Role of two therapeutic interventions on balance in children with spastic diplegia and hemiparasis : A comparative study (original) (raw)
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BMC Pediatrics, 2012
Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT-A. Methods/Design: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.
2019
Objectives: Cerebral Palsy (CP) is a non-progressive brain damage that leads to movement and balance disorders. One of the new rehabilitation approaches for such children is Kinesio taping. The present study aimed to investigate the effect of lower limbs kinesio taping on static and dynamic balance in children with CP. Methods: In this pilot randomized clinical trial, 30 children with CP were randomly classified into two control and intervention groups each containing 15 subjects. In the intervention group, Kinesio tape was applied with 30% tension on anterior muscles of lower limbs. However, in the control group, Kinesio tape was used just in a sham mode. In both groups, Kinesio tape was used along with occupational therapy interventions for two weeks. Berg Balance Scale (BBS) and forward Functional Reach (FR) tests were used before, two days, and two weeks after intervention. Two-way repeated measures ANOVA was used to study the intervention effects, within-group data were analyzed with the paired t-test, and between-group effects were assessed using independent t-test. Results: Short term results (two days after intervention) indicated no significant difference between the scores of BBS (P=0.7) and FR (P=0.08) in the intervention group, and BBS (P= 0.8) and FR (P=0.1) in the control group. Long term results indicated a significant change in BBS (P<0.001) and FR (P<0.001) in the intervention group, however, no significant changes were observed in FR (P=0.1) and BBS (P=0.8) in the control groups. Discussion: Application of Kinesio tape on lower limbs of children with CP improved their balance. Therefore, this method can be used in rehabilitation clinics for functional improvement of children with Cerebral Palsy.
https://www.ijhsr.org/IJHSR\_Vol.8\_Issue.11\_Nov2018/IJHSR\_Abstract.017.html, 2018
Background: The purpose of this study was to examine the effect of neuromuscular taping over trunk muscles along with providing activities which gives internal and external perturbations on the static, dynamic trunk balancing abilities of children with cerebral palsy and generate some postural response in the trunk of these children with spastic diplegic cerebral palsy. Objective: To find out the effect of neuromuscular taping along with activities providing Reactive Postural Adjustments & Anticipatory Postural Adjustments, in improving sitting balance, in children with spastic diplegic cerebral palsy. Study Design: Pretest and Posttest experimental study design. Method: Spastic diplegic cerebral palsy children who were fulfilling the inclusion criteria were selected by convenient sampling from Occupational Therapy unit of Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India with sample size of 60. A written informed consent was obtained from the guardians. Ethical permission was taken from the institute. Pediatric Balance Scale & Pediatric Reach Test was used as instruments for measuring improvement in sitting balance. A frame for reaching and a platform for external perturbation were designed for the study. Therapy for both groups was given for 1 hour per session. Children in experimental group were exposed to 30 minutes each of Reactive Postural Adjustment & Anticipatory Postural Adjustment along with application of neuromuscular taping over the muscle belly of erector spinae. While control group, was exposed to Reactive Postural Adjustment & Anticipatory Postural Adjustment without neuromuscular taping over the trunk muscles. Results: Results of Wilcoxon signed rank test of Pediatric Reach Test were significant for experimental group and control group (P=0.004; 95% CI: 5.34 to 10.67 and P=0.014; 95% CI: 4.16 to 7.89 respectively). There was also significance of results of Wilcoxon signed rank test of Pediatric Balance Scale in experimental and control group (P=0.025; 95% CI: 8.98 to 11.12 for experimental group and P=0.005; 95% CI: 8.09 to 9.54 for control group) with the level of significance set atP≤0.05. This shows that results were significant for experimental group as well as control group. Also the results of Mann Whitney U test show that Z= -3.507 for Pediatric Balance Scale is more making it more sensitive to capture changes in balances in children than Pediatric Reach Test with Z= -3.905 with P=0.002; 95% CI: 4.14 to 9.00 and P=0.001; 95% CI: 7.56 to 9.70 with the level of significance set atP≤0.05. Conclusion: It can be concluded that application of neuromuscular taping along with activities providing Reactive Postural Adjustment &Anticipatory Postural Adjustment can be used to enhance & improve sitting balance among children with spastic diplegic cerebral palsy; so that they can have the functional balance in sitting, to safely meet the demands of everyday life.
New Trends and Issues Proceedings on Advances in Pure and Applied Sciences, 2017
Balance problems in individuals with cerebral palsy (CP) restrict their motor skills for fulfilling daily life activities and acting independently in society. This study investigates the effect of kinesiology taping (KT) on the feet and ankles for static and dynamic balance. Forty individuals with CP with an average age of 10.85 ± 3.893 were included. Records of demographic information and anamnesis of individuals were made. Gross motor function classification system, gross motor function measure and Berg balance scale (BBS) were used for evaluation. Static and dynamic balances of the individuals were measured with Techno Body Postural Line device at pre-treatment and post-treatment of KT. Following KT, falling risks of the individuals were observed to decrease significantly based on the BBS scores. We consider that usage of KT in treatment programmes along with other physical therapy methods will play an important role in improvement of balance and functional capacity. Keywords: Ce...
Effect of Kinesio Taping on Gait Performance and Balance in Children with Hemiplegic Cerebral Palsy
Türk Fizyoterapi ve Rehabilitasyon Dergisi, 2017
Purpose: The objective of this study was to evaluate the effectiveness of kinesio taping (KT) on gait performance and balance in children with hemiplegic cerebral palsy (CP). Methods: Nineteen ambulant children with spastic hemiplegic CP (mean age; 11.63±3.59 years, 8 boys, 11 girls) participated in this study. Passive dorsi flexion and plantar flexion range of motion (ROM) of ankle were measured with a goniometer in a supine position. Plantar flexor muscle tone and gait performance were evaluated by Modified Ashworth Scale and One-Minute Walk Test. Balance was evaluated with Pediatric Balance Scale (PBS) and Modified Timed Up Go (mTUG) Test. After pre-evaluation, kinesio tape was applied over the gastrocnemius and tibialis anterior muscles of hemiplegic side. Results: The plantar flexor muscle tone and ankle ROM unchanged immediately and 48 h after KT application (p>0.05). However, there were significant differences in measurements of gait performance, PBS, mTUG test at 48 h after KT application (p<0.05), but not immediately (p>0.05). Discussion: It is concluded that KT has not an effect on ankle plantar flexor muscle spasticity and ankle ROM, but improves gait performance and balance in children with hemiplegic CP at 48 h after application.
Efficacy of ankle kinesiotape on balance in children with spastic diplegia
Bulletin of Faculty of Physical Therapy, 2020
Background Adequate and efficient standing postural balance is key for functional walking and handling abilities in children with spastic diplegia. This study was designed to evaluate the effect of kinesiotape applied on ankle dorsiflexor muscles on balance in children with spastic diplegia. Thirty children with spastic diplegia of both genders participated in the study: 16 boys and 14 girls between 4 and 10 years old. They were divided randomly and equally into two groups: a control group, in which children received the standard physical therapy program for children with diplegia; and the study group, who received the same physical therapy program as in the control group but after kinesiotape application over the ankle dorsiflexor muscles. Both groups received the treatment program for 1 h, three times per week, for three successive months. Postural stability was assessed through evaluation of three stability index (anteroposterior, mediolateral, and overall) for all children by th...
Egyptian Journal of Medical Human Genetics, 2013
Cerebral palsy (CP) is a heterogeneous group of permanent, non-progressive motor disorders of movement and posture. Ankle-foot orthoses (AFOs) are frequently prescribed to correct skeletal misalignments in spastic CP. The present study aims to evaluate the effect of the three side support ankle-foot orthosis on standing balance of the spastic diplegic CP children. Thirty spastic diplegic CP children participated in this study from both sexes. They were divided randomly into two age and sex matched groups: (Group I: study group and Group II: control group). The degree of spasticity was evaluated by passive movement for both limbs, while the child was completely relaxed. The Biodex stability system, was used for the assessment of the dynamic postural control of all diplegic children. Also the system measures the subject's ability to control the platform's angle of tilt. The patient's performance is noted as stability index which represents the variance of the platform displacement in degrees. Every patient in the study group was exercised on three side support ankle-foot orthosis for 30 min, three times weekly, for 6 months, also they received the same therapeutic exercise program which was given to the control group. The results revealed no significant difference as regards the pre-treatment mean values of all stability indices in both the control and the study groups (P < 0.05). However comparison between post-treatment mean values of all stability indices in both groups showed significant improvement in favor of the study group
Indian Journal of Physiotherapy and Occupational Therapy an International Journal, 2011
To see the effectiveness ofAnkle Foot Orthosis on plantarflexor tone and gross motor functional abilities in children with hemiplegic cerebral palsy Method A total of 30 subjects coming to OPD, Dept of Physical Medicine and Rehabilitation and Paediatrics with a diagnosis of hemiplegic cerebral palsy were included and baseline evaluation was done for tone in ankle and lower extremity (using MAS) and gross motor functional abilities (using GMFM-66). The subjects were allocated equally among group A and group B by convenient sampling scheme with 15 subjects each. ln group A, Ankle Foot orthosis (AFO) along with conventional therapy and in group B, conventional treatment with no Ankle Foot orthosis were used for a period of 3 months followed by reevaluation. Result: The two groups were compared for their scores. These were found to be statistically significant with p value ranging from.003 to <.0001. Conclusions: lt can be concluded thatAnkle Foot orthosis (AFO) helps in normalizing the tone in ankle (plantar-flexors) and lower extremity and can be used as an adjunct to the treatment / therapeutic process to enhance gross motor functional abilities in hemiplegic cerebral palsy children.
Zanjan University of Medical Sciences, 2023
Background & Objective: In-toeing is the most common gait pattern in children with spastic diplegic cerebral palsy (CP). Kinesio Taping (KT) has been suggested to improve the function and posture of children with CP. No study has yet evaluated the effects of spiral KT on this gait pattern. The objective of this study was to evaluate whether spiral KT could improve in-toeing in children with spastic diplegic CP. Materials & Methods: This pre-post designed experimental study was performed on 14 patients with spastic diplegic CP aged between 6 and 10 years at the first level of the Gross Motor Function Classification System. KT was applied spirally with 100% of available tension. Hip, knee, and ankle joint angles in the transverse plane and spatio-temporal parameters including velocity and duration of stride were measured before and immediately after the intervention. Results: The results showed a significant decrease in hip (p=0.04) and knee (p<0.001) internal rotation, foot adduction, and abduction (p<0.001) in the transverse plane after using KT. Also, significant differences were found for spatio-temporal indices including velocity (p<0.001) and duration of stride (p<0.001). Conclusion: Spiral KT with 100% of available tension immediately improved the spatio-temporal indices of in-toeing gait pattern in children with spastic diplegic CP. Hence, clinicians can use the applied method to improve the gait pattern in this group of CP children.