PNF Training for Improving Lower Limb Coordination in Cerebral Palsy: A Case Study in a Child with Spastic Diplegia (original) (raw)
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Indian Journal of Public Health Research & Development, 2020
Cerebral palsy is a common non-Progressive neuromotor disorder which leads to various impairments and disabilities. There are various treatment approaches in the management of children, adolescents and adults with cerebral palsy. Proprioceptive Neuromuscular Facilitation (PNF) is used to stimulate the neuromuscular system in an effort to excite proprioceptors in order to produce a desired movement. Patient was 19 years old boy with spastic diplegia. He was under physiotherapy treatment elsewhere for the past 10 years here they were focussing more on passive movements and mat activities. Patient's main concerns on approaching us were difficulty to stand independently and walk. The important clinical findings were Grade 1+ Muscle tone according to Modified Ashworth scale in bilateral adductors of hip, hamstring muscles and Bilateral Calf muscles. Highest functional status was he can able to sit independently. Patient was initially treated with tone inhibitory techniques and movement facilitatory techniques. Once the tone is normalized PNF techniques mainly rhythmic stabilization and dynamic reversals were given for 12 weeks. Berg balance scale and Gait parameters(Stride length, Cadence and Gait velocity) were taken before beginning of study and after completion of 8 weeks. There were significant changes in Berg balance scale and Gait parameters. This case report confirms that a goal oriented problem specific treatment approach can yield better outcomes even in adolescents with cerebral palsy.
Physical Rehabilitation of a Spastic Diplegic Cerebral Palsy Patient -A Case Study
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.3\_March2022/IJHSR-Abstract.015.html, 2022
Cerebral palsy (CP) is a group of motor deficits induced by non-progressive brain damage in children. CP is a geographic ailment that affects both developed and developing countries with equal frequency. The study's purpose is to help Cerebral Palsy patients better their rehabilitation. The child's problems are being unable to stand without assistance due to truncal imbalance, having poor cognitive and social conduct, and being unable to do daily living activities independently. Children with CP usually have normal anatomic hip alignment when they are born. A variety of factors influence development, including delayed motor milestones and soft tissue anomalies, such as a muscle tone imbalance with strong hip flexors and adductors vs weaker hip extensors and abductors. When the GMFCS was used to evaluate the patient, the diagnosis of Spastic Diplegia cerebral palsy was confirmed. Physiotherapy intervention has been demonstrated to be useful in minimizing problems and improving patient outcomes. Results: These studies revealed the difficulty of evaluating children with cerebral palsy. Clinical PTs must be aware of these complications and the fact that more than one assessment may be required to capture the children with CP's specific skills and behaviors. Conclusion: Because of PT therapy, the patient was able to control his posture, regulate his head and neck, and stand with limited assistance despite wearing a KAFO.
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.
Biomedicine, 2021
Introduction and Aim: One of the most significant and common clinical finding in a majority of children with (CP) is difficulty in walking and exhibiting poor balance control which results in poor gait and reaching movements as maintenance of stability is critical. There are numerous approaches, protocols and treatment strategies to improve balance and gait control. The aim of this study was to compare the effects of task-oriented training and proprioceptive neuromuscular facilitation exercises (PNF)on mobility and balance in spastic cerebral palsy. Methodology: This was a comparative study design with pre-post type 20 samples were selected based on the inclusion criteria and were divided into two groups. Group A received task-oriented training and group B proprioceptive neuromuscular facilitation and Pre & post measurements were done using paediatric balance scale and timed up and go test. Results:On comparing the post-test values of group A and group B both the group showed significant difference with the pre-test, on comparing the post-test values of group A and group B, group A showed better significance than group B. Conclusion: The present study concluded that there seems to be evidence that task-oriented training is more beneficial in training program for increasing the mobility and balance in spastic cerebral palsy comparing to proprioceptive neuromuscular facilitation.
2019
The study aims to develop a handbook to improve the motor coordination of the learners of cerebral palsy type of spastic diplegia at YPAC (a Foundation for Children with Disabilities) in Surakarta, Indonesia. This study implemented 4-D development model from Thiagarajan which is define, design, develop, as for disseminate not applied. Further, the subject of research includes the learners of cerebral palsy with the type of spastic diplegia. The research instruments used were expert validation questionnaire, parent poll, teacher poll, and observation sheet. Data on small-scale trials were analyzed using the gain score test. Product eligibility based on the expert validation test showed the value of 81% and 89% feasibility percentage and a learning design expert showed the value of the qualification percentage of 83%. As for the test of the gain score in the individual trials showed <g> ≥ 0.7 which means that the outcome of learning of students with cerebral palsy with the type ...
ANKLE STRENGTHENING TO IMPROVE GAIT AND FUNCTION IN CEREBRAL PALSY???A PILOT STUDY
Pediatric Physical Therapy, 2006
Purpose: This pilot study was designed to determine whether increases in ankle strength could improve gait and function in children with spastic diplegia. Methods: Data were obtained from 12 children with spastic diplegia who were assigned randomly to a dorsiflexor group, a plantarflexor group, a dorsi-and plantarflexor group, or a control group. Training group subjects participated in a 12-week strength program using an isokinetic dynamometer. Results: The majority of subjects increased their strength in the trained muscles; the strength of untrained muscles was unchanged. The Gross Motor Function Measure (GMFM) walk-run-jump dimension and a quality of life measure (ie, Peds QL) improved significantly for the entire training group. Gait speed was not significantly increased for the entire training group but varied among training groups. Gait kinematics significantly improved or showed trends for improvement for the entire training group. Conclusion: This pilot investigation indicates that ankle strength increases may lead to improved function, gait speed, and quality of life in children with spastic diplegia. (Pediatr Phys Ther 2006;18:266 -275)
Physical activity as a prescription for the children with cerebral palsy
After so many years devoted to practicing medicine as children physiotherapists, the therapists finally found the importance of balance training exercises in children who suffer from cerebral palsy. It is only through controlling balance that we can achieve improvement in body movement and position that will culminate into performance independence in a child. Formerly, working over controlling balance in cerebral palsy children has been very difficult, because contracture and spasticity did not let us to have an effective balance training exercise. In this respect, we have summarized the results of previous authors that specify the level of effectiveness of exercise therapy. The results of different studies showed that level of effectiveness of exercise therapy on alleviating the symptoms of spastic cerebral palsy is average in accordance with Cohen's effect size Interpretation table.
Physical Management of Children with Cerebral Palsy
Cerebral Palsy - Challenges for the Future, 2014
Cerebral palsy (CP) refers to a group of permanent disorders of the development of movement and posture, causing activity limitations, which are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Damage to the central nervous system cause disorders in neuromuscular, musculoskeletal and sensorial systems. These disorders result in posture and movement deficiencies. The causes of motor disorders are developmental retardation, abnormal muscle tone, muscle weakness, postural control deficiencies, sensorial problems, behavioral problems, orthopedic problems, abnormal movement patterns and reflex, activity, asymmetry and deformities. Within the scope of the assessment to be performed in terms of motor, besides the changes in the muscle tone, co-contraction capacities of the muscles, involuntary extremity and body movements, stabilization of the extremities, correction, balance and protective reactions, sitting balance, upper extremity and hand functions and sensory-perception problems; orthotics, need of mobilization tools and other aid tools, cooperation of the family and their knowledge on the disease also needs to be assessed. Modern therapy methods in CP rehabilitation aim to develop the maximum functionality and independence possible for the child by using the present neuromotor potential. The dynamic motor control approach based on changing the motor patterns and configuration of the tasks rather than the hierarchical modeling of the neurological motor development is used for rehabilitation.