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Journal presentation

By- HARSHITHA T
Physiotherapy Intern
SDUAHER
TAMAKA, KOLAR.
CITATION
• Gulzar A, Waris M; Qurat Ul Ain. Effects of 8 weeks functional
training programme on posture control and functional
mobility in spastic hemiplegic cerebral palsy. J Pak Med Assoc.
2022 Jul;72(7):1278-1281. doi: 10.47391/JPMA.3476. PMID:
36156543.
TITLE: Effects of 8 weeks functional training programme
on posture control and functional mobility in spastic
hemiplegic cerebral palsy
BACKGROUND
• Cerebral palsy (CP) is a non-progressive neurological condition, which
occurs due to disturbance in brain development in the foetus or the
infant. It results in abnormal motor skills, muscle tones, movements
and postures. Along with activity limitation, it can also affect
perception, communication, sensation, cognition and behaviour.
• Types of CP include ataxic, spastic, athetoid and mixed. Another
classification is done according to degree of disability, like quadriplegic,
triplegic, hemiplegic, diplegic, monoplegia or paraplegic.
• Different studies showed that CP children may have some visual
disorders, auditory effects, speech disorders, behavioral and mental
issues.
• There can be several causes of CP, from idiopathic to some known
reasons. CP risk factors include anaemia in mother, birth asphyxia and
seizure.
CONT
• Early intervention includes multidisciplinary team
services. Treatment has to be focused to improve fine
and gross motor functions.
• According to studies, functional-gait-training and
intensive intervention for lower extremity had positive
effects on gait improvement and balance control in CP
children.
• The current study was planned to determine the
impacts of functional training versus conventional
training on posture control and functional mobility in
spastic hemiplegic CP children.
AIM
• To determine the impacts of functional
training versus conventional training on
posture control and functional mobility in
spastic hemiplegic cerebral palsy children.
METHODOLOGY
• STUDY DESIGN: Randomized clinical trial
• The subjects were randomized 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.
• INCLUSION CRITERIA: The sample was raised using non-probability
convenience sampling technique13 from among spastic hemiplegic CP
children. Those included were children diagnosed with CP, aged 4-14
years, having Gross Motor Functional Classification System (GMFCS)14
level II or lll, having no mental retardation and with Modified-Ashworth-
Scale (MAS)15 spasticity level grade 1-III
• EXCLUSION CRITERIA: Those excluded were children who had had
orthopedic surgery or had used botulinum toxin, had severe visual defect,
auditory problems and vestibular issues.
CONT..
Patients and Methods: The single-blind
randomized clinical trial (RCT) was conducted at
the Rehab Cure physiotherapy Centre, Lahore,
Pakistan, from January to September 2020. After
approval from the Riphah International University,
Lahore, the sample size was calculated using Epi-
Tool,11 with mean 1=19.8, variance 1=11.32, mean
2=25.4, variance 2= 13.37, power 0.8, confidence
level=0.95 and ratio of sample size n2/n1=1. 12
ASESSMENT TOOLS USED

• Pediatric 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 analyzed using SPSS 21.


TREATMENT/INTERVENTIONS
First of all, the subjects were randomized using the lottery method20 into
conventional therapy group A and functional training group B.
Baseline treatment included transcutaneous electrical nerve stimulation (TENS), hot
pack and stretching exercises.
Group A received exercises, like bridging, diagonal pattern exercises, perturbation-
based balance training in sitting and standing positions, supine-to-sit exercises,
lateral walks, step-ups, gait training, stair climbing, weight-shifting and cat position.
Group B additional received exercises, like gym ball exercises, exercise with resistance
bands, unilateral pelvic bridging, trampoline jumping, resistance kneeling, Bosu
ball exercises, treadmill walk, cycling, catwalk, back-walk, squats and stepper
exercises. The intensity of exercises was gradually increased each week, staring
from 10 reps to 20 reps.
The subjects received the sessions 3 times a week for 8 weeks, with each session
lasting 45-60min. Treadmill walk training gradually increased from 3min to 7min
with 2min warm-up and 2min cool down. The groups received treatment on
alternate days to maintain blindness to therapy. All measurements were taken at
baseline and post-intervention.
STATISCAL ANALYSIS
• Data was analyzed using SPSS 21. Intragroup
analysis was done using paired t test, while
intergroup comparisons were done using
independent sample-t-test. P
RESULTS
• Of the 14 subjects, there were 7(50%)in each
ofthe 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(p0.05).
RESULTS:
There were 8(57.14%) males and 6(42.86%)
females with a mean age of 7.57±1.86 years.
GMFCS levels and MAS grades were noted.
RESULTS
RESULTS
CONCLUSION
• Both functional training and conventional
therapy significantly improved postural
control and functional mobility in spastic
CP children, but intergroup differences
were not significant
CRITICAL APPRAISAL
1. Eligibility Criteria Were Specified: YES
2. Subjects Were Randomly Allocated To Groups: YES
3. Allocations Were Concealed: YES
4. The Groups Were Similar At Baseline Regarding The
Most Important Prognostic Indicators: NO
5. There Was Blinding Of All Subjects: YES
6. There Was Blinding Of All Therapists Who
Administered The Therapy: NO
7. There Was Blinding Of All Assessors Who Measured At
Least One Key Outcome: NO
cont
8. Measures Of At Least One Key Outcome Were Obtained From More
Than 85% Of The Subjects Initially Allocated To Groups:YES
9. All Subjects For Whom Outcome Measures Were Available Received
The Treatment Or Control Condition As Allocated Or, Where This Was
Not The Case, Data For At Least One Key Outcome Was Analyzed By
“Intention To Treat”: NO
10. The Results Of Between-group Statistical Comparisons Are Reported
For At Least One Key Outcome: YES
11. The Study Provides Both Point Measures And Measures Of
Variability For At Least One Key Outcome: NO
• TOTAL SCORE= 5/10
Eligibility criteria should not be recorded in the score.
REFERENCES
1. Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical
overview. Transl Pediatrics 2020; 9: S125-35.
2. Philip SS, Guzzetta A, Chorna O, Gole G, Boyd RN. Relationship between brain
structure and Cerebral Visual Impairment in children with Cerebral Palsy: A
systematic review. Res Dev Disabil 2020; 99: 103580.
3. Ansari M, Raghunathrao R, Ansari M. Auditory brainstem response characteristics of
children with cerebral palsy: Clinical Utility and Prognostic Significance. Otolaryngol
(Sunnyvale). 2016; 6: 259.
4. Mei C, Reilly S, Bickerton M, Mensah F, Turner S, Kumaranayagam D, et al. Speech in
children with cerebral palsy. Dev Med Child Neurol 2020; 62: 1374-82.
5. Downs J, Blackmore AM, Epstein A, Skoss R, Langdon K, Jacoby P, et al. The
prevalence of mental health disorders and symptoms in children and adolescents
with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol
2018; 60: 30-8.
6. Miller F, Bachrach SJ. Cerebral palsy: A complete guide for caregiving. JHU Press;
2017.

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