Effect of Postural Stability Exercises on Gait Parameters in Children with Spastic Diplegia Cerebral Palsy: An Experimental Trial

Latika Gulyani; Kanniapan Vadivelan; Anshika Singh; Shagun Agarwal; Sumit Raghav

doi:10.15391/prrht.2024-9(6).04

Authors

Latika Gulyani Department of Physiotherapy, College of Medical Sciences (Allied Health Sciences) IIMT University, Meerut, Uttar Pradesh, India https://orcid.org/0000-0003-1129-123X
Kanniapan Vadivelan SRM College of Physiotherapy, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India https://orcid.org/0000-0003-2088-9874
Anshika Singh School of Allied Health Science, Galgotias University, Greater Noida, Uttar Pradesh, India https://orcid.org/0000-0002-2254-6632
Shagun Agarwal School of Allied Health Science, Galgotias University, Greater Noida, Uttar Pradesh, India https://orcid.org/0009-0004-4342-0950
Sumit Raghav School of Allied Health Science, Galgotias University, Greater Noida, Uttar Pradesh, India https://orcid.org/0000-0003-4485-9725

DOI:

https://doi.org/10.15391/prrht.2024-9(6).04

Keywords:

Cerebral Palsy, Edinburg Visual Gait Score, Gait parameters, Postural Stability, Postural Stability Exercises, Spastic Diplegia CP

Abstract

Postural stability helps maintain the position of the body within the support area to maintain control, but this postural stability is affected in children with cerebral palsy during static or dynamic activities. However, the practical application of postural stability exercises combined with muscle strengthening has not been studied in spastic diplegia cerebral palsy children with gait difficulties.

Purpose: To study the effect of postural stability exercises on the gait and posture of children with spastic diplegia cerebral palsy.

Materials & Methods. 23 subjects with spastic diplegia cerebral palsy within the age group of 8 to 15 years, both male and female were randomly allocated into two groups Group A (Experimental) n=12 and Group B (Control) n=11, voluntarily participated and EVGS and DGI were used to assess the posture, gait, and functional capacity as outcome measures. Pre-test and post-test values were used for the interpretation of data.

Results: The mean difference of 3.25 with a t-value of 8.74 at a significance of 0.000 (p<0.005) was calculated which shows a statistically significant difference between the pre and post-values of Group A and the mean difference of 1.63 with a t-value of 8.05 at a significance of 0.000 was calculated, which is statistically significant.

Conclusion: Combined effect of postural stability exercises along with muscle strengthening exercises have a significant effect on the gait functions in children with spastic diplegia CP of GMFCS level II and III.

References

Akbas, A.N. (2016). Assessment and outcome measures of cerebral palsy, Intech open book chapter 2. https://doi.org/10.5772/64254

Aye Thanda, Thein Soe, & Hlang Thaningi (2016). Effects of a strength training program on hip extensors and knee extensors of lower limb in children with spastic diplegic cerebral palsy. J. Phys.Ther. Sci., (28), 671-676. https://doi.org/10.1589/jpts.28.671

Booth, A.T.C., Buizer, A.I., Meyns, P., Lansink, L.B., Steenbrink, F., & Krogt, M. (2018). The Efficacy Of Functional Gait Training In Children And Young Adults With Cerebral Palsy: A Systematic Review And Meta-Analysis, Developmental Medicine & Child Neurology. https://doi.org/10.1111/dmcn.13708

Capucho, P., Carnier, S., Carnier, S., Souza, P., Castro, D., Finocchio, A. et al. (2012). Cerebral palsy - lower limbs: rehabilitation. Acta Fisiátrica, 19(2) 114-122. https://doi.org/10.5935/0104-7795.20120018

Cerebral Palsy (2014)., J. Phys. Ther. Sci., 26, 1667-1669. https://doi.org/10.1589/jpts.26.1667

Damiano, D.L., & Abel, M.F. (1998). Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil, (79), 119-25. https://doi.org/10.1016/S0003-9993(98)90287-8

Eek, M., Tranberg, R., Zügner, R., Alkema, K., & Beckung, E. (2008). Muscle strength training to improve gait function in children with cerebral palsy. Developmental Medicine & Child Neurology, 50(10), 759-764. https://doi.org/10.1111/j.1469-8749.2008.03045.x

Hicksa, J.L., Schwartz, M.H., Arnold, A.S., & Delp, S.L. (2008). Crouched postures reduce the capacity of muscles to extend the hip and knee during the single limb stance phase of gait, J Biomech., 41(5), 960-967. https://doi.org/10.1016/j.jbiomech.2008.01.002

Kalirathinam. D. (2012). Gait training On Spastic Diplegic children-A physiotherapy Approach. IOSR Journal of Nursing and Health Science., 1(1), 1-5. https://doi.org/10.9790/1959-0110105

Lee, M.Y., & Lee, H.Y. (2013). Analysis for sit-to-stand performance according to the angle of knee flexion in individuals with hemiparesis, J Phys Ther Sci, 25: 1583-1585. https://doi.org/10.1589/jpts.25.1583

Liao, H.F., Liu, Y.C., Liu, W.Y., & Lin, Y.T. (2007). Effectiveness of loaded sit-to-stand resistance exercise for children with mild spastic diplegia: a randomized clinical trial, Arch Phys Med Rehabil, 88, 25-31. https://doi.org/10.1016/j.apmr.2006.10.006

Lubetzky, V., Tracy, J., & Mccoy, S. (2011). Westcott, Investigation of the Dynamic gait index in children: a pilot study, Pediatr Phys Ther., 23(3), 268-273. https://doi.org/10.1097/PEP.0b013e318227cd82

Mohsen Hatem Abdel, & Emara Abdel Hamid (2015). Effect of a new physical therapy concept on dynamic balance in children with spastic diplegic cerebral palsy, The Egyptian Journal of Medical Human Genetics, 16, 77-83. https://doi.org/10.1016/j.ejmhg.2014.09.001

Morais Filho, M., Kawamura, C., Lopes, J., Neves, D., Cardoso, M., & Caiafa, J. (2014). Most frequent gait patterns in diplegic spastic cerebral palsy. Acta Ortopédica Brasileira, 22(4), 197-201. https://doi.org/10.1590/1413-78522014220400942

Palmer, B. (2014). Improving Gait and Function in Children with Cerebral Palsy; A Comparison of Supported Speed Treadmill Training to Therapeutic Exercise.

Pavão, S., dos Santos, A., Woollacott, M., & Rocha N. (2013). Assessment of postural control in children with cerebral palsy: A review. Research in Developmental Disabilities, 34(5), 1367-1375. https://doi.org/10.1016/j.ridd.2013.01.034

Peungsuwan Punnee, Parasin Pattamavadee, Siritaratiwat Wantana, Prasertnu Jilada, & Yamauchi Junichiro (2017). Effects of Combined Exercise Training on Functional Performance in Children With Cerebral Palsy: A Randomized-Controlled Study, Pediatr Phys Ther, 29, 39-46. https://doi.org/10.1097/PEP.0000000000000338

Read, H.S., Hazelwood, M.E., Hillman, S.J., Prescott, R.J., & Robb, J.E. (2003). Edinburgh Visual Gait Score for Use in Cerebral Palsy, Journal of Pediatric Orthopaedics, 23, 296-301. https://doi.org/10.1097/01241398-200305000-00005

Rose, J., Wolff, D., Jones, V., Bloch, D., Oehlert, J., & Gamble, J. (2007). Postural balance in children with cerebral palsy. Developmental Medicine & Child Neurology, 44(1), 58-63. https://doi.org/10.1111/j.1469-8749.2002.tb00260.x

Rosenbaum, P.L, Palisano, R.J, Bartlett, D.J, Galuppi, B.E., & Rusell, D.J. (2008). Development of the Gross Motor Function Classification System for cerebral palsy, Developmental Medicine & Child Neurology, 50, 249-253. https://doi.org/10.1111/j.1469-8749.2008.02045.x

Shin, H., Sung, K., Chung, C., Lee, K., Lee, S., Lee, I. et al. (2016). Relationships between Isometric Muscle Strength, Gait Parameters, and Gross Motor Function Measure in Patients with Cerebral Palsy. Yonsei Medical Journal, 57(1), 217. https://doi.org/10.3349/ymj.2016.57.1.217

Westcott, S., Lowes, L., & Richardson, P. (1997). Evaluation of Postural Stability in Children: Current Theories and Assessment Tools. Physical Therapy, 77(6), 629-645. https://doi.org/10.1093/ptj/77.6.629

Willoughby, K.L., Dodd, K.J., Sheilds, N., & Foley, S. (2010). Efficacy of partial body weight- supported treadmill training compared with overground walking practice for children with cerebral palsy: A Randomized Controlled Trial, Arch Phys Med Rehabil, 91, 333-9. https://doi.org/10.1016/j.apmr.2009.10.029

World Health Organization (2001). International classification of functioning, disability, and health. ICF Short version. Geneva: Switzerland.

Yalcinkaya Y.E., Caglar N.S., Betul, T., & Aysegul, T. (2014). Rehabilitation outcomes of children with cerebral palsy, J. Phys. Ther. Sci, 26(2), 285-289. https://doi.org/10.1589/jpts.26.285