study, the male gender showed more distribution of postural alteration in their vertebral column as a whole, what leads us to agree with RESENDE et al (18), who affirmed that the postural alterations can lead to the degeneration of the musculoskeletal system represented by algic diseases. VASCONCELOS et al (22)'s study also evaluated the painful symptomatology in the vertebral column among the students with hearing loss and they showed that the pain was found in 86.2% of the evaluated students.
There was no association between pain and age, however, the authors associated pain with the postural alterations and observed that the pain was found more among the students presenting thoracic hyperkyphosis (91.7%), and this alteration was the most predominant among the students of this study, what comes to corroborate with RESENDE et al (18). According to KENDALL, MCCREARY E PROVANCE (6), pain arises from the accumulation of repeated biomechanical overstrains for a long time. DETSCH & CANDOTTI (30) also reported that many corporal postures adopted in the day-to-day life interfere with the anatomic structures, increasing the stress over the vertebral column and provoking discomforts, pains or functional disabilities. According to this data, it was observed that children and teenagers with hearing loss are subject to develop postural alterations in their vertebral column. Besides the risk factors of the school environment, such as inadequate proportions of furniture, inadequate transportation of material and school backpack, bad postural habits in daily life, such as: watch TV, play videogame and use the computer, the students with hearing loss showed still an attack of the vestibular system together with hearing loss, provoking alterations in the activity of this sensorial system, which is one of the three systems responsible for regulating the postural control.
Accordingly, children with hearing loss can present difficulties in regulating postural control, or this regulation seems to be uncoordinated.
Such a fact could justify the high indexes of postural alterations in the vertebral column observed in the students with hearing loss evaluated in this study.The satisfactory postural control is essential to the success of a great deal of the daily tasks. Knowing the neurological and biomechanical aspects of this control has direct implications for physiotherapy, justifying the importance of future researches approaching this theme. There are scarce studies in literature evaluating the posture and painful symptomatology of the vertebral column in children with hearing loss, restraining the authors to go more deeply into the discussion of this study.Graphic 2. Occurrence of painful symptomatology in the vertebral column of the sample children and teenager with hearing loss (n = 44).Graphic 3. Occurrence of painful symptomatology in the vertebral column of the sample male children and teenagers with hearing loss (n = 22).Graphic 4. Comparacao do desempenho funcional de criancas portadoras de sindrome de Down e criancas com desenvolvimento normal aos 2 e 5 anos de idade. Self'sitting and reaching in 5 to 8 months old infants: the impact of posture and its development on early eye-hand coordination. Postural ajustments during spontaneous and goal-directed arm movements in the first half-year of life. Multsensory fusion: simultaneous re-weighting of vision and touch for the control os human posture.

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