Effect of Forward Versus Backward Walking Training on Back Geometry and Mobility Function in Children With Cerebral Palsy: a Randomized Controlled Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 33
- 试验地点
- 2
- 主要终点
- Lateral deviation
研究概览
简要总结
PURPOSE: To assess the effect of backward walking training on back geometry and mobility function in children with hemiparetic cerebral palsy through a comparative analysis with forward walking training.
BACKGROUND:
Spinal deformities are important orthopaedic problems among children with cerebral palsy. A detailed evaluation of all these areas when the child first arrives for treatment is essential. The majority of research in children with CP is focused on assessment and treatment of upper and lower extremities. In contrast, literature on trunk control in children with CP is scarce. Although proximal trunk control is a prerequisite for improving balance and weight symmetry, there is a lack of studies that reported the role of forward and backward walking training in treating the trunk for children with CP. Therefore, the purpose of this study will investigate the role of backward walking training in addition to conventional physiotherapy program on back geometry and mobility function in children with spastic hemiparetic cerebral palsy.
HYPOTHESES: The null hypothesis of this study could be stated as: There will be no statistically significant difference in back geometry and mobility function after adding backward walking training to conventional physical therapy program in spastic hemiparetic cerebral palsy children compared with forward walking training.
RESEARCH QUESTION: Do adding backward walking training to conventional physical therapy program improves back geometry and functional mobility in children with hemiparetic cerebral palsy?
详细描述
Introduction:
Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation. It is the most common cause of physical disability during childhood that affects the child on several health dimensions including neuromuscular deficits, such as spasticity, muscle weakness, and decreased selective motor control, and secondary musculoskeletal problems such as bony malformations and contractures.
Trunk impairment is very common but an underscored feature of spastic CP that affects the upper and lower extremity motor functions as well. Impairments associated with the trunk seen in children with CP include but are not limited with decreased stability of the head and trunk, shoulder protraction, spinal curve deviations, and trunk muscle weakness. Inadequate control of trunk muscles leads to compensation of other muscles to maintain the upright posture. Inability of proximal stabilization and increased activation of extremity muscles during postural adjustments reduces their functionality during extremity movements.
Trunk control is the initial frame of reference for postural control; it involves stabilization through selective movements of the trunk. Although trunk control strategies vary depending on the task and the environment, all functional tasks require adequate trunk control. Without the trunk as a stable center, selective movements of the extremities and of the head are profoundly impaired. In children, trunk control ensures the acquisition of basic gross motor skills in order to develop the goal-directed activities that are essential for independent life at home and in the community.
Evaluation of the CP child's passive and active movement of the trunk is an essential part of the evaluation because mobility of the spine in all planes is necessary for correct alignment, smooth and asymmetric movements of the spine and for full range of motion of the extremities. The therapist must document any deviation from normal, note scoliosis, excessive kyphosis and lordosis and whether the curves are structural or functional.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 5 Years 至 7 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age ranged from 5 to 7 years
- •Average height around one meter or more as it is the suitable height for formetric measures
- •They were able to stand alone independently and have the ability to walk both forward and backward over ground without an assistive device.
- •They were able to understand and follow verbal command. They were classified as I or II by gross motor function classification system (GMFCS).
- •The degree of spasticity in the involved lower extremity according to Modified Ashworth Scale ranged between grades 1, 1+ and 2.
排除标准
- •Neurological or orthopedic surgery in the last 12 months, uncontrolled seizure disorder, visual, auditory or perceptual problems and who had any experience of backward training before the trial.
结局指标
主要结局
Lateral deviation
时间窗: Change from Baseline Lateral deviation at 3 months
The root mean square (RMS) lateral deviation of the spinal midline from the line VP-DM. It is measured in millimeters
Trunk imbalance
时间窗: Change from Baseline Trunk imbalance at 3 months
It represented the lateral deviation of the vertebra prominence from the dimple midpoint. It is measured in millimeters.
Pelvic tilt
时间窗: Change from Baseline Pelvic tilt at 3 months
The pelvic tilt refers to a height difference of the lumber dimples relative to a horizontal plane. It is measured in millimeters
Surface rotation
时间窗: Change from Baseline Surface rotation at 3 months
The root mean square (RMS) value of the surface rotation on the symmetry line (in degrees).
Pelvic torsion
时间窗: Change from Baseline Pelvic torsion at 3 months
It is the twisting of the pelvis about a transverse axis (in degrees).
次要结局
- Mobility function(Change from Baseline dynamic gait index at 3 months)
研究者
Amr Almaz Abdel-Aziem
Professor of Biomechanics
Cairo University