Hemiplegic Cerebral Palsy Children Research Articles

Level of Participation in Daily Activities and its Association with Scoliosis among Hemiplegic Cerebral Palsy

Background: Cerebral palsy (CP) encompasses a spectrum of permanent movement disorders that originate in early childhood, leading to lifelong physical disabilities. Hemiplegic CP, the most prevalent subtype, features notable mobility but poses significant challenges in daily function and adaptation to everyday activities. Objective: This study aims to evaluate the level of daily activity participation and its association with scoliosis in children with hemiplegic CP. Methods: In this correlational study, data were gathered through non-probability convenient sampling from 110 hemiplegic CP children aged 4-18 years across various private and government hospitals and special education centers. The study excluded children with severe pain, impaired mobility, other neuromuscular diseases, or recent orthopedic surgery. Assessments included the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and KIDSCREEN-10 for quality of life. The association of scoliosis with GMFCS and MACS was analyzed using the chi-square test on SPSS-22 software. Results: The majority (60.9%) of participants were classified as GMFCS level II, while 46.4% ranked at MACS level I. There was a significant association between GMFCS levels and scoliosis presence (p < 0.05), but no significant relationship between MACS levels and scoliosis (p > 0.05). Scoliotic children exhibited poorer health outcomes, with 52% reporting poor health status. Conclusion: While most children with hemiplegic CP were capable of handling objects, they faced limitations in mobility affecting their daily activities. Scoliosis was relatively uncommon but significantly associated with reduced gross motor function.

Differences in pulmonary function between diplegic and hemiplegic spastic cerebral palsy children

Differences in pulmonary function between diplegic and hemiplegic spastic cerebral palsy children

Assessing the Therapeutic Impact of Virtual Reality Interventions on Upper Limb Range of Motion and Functional Mobility in Pediatric Patients with Spastic Hemiplegic Cerebral Palsy: A Faisalabad-based Study

Cerebral palsy is a non-progressive central nervous system injury, most common in children, resulting from the damage to brain. Objectives: To see the effects of non-immersive virtual reality on range of motion, muscle strength, spasticity and functional mobility of upper limb in spastic hemiplegic cerebral palsy children. Methods: This was a quasi-experimental study, in which participants were selected through simple random sampling on the basis of defined selection criteria, there were two groups. Group A received conventional physical therapy exercises and group B was a received functional mobility exercises using non-immersive virtual reality. Data collection tools included Modified Ashworth scale to measure the spasticity, Functional assessment scale for functional status, Goniometer was used to measure the rage of mobility and Manual muscle testing MMT was used to measure the strength. Data was analyzed by SPSS version 26. Results: Mean age of children was 9.818 ± 2.639. From total participants 63.6% were males and 36.4% were females CP child. Paired-t test sowed that, there was a statistically significant difference in means of all outcome measures before and after treatment in group-A as well as in group–B (p-value<0.05). Between-group analysis of A and B showed a statistically significant difference with p-value ≤0.05. Conclusions: Both groups showed improvement in spasticity, functional status, range of motion and muscle strength, but treatment group receiving functional mobility exercises using non-immersive virtual reality was found to be more effective than the control group.

The effect of vibration-hinged ankle foot orthoses on gait and spasticity in children with cerebral palsy: A randomized clinical trial design.

Hinged ankle foot orthoses (HAFO) are commonly prescribed for children with cerebral palsy (CP) to improve their ambulatory function. The aim of this study was to compare the effect of vibration-HAFO with that of the same orthosis without vibration on gait, function, and spasticity in hemiplegic CP children. Randomized Control Trial Design (a pilot study). Twenty-three children with hemiplegic CP participated in this study. The control group (n = 12) used HAFO, and the intervention group (n = 11) used vibration-HAFO for four weeks. Pre-post three-dimensional gait analysis was done. Calf muscle spasticity and function were also measured. Results showed significant differences between the two groups in the one-minute walking test (p = 0.023) and spasticity (after intervention [p = 0.022], after follow-up [p = 0.020]). Also, significant differences were detected between the two groups in the step width (p = 0.042), maximum hip abduction (p = 0.008), stance maximum dorsiflexion (p = 0.036) and mean pelvic tilt (p = 0.004) in the barefoot condition. Gait cycle time (p = 0.005), maximum hip abduction (p = 0.042), and cadence (p = 0.001) were different between groups in the braced condition. We couldn't find any significant within and between groups differences in knee kinematic parameters. The mean time of using vibration was 16.83 minutes per day. The vibration-hinged AFO is feasible, safe, and acceptable for children with hemiplegic CP to be integrated into practice. Temporospatial and clinical parameters, especially spasticity, were improved. There were slight trends toward improvement in pelvic and knee kinematics. Vibration-HAFO is of benefit to ambulatory CP children with mild and moderate spasticity. It improved the walking capacity of the children.

Effects of Expanded Constraint-Induced Movement Therapy on Hand Function in Children with Cerebral Palsy: A Randomized Controlled Trial

Background: Hemiplegic cerebral palsy children can attend schools regularly, but due to impairment of upper limb function, participation is restricted in leisure and educational tasks and it affects their social and functional activities. Constraint-induced movement therapy is specifically used for the upper extremity and can enhance cerebral palsy children’s hand function. Objective: To evaluate the effectiveness of expanded constraint-induced movement therapy on hand function in children with cerebral palsy. Methods: A single-blinded randomized controlled trial was conducted at the department of Physical Therapy, Children’s Hospital, Lahore, Pakistan from December 2021 to April 2022 using non-probability convenient sampling. Children with hemiplegic cerebral palsy aged between 5 and 12 years were randomly allocated into two groups (22 patients per group), the experimental group treated with expanded constraint-induced movement therapy and routine physical therapy and the conventional group treated with routine physical therapy only. The pediatric motor activity log scale and Wolf motor function test were the outcome measuring scales. The trial was approved by the ethical committee of the hospital and registered prospectively in the clinical trial registry of the US (ClinicalTrials.gov trial ID 57520). Results: As compared to the conventional group, the score of the pediatric motor activity log scale improved significantly (p-value ≤0.001) in the experimental group. Participants showed significant differences for both domains of the wolf motor function test in the experimental group as compared to other groups and they showed significant improvement in hand function (p≤0.001) within the groups. Conclusion: Expanded constraint-induced movement therapy along with routine physical therapy is found to be more effective in improving the function of the pelagic hand in children with hemiplegic cerebral palsy.

Comparison of Constrained Induced Movement Therapy and Bimanual Training on Functional Outcome of Hemiplegic Cerebral Palsy

OBJECTIVES The aim of this study was to compare the effects of constrained induced movement therapy (CIMT) and BimanualIntensive Training (BIT) on functional outcomes of hemiplegic cerebral palsy children. METHODOLOGY Cerebral palsy children with age groups of 5 to 12 years were included with a total sample size of 38. Simplerandom sampling was done, and data was collected from Islamabad. Two groups were formed and named groupA: constrained induced movement therapy with 19% and group B: bimanual training with 19% respectively. Thefunctional outcome for the CIMPT and for the BIT group was assessed on the pretest and post-test scoreevaluation of QUEST and JTHF tests. RESULTS Statistically significant (p <0.05) improvement was found in The Quality of Upper Extremity Skills Test (QUEST)and Jebsen-Taylor Test of Hand Function (JTHF) in the between -group analysis. For within the group analysisthe p-value <0.05 suggests that there was a significant diffe rence in within-group analysis too. The values forgrasp and dissociated movements suggest that QUEST post-test values are impactful in the CMIT group whereasin the BIT group simultaneous and spontaneous movement was increased but JTHF post -test values were moresignificant in CMIT. CONCLUSION BIT is more beneficial for both hand’s simultaneous and spontaneous movement, whereas CMIT is morebeneficial for grip and overcoming the “learned-nonuse” phenomena in cerebral palsy children.

Q ANGLE VARIATIONS IN PREADOLESCENT CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY

Background and Aim: Hemiplegic cerebral palsy children presented with wide variations of lower limb kinematics. The normal limb in children with spastic hemiplegic cerebral palsy shows variations in Q angle. So, this study aimed to determine the different values of Q angle from both legs among hemiplegic cerebral palsy children having age between the 7 to 12 years. Methodology: An observational cross-sectional study was conducted by using non-probability convenience sampling technique. 71 diagnosed cases with unilateral cerebral palsy in Mobility Quest clinic Lahore and Children Hospital Lahore were enrolled in the study during the duration of six months from September 2019 to March 2020. The consent was taken from those subjects who fulfill the inclusion criteria (n=71) and assessed by the Goniometer that is used to measure the Q angle in hemiplegic Cerebral palsy. Data entry and analysis was done by using SPSS version 25. Descriptive measures of mean and standard deviation were used to summarize data collection. Results: The study included 71 children diagnosed with unilateral cerebral palsy. The Mean Q angle for hemiplegic CP children in right leg is 14.65 ± 2.8 (Normal Range: 11.71-16.98) and in left leg it is 15.09 ± 3.4(Normal Range: 11.47 -18.33) but it differs with the distribution pattern of hemiplegia. Out of 71 children 39 kids were experienced with right sided weakness while 32 were with left sided weakness. Conclusion: Mean Q angles are higher in the affected leg as compared with the unaffected leg in hemiplegic CP. Q angle increase with age and more in female subjects as compared to male subjects.

Instantaneous effect of prolonged stretch on monosynaptic excitability in hemiplegic cerebral palsied children: Repeated measures design

Instantaneous effect of prolonged stretch on monosynaptic excitability in hemiplegic cerebral palsied children: Repeated measures design

Effects of 8 weeks functional training programme on posture control and functional mobility in spastic hemiplegic cerebral palsy.

To determine the impacts of functional training versus conventional training on posture control and functional mobility in spastic hemiplegic cerebral palsy children. The randomised clinical trial was conducted at the Rehab Cure physiotherapy centre, Lahore, Pakistan, from January to September 2020, and comprised children of either gender aged 4-14 years, diagnosed with cerebral palsy, gross motor functional classification system level II or III, and no mental retardation. The subjects were randomised into conventional therapy group A and functional training group B. Intensity of exercises was gradually increased each week, starting from 10 reps to 20 reps. The subjects received treatment 3 times a week for 8 weeks, and each session lasted 45-60 min. Paediatric Balance Scale, Trunk Control Measurement Scale, Five Times Sit to Stand Test and Timed-Up-and-Go test were used at baseline and post-intervention. Data was analysed using SPSS 21. Of the 14 subjects, there were 7(50%) in each of the two groups. Overall, there were 8(57.14%) males and 6(42.86%) females with a mean age of 7.57±1.86 years. Significant improvement was noted in both groups post-intervention (p<0.05), but intergroup differences were not significant (p>0.05). Both functional training and conventional therapy significantly improved postural control and functional mobility in spastic cerebral palsy children, but intergroup differences were not significant. IRCT20200909048676N1.

Topical Anesthesia versus Hand Weight Bearing on Modulating Upper Limb Spasticity in Hemiplegic Children

Purpose: This study was conducted to compare between the effects of topical anesthesia and hand weightbearing on controlling upper limb spasticity in hemiplegic cerebral palsy children. Materials and Methods:Thirty hemiplegic cerebral palsy children from both sexes, ranging in age from 4 to 6 years with spasticitygrade of 1 to 1+. The patients were assigned randomly into two groups (I and II). The range of motionof elbow and wrist extension and hand grip strength were determined before and after three months oftreatment. Both groups received a designed exercise program, for one hour, 3 times / week for 3 successivemonths, in addition; group I received topical anesthesia on the affected upper limb for 30 minutes, whilegroup II received a maintained weight bearing in diagonal extension position for 30 minutes. Results: Studyresults revealed significant improvement in all measuring variables of both groups when comparing theirpre and post treatment mean values. Significant difference was observed in group II, when comparing thepost treatment mean values of the range of motion of both groups. Conclusion: Topical anesthesia and handweight bearing may be used for modulation of upper limb spasticity when combined with exercise programand increases the range of motion of elbow and wrist extension.

Forced use therapy to improve hand function in spastic cerebral palsy children

Introduction: Prehension, the ability to grasp, hold and manipulate objects is an important hand function. Impairment in hand function makes it difficult to fulfill activities of daily living. Objectives: To assess the effect of forced use therapy (FUT) in improving hand function of hemiplegic cerebral palsy children. Outcome measures: Modified Ashworth scale, Fegl Meyer assessment upper extremity, 9-hole peg board, upper extremity functional index and caregiver functional use survey are the outcome measures. Method: Fifty two children with cerebral palsy were divided into 2 groups A and B, 26 subjects in each group. Group A was given conventional hand function exercise whilst group B was given forced hand use therapy. Both groups received the treatment for 45 minutes for the affected limb for 5 days a week. But the FUT group was administered with gloves to constraint the hand movement for 6 hours daily. They were administered with the protocol for 4 weeks and outcomes were measured pre- and post-treatment duration. Results: FUT showed significantly better improvement over the conventional group in outcome measures (p Conclusions: FUT caused reduction in spasticity and increased functional ability in children with spastic hemiplegic cerebral palsy. Sri Lanka Journal of Child Health, 2020; 49(4): 335-340

The Utility of Gait Deviation Index (GDI) and Gait Variability Index (GVI) in Detecting Gait Changes in Spastic Hemiplegic Cerebral Palsy Children Using Ankle-Foot Orthoses (AFO).

Background: Cerebral palsy (CP) children present complex and heterogeneous motor disorders that cause gait deviations. Clinical gait analysis (CGA) is used to identify, understand and support the management of gait deviations in CP. Children with CP often use ankle–foot orthosis (AFO) to facilitate and optimize their walking ability. The aim of this study was to assess whether the gait deviation index (GDI) and the gait variability index (GVI) results can reflect the changes of spatio-temporal and kinematic gait parameters in spastic hemiplegic CP children wearing AFO. Method: The study group consisted of 37 CP children with hemiparesis. All had undergone a comprehensive, instrumented gait analysis while walking, both barefoot and with their AFO, during the same CGA session. Kinematic and spatio-temporal data were collected and GVI and GDI gait indexes were calculated. Results: Significant differences were found between the barefoot condition and the AFO conditions for selected spatio-temporal and kinematic gait parameters. Changes in GVI and GDI were also statistically significant. Conclusions: The use of AFO in hemiplegic CP children caused a statistically significant improvement in spatio-temporal and kinematic gait parameters. It was found that these changes were also reflected by GVI and GDI. These findings might suggest that gait indices, such as GDI and GVI, as clinical outcome measures, may reflect the effects of specific therapeutic interventions in CP children.

Functional Strength Training In Children With Spastic Cerebral Palsy

To find out functional strength training exercise on improving gross motor function among the children with spastic hemiplegic cerebral palsy children. Single group pre-experimental research design. The most common cause of movement disability in infancy is cerebral palsy. Cerebral palsy patients have impairments such as spasticity, low muscle strength and selective motor control in their body function. Such deficiencies may limit activity performance and participation in everyday life. Improving and optimising activities and involvement are crucial treatment objectives. Functional strength workouts are vital to overcoming obstacles to improving the functionality of children with neurological issues. 92 subjects of spastic hemiplegic cerebral palsied aged 4-8, male and female with spastic hemiplegic cerebral palsy were selected under purposive sampling technique and received functional strength training exercise for a period of ten weeks. To assess the gross motor function (functional independence) pre and post the exercise program, Gross motor functional measure was used. Results: The pre and post measurements shows significant changes in the gross motor function among children with spastic hemiplegic cerebral palsy. The results of the post-test mean values show improvement in gross motor functions after functional strength training program (p&lt;0.05). The functional strength training program proves that increased gross motor function and thereby improvement in functional abilities among children with spastic hemiplegic cerebral palsy after ten weeks of intervention.

SEAS Exercise to Treat Scoliosis and Improve Functional Activities in Children with Spastic Cerebral Palsy

SEAS exercise to improve functional activities among the children with spastic hemiplegic cerebral palsy children. Single group pre- post experimental research design. Cerebral paralysis is a static encephalopathy which affects the immature brain and leads to permanent motor disability. Due to a combination of spasticity, muscle weakness and incompletion of muscle control, the spinal deformity occurs in rising patients with CP; it can lead to poor balance in the trunk and significantly limits patient function. SEAS exercise capacity to enhance the self-corrected posture by concentrating during everyday activities. Eighty eight subjects of spastic hemiplegic cerebral palsied children, aged 6-12, male and female with scoliosis were selected under purposive sampling technique and received SEAS exercise training for a period of eight weeks. pre and post outcome measures were assessed using Modified Ashworth scale and Scoliometer to measure the functional activity in the children Pediatric balance scale, functional gait assessment and Gross motor function were used. Significant changes in spasticity and scoliosis were observed, and functional parameters were increased. The results of the post-test mean values for all SEAS variables demonstrated substantial improved balance, reduced scoliosis and gross motor functions in those receiving SEAS protocol (p&lt;0.05). The SEAS exercise proves there was a decrease in scoliosis and their by improvement in functional abilities among children with spastic hemiplegic cerebral palsy after eight weeks of intervention.

Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy

BackgroundChildren with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination. AimsWe investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy. Methods and proceduresForty-five spastic hemiplegic cerebral palsy children (5–8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months. Outcomes and resultsChildren that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention. Conclusions and implicationsAugmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.

Impact of task-oriented training on balance in spastic hemiplegic cerebral palsied children

IntroductionA large majority of hemiplegic cerebral palsy children demonstrate poor balance, which leads to poor gait and impaired reaching movements as the maintenance of stability is critical to all movements. Various approaches and strategies are used to improve balance; task-oriented training is one of them. This study aimed to evaluate the effect of task-oriented training on balance in spastic hemiplegic cerebral palsied children.MethodsOverall, 30 spastic hemiplegic cerebral palsy children who fulfilled the inclusion criteria were randomly allocated into 2 equal groups (control and study group). The control group received a selected therapeutic exercise program for 90 min. The study group received the same program for 60 min and task-oriented training for 30 min. The total treatment provided for both groups was 90 min/day, 3 days/week for 4 successive months. Baseline and post-treatment assessment of each child with regard to overall, anteroposterior, and mediolateral stability indices was performed by using the Biodex Balance System.ResultsChildren in both groups showed significant improvements in post-treatment mean values of all measured variables when compared with the pre-treatment mean values (p &lt; 0.05). Significant improvement was observed in favour of the study group when comparing the post-treatment mean values of both groups.ConclusionsTask-oriented training is a useful tool that can be applied in improving balance in children with hemiplegic cerebral palsy.

Swiss ball training to improve trunk control and balance in spastic hemiplegic cerebral palsy

Introduction: Trunk control is one of the impairments in spastic hemiplegics which affects the balance in cerebral palsy children. Trunk balance is a pre-requisite for upper limb function. By improving trunk control, the balance increases, helping the child to be functionally independent. Objectives: To improve trunk control and balance in spastic hemiplegic cerebral palsy children by Swiss ball training. Method: Thirty subjects were included in the study after obtaining informed consent from their parents and they were separated into two groups. One group was given conventional training and the other group was given Swiss ball training for 30 minutes, 4 times weekly for 6 weeks. Gross Motor Functional Measure (GMFM-88) scale was utilized for assessment of trunk balance and Paediatric Balance Scale (PBS) for assessment of functional balance.Paired t-test was used to analyse the effect of trunk control and balance functions Results: The post-test mean values of all the variables of Swiss ball training group were significantly improved compared to those of the conventional group (p Conclusions: The study shows that Swiss ball training improves trunk control and balance in spastic hemiplegic cerebral palsy children. Sri Lanka Journal of Child Health, 2019; 48(4): 300-304

Effect of Augmented Reality on the Motor Performance of Upper Extremity and Balance of Hemiplegic Cerebral Palsy Children

Effect of Augmented Reality on the Motor Performance of Upper Extremity and Balance of Hemiplegic Cerebral Palsy Children

Does repetitive Transcranial Magnetic Stimulation (rTMS) have therapeutic effects on Dynamic Balance of Children with Cerebral Palsy?

Our big goal in this research was to evaluate the therapeutic effects of repetitive Transcranial Magnetic Stimulation (rTMS) on cerebral palsy (CP) children with balance deficits. Four spastic hemiplegic CP children were participated; the experimental group received rTMS training 4 days a week for 3 weeks and then for the next 3 weeks they received typical occupational therapy just after rTMS therapy. The control group received placebo rTMS instead of real one accordingly. Their dynamic balance was evaluated before the start of the treatment and 6 weeks after it. Center of pressure (COP) and center of mass (COM) features were regarded as dynamic balance parameters. Our results showed that the peak to peak of COP, COM, COM-COP, COM-COP inclination angles all improved for both experimental (15-86%) and control group patients, though there was less improvement about 8-46% in features of the control patients. Our results demonstrate that intensive sessions of the rTMS training could have the potential to enhance the therapeutic effects of typical occupational therapy that can produce dynamic balance improvements in CP children compared to using the occupational therapy by itself.

Effect of Intermittent Serial Casting on Equinus Ankle Deformity in Children with Hemiplegic Cerebral Palsy

AbstractBackground: Equinus is the most common problem in ambulatory children with spastic hemiplegic cerebral palsy, which results in an unstable and inefficient gait pattern. Without proper management at an early stage, it can lead to permanent foot deformities.Aim of Study: The aim of this study was to evaluate the effect of serial casting on ankle range of motion, tone of the calf muscle and ankle kinematics during gait in children with spastic hemiplegic cerebral palsy.Material and Methods: Twenty-five spastic hemiplegic cerebral palsy children of both sexes (15 boys and 10 girls) participated in this study. Patients were selected at level I according to Gross Motor Function Classification System and the degree of spasticity ranged from 2 to 3 according to Modified Ashworth Scale with true equinus, with their mean age were 4.8±0.8 years. They were randomly assigned to two groups. The first group, 12 children, Group (A) who received a selected physical therapy program once a day/3 times a week for three successive weeks; while the second group, 13 children, Group (B) who received three consecutive casts for five days each and removed in the last two days in each week to conduct the same selected physical therapy program which conducted for the Group (A). Ankle range of motion was assessed by electronic goniometer, calf muscle spasticity was assessed by modified ashworth scale and ankle kinematics during gait was assessed by observational gait scale.Results: The results of the present study revealed that Group (B) showed statistically significant improvement in ankle range of motion, tone of calf muscle and ankle kinematics during gait (p=0.0001 for all) than those of the Group (A).Conclusion: Serial casting of equinus ankle deformity could improve ankle range of motion, tone of calf muscle and ankle kinematics during gait in children with spastic hemiplegic cerebral palsy.