Effectiveness of Home Based Telerehabilitation for Forward Versus Backward Stepping Strategy in Ground Walking Training on Functional Mobility and Balance Among Spastic Diplegic Cerebral Palsy-- A Simple Experimental Study

Abstract

Background: The primary focus of physiotherapy interventions for children with CP is to improve locomotor function and functional activities. It is suggested that walking training activates neural circuits that mediate central pattern generators to activate limb muscles repetitively and produced rhythmic movements. Additionally, it adjusts control between agonist and antagonist muscles, leading to enhanced walking speed, and static and functional balance. The purpose of the study is to find out the effectiveness of home based telerehabilitation for forward stepping vs backward stepping strategy in ground walking training on functional mobility and balance among spastic diplegic cerebral palsy. Methodology: A simple experimental study was conducted on 24 spastic diplegic cerebral palsy who fulfill the selection criteria were selected for this study at the telerehabilitation Unit. A clear explanation was given to every subject and parents/guardian about the procedures and a written consent was obtained from them. Twenty spastic diplegic children were evaluated in person in the department for pre-training and post-training were used as a study design with total study duration was six weeks. (from April 2021 to May 2021). The subjects in group A&B were consisting of 12 subjects and they were treated with home based telerehabilitation for forward and backward ground walking training. Along with that both the group children received routine physiotherapy. Both the groups were received intervention for 15-30 minutes per session, 5 days in a week for a period of 6 weeks. The pre and post score values of balance and functional mobility were measured by using, GMFM walking dimension, modified timed get up and go test and Pediatric Berg balance scale. The values were recorded and documented. Result: In the statistical analysis of pretest values of both group A and group B were calculated. The pre mean values of PBS for both groups were 33.33 and 33.38. The T-value was 0.3721 the obtained t-value is lesser than the table value and the P-value showed there were no significant in pretest comparison. The posttest mean values of PBS for both groups were 46.08 and 46.33.The T-value was 2.38967,the obtained t-value is greater than the table value. and the P-value showed there were significant in posttest comparison. Alternative hypothesis was accepted. Hence the statistical report states that there were statistically significant differences in posttest comparison. The post score values of the Gross Motor Function Meaure-88, Pediatric Berg Balance Scale and TUG test score in all the variables showed significant difference. Conclusion: The study concluded that the 6 weeks of backward stepping strategy in ground walking home based telerehabilitation training program along with regular physiotherapy treatment showed statistically significant improvement in balance and functional mobility among spastic diplegic children when compared to forward stepping strategy in ground walking home based telerehabilitation training program.