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Shekari Z, Sadeghian Afarani R, Fatorehchy S, Bakhshi E, Shahshahani S, Mousavi E. Relationship Between Postural Asymmetry, Balance, and Pain in Children With Spastic Cerebral Palsy. Pediatr Neurol 2024; 155:84-90. [PMID: 38608553 DOI: 10.1016/j.pediatrneurol.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Primary symptoms of cerebral palsy (CP), such as spasm and weakness, can lead to secondary musculoskeletal problems. Exploring the interplay and impact of secondary symptoms is essential in CP management. METHODS A total of 56 children (32 males and 24 females) aged eight to 12 years in level I to III of Gross Motor Function Classification System (GMFCS) completed The Pediatric Balance Scale and Wong-Baker Faces Scale and the Posture and Postural Ability Scale. Relationships between the three groups were examined using the Kruskal-Wallis test, Tukey test, gamma coefficient, De Somers D, phi coefficient, Cramér V, and one-way analysis of variance. RESULTS There was a significant correlation between balance and postural asymmetry (P < 0.001), and no significant difference in balance was there between the severe and moderate asymmetry groups (P = 0.759) and between the mild asymmetry and no asymmetry groups (P = 0.374). Furthermore, there was a significant relationship between postural asymmetry and each of the variables of pain (P < 0.001) and gross motor function (P = 0.002). Although a meaningful correlation was identified between balance and gross motor function (P < 0.001), the relationship between postural asymmetry and balance in GMFCS levels was not found (P = 0.052, P = 0.052, P = 0.233). Conversely, no significant relationship was detected between pain and gross motor function (P = 0.072). SIGNIFICANCE Postural asymmetry negatively impacts balance and correlates with pain intensity. Addressing postural problems can contribute to pain management and improved balance.
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Affiliation(s)
- Zahra Shekari
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Razieh Sadeghian Afarani
- Masters' Student, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Saeid Fatorehchy
- Assistant Professor, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Professor, Department of Biostatistics and Epidemiology, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Soheila Shahshahani
- Associate Professor, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elahe Mousavi
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Ha SY, Sung YH. Stimulus zones of Vojta method and trunk control in children with spastic-type cerebral palsy: A quasi-experimental pilot study. J Bodyw Mov Ther 2024; 38:150-154. [PMID: 38763554 DOI: 10.1016/j.jbmt.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 11/21/2023] [Accepted: 01/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Vojta method improves motor function by inducing a response by pressing the stimulus zones. PURPOSE To determine the effect of the stimulus zones on trunk muscle thickness, trunk control, trunk angle, and gross motor function in children with spastic-type cerebral palsy. METHODS A quasi-experimental pilot study was conducted with 19 children with spastic-type cerebral palsy divided into two groups: Vojta method group (n = 10) and general physical therapy group (n = 9). Each group underwent a 6-week intervention, and assessments were conducted to evaluate abdominal muscle thickness, trunk control, trunk angle, and gross motor function. RESULTS In the Vojta method group, the change rate in the thickness of the internal oblique and transversus abdominis increased significantly within the group (P < 0.05) and the difference (post-pre) of the transversus abdominis was higher (P < 0.05). The trunk angle increased significantly within the group when thoracic 7 and 11, lumbar 3, and sacrum 1 were supported (P < 0.05). There was a significant difference in trunk angle difference (post-pre) between groups when thoracic 11 and sacrum 1 were supported (P < 0.05). Segmental assessment of trunk control and gross motor function measure-88 scores were significantly increased within the group in all groups (P < 0.05). CONCLUSION The stimulus zones of the Vojta method could improve trunk control in children with spastic-type cerebral palsy through intra-abdominal pressure and anti-gravity movement.
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Affiliation(s)
- Sun-Young Ha
- The Basic Sciences Research Institute, Kyungnam University, Changwon, South Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon, South Korea.
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Rastgar Koutenaei F, Noorizadeh Dehkordi S, Amini M, ShahAli S. Effect of Swiss Ball Stabilization Training on Trunk Control, Abdominal Muscle Thickness, Balance, and Motor Skills of Children With Spastic Cerebral Palsy: A Randomized, Superiority Trial. Arch Phys Med Rehabil 2023; 104:1755-1766. [PMID: 37442218 DOI: 10.1016/j.apmr.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To compare the effects of Swiss ball stabilization training (SBST) and stable surface stabilization training (SSST) on the trunk control, abdominal muscle thickness, balance, and motor skills of children with spastic cerebral palsy (CWSCP). DESIGN Single-blind, randomized superiority trial. SETTING General Community and Referral Center. PARTICIPANTS Thirty CWSCP, aged 6-12 years, with Gross Motor Function Classification System levels I-III were randomly assigned to the SBST and SSST groups (N=30). INTERVENTIONS The participants were randomized to receive either SBST or SSST for 5 weeks, 3 days a week. OUTCOME MEASURES The Trunk Control Measurement Scale (TCMS), abdominal muscle thickness, Pediatric Balance Scale (PBS), standing and walking sections of Gross Motor Function Measure (GMFM-88), and mobility section of the Pediatric Evaluation of Disability Inventory (PEDI) were assessed. RESULTS After 5 weeks of the intervention and 9 weeks of follow-up, the SBST group showed statistically significant improvements in the TCMS, GMFM-88, PEDI, thickness of the internal oblique muscle at rest and contraction, and thickness of the transverse abdominis muscle at rest and contraction compared with the SSST group (P<.0001). Contrarily, the thickness of the external oblique muscle increased statistically significantly in the SSST group compared with the SBST group after 5 weeks of the intervention and 9 weeks of follow-up both at rest (P<.0001 and P=.0001, respectively) and contraction (P=.015 and P=.017, respectively). No statistically significant difference was found between the groups regarding the PBS score after 5 weeks of intervention. CONCLUSION The SBST could improve the trunk control, balance, and motor skills of CWSCP and increase the thickness of local abdominal muscles. Also, SBST was more effective than SSST for CWSCP.
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Affiliation(s)
- Forouzan Rastgar Koutenaei
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Malek Amini
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Park M, Kim J, Yu C, Lim H. The Effects of Neurodevelopmental Treatment-Based Trunk Control Exercise on Gross Motor Function and Trunk Control in Children with Developmental Disabilities. Healthcare (Basel) 2023; 11:healthcare11101446. [PMID: 37239732 DOI: 10.3390/healthcare11101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Good trunk control is essential for higher developmental stages as the trunk is activated first when movement occurs, providing stability for the head and extremities. PURPOSE To determine if neurodevelopmental treatment-based trunk control exercise (NDT-TCE) is effective in improving gross motor function and trunk control in children with developmental disabilities (DD). MATERIALS AND METHODS Twenty children with developmental disabilities were randomly assigned to the NDT-TCE (12 children) and control (8 children) groups. RESULTS After the intervention; the NDT-TCE group showed improvement in GMFM (Gross Motor Function Measure; except for the GMFM-E dimension) and SATCo scores. The control group showed improvement in GMFM-A; B; C; and total scores; as well as static and active control of SATCo. The NDT-TCE group had a significant improvement in the GMFM B dimension and total score compared to the control group. The NDT-TCE group showed a significant improvement in static and active control of SATCo compared to the control group, but there was no significant difference in reactive control. CONCLUSIONS The NDT-TCE intervention specifically improved GMFM-B and trunk control scores. Therefore, NDT-TCE can be applied as a trunk-focused intervention for children with DD who have difficulty controlling their trunk.
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Affiliation(s)
- Miho Park
- Department of Physical Therapy, Graduate School, Dankook University, Cheonan 31116, Republic of Korea
| | - Jeongseon Kim
- Department of Physical Therapy, Gangdong University, Eumseong-gun 27600, Republic of Korea
| | - Changseon Yu
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Hyoungwon Lim
- Dankook University Disabled Rehabilitation Research Institute, Department of Physical Therapy, Dankook University, Cheonan 31116, Republic of Korea
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Allah NEA, Kamal HM, El-Nabie WAEHA. Association between pelvic inclination and balance in children with spastic diplegia. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2023. [DOI: 10.1186/s43161-022-00115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
Children with spastic diplegia experience gait abnormalities and problems caused by deficits in balance, motor control, and spasticity. Abnormal pelvic inclination is common in patients with diplegia which may result in poor pelvic balance.
Purpose
This study was conducted to investigate the relation between pelvic inclination and standing balance in children with spastic diplegia.
Subjects and methods
Thirty children with spastic diplegic cerebral palsy from both sexes, aged from 5 to 14 years participated in this study. Their degree of spasticity ranged from 1 to 1+ according to Modified Ashworth Scale and they were on level I or II on Gross Motor Function Classification System. Pelvic inclination angle was measured by using the formetric instrumentation system during standing position while standing balance was assessed by the Biodex Balance System.
Results
There was a statistically significant relation between pelvic inclination and the overall, anteroposterior, and mediolateral stability indices of standing balance (P < 0.05).
Conclusion
The obtained results suggested that there was significant correlation between balance and pelvic inclination in children with diplegic cerebral palsy.
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Ozer Kaya D, Kocak UZ, Emuk Y, Olgac Dundar N, Bozkaya Yilmaz S, Gencpinar P. The comparison of regional spinal curvatures and movements in sitting posture in ambulatory children with cerebral palsy having minimal-to-moderate functional limitations. Gait Posture 2021; 90:408-414. [PMID: 34571351 DOI: 10.1016/j.gaitpost.2021.09.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 02/02/2023]
Abstract
AIM To examine the regional spinal curvatures and movements in the sagittal and frontal planes during sitting position, and the ability to act independently in patients with CP and to compare the differences between children and adolescents with minimal-to-moderate functional limitations. METHOD Twenty-one participants diagnosed with CP aged 5-16 years were included. The participants' Gross Motor Function Classification System (GMFCS) levels were determined and those at levels I (minimal functional limitation group: minFLG) or II-III (moderate functional limitation group: modFLG) were included. Spinal curvatures, mobilities, and inclinations in the sagittal and frontal planes were evaluated in the sitting position using a hand-held, computer-assisted non-invasive electromechanical device. Participants' functional independence levels were assessed with the Functional Independence Measure (WeeFIM). RESULTS In the sagittal plane, there were no differences in terms of spinal curvatures between the minFLG and modFLG (p > 0.05). Spinal mobility degrees for flexion (thoracic and lumbar regions and total spine), extension (sacral region), and total spine mobility scores were significantly greater in the minFLG (p < 0.05). In the frontal plane, lumbar spinal curvature significantly increased, and total spine mobility in the right/left lateral motions and functional independence decreased in the modFLG (p < 0.05). INTERPRETATION The children/adolescents with minimal functional limitations had greater spinal mobility during flexion, extension, and lateral flexions. Spinal curvatures were similar between groups in the sagittal plane. The lumbar region posture scores in the frontal plane observed as lordoscoliosis were higher, and functional independence was lower in the modFLG.
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Affiliation(s)
- Derya Ozer Kaya
- Izmir Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey.
| | - Umut Ziya Kocak
- Izmir Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
| | - Yusuf Emuk
- Izmir Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
| | - Nihal Olgac Dundar
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Neurology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sema Bozkaya Yilmaz
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Neurology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Pinar Gencpinar
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Neurology, Tepecik Training and Research Hospital, Izmir, Turkey
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Hou Y, Zheng H, Li J, Wang S, Zhang D, Tang T, Xu M, Zhou H. A New Method for Postural Misalignment of a 6-Year-Old Girl With Cerebral Palsy: A Case Report. Arch Rehabil Res Clin Transl 2021; 3:100116. [PMID: 34179752 PMCID: PMC8212001 DOI: 10.1016/j.arrct.2021.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To demonstrate the effects of a newly designed postural alignment relearning system on postural control dysfunction in a typical patient with cerebral palsy (CP). Design Evaluation before and after 8 weeks of Constraint Standing Training 3-dimensional postural alignment relearning system. Setting Department of Rehabilitation Medicine. Participant A 6-year-old girl with CP and postural misalignment on Gross Motor Function Classification System level I. Interventions Constraint Standing Training for 8 weeks to correct postural misalignment. Main Outcome Measures Parameters of lateral plain radiographs in static standing, posturography measurements in standing and walking, motor ability (Gross Motor Function Measure-88 [GMFM-88] scores, manual muscle testing [MMT] scores, muscle architecture), and gait kinematic parameters (40 3-dimensional parameters of arms, trunk, waist, and lower limbs). Results Knee hyperextension angle in static standing; peaks of knee flexion angle (KFA) when walking, hip flexion angle and ankle flexion angle in dynamic standing; and the KFA at initial contact in gait cycle all decreased significantly (P<.01). Scores of GMFM-88 sections D and E and MMT of 5 core stability muscles improved (P<.01). The velocities and range of motion of the arms, the 3-dimensinoal range of motion of the trunk and waist, and most of the parameters of the lower limbs showed statistically significant change (P<.01). Bilateral muscle thickness did not change significantly after the treatment (P=.738 left, P=.978 right), but the gluteus maximus morphology was changed: the muscle fibers became rounder, the interfiber space decreased, and the border lines of the muscle fibers got clearer. Conclusions Postural alignment, motor ability, and gait may be homologous external manifestations of more fundamental core abilities, referring to correct standing posture cognition, muscle activation, and postural unconsciousness. Constraint Standing Training 3-dimensional postural alignment relearning system aimed to improve the static and dynamic standing control ability, may fix postural misalignment and improve motor ability and flexed-knee gait. Future work should use Constraint Standing Training with patients with different kinds of misalignment, choose sensitive indicators, observe the duration of each step, and reveal the mechanism causes postural misalignment.
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Affiliation(s)
- Ying Hou
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Huitian Zheng
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Jinping Li
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Shujia Wang
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Dongmei Zhang
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Tong Tang
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Mindan Xu
- Neurological Rehabilitation Department, Zhangjiagang Gangcheng Rehabilitation Hospital, Zhangjiagang
| | - Hong Zhou
- Children Rehabilitation Department, Kunshan Rehabilitation Hospital, Kunshan, China
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