The effects of dual-task training on balance and gross motor function in children with spastic diplegia

Synergistic effect of functional strength training and cognitive intervention on gross motor function in children with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is a posture and movement disorder, however; it often includes disturbance of different aspects of cognitive function. This study aimed to investigate if combined functional strength training (FST) and cognitive intervention are more effective than either of them alone on gross motor function in children with spastic diplegic CP.

METHODS

Sixty-four children with spastic diplegic CP, with ages ranging from 8 to 12 years, were assigned randomly into four treatment groups; Group I; FST, group II; cognitive training, group III; combined FST and cognitive training, group IV; conventional physical therapy. The Gross Motor Function Measure (GMFM-88) was used to assess gross motor function at baseline, post-treatment, and 6 months follow-up.

RESULTS

Group III achieved a significant improvement in GMFM-88 when compared to other groups post-treatment and at follow-up.

CONCLUSION

This study suggests that combined lower limb FST and cognitive intervention had the potential to produce significantly more favorable effects than the single use of either of them on gross motor function in children with spastic diplegia.

Heterogeneity of Tasks and Outcome Measures in Dual Tasking Studies in Children With Cerebral Palsy: A Scoping Review

OBJECTIVE

The aims of this scoping review are to examine the available literature regarding dual tasking in children with cerebral palsy (CP) and to identify and categorize both the motor and cognitive tasks and outcome measures used primarily through the International Classification of Functioning, Disability, and Health model.

METHODS

Five electronic databases were searched. Studies were included if they: (1) were published in English; (2) included at least 1 group of children or adolescents with a diagnosis of CP; (3) assessed dual tasking as part of the study; (4) reported the method for performing the dual task; and (5) reported the outcome measures utilized.

RESULTS

Twenty-three studies with 439 children with CP were included. All studies utilized motor activities as the primary task, including walking, balance, and a functional transition. Motor secondary tasks occurred in 10 studies, cognitive secondary tasks in 12 studies, and 1 study used both. Forty-one outcome measures over 23 studies assessed the body structure and function domain, 7 measures over 6 studies assessed activity limitations, and 2 outcomes over 2 studies assessed participation.

CONCLUSION

The 23 included studies demonstrated heterogeneity in the age and function of participants, secondary tasks, and outcome measures. Future studies on dual tasking in children with CP should consider the difficulty of the primary motor or cognitive task and compare secondary tasks to establish this contribution to motor performance. Studies should incorporate activity and participation measures to assess meaningful functional outcomes.

IMPACT

Children with CP experience challenges when exposed to dual task situations. This scoping review highlights the importance of considering multiple factors when designing dual tasking studies involving children with CP to facilitate results translation, improved participation, and enhanced function. Similarly, studies should utilize activity and participation outcomes to assess quality of life.

An investigation of the effects of dual-task balance exercises on balance, functional status and dual-task performance in children with Down syndrome

PURPOSE

To investigate the effects of dual task (DT) balance exercises on functional status, balance, and DT performance in children with Down Syndrome (DS).

METHODS

Participants were divided into two groups: intervention group (IG; n = 13) and control group (CG;n = 14). WeeFIM was used to measure the functional independence level and balance was evaluated using the Pediatric Balance Scale. DT performance was assessed using Timed Up and Go, Single Leg Stance, Tandem-Stance and 30 s Sit to Stand tests without concomitant task, with motor task or cognitive task. The IG received 16 sessions of DT training twice a week for 8 weeks.

RESULTS

Functional level, balance, and DT performance improved significantly in the IG, whereas only balance improved in the CG. Significantly better results were achieved in the IG, as demonstrated by greater pre/post-treatment changes.

CONCLUSION

DT balance exercises improved functional level, balance and DT performance of children with DS.

Effects of cognitive-motor dual task training on cognitive and physical performance in healthy children and adolescents: A scoping review

Simultaneous dual- or multitasking training has been used in manifold ways to improve cognitive-motor performance in different age groups. Dual task (DT) training is assumed to improve both, single task (ST) motor and cognitive performance, but particularly, performance under dual tasking conditions. Further, DT interventions have been shown to be beneficial for motor skill learning and cognitive performance as well as academic achievements in children and adolescents. The aim of this scoping review was to summarize current evidence on different cognitive-motor interventions that practice motor and cognitive performance simultaneously in children and adolescents and to identify training regimes that are most effective to improve cognitive or motor performance in this target group.

METHODS

Four electronic databases were searched (Pubmed, MEDLINE, Web of Science and APA Psycinfo) until May 2021. Following the PRISMA guidelines, title, abstract, and full-text screening as well as quality assessment was done by two independent reviewers. Studies were eligible if they (1) were published in English or German language, (2) accessible as a full-text version, (3) included at least one group of children or adolescents with a mean age of 4 to 21 years, (4) used dual-tasks as part of the intervention, (5) conducted one or more training sessions, and (6) reported at least one cognitive or motor outcome. The main outcome measures were cognitive and motor as well as cognitive-motor DT performance. Due to the heterogeneity in the characteristics of the included studies, we designed this review as a scoping review.

RESULTS

Seven studies met the inclusion criteria (n = 543, age four to 14 years, 47.1% female). One study reported two intervention experiments. Studies differed in sample size (20-189) as well as in type of training (specific or general DT training) and dose (frequency: one session/week to 110 sessions within 22 weeks). Overall, task-specific improvements in physical and cognitive functions were found, but not consistently across all interventions. Two interventions out of five interventions that measured motor performance demonstrated improvement in that domain, especially in balance. Three out of five interventions that measured cognitive functions found improved cognition. Only one study examined DT performance post training but failed to gain significant improvements in comparison to a control group. Studies only occasionally integrated training principles like individualization or progression in the design of their intervention.

DISCUSSION

The results indicate that DT training interventions may improve physical and/or cognitive functions in children and adolescents. Best practice recommendations for training regimes cannot be derived as outcomes differed a lot and were not systematically assessed across studies. Future studies should integrate more principles of training monitoring and aspects like individualization and progression to provide ideal training control and achieve better DT training results. Further, more high-quality trials are needed that adhere to the previous concepts.

PSYCINFO CLASSIFICATION

2340 Cognitive Processes 2820 Cognitive & Perceptual Development. 3720 Sports.

The effects of sling exercise program on balance and body activities in children with spastic cerebral palsy

The purpose of this study was to investigate the static and dynamic balance and body activities after administering a trunk stability exercise program using a sling for children with spastic cerebral palsy of Gross Motor Function Classification System (GMFCS) levels III–IV. This study was conducted based on a quasi-experimental study design. Six of the study participants were assigned to the control group and six were assigned to the experimental group using simple random sampling. Both groups underwent a double-blind clinical trial study in which exercise therapy was performed for 40 min twice a week for 8 weeks. The experimental group underwent the sling exercise program and the control group underwent neuro-developmental treatment. The results showed that static and dynamic balance were significantly different before and after intervention in both the experimental and control groups (P<0.05), and there was also a statistically significant difference between the two groups (P<0.05). Gross motor function and activities of daily life showed significant improvement before and after intervention in the experimental group (P<0.05), but there was no statistically significant difference in the control group (P<0.05). There was a statistically significant difference between the two groups (P<0.05). Therefore, the sling exercise program can be used as an effective treatment for improving balance and physical activity in children with cerebral palsy of GMFCS levels III–IV who have difficulty walking. In addition, such exercise will have a positive impact on the independence of such children and help them to participate in social activities.

Vojta Approach Affects Neck Stability and Static Balance in Sitting Position of Children With Hypotonia

Purpose

In this study, the effect of the Vojta approach on neck stability and static balance in children with hypotonia was studied.

Methods

Seventeen children with hypotonia were randomly divided into the Vojta approach group (n=9) and the general physical therapy group (n=8). Each group was applied intervention for 30 minutes per session, 3 times a week, for a total of 4 weeks. Ultrasonography was used to measure deep neck flexor muscle thickness, craniovertebral angle (CVA) to measure neck alignment along the spine segment, and Balancia software program to measure static balance.

Results

In the Vojta approach group, the deep neck flexor muscle thickness was significantly increased (P<0.05), and the CVA was significantly improved (P<0.05). In addition, path area among static balance was significantly improved (P<0.05).

Conclusions

The Vojta approach can be suggested as an effective intervention method for improving neck stability and static balance in children with hypotonia.