The effect of two therapeutic interventions on balance in children with spastic cerebral palsy: A comparative study

Effect of core stabilization versus rebound therapy on balance in children with cerebral palsy

OBJECTIVE

This study aimed to compare the effect of core stabilization exercises and rebound therapy on balance in children with hemiplegic cerebral palsy (CP).

METHODS

Fifty- two children of spastic hemiplegic CP aged 5 up to 8 years from both genders were assigned randomly into two groups: core stability and rebound therapy groups. Both groups received 3 sessions/week, 1.5-h training per session, for 12 successive weeks. The measurement was performed at baseline and post-treatment. Balance as a primary outcome for this study was measured by a Biodex Balance System (BBS), and knee extensor strength and functional capacity as secondary outcomes were assessed using a hand-held dynamometer, and a six-minute walk test (6MWT), respectively.

RESULTS

All variables showed a significant improvement after intervention in each group (p < 0.0001), with significant improvement in all stability indices (overall, anteroposterior, and mediolateral) in core stability group when compared to rebound therapy group.

CONCLUSION

Core stability exercises and rebound therapy are recommended in the rehabilitation of children with hemiplegic CP. Core stability exercises were more effective than rebound therapy for balance improvement.

TRIAL REGISTRATION NUMBER

NCT05739396.

Effectiveness of Wii-Fit Combined with Conventional Exercises on the Functional Mobility and Balance of Children with Cerebral Palsy and Their Typically Growing Peers

Nintendo Wii Fit is an accessible, affordable, and productive inclusion into rehabilitation programs for children with cerebral palsy (CP) as a physical activity intervention; however, to our knowledge, there are no comparative studies 8 investigating the effects on the functional mobility and balance of children with CP compared to typically growing (TG) children. We evaluated the effects of Nintendo Wii Fit video exercises on static and dynamic balance, functional capacity, and walking endurance in children with CP compared to their TG peers. Children with CP and their TG peers were trained with Nintendo Wii Fit Balance Board games and conventional exercises (40 minutes each) for 16 weeks, twice a week. Their static and dynamic balance, functional capacity, and walking endurance were evaluated at the beginning and end of the study. The improvement achieved within the groups in all parameters, as well as between the groups, was significant, except for the dynamic balance and walking endurance. Standing Nintendo Wii Fit exercises combined with conventional exercises can be included as axial exercises in the physiotherapy program for children with CP as an enjoyable physical activity. TG children may also benefit, increasing their functional mobility and walking endurance in a fun way.

Trunk-oriented Exercises Versus Whole-body Vibration on Abdominal Thickness and Balance in Children with Duchene Muscular Dystrophy

OBJECTIVES

Progressive proximal muscle weakening in children with Duchenne muscular dystrophy (DMD) impairs postural adjustments by impairing motor function and preventing ambulation. During daily activities, for gait and dynamic balance, certain postural modifications are required. The objective was to compare the impact of trunk-oriented exercises versus whole-body vibration on abdominal muscle thickness and balance in children with DMD.

METHODS

Participants in this study were 30 boys with DMD, aged 6 to 10 years old. Children were divided into two groups (A and B) randomly. Children in group (A) underwent a prescribed regimen of physical therapy along with trunk-oriented exercises, whereas group (B) received the same regimen as group (A) together with whole-body vibration three times per week for three consecutive months. Balance and the thickness of the abdominal muscles were measured using the Biodex balance system and ultrasonography, respectively, before and after therapy.

RESULTS

When compared to the pre-treatment results in both groups, the post-treatment results showed a significant difference in all measured variables (p<0.05). Post-treatment values showed that all of the measured variables significantly differed in favor of group A.

CONCLUSIONS

Trunk-oriented exercises can improve abdominal thickness and balance more effectively than whole-body vibration in children with DMD.

CLINICALTRIALS

gov ID: NCT05688072.

Vibration therapy in young children with mild to moderate cerebral palsy: does frequency and treatment duration matter? A randomised-controlled study

BACKGROUND

Vibration therapy (VT) has been increasingly studied in children with cerebral palsy (CP) over the last years, however, optimal therapeutic VT protocols are yet to be determined. The present study compared the effects of side-alternating VT protocols varying in frequency and treatment duration on the health of young children with mild-to-moderate CP.

METHODS

Thirty-four participants aged 6.0 to 12.6 years with CP acted as their own controls and underwent two consecutive study periods: a 12-week lead-in (control) period prior to the intervention period of 20-week side-alternating VT (9 min/session, 4 days/week), with the frequency either 20 Hz or 25 Hz, determined by randomisation. Participants had 4 assessment visits: baseline, after the control period, after 12-week VT (12VT), and after further 8 weeks of VT (20VT). Assessments included 6-minute walk test (6MWT); dual-energy x-ray absorptiometry; gross motor function; muscle function testing on the Leonardo mechanography plate and by hand-held dynamometry, and a quality-of-life questionnaire (CP QOL). Analysis was carried out using linear mixed models based on repeated measures.

RESULTS

Side-alternating VT was well-tolerated, with occasional mild itchiness reported. The median compliance level was 99%. VT led to improvements in 6MWT (+ 23 m; p = 0.007 after 20VT), gross motor function in standing skills (+ 0.8 points; p = 0.008 after 12VT; and + 1.3 points; p = 0.001 after 20VT) and in walking, running and jumping skills (+ 2.5 points; p < 0.0001 after 12VT; and + 3.7 points; p < 0.0001 after 20VT), spine bone mineral density z-score (+ 0.14; p = 0.015 after 20VT), velocity rise maximum of the chair rising test (+ 0.14 m/s; p = 0.021 after 20VT), force maximum of the single two-leg jump test (+ 0.30 N/kg; p = 0.0005 after 12VT; and + 0.46 N/kg; p = 0.022 after 20VT) and in the health module of CP QOL (+ 7 points; p = 0.0095 after 20VT). There were no observed differences between the two VT frequencies (i.e., 20 Hz vs 25 Hz) on study outcomes.

CONCLUSIONS

The study confirms that side-alternating VT has positive effects on mobility, gross motor function, body composition, muscle function, and quality of life, independent of VT frequencies tested. Long-term, 20VT appears to be a more efficient treatment duration than a short-term, 12VT.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12618002026202 ; 18/12/2018.

A Review on Recent Advances of Cerebral Palsy

This narrative review summarizes the latest advances in cerebral palsy and identifies where more research is required. Several studies on cerebral palsy were analyzed to generate a general idea of the prevalence of, risk factors associated with, and classification of cerebral palsy (CP). Different classification systems used for the classification of CP on a functional basis were also analyzed. Diagnosis systems used along with the prevention techniques were discussed. State-of-the-art treatment strategies for CP were also analyzed. Statistical distribution was performed based on the selected studies. Prevalence was found to be 2-3/1000 lives; the factors that can be correlated are gestational age and birth weight. The risk factors identified were preconception, prenatal, perinatal, and postnatal categories. According to the evidence, CP is classified into spastic (80%), dyskinetic (15%), and ataxic (5%) forms. Diagnosis approaches were based on clinical investigation and neurological examinations that include magnetic resonance imaging (MRI), biomarkers, and cranial ultrasound. The treatment procedures found were medical and surgical interventions, physiotherapy, occupational therapy, umbilical milking, nanomedicine, and stem cell therapy. Technological advancements in CP were also discussed. CP is the most common neuromotor disability with a prevalence of 2-3/1000 lives. The highest contributing risk factor is prematurity and being underweight. Several preventions and diagnostic techniques like MRI and ultrasound were being used. Treatment like cord blood treatment nanomedicine and stem cell therapy needs to be investigated further in the future to apply in clinical practice. Future studies are indicated in the context of technological advancements among cerebral palsy children.

Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation.

DATA SOURCES

Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021.

REVIEW METHODS

Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration's tool for assessing the risk of bias and PROSPERO's registration number ID: CRD42020193535.

RESULTS

Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity.

CONCLUSION

A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.

Effect of whole-body vibration on abdominal thickness and sitting ability in children with spastic diplegia

Objective

Reduced muscle and bone mass, improper muscle function, and varying degrees of mobility dysfunctions are the main complications of cerebral palsy (CP). Many children with CP also present with poor abdominal muscle activation. Whole-body vibration (WBV) is a unique approach for enhancing strength and motor abilities in several clinical conditions. This study aimed to determine the influence of a 12-week WBV intervention on the thickness of the abdominal muscles and the sitting ability of children with diplegia.

Methods

A total of 30 children with spastic diplegic CP (aged 4–6 years) were randomly divided into two groups (control and experimental). The control group received a selected physical therapy program for 1 h, and the study group received WBV training for 10 min in addition to the same selected program for the control group for 3 times/week over a period of 12 weeks. Thereafter, abdominal muscle thickness and sitting ability were measured using ultrasonography and the Gross Motor Function Measure-88 (GMFM-88, sitting domain).

Results

Post treatment values revealed significant improvement in the measured variables in favour of the experimental group (p < 0.05), as there was improvement in the thickness of the four abdominal muscles compared to the control group (external oblique: F = 38.783; internal oblique: F = 99.547; transverse abdominis: F = 111.557, and rectus abdominis: F = 129.940, p < 0.05). Additionally, the study group showed a significantly greater improvement in GMFM-88 values compared to the control group (F = 129.940, p < 0.05).

Conclusion

WBV can be a viable strategy for improving sitting ability and abdominal muscle thickness among children with spastic diplegia.