Spastic Cerebral Palsy Children Research Articles

HABIT training in unilateral spastic cerebral palsy children having mirror movement disorder.

The single-arm feasibility study was planned to evaluate the therapeutic effect of hand arm bimanual intensive training in improving the fine and gross motor functions of hand, and in the reduction of intensity with respect to mirror movement disorder. The sample comprised unilateral spastic cerebral palsy children aged 6-16 years who were having mirror movement disorder and were able to make a gross grip. The hand arm bimanual intensive training was provided to the participants for 6 hours per day for 15 days for a total of 90 hours. Comparison of baseline and post-intervention showed that the functional independence level of children had improved, with improvement in unimanual and bimanual hand performance (p˂0.05). However, there was no improvement seen in the severity of mirror movements (p>0.05). Hence, hand arm bimanual intensive training was found to be effective in increasing the functional independence of cerebral palsy children by improving the hand function, but there was no effect on mirror movement disorder.

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

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

The Effects of Whole-Body Vibration Therapy in Weight-Bearing and Non-Weight-Bearing Positions for Upper and Lower Extremities on Balance and Function in Cerebral Palsy Children: A Randomized Controlled Trial.

Background and objective Cerebral palsy (CP) is one of the most prevalent neurological conditions affecting children; it is characterized by poor motor control, restricted range of motion (ROM), and poor balance. While whole-body vibration therapy (WBVT) has been used to treat these symptoms, its efficacy in different configurations remains unexplored. Hence,this study aimed to determine and compare the effects of WBVT applied to either the upper extremities, lower extremities, or both upper and lower extremities in weight-bearing and non-weight-bearing positions on ROM (shoulders, elbows, wrists, hips, knees, and ankle joints), balance, and function in children with spastic hemiplegic CP. Methods This randomized clinical trial involved 60 hemiplegic spastic CP children aged5-15 years. After randomization, all the participants were divided into sixgroups of equal size based on the WBVT application for upper extremities, lower extremities, or both in weight-bearing or non-weight-bearing positions. The therapy was applied three times per week for four consecutive weeks. The outcome measures were ROM, hand grip strength, balance quantification score using My Fitness Trainer (MFT) 2.0, and timed up and go (TUG) scores. Results While all the groups were homogenous before treatment, after treatment, it was observed that all the ranges improved significantly in all groups. The same was observed for hand grip strength, balance score, and TUG test scores (p<0.05).The post-hoc analysis revealed that the weight-bearing position for the upper and lower extremities combined showed the highest level of improvement. Conclusions Based on our findings, WBVT in weight-bearing positions produces more significant results than in non-weight-bearing positions. We also observed that when WBVT is applied to the upper extremities, it can improve the function of the lower extremities and vice versa.

Comparing the Effectiveness of Soft Tissue Manipulation and IASTM for Calf Muscle Tightness in Spastic Cerebral Palsy Children

This experimental study aimed to assess the effectiveness of soft tissue manipulation and Instrument Assisted Soft Tissue Mobilization (IASTM) in alleviating calf muscle tightness in children diagnosed with spastic cerebral palsy (CP). Cerebral palsy, a condition affecting two to three out of every 1,000 live births, encompasses a range of challenges related to movement, posture, gait abnormalities, and balance issues. Specifically, spastic diplegic cerebral palsy, characterized by leg spasticity, often results in walking difficulties, with tiptoeing as a common symptom due to calf muscle tightness. The study involved 30 children aged 5-12 diagnosed with spastic cerebral palsy at ACS Medical College and Hospital. Participants meeting the inclusion criteria were divided into two groups: Group receiving soft tissue manipulation and Group B undergoing IASTM. Outcome measures included goniometry and the Modified Ashworth Scale. Random sampling was employed to select subjects, with exclusions for specific medical conditions. Written consent was obtained and demographic data were collected. Based on goniometry and the Modified Ashworth Scale, both interventions demonstrated highly significant differences in mean values within their respective groups. The findings underscore the potential efficacy of both soft tissue manipulation and IASTM in addressing calf muscle tightness in children with spastic cerebral palsy.

The effect of proprioceptive neuromuscular facilitation on functional skills, muscle strength, and trunk control in children with cerebral palsy: A randomized controlled trial

BackgroundProprioceptive neuromuscular facilitation (PNF) is generally used for the lower limbs in children with Cerebral Palsy (CP). This study aimed to determine the effect of PNF and Neurodevelopmental Therapy (NDT) on functional abilities, muscle strength, and trunk control in children with CP. MethodsThirty spastic CP children classified as either level I–II in the Gross Motor Function Classification System (GMFCS) or level I–II in the Manual Ability Classification System (MACS) were included. The PNF (n = 15) and the NDT group (n = 15) had physiotherapy for six weeks. The ABILHAND-Kids scale, the Purdue Pegboard Test (PBPT), the Nine-Hole Peg Test (9-HPT), and the Jebson-Taylor Hand Function Test (JTHFT) were employed. Pinch meters, Jamar handheld dynamometers, and digital muscular strength assessments were used. ResultsThe PNF group increased shoulder flexion (p < 0.05), adduction (p < 0.05), elevation (p < 0.05), scapular abduction (p < 0.05), elbow extension (right) (p < 0.05), grip (p < 0.05), and pinch strengths (left p < 0.05, right p < 0.05). The PNF group had significantly lower 9-HPT (p < 0.05), JTHFT (card turning), JTHFT (simulated feeding), JTHFT (lifting light cans), and JTHFT (lifting weight cans) durations (p < 0.05), and significantly higher PBPT (right-left) PBPT (bimanual), PBPT (assembly).(p < 0.05), ABILHAND (p < 0.05), and TCMS total scores (p < 0.001). While JTHFT (simulated feeding-left), JTHFT (stacking checkers-left), JTHFT (lifting light cans-left), and JTHFT (lifting weight cans-right/left) (p < 0.05) durations decreased in the NDT group, PBPT (right) (p < 0.05) had an increase in duration. ConclusionPNF improves trunk control, upper extremity functional skills, selective proximal muscle strength, and distal upper extremity muscle and grip strength.

Effects of Therapeutic Dosing through Enriched Environment on Gross Motor Function in Spastic Quadriplegic Cerebral Palsy

Background: Cerebral palsy differs in every child in terms of impairments, activity limitations and participation restrictions, so intervention should be designed in a way which is specific to every child and is constantly adjusted according to the needs of the child. Level appropriate selection of dosage (frequency, type, time, intensity) of treatment plays a vital role in treatment efficacy. Objective: To investigate the effects of therapeutic dosing through age-appropriate enriched environment on gross motor function in spastic quadriplegic cerebral palsy. Methods: In this RCT, 82 spastic cerebral palsy children were randomly allocated to two groups. Group A received level appropriate enriched environmental inputs consisting of motor and sensory enriched play environment with therapeutic dosing (20-25 minutes intermittently, 5 hours per day, 5 days a week for 24 weeks) along with Neurodevelopmental Technique. The goal was to promote participant’s self-generated movements, exploration of the environment and successful task completion. Group B received clinical based regular physical therapy consisting of NDT. Guidance was given to parents on how to carry out a home program. Data was collected at the end of 5 months on GMFM scale to check improvement in gross motor function. Results: The data was analyzed using Mann Whitney U test. There was statistically significant difference between the two groups. Group A showed improvement in gross motor function (p value&lt;0.05) whereas improvement in group B was not as significant (p-value&gt;0.05). Conclusion: This study concluded that optimal dosage of an intervention along with parent/caregiver education started at an early age resulted in significant functional improvements in spastic quadriplegic cerebral palsy children. These improvements were observed not only in body functions but also in active involvement and participation of the child.

Analysis of Traditional Chinese Medicine Symptoms in Children with Spastic Cerebral Palsy: A Data Mining Study.

Cerebral palsy (CP) ranks as a major cause of motor disabilities in children, with spastic CP making up roughly 70-80% of all CP cases. The primary objective of our study is to identify characteristics of Traditional Chinese Medicine(TCM) symptom of spastic CP, thereby establishing correlations between the TCM symptom and the disease, providing a more scientific theoretical foundation for TCM treatments on spastic CP, enabling a deeper comprehension of clinical interventions, ultimately, improving rehabilitation outcomes in TCM treatment for spastic CP. We conducted a data mining study on TCM symptom of spastic CP children aged 4-14 years old treated at Xi'an Encephalopathy Hospital Affiliated to Shaanxi University of Chinese Medicine, from October 2021 to March 2023. The medical records of all eligible and complete spastic CP patients were extracted, processed for data cleansing, transformed, and subsequently analyzed to discern distinctive TCM symptom. K-Means Clustering Analysis and Association Rule Analysis were used for data mining. Core symptoms identified for spastic CP encompassed "Motor Dysfunction", "Impaired Speech", "Delayed Development", "Limb Stiffness", "Rigidity in the limbs", "Intellectual Impairment", "Timidity and susceptibility to startle responses", "Muscle Wasting", and "Pale or Dull Complexion". Among the top-ranking associations of symptom, patterns emerge wherein "Motor dysfunction" intertwine with "Impaired speech", "Motor dysfunction" coexist with "Delayed development", and "Impaired speech" are accompanied by "Delayed development". This study identified the core symptom of spastic CP and tentatively suggests that the clinical manifestations of spastic CP are essentially consistent with the TCM pattern "liver exuberance and spleen weakness". This finding has facilitated the preliminary establishment of correlations between TCM pattern differentiation and the disease in medicine. It is anticipated that this correlation will bring tangible benefits to a larger number of children with spastic CP.

Effect of treadmill training combined with ankle weight on balance in spastic cerebral palsied children: A randomized controlled trial

The aim of this study was to examine the impact of treadmill training combined with ankle weights on balance and dorsiflexor muscle strength in children with spastic hemiparetic cerebral palsy (CP). This clinical, randomized trial included forty boys and girls suffering from spastic hemiparetic cerebral palsy, ranging in age from 6 to 9 years old. They were split into two equal groups (control group = 20, study group = 20). Both groups received a program of physiotherapy in addition to treadmill exercise, while the study group also received ankle weights for eight weeks. The Biodex stability system was employed to evaluate stability indices, including the overall stability index (OASI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI). Functional balance was measured using the Pediatric Balance Scale (PBS). A Lafayette manual muscle tester (MMT) was used to record the peak force of ankle dorsiflexor muscle strength for both groups, pre- and post-therapy. Post-therapy results showed a significant decrease in all stability indices at stability levels 8 and 4, and a significant increase was observed in functional balance and ankle dorsiflexor muscle strength in both groups (p&lt;0.05). The study group showed a more significant improvement in all outcome measures after therapy than the control group (p&lt;0.05). The program of physiotherapy, treadmill training, and ankle weights was effective in improving balance and dorsiflexor muscle strength among children with spastic hemiparetic cerebral palsy, with ankle weights contributing to greater progress.

Comparison of PNF Stretching and Static Stretching to Reduce Spasticity of Lower Extremity in Spastic Cerebral Palsy Children

Background: Cerebral palsy (CP) presents a significant burden on childhood health, with the spastic type being the most prevalent manifestation. This neurological disorder, affecting 2-3 per 1000 births, stems from various prenatal, perinatal, or postnatal brain injuries. Commonly impacted outcome measures include muscle tone, pain, and range of motion, assessed by the Modified Ashworth Scale, Wong-Baker Face Pain Rating Scale, and popliteal angle measurement, respectively. While conservative static stretching is a widely used treatment option for spasticity, its efficacy remains inconclusive due to temporary effects. Conversely, proprioceptive neuromuscular facilitation (PNF) stretching, introduced by Harman Kabat and Margaret Knott in the 1940s, has shown promise in improving functional outcomes and reducing spasticity in neurological conditions like stroke and CP. However, limited evidence exists regarding its comparative efficacy with conventional static stretching in reducing spasticity among children with spastic cerebral palsy. Therefore, this study aims to compare the effectiveness of PNF stretching and static stretching in reducing lower extremity spasticity in children with spastic cerebral palsy, with pain and popliteal angle as secondary objectives. Objective: The primary objective of this study is to assess the comparative effectiveness of PNF stretching and static stretching in reducing spasticity in the lower extremities of children with spastic cerebral palsy. Additionally, pain intensity and popliteal angle will be evaluated as secondary objectives. Methods: A sample size of 60 children was determined using Epitool Google calculator and selected through non-probability purposive sampling. Participants were randomly assigned to either the experimental group, receiving PNF stretching, or the control group, receiving static stretching, with both groups undergoing identical baseline treatment. Pre- and post-intervention assessments were conducted for spasticity, pain intensity, and popliteal angle measurement using appropriate scales and instruments. Data were analyzed using SPSS 20.0, employing independent sample t-tests and paired sample t-tests for intergroup and intragroup comparisons, respectively. Results: Inter-group analysis revealed significant improvements in both groups concerning pre- and post-treatment outcomes across all variables. However, intra-group analysis demonstrated statistically significant improvements in the PNF stretching group compared to the static stretching group across all measured variables. Conclusion: The study concludes that proprioceptive neuromuscular facilitation stretching is more effective than static stretching in reducing spasticity in children with cerebral palsy. Nevertheless, both techniques exhibit efficacy in their respective capacities.

Effectiveness of Abdominal Activation on Motor Control in Diplegic Cerebral Palsy: A Randomized Control Trial

Background: Cerebral palsy (CP) is a disorder of the nervous system manifested in movement, posture, muscle tone, and functional activity. Poor postural control is the most common problem related to CP. Neuro-developmental techniques, or facilitation techniques, were used to activate muscles and improve trunk control. Aim: To determine the influence of the effects of abdominal activation for correcting posture in spastic diaplegic CP children. Methods: A quantitative, randomized clinical trial was conducted, allocating 26 CP patients randomly into two groups: the control group and the treatment group. Baseline treatment was given to the control group, which included lower-limb passive stretching exercises and interrupted direct current. However, baseline treatment with neuro-developmental techniques was given to the treatment group. The measuring tool used for assessment of postural correction and stability was the trunk control measurement scale. Results: The study recruited 26 CP patients, of who 10 belonged to the age groups 8–10 years and 11–13 years, respectively, while 6 children were from the age group 14–15 years. An independent sample t-test was used for between-group analysis, and the results showed a significant improvement in the TCMS score post-treatment, as the p-value was 0.012, while within-group analysis was done by applying a paired sample t-test. There was a significant improvement in the treatment group (p-value 0.000) where NTD was applied, compared to the control group (p-value 0.096), where only baseline treatment was given. Implication: Neurodevelopmental approaches can improve trunk control in children with cerebral palsy, enhancing mobility, independence, posture, and functional skills. This reduces the risk of musculoskeletal issues and facilitates activity participation. Conclusion: The study showed significant improvement in postural control with the use of Neuro-developmental techniques in CP children. Children with cerebral palsy (CP) can benefit from improved trunk control using neurodevelopmental approaches, which can increase their mobility, independence, posture, ability to participate in activities, and functional skills. Keywords: Cerebral palsy (CP), Neuro-developmental techniques (NDT), Interrupted direct current (IDC).

Impact of selective dorsal rhizotomy to cerebral palsy children caregivers' burden.

It is known that cerebral palsy (CP) children's caregivers suffer from burden, depression, and stress, impairing their quality of life (QoL). The more severe the CP, the more burden the caregiver has. Psychosocial support, education, therapies, and financial support are inversely related to the level of stress of the caregiver. Most parents of CP patients submitted to selective dorsal rhizotomy (SDR) report improvement not just on spasticity, but also in the functional role of the children, what can impact on caregiver's QoL. Our objective was to evaluate the burden of CP children's caregivers with and without previous SDR. Spastic CP children caregivers were divided into two groups: those who take care of children without previous SDR (control group) and those that children were previously submitted to SDR (surgical group). The burden index was compared between groups using Burden Interview Questionnaire (BIQ). For statistical analysis, we used SPSS. The control group had enrolled 31 participants and the surgical group 36. The mean GMFCS level on the control and surgical groups was 3.94 ± 1.26 and 3.74 ± 1.12 (p = 0.61), respectively. The surgical group caregivers presented less burden related to the feeling that they should be doing more to their child (p = 0.003) and if they could do a better job in caring (p = 0.032), compared to controls. The total BIQ index was not significantly different between groups (surgical 32.14 ± 12.34 vs. control 36.77 ± 12.77; p = 0.87). Low economic status had a weak correlation to a higher BIQ index (R2 = 0.24). After age-matching, there was a significative higher BIQ index in the control group (p = 0.008). Caregivers of spastic CP children who were previously submitted to SDR presented less burden related to feeling of the amount of given care than those without previous surgery. The impression that they could do a better job with their kids was higher in the control group. The severity of CP and low economic status were related to more burden in both groups. After pairing groups by age, the control group had a significative higher BIQ index compared to the SDR group. Trial registration number: CAAE 73407317.6.0000.0068 (Ethical and Research Committee of University of Sao Paulo, Sao Paulo, Brazil, approved on 08/06/2021). All the subjects were freely given an informed consent to participate in the study that was obtained from all participants. Non-consented ones were excluded from the study.

Effectiveness of Spider Cage Therapy for Balance Control in Spastic Diplegic Cerebral Children: A Pilot Study

Background: Spastic diplegic cerebral palsy (CP), a neurological disorder that specifically affects the lowerextremities, affects mobility and posture. People with spastic diplegia frequently have balance problems, whichreduces their functional independence and raises their risk of falling. In order to treat balance impairments in thispopulation.Purpose: The aim of the study is to examine novel and alternative treatment approaches that may possibly enhancethe motor function and general quality of life in spastic diplegic cerebral palsy children by examining the efficacyof spider cage therapy for balance control.Methods: 10 children with spastic diplegic cerebral palsy were allocated into developmental and experimentalgroup. The experimental group (n=5) received spider cage therapy and the developmental group (n=5) receivedconventional physiotherapy.Result: This finding shows that the conventional group pre and post-test values by using GMFM (30.2±1.67,34.95±1.58) experimental group pre &amp; post value of GMFM (30.55±5.63,36.95±1.64) with p value&lt;0.0001.Conventional group pre &amp; post-test values by using PBS (9.2±3.11,14.95±4.52) and experimental group pre andpost-test values of PBS (9.75±1.58,16.7±1.78) with a p value &lt;0.0001.Conclusion: The study’s findings suggest that children with spastic diplegia might benefit from balance trainingin a spider cage.

Association Between Calf Muscle Tone, Plantar Surface Area, and Gross Motor Function in Children with Spastic Diplegic Cerebral Palsy.

Children diagnosed with spastic diplegic Cerebral Palsy (CP) usually demonstrate hypertonicity of the lower limb muscles which affects the normal alignments and weight reception by the feet. These impairments could be correlated to the limitations in gross motor function such as standing and walking abilities. Understanding these relationships can contribute to developing more effective rehabilitation strategies and improving overall motor outcomes for affected children. The current study was designed to explore the relationship between plantar surface area, weight distribution on the plantar surface, and gross motor function (namely, standing and walking abilities) in spastic diplegic CP children. Seventy-one spastic diplegic CP children aged 8-14 years joined this cross-sectional study. The Person's correlation coefficient and regression tests were used to assess the correlation between variables, namely, Gross Motor Function (GMFM), Calf Muscle Tone, Plantar surface area (PSA), and Peak pressure on mid and hind feet (PPMF, PPHF, respectively). These variables were assessed using the GMFM-88 scale, Modified Ashworth scale, and foot scan plantar pressure detection system, respectively. The correlation analysis demonstrated a strong to moderate positive correlation between PSA, PPMF, PPHF, and GMFM-D and GMFM-E. Additionally, regression model showed prediction levels equal to 0.791 for the GMFM-D and 0.720 for the GMFM-E categories, respectively. Standing and walking abilities were positively correlated (r ≥.6) with the increased plantar surface area and higher peak pressure on mid and hind feet in spastic diplegic CP. Future longitudinal studies should investigate changes in gross motor function in relation to improvement in plantar surface area and peak pressure values.

Efficacy of Pilates Training on Balance in Spastic Cerebral Palsy Children: A Pilot Study

Introduction: Impaired postural and reactive balance control is a substantial challenge for children with Cerebral Palsy (CP). Evidence states that Pilates Training (PT) increases strength, endurance and flexibility of the trunk and abdominals, and demonstrates improvement in the deep core muscles which helps body’s ability to relax and improve balance in Spastic Cerebral palsy (SCP) children. Aim: To measure the efficacy of PT on improving balance in SCP children. Materials and Methods: A quasi-experimental pilot study with convenient sampling was conducted for 2 weeks, from March 6, 2024 to March 21, 2024 in Xcell Physiocare, Greater Kailash-I, New Delhi, India among children aged between 5 to 9 years, who were able to understand Hindi and English, with spasticity ranging from 1 to 1+ (Modified Ashworth Scale), level 3 and 4 (Gross Motor Function Classification System) and normal flexibility of lower back muscle. They received 10 minutes of stretching, followed by 45 minutes of PT, 10 repetition each, 4 times a week for 2 weeks. The measurement was performed at baseline and post-treatment using Pediatric Balance Scale (PBS), modified Timed Up and Go (mTUG). Data was analysed using Wilcoxon’s Signed-rank test. Results: The measured variables before and after therapy showed a significant improvement (p&lt;0.05) in both PBS and mTUG. Conclusion: PT is an effective treatment program for improving balance in SCP 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&lt;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.

Impact of mother's care burden, fatigue and child's functional level on quality of life in spastic cerebral palsy.

Cerebral palsy (CP) may be considered one of the most common motor disabilities that require a lot of caregiving from mothers or caregivers; therefore, the mothers of children with CP face a lot of difficulties in their caregiving, which in turn may affect the child's quality of life (QOL). This work was conducted to evaluate the impact of the children's functional level in different types of spastic CP, mothers' care burden (CB), and fatigue on the child's QOL. One hundred thirty-eight children with different types of spastic CP (unilateral and bilateral) with different levels of the gross motor function classification system (GMFCS), with an age range of 6-12years, and their mothers with ages ranged from 25 to 45years, participated in this study. Mother CB, fatigue, and child QOL were measured and compared between different groups by using the Zarit burden Interview (ZBI), Chalder Fatigue Questionnaire (CFQ), and Pediatric Quality of Life Inventory (PedsQL) CP Module, respectively. There were significant differences in all measured variables (ZBI, CFQ, GMFCS, and PedsQL) with p-value <0.001 among the different spastic groups (unilateral and bilateral CP). However, the results revealed a positive impact of the child's GMFCS, mother's CB, and fatigue level on the quality of the child's life, with a greater effect on those with quadriplegic type. The mother's CB and fatigue should be considered in the rehabilitation of spastic CP children based on their GMFCS, as they have a negative impact on child QOL; therefore, helping the mother with her needs should not be ignored, especially in families with severely spastic CP children and low financial income.

Effects of routine physical therapy with and without kinesio taping in improving gross motor function in sitting and standing in spastic diplegic cerebral palsy children

ObjectiveTo determine the effectiveness of Kinesio taping along with routine physical therapy on improving gross motor function in sitting and standing among spastic diplegic Cerebral Palsy children. DesignRandomized controlled trial. SettingsUniversity Teaching Hospital University of Lahore, Lahore. Participants53 participants with diagnosed spastic diplegic cerebral palsy were randomly allocated in control and experimental groups. Intervention26 Participants were treated by kinesio taping which was applied in a criss-cross manner along with routine physical therapy program while the control group (n = 27) received NDT exercise program that comprises of stretching, functional reaching, weight-bearing exercises and walking. Outcome measureGross motor function was assessed using 2 components of Gross Motor Function Classification System (GMFCS-88), i.e., sitting as well as standing at the base line and after every 3rd week for 12 weeks follow up. ResultsIn study and control group the mean score of gross motor function for sitting at baseline was 33.96 ± 3.11 and 31.50 ± 3.32 respectively. After intervention, it changed to 47.70 ± 5.46 and 43.46 ± 1.81 respectively. Mean score for Gross Motor Function calculated at base line in study and control group for standing was 27.37 ± 1.14 and 26 ± 3.01 respectively. At the end of intervention, the score improved to 36.55 ± 4.27 and 33.69 ± 2.46 respectively. ConclusionIn comparison to control group, significant increase in gross motor function of intervention group was seen after the 12 weeks of intervention. In this way, over back muscles the application of kinesio tape in a Criss-Cross manner may be helpful. Also it can be used as an additional approach along with routine physical therapy to improve standing and sitting in spastic diplegic children.

Effectiveness of Sensory Integration Therapy on Functional Mobility in Children With Spastic Diplegic Cerebral Palsy.

Background A set of non-progressive brain abnormalities and nervous system dysfunctions are referred to as cerebral palsy (CP). Due to this,the child's mobility, eyesight, learning, and thought processes are affected. It can evolve before, through birth, or the firstyear of a child's life.The activity through which the brain organizes and analyses external sensations like touch, motion, body awareness, vision, hearing, and gravity is indicated as sensory integration. The use of sensory integration therapy (SIT)necessitates that the sensorimotor exercises target the specific parts of difficulties that the child experiences daily. This study aims tostudy the effectiveness of SIT on functional mobility in children with spastic diplegic CP. Methods In this study, 40 children of CP with spastic diplegic who met the inclusion and exclusion criterion were enlisted and were separated into two groups, with Group A (n=20) receiving SITfor 25 minutes along with conventional physiotherapy for 20 minutes, and Group B (n=20) were given conventional physiotherapy for 45 minutes. A four-week therapy plan was followed. Short sensory profile (SSP) and Gross Motor Function Classification System (GMFCS), Pediatric mini-mental state examination (MMSE), and Modified Ashworth Scale were taken as outcome measures. Results SIT along with traditional treatment is described in the study protocol which aids CP children to improve themselves. Following a four-week protocol, combined therapy of SIT and conventional physiotherapy show an effect on the motor function of the children. After therapy, scores in GMFCS and SSP improved. By using Student's paired t-test, a statistically significant difference was found in GMFCS score at pre and post-test treatment in group A (7.28, p=0.0001) and group B (4.48, p=0.0001),in SSP score at pre and post-test treatment in group A (27.91, p=0.0001) and group B (11.31, p=0.0001), in MMSE score at pre- and post-test treatment in group A (6.89, p=0.0001) and group B (6.32, p=0.0001). The significance threshold was p<0.0001. Conclusion Under the study's experimental conditions, both groups showed substantial improvements in the functional mobility of children. When the efficacy of SIT along with conventional physiotherapy was examined, the impact resulted in a significantly greater improvement in the functional mobility of spastic diplegic CP children.

Split transfer of tibialis anterior for equinovarus foot deformity in cerebral palsy

: Foot deformities in children with cerebral palsy are common. The various foot deformities are equinus, planovalgus, equinovarus, equinovalgus. Treatment for the flexible foot deformity should be with orthotics and manual therapy initially and then with tendon lengthening. Equinovarus deformity of the foot is a result of the muscle imbalance in which invertors of the foot, posterior and anterior tibialis muscle, overpower evertors. Untreated spastic equinovarus deformity may cause severe fixed foot deformity and painful callosities under metatarsal heads and on the lateral side of foot. To evaluate the effectiveness of split transfer of tibialis anterior for equinovarus foot deformity in spastic cerebral palsy children.40 spastic cerebral palsy (13 diplegic and 27 hemiplegic) children between the age of 5-15 years with equinovarus foot deformity were selected. The procedure adopted in all the cases was tendoachilles lengthening and split anterior tibialis tendon transfer to cuboid. The result was graded as good, fair and poor. In 28 of the cases varus deformity of the forefoot and midfoot got corrected with plantigrade foot, in 10 of the cases forefoot and midfoot supination was corrected but heel was in varus and in 2 of the cases there was no improvement.: Spastic T.A. is most often the cause of varus of forefoot. Split transfer utilises the spastic nature of the muscle to counter balance the deformity caused by the original muscle. Hence, it is better solution to the problem. However accurate diagnosis of deforming muscle, i.e, T.A or T.P. is essential to produce good result.

Nerve conduction study in young children suffering from cerebral palsy

Objectives: Cerebral palsy (CP) is a motor impairment syndrome leading to disorders of movement and posture. Screening of electrophysiological parameters Hoffman reflex (H-reflex and nerve conduction velocities) becomes a necessary for the early detection and management of the disease. The study aimed to assess the various electrophysiological parameters of nerve conduction velocity in CP and age-matched normal children. Matrials and Methods: The present cross-sectional study was performed between children suffering from CP and healthy control. A total of 27 children of 12–24 months of age of either sex were examined. Among them, six children were normal (with age match), seven were diagnosed with spastic CP and remaining 14 children were diagnosed with hypotonic CP The electrophysiological parameters were recorded in the right lower limb (posterior tibial nerve-soleus muscle) of all children. Results: In electrophysiological parameters, H-reflex latency in secs values was significantly decreased in all CP children. The maximum amplitudes of reflexly excitable motor neurons (Hmax) (mV) and Hmax/maximum amplitude of motor response ratio in the gastrocnemius-soleus muscle were significantly increased in spastic CPas compared to control. H-reflex conduction velocity (HRCV) was significantly higher than motor nerve conduction velocity (MNCV) in hypotonic CP children. Conclusion: The electrophysiological parameters were altered in spastic CP children. The electrophysiological parameters in hypotonic CP were within range, indicating they did not suppress the neuronal motor pool. However, HRCV was significantly more than MNCV in hypotonic CP, suggesting some myelination process defect/white matter injury in motor neurons. We concluded that the electrophysiological parameters of the nerve conduction study are a reliable test for the assessment of tone of muscles in children. Thus, it may help in the early initiation of the treatment and therapies in CP children.