Spastic Hemiplegic Cerebral Palsy Research Articles

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.

Prevalence and Risk Factors for Cerebral Palsy in Children With Congenital Heart Disease Based on Risk of Surgical Mortality

BackgroundChildren with congenital heart disease (CHD) have a higher prevalence of motor impairment secondary to brain injury, resulting in cerebral palsy (CP). The purpose of this study is to determine the prevalence of CP in CHD in a single-center cohort, stratify risk based on surgical mortality using Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) categories and identify risk factors. MethodsRetrospective cohort study of pediatric patients registered in the University of Florida (UF) Society of Thoracic Surgeons Congenital Heart Surgery database from 2006 to 2017 with a diagnosis of CHD who continued follow-up for more than two years at UF. ResultsA total of 701 children with CHD met inclusion criteria. Children identified to have CP were 54 (7.7%). Most common presentation was spastic hemiplegic CP with a Gross Motor Function Classification System of level 2. Analysis of surgical and intensive care factors between the two groups showed that children with CHD and CP had longer time from admission to surgery (P = 0.003), higher STAT categories 4 and 5 (P = 0.038), and higher frequency of brain injury and seizures (P < 0.001). Developmental disabilities and rehabilitation needs were significantly greater for children with CHD and CP when compared with those with CHD alone (P < 0.001). ConclusionsIn our cohort, 7.7% children with CHD develop CP; this is significantly higher than the 2010 US population estimate of 0.3%. Our study suggests higher STAT categories, brain injury, and seizures are associated with developing CP in children with CHD.

Effects of positive and negative normative feedback on the learning of throwing task in children with spastic hemiplegic cerebral palsy

Effects of positive and negative normative feedback on the learning of throwing task in children with spastic hemiplegic cerebral palsy

Effect of core stabilization versus rebound therapy on balance in children with cerebral palsy

ObjectiveThis study aimed to compare the effect of core stabilization exercises and rebound therapy on balance in children with hemiplegic cerebral palsy (CP).MethodsFifty- two children of spastic hemiplegic CP aged 5 up to 8 years from both genders were assigned randomly into two groups: core stability and rebound therapy groups. Both groups received 3 sessions/week, 1.5-h training per session, for 12 successive weeks. The measurement was performed at baseline and post-treatment. Balance as a primary outcome for this study was measured by a Biodex Balance System (BBS), and knee extensor strength and functional capacity as secondary outcomes were assessed using a hand-held dynamometer, and a six-minute walk test (6MWT), respectively.ResultsAll variables showed a significant improvement after intervention in each group (p < 0.0001), with significant improvement in all stability indices (overall, anteroposterior, and mediolateral) in core stability group when compared to rebound therapy group.ConclusionCore stability exercises and rebound therapy are recommended in the rehabilitation of children with hemiplegic CP. Core stability exercises were more effective than rebound therapy for balance improvement.Trial registration numberNCT05739396.

The Effect of Transcranial Direct Current Stimulation on M1 with and without Mirror Visual Feedback on Range of Motion and Hand Grip Strength of the Affected Upper Limb in Children with Spastic Hemiplegic Cerebral Palsy.

This study investigated the effects of transcranial direct current stimulation (tDCS) before and during the mirror visual feedback (MVF) on hand grip strength (HGS) and range of motion of the affected hand in children with spastic hemiplegia cerebral palsy (SHCP). Twelve children with SHCP participated in this randomized, crossover, and double-blind study. They were randomly exposed to one of four intervention conditions, including 1) a-tDCS-offline, 2) s-tDCS-offline, 3) a-tDCS-online, and 4) s-tDCS-online, with a one-week interval. Participants in the online condition received either anodal or sham tDCS during MVF, while those in the offline condition received tDCS before performing MVF. The tDCS was applied over the M1 area of the affected hemisphere for 20 minutes at 1 mA intensity. The HGS and range of motion of the wrist and elbow (ROM-W and ROM-E) of the affected limb were measured before (pre) and immediately after (post) interventions in each session. The results showed that the HGS was significantly higher under a-tDCS-offline (p=0.001), s-tDCS-offline (p=0.004), and s-tDCS-online (p=0.005) compared to the a-tDCS-online. Moreover, the ROM-W was significantly higher under a-tDCS-offline (p=0.034), s-tDCS-offline (0.011), and s-tDCS-online (p=0.027) compared to the a-tDCS-online. Eventually, the ROM-E was significantly higher under a-tDCS-offline, s-tDCS-offline, and s-tDCS-online compared to the a-tDCS-online (p ˂0.001; p ˂0.001; p=0.01, respectively). The results might have practical implications regarding the timing of the application of tDCS in conjunction with MVF in children with SHCP.

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.

Effect of contralateral isokinetic training on strength and reaching skill in children with spastic hemiplegic cerebral palsy: randomized control trail

Effect of contralateral isokinetic training on strength and reaching skill in children with spastic hemiplegic cerebral palsy: randomized control trail

Altered corpus callosum structure in adolescents with cerebral palsy: connection to gait and balance.

Cerebral palsy (CP) is the most common motor disorder in childhood. Recent studies in children with CP have associated weakened sensorimotor performance with impairments in the major brain white-matter (WM) structure, corpus callosum (CC). However, the relationship between CC structure and lower extremity performance, specifically gait and balance, remains unknown. This study investigated the transcallosal WM structure and lower limb motor stability performance in adolescents aged 10-18 years with spastic hemiplegic (n = 18) or diplegic (n = 13) CP and in their age-matched controls (n = 34). The modern diffusion-weighted MRI analysis included the diffusivity properties of seven CC subparts and the transcallosal lower limb sensorimotor tract of the dominant hemisphere. Children with CP had comprehensive impairments in the cross-sectional area, fractional anisotropy, and mean diffusivity of the CC and sensorimotor tract. Additionally, the extent of WM alterations varied between hemiplegic and diplegic subgroups, which was seen especially in the fractional anisotropy values along the sensorimotor tract. The diffusion properties of transcallosal WM were further associated with static stability in all groups, and with dynamic stability in healthy controls. Our novel results clarify the mechanistic role of the corpus callosum in adolescents with and without CP offering valuable insight into the complex interplay between the brain's WM organization and motor performance. A better understanding of the brain basis of weakened stability performance could, in addition, improve the specificity of clinical diagnosis and targeted rehabilitation in CP.

Improving dynamic balance by self-controlled feedback in children with cerebral palsy

AimsMaintaining balance is an important topic for participation of children with Cerebral Palsy (CP) in their own activities. Purpose of the present study was to investigate the effect of self-controlled and yoked-group feedback on dynamic balance of children with Spastic Hemiplegic Cerebral Palsy (SHCP). MethodsUsing Convenience Sampling Method, twenty students with Cerebral Palsy, aged 8–10 years old, were selected from special schools and divided into the Self-Controlled (SC) and Yoked feedback groups. Children in SC group requested feedback when necessary during the acquisition phase; in contrast, participants in yoked group replicated the feedback schedule of their counterparts in SC group without any choice. Modified Star Excursion Balance Test (SEBT) was used for both dynamic balance intervention and assessment. To analyze the data, Multivariate Analysis of Covariance (MANCOVA) and Analysis of Covariance (ANCOVA) Tests were performed at p < 0.05. ResultsBased on MANCOVA test results, a significant difference were found between SC and Yoked groups after controlling for pretest at least in one balance variables (anterior, posterolateral, and posteromedial). Results of ANCOVA test showed a significant difference between the balance variables in the anterior, Posterolateral, and posteromedial directions in children with cerebral palsy. ConclusionsFindings of our study support the idea that requested feedback in SC conditions could have more benefits for motor learning since it is adjusted with the needs and preferences of children.

Nonmetallic Anterior Hemiepiphysiodesis of the Distal Femur with a Low-Profile, Pretensioned Implant: A Case Report.

A 14-year-old adolescent boy with left-sided spastic hemiplegic cerebral palsy presented with a 14° left knee flexion contracture and resultant gait disturbance in the setting of an open distal femoral physis. He underwent subsequent anterior distal femur hemiepiphysiodesis with a suture anchor-based, nonmetallic implant. He achieved full correction at the 1-year follow-up and underwent uncomplicated implant removal. A low-profile, suture-based implant used for pediatric knee flexion deformity may allow surgeons to control growth in a reversible fashion by tensioning the physis while possibly avoiding some of the complications associated with currently used implants.

The Effect of Induced Weight Bearing Method Using a Cane on Weight Bearing Distribution in Children with Spastic Hemiplegic Cerebral Palsy

The Effect of Induced Weight Bearing Method Using a Cane on Weight Bearing Distribution in Children with Spastic Hemiplegic Cerebral Palsy

The Effect of Induced Weight Bearing Method Using a Cane on Weight Bearing Distribution in Children with Spastic Hemiplegic Cerebral Palsy

The Effect of Induced Weight Bearing Method Using a Cane on Weight Bearing Distribution in Children with Spastic Hemiplegic Cerebral Palsy

Inter- and intra-rater reliability of new application software for computerised paediatric version of Wisconsin Gait Scale

The paediatric version of Wisconsin Gait Scale (WGS) is a reliable tool for gait assessment in children with spastic hemiplegic cerebral palsy (CP). We decided to develop a solution which will make it possible to objectify the descriptive paediatric version of the WGS, and which, consequently, will allow researchers/clinicians to more easily perform accurate assessment of gait patterns in patients. The aim of the study was to assess inter- and intra-rater reliability of new application software for computerised paediatric version of the WGS in children with hemiplegic CP. The study involved 31 children with hemiplegic CP. The app was designed using a model based on thematic categories of the paediatric WGS, and utilising auxiliary lines between specific points on the patient’s body, and taking into account angular values, duration and length of the specific gait phases, in order to enable acquisition of quantitative data corresponding to the components of the WGS. The gait of the study participants was recorded, in series of videos. These provided material for three independent raters who reviewed the recordings twice and assessed the participants’ gait using the app. After the evaluation was completed, the data were retrieved from the software. The new application software for the computerised paediatric WGS presents very good inter- and intra-rater reliability. Intra-class correlation coefficient (ICC) was very high in measurement 1 (ICC > 0.9) and 2 (ICC > 0.8), which reflects a very high degree of agreement between the three examiners; there was also high agreement for the specific examiners, between the two measurements (ICC > 0.9). The observational gait scale, objectified through the new software, and enabling computer-aided use of the paediatric WGS, presents practical advantages for examiners since it facilitates decisions taken in the process of WGS-based assessment in children with spastic hemiplegic CP.

Correlation between Selective Motor Control of the Lower Extremities and Balance in Spastic Hemiplegic Cerebral Palsy: a randomized controlled trial

BackgroundChildren with cerebral palsy (CP) have motor deficits caused by spasticity, weakness, contractures, diminished selective motor control (SMC), and poor balance. The purpose of the current study was to evaluate the influence of mirror feedback on lower extremity selective motor control and balance in children with hemiplegic cerebral palsy. Understanding the relationship between SMC and balance will help children with hemiplegic CP receive more appropriate therapies.MethodsForty-seven children of both sexes diagnosed with hemiplegic CP participated in the study. Group1 (Gr1 - control group) received conventional physical therapy training while group 2 (Gr2 - intervention group) received conventional physical therapy training in addition to bilateral lower extremity mirror therapy (MT). The primary outcome measure used was Selective Control Assessment of Lower Extremity scale (SCALE), while the secondary outcome measure was the Pediatric Balance Scale (PBS).ResultsThere were significant differences in Selective Control Assessment of Lower Extremity Scale (SCALE) and Pediatric Balance Scale (PBS) between both groups in favor of Gr2. After treatment, both groups improved significantly, yet Gr2 outperformed Gr1 by a large margin.ConclusionMirror therapy may be a useful addition to home-based motor interventions for children with hemiplegic CP due to its relative simplicity, low cost, and high patient adherence. Additionally, it may help children improve their selective motor skills and balance.Trial registrationCurrent Controlled Trials using African Clinical Trials Registry website with ID number PACTR202105604636415 retrospectively registered on 21/01/202.

The Role of Repetitive Transcranial Magnetic Stimulation in Spastic Hemiplegic Cerebral Palsy in a Sample of Egyptian Children

The Role of Repetitive Transcranial Magnetic Stimulation in Spastic Hemiplegic Cerebral Palsy in a Sample of Egyptian Children

Effect of circuit training program on functional performance in children with hemiplegic cerebral palsy

Background: There is a plethora of literature with some conflicting findings on the effects of implementing strength and/or aerobic training or circuit training exercises to improve motor function of children with spastic hemiplegic cerebral palsy (CP). Circuit training is a form of body conditioning that involves endurance training, resistance training, high-intensity aerobics, and exercises performed in a circuit. Purpose: To investigate the effect of circuit training program on gross motor functions and functional capacity in children with hemiplegic CP. Methods: Thirty-two children with hemiplegic CP from both genders (8-12 years) with motor functional level of I and II based on Gross Motor Functional Classification System were assigned into two equal groups (control and study). The control group received a selected conventional physical therapy program for 60 minutes, including 35 minutes directed to lower limb. The study group received circuit training program for 35 minutes. The program for both groups was conducted twice per week for 12 successive weeks. Gross motor functions and functional capacity of both groups were evaluated by the Gross Motor Function Measure (GMFM) version 66 (Domains D and E) and the Six-Minute Walk Test (6MWT) respectively before as well as after the treatment period.

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.

Construct validity, reliability, and responsiveness of the Wrist Position Sense Test for use in children with hemiplegic cerebral palsy.

We investigate the construct validity, test re-test reliability, and responsiveness of the Wrist Position Sense Test (WPST) for children with hemiplegic cerebral palsy (CP). Twenty-eight children with spastic hemiplegic CP [mean age 10.8 years; SD 2.4 years] and 39 typically developing (TD) children [mean age 11 years; SD 2.9 years] participated in a cross-sectional study to investigate construct validity and association with an upper limb activity measure, the Box and Block Test (BBT). Twenty-two TD children were tested at a second time-point to examine reliability. Test responsiveness was determined by random allocation of 17 children with CP to a treatment (n = 10) or control (n = 7) group with assessments completed at four time-points. Significantly greater differences were observed in mean error of indicated wrist position (p &lt; 0.01) in children with CP at baseline (M = 21.6°, SD = 21.6°) than in TD children (M = 12.8°, SD = 11.0°). Larger WPST errors were associated with poorer performance on the BBT (p &lt; 0.01) indicating a substantial association, and there were no consistent differences between time-points indicating test re-test reliability within a TD population. The WPST demonstrated responsiveness to intervention with a statistically significant reduction in mean error following treatment (p &lt; 0.001), not seen in the control group (p = 0.28). The WPST demonstrated construct validity in this preliminary study. Scores were associated with an upper limb activity measure, and scores changed significantly following somatosensory training. These findings support further research and future psychometric investigation of the WPST in children with CP. This study provides psychometric knowledge about the WPST tool The WPST shows promise as a discriminative measure with preliminary evidence of responsiveness and intra-rater reliability Until further testing, the WPST can be used cautiously in future research studies to measure wrist position sense.

Loaded Functional Strength Training versus Traditional Physical Therapy on Hip and Knee Extensors Strength and Function Walking Capacity in Children with Hemiplegic Cerebral Palsy: Randomized Comparative Study.

Objective: This study’s objective was to see how loaded functional strengthening exercises using a plantigrade foot position and a shoe supporter affected muscle strength and walking ability in spastic hemiplegic children. Methods: Seventy-two children with spastic hemiplegic cerebral palsy, both sexes, aged ten to twelve years, were randomly assigned into two groups equal in number (control and intervention groups). The control group received a specially designed physical therapy program, whereas the intervention group received a loaded functional strengthening exercises program using a shoe supporter to maintain a plantigrade foot position. The training program was carried out for 60 min, three times per week for three consecutive months. All participants were evaluated both before and after the therapy program by using a Medical Commander Echo Manual Muscle Tester dynamometer to assess isometric muscle power of hip and knee extensors on the affected side. To assess functional walking capacity, a 6 min walking (6MWT) test was used. Results: Study groups were comparable with respect to all outcome measures at entry (p > 0.05). Within-group comparison showed significant improvements in all measured variables. Furthermore, between-group comparison revealed significantly greater improvements (p < 0.05) in hip and knee extensors strength as well as the functional walking capacity in favor of the intervention group. Conclusions: In all the analyzed variables, loaded functional strength exercises from the plantigrade foot position were found to be considerably more effective in the intervention group than in the control group.

Effects of Augmented Reality Interventions on the Function of Upper Extremity and Balance in Children With Spastic Hemiplegic Cerebral Palsy: A Randomized Clinical Trial.

ObjectiveTo determine the effects of augmented reality (AR) interventions on the function of the upper extremity (UE) and balance in children with spastic hemiplegic cerebral palsy (SHCP).MethodsIn total, 30 children with SHCP, aged 6 to 12 years, were randomly divided into three interventional groups. Each group received an AR game, i.e., Balance It, Bubble Pop, or Scoop'd (WonderTree, Pakistan). The UE function and balance were assessed at the baseline and after 8 weeks of intervention through the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and Pediatric Balance Scale (PBS), respectively. The mixed ANOVA was used to determine the combined with-in and between-the-groups differences in the function of the upper extremity. The Wilcoxon sign ranked test was used for with-in group changes, while the Kruskal Wallis test with the bonferroni correction post-hoc analysis was used to compare the groups in terms of balance. The data were analyzed by using SPSS version 21 and the level of significance was set at p < 0.05. Paired sample t-test and Wilcoxon signed-rank test was used for analyzing the changes in the total DASH and PBS scores within the groups, respectively. One-way ANOVA was used to determine the differences between the groups in the total DASH and PBS scores, while the Kruskal Wallis test was used for the differences between the groups in the PBS items. The data were analyzed by using SPSS version 21.ResultsAll the groups improved significantly in the total DASH and PBS scores post-intervention. A significant difference was determined in standing with one foot in front between Bubble Pop and Balance It groups (p = 0.03). The total score of PBS also showed a significant difference between Bubble Pop and Balance It groups (p = 0.02).ConclusionThe AR interventions used in this study were found to be effective in improving the UE function and balance of children with SHCP. The Balance It game showed more promising results in improving the balance as compared with the other games, however, no significant difference was determined between the three AR games in terms of the UE function of the participants.