Differences in standing balance between patients with diplegic and hemiplegic cerebral palsy

Effectiveness of virtual reality training compared to balance-specific training and conventional training on balance and gross motor functions of children with cerebral palsy: A double blinded randomized controlled trial

PURPOSE

The purpose of this study was to compare the clinical efficacy of a virtual reality rehabilitation-based training (VRT) with balance-specific training (BST) and conventional training (CT) on the balance and gross motor functions (GMF) of children with cerebral palsy (CwCP).

METHODS

This study was a double blinded, randomized controlled trial. Participants were recruited from different CP rehabilitation centers and clinics and were then randomly allocated using the block randomization method into three groups: (1) group 1 (VRT using a set of Xbox 360 games that triggered balance), (2) group 2 (BST applying a protocol of 13 exercises to enhance balance in different conditions), and (3) control group 3 (CT using traditional physiotherapy techniques). All groups received 18 sessions over six weeks, three sessions per week, each lasting 60 minutes. Participants were assessed at three timepoints (baseline, post-treatment, and follow-up) using the Pediatric Balance Scale (PBS), the Gross Motor Function Measure (GMFM D & E), the Five Times Sit-To-Stand Test, and upper and lower segments' center of mass (COM) displacement (UCOM and LCOM).

RESULTS

A total of 46 CwCP participated in this study. The repeated measures ANOVA revealed a statistically significant difference between groups in the dependent variables, except for the GMFM (D & E) and the PBS (p < 0.05 and partial η2 = 0.473). The post-hoc test showed a statistically significant difference in favor of the VRT group compared to other groups in terms of right UCOM (p < 0.05) with a large effect size of the time*group interaction (partial η2 = 0.87). Moreover, there was a statistically significant effect of time (i.e., baseline to post-treatment and baseline to follow-up) with F (18, 23) = 59.954, p < 0.05, Wilks' lambda = 0.021, partial η2 = 0.979.

CONCLUSION

The findings revealed that VRT was not superior to BST in the rehabilitation of balance and GMF in CwCP aged four to 12 years. However, when compared to CT, better results were reported. Furthermore, it appears that customized programs lead to greater improvements in balance than commercial programs. Future studies are needed to assess the physiological effects of the three types of rehabilitation interventions using more advanced measurement tools, such as functional magnetic resonance imaging, following VRT protocols.

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.

Altered corpus callosum structure in adolescents with cerebral palsy: connection to gait and balance

Cerebral palsy (CP) is the most common motor disorder in childhood. Recent studies in children with CP have associated weakened sensorimotor performance with impairments in the major brain white-matter (WM) structure, corpus callosum (CC). However, the relationship between CC structure and lower extremity performance, specifically gait and balance, remains unknown. This study investigated the transcallosal WM structure and lower limb motor stability performance in adolescents aged 10-18 years with spastic hemiplegic (n = 18) or diplegic (n = 13) CP and in their age-matched controls (n = 34). The modern diffusion-weighted MRI analysis included the diffusivity properties of seven CC subparts and the transcallosal lower limb sensorimotor tract of the dominant hemisphere. Children with CP had comprehensive impairments in the cross-sectional area, fractional anisotropy, and mean diffusivity of the CC and sensorimotor tract. Additionally, the extent of WM alterations varied between hemiplegic and diplegic subgroups, which was seen especially in the fractional anisotropy values along the sensorimotor tract. The diffusion properties of transcallosal WM were further associated with static stability in all groups, and with dynamic stability in healthy controls. Our novel results clarify the mechanistic role of the corpus callosum in adolescents with and without CP offering valuable insight into the complex interplay between the brain's WM organization and motor performance. A better understanding of the brain basis of weakened stability performance could, in addition, improve the specificity of clinical diagnosis and targeted rehabilitation in CP.

The effects of balance board on the balance parameters in five children with spastic cerebral palsy

PURPOSE

This study evaluated the effects of an instrumented balance board on the balance parameters in children with spastic cerebral palsy by carrying out a pilot single-group pre-post clinical trial.

METHODS

Five children aged 5 to 15 years with spastic diplegia and a Gross Motor Function Classification System level of I or II were included. All participants attended 20 sessions with an instrumented balance board, 45 minutes per session, 3 times a week for 7 weeks. The main outcome measures included the center of pressure excursion, velocity, and overshoot during quiet standing with open and closed eyes. The assessments were performed in the mediolateral and anteroposterior directions at pre- and one week post-intervention.

RESULTS

Non-parametric tests showed that the excursion did not change significantly except in the mediolateral direction with eyes closed (p <  0.05). The velocity of the center of pressure improved in both directions and eye conditions (p <  0.05). Also, the maximum velocity decreased with eyes open (mediolateral, anteroposterior, and total) (p <  0.05), while the change was not significant with the eyes closed. The overshoot measurements did not change significantly.

CONCLUSION

It is recommended to consider balance board training for improving balance parameters in children with cerebral palsy.

Standing economy: does the heterogeneity in the energy cost of posture maintenance reside in differential patterns of spontaneous weight-shifting?

PURPOSE

Due to sedentarity-associated disease risks, there is much interest in methods to increase low-intensity physical activity. In this context, it is widely assumed that altering posture allocation can modify energy expenditure (EE) to impact body-weight regulation and health. However, we have recently shown the existence of two distinct phenotypes pertaining to the energy cost of standing-with most individuals having no sustained increase in EE during steady-state standing relative to sitting comfortably. Here, we investigated whether these distinct phenotypes are related to the presence/absence of spontaneous "weight-shifting", i.e. the redistribution of body-weight from one foot to the other.

METHODS

Using indirect calorimetry to measure EE in young adults during sitting and 10 min of steady-state standing, we examined: (i) heterogeneity in EE during standing (n = 36); (ii) EE and spontaneous weight-shifting patterns (n = 18); (iii) EE during spontaneous weight-shifting versus experimentally induced weight-shifting (n = 7), and; (iv) EE during spontaneous weight-shifting versus intermittent leg/body displacement (n = 6).

RESULTS

Despite heterogeneity in EE response to steady-state standing, no differences were found in the amount or pattern of spontaneous weight-shifting between the two phenotypes. Whilst experimentally induced weight-shifting resulted in a mean EE increase of only 11% (range: 0-25%), intermittent leg/body displacement increased EE to >1.5 METs in all participants.

CONCLUSIONS

Although the variability in spontaneous weight-shifting signatures between individuals does not appear to underlie heterogeneity in the energy cost of standing posture maintenance, these studies underscore the fact that leg/body displacement, rather than standing posture alone, is needed to increase EE above the currently defined sedentary threshold.

Effectiveness of a Nintendo Wii balance board exercise programme on standing balance of children with cerebral palsy: A randomised clinical trial protocol

Background

Patients with cerebral palsy (CP) typically receive limited physical therapy services. However, the Nintendo Wii system offers a simple and affordable mode of virtual reality therapy. There are no clinical trials assessing the Nintendo Wii balance board for improving standing balance in CP.

Methods

This randomised clinical trial will evaluate the effectiveness of an 18-session/six-week protocol using Wii therapy (W-t) compared with conventional therapy (C-t) in Chilean CP patients. The C-t group will perform the typical exercises prescribed by physical therapists for 40 min each session. W-t will consist of a virtual reality training session using the Nintendo Wii balance board console for 30 min each session. The primary outcome variable is the area of centre-of-pressure (CoP) sway (CoP_Sway). The secondary outcomes are the standard deviation (SD_ML; SD_AP) and velocity (V_ML; V_AP) of CoP in the ML and AP directions. For a mean difference of 21.5 cm² (CoP_Sway) between the groups, we required a minimum of 16 participants in each group. Data will be collected at baseline (week 0), during the study (weeks 2 and 4), at the end of the study (week 6), and during the follow-up (weeks 8 and 10). Measurements of postural control during quiet standing for both groups will be assessed on a force platform AMTI OR67.

Discussion

This is the first trial that measures and compares the effects of a Nintendo Wii Balance Board exercise programme on standing balance in children with cerebral palsy compared to conventional therapy.