Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Children with Spastic Diplegia: A Study Protocol for a Randomized Clinical Trial

Background: Cerebral Palsy is a spacious term which highlights an extensive gamut of motor affliction which has a stagnant tendency. The estimated Cerebral Palsy is indeed very prevalent in developed nations 2 out of the next 1000 live births and neonatal survivors. Among several Cerebral Palsy comes in a variety of manifestations. Spastic Diplegia is common in a majority of Preterm babies. Several treatment strategies of Physical therapy are utilized for Spastic Diplegia. This research focusses on assessing the Efficiency of Pelvic Proprioceptive Neuromuscular Facilitation (PNF) techniques over the Dimensions of Balance and Gait in children with Spastic Diplegia. Objective: To evaluate the Effectiveness and impact of the techniques of Pelvic Proprioceptive Neuromuscular Facilitation (PNF) on Balance, Gait Parameters and Pelvic Asymmetry in children having Spastic Diplegia. Methods: In this Randomized Clinical Trial, subjects (n= 40) having Spastic Diplegia will be selected and segregated in two groups using simple random sampling method with 1:1 allocation ratio. The allocation will be done through sequentially numbered opaque sealed envelope (SNOSE). Subjects in the experimental group will receive Pelvic PNF techniques like Rhythmic initiation and Slow reversal with Task- Oriented training which will contain sit to stand exercises, walking on the ground and reaching tasks for improving the balance and those in the other group will be given only Task- Oriented training for 4 weeks following baseline assessments. Throughout the treatment session and following 4 weeks follow up will be taken by assessing the Balance and Gait parameters of the subjects. The study duration will. be of 1 year. Subjects with Spastic Diplegia with an age group of 8 to 12 years who are able to do independent sitting, who are coming under GMFCS level I to III and those who are having pelvic asymmetry will be included in the study while subjects who had any surgery of spine or lower limb in past 6 months, who are having fixed deformities of spine or lower limb or any fracture or dislocation of spine or lower limb will be excluded from the study. Results: Results will be recorded by using the outcome measures and instruments such as Pediatric Balance Scale, Gait Parameters and Palpation meter device at the end of the intervention and the effects of Pelvic PNF techniques will be compared with the other group which will receive Task oriented training. The statistical analysis will be done by using paired t test but if the data does not follow a normal distribution then Wilcoxon sign rank test will be used. Discussion: The intention and motive of the study is to check the Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation techniques on Balance and Gait Parameters in children with Spastic Diplegia. Conclusion: The conclusion of this research is to acquire the fruitfulness of Approaches of Pelvic PNF on Balance and Gait Parameters in children having Spastic Diplegia.

Functional changes in neural networks of the brain in patients with spastic diplegia after translingual neurostimulation

Introduction. Rehabilitation of children with cerebral palsy is one of the most difficult tasks in modern neurology. One of the promising areas is the combination of physiotherapy with methods of stimulation of various parts of the nervous system, among which functional electrical stimulation of muscles and nerves (FES) is distinguished.Purpose of research. Assessment of changes in the functional connectivity of neural networks in the brain in patients with cerebral palsy before and after translingual neurostimulation using functional MRI at rest.Materials and methods. Analyzed the results of changes in the functional connectivity of neural networks in the brain in 25 patients with cerebral palsy before and after translingual neurostimulation. A clinical examination was carried out with an assessment of complaints, anamnesis and an assessment on neurological scales, followed by standard and functional MRI of the brain at rest.Summary. In children with spastic diplegia, functional changes in neural networks with a predominance of processes of strengthening intra- and interhemispheric connections (p<0,05) were revealed, which correlates with clinical changes in the form of a decrease in spasticity and an improvement in motor skills.

Combination taping technique versus ankle foot orthosis on improving gait parameters in spastic cerebral palsy: A controlled randomized study

Background: One of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society. Objective: To compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia. Methods: Thirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions. Results: Significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups than pre-intervention values. [AQ9] Moreover, the post--intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters. Conclusion: The results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.

Structural reorganization of the white matter pathways of the brain in patients with spastic diplegia after translingual neurostimulation

Background. Spastic diplegia (Little’s disease) is the most common form of infantile cerebral palsy (ICP), leading to persistent motor and functional impairments. One promising area of rehabilitation is a combination of physical therapy with methods of stimulation of various parts of the nervous system, among which functional electrical stimulation of muscles and nerves is the most prominent.Objective. To study structural changes of cerebral white matter conduction pathways in patients with spastic diplegia after translingual neurostimulation using magnetic resonance tractography.Materials and Methods. An open single center-controlled study was conducted. A total of 18 children were examined. All patients underwent comprehensive MRI in two time points, before and after a course of translingual neurostimulation, on a tomograph with magnetic field induction 3.0 Tesla, which included a traditional protocol in 3 mutually perpendicular planes), and diffusion-weighted imaging — DWI (Diffusion-Weight Imaging).Results. All patients after neurostimulation showed clinical improvement of movement coordination and decrease of muscle tone with formation of new motor skills, improvement of limb motor function. Statistically significant decrease of spasticity index was revealed up to 17% for arms and 23% for legs, improvement of motor skills on all three scales.Conclusion. Translingual neurostimulation allows to affect all components of motor activity, as a result of which neuroplasticity processes are activated and the brain of patients with spastic diplegia becomes more receptive to motor rehabilitation aimed at restoration of motor control and formation of new motor skills.

An effect of spinal and ankle-foot orthoses on gait of spastic diplegic child: A case report

BACKGROUND: In children with spastic cerebral palsy (CP), the most common motor dysfunction is pathological gait. OBJECTIVE: To evaluate the effectiveness of measures for an individual CP case. METHODS: The case of one spastic diplegia child has been analyzed. Both lower extremities and spine were examined under three gait conditions: 1) barefoot, 2) with ankle-foot orthoses (AFOs) and thoracolumbosacral spinal orthosis (TLSO), and 3) with TLSO only. Spatiotemporal gait and kinematic parameters of the pelvic, hip, knee, ankle joints, and spine were obtained using Vicon Plug-in-Gait model. The difference (Δ) between the measured values and normative ranges was calculated to determine the efficiency of the orthoses. RESULTS: Significant differences were found in kinematic and spatiotemporal parameters comparing results between conditions and body sides. The effectiveness of the measures was confirmed by the smallest Δ values in the double and single support time with the AFOs/TLSO and in the stride and stance time with TLSO. CONCLUSIONS: Based on the study results, the best stability of the spine, ankle plantarflexion, and knee hyperextension is achieved with the AFOs/TLSO; therefore, this combination of measures was considered the most effective. However, not only quantitative parameters should be taken into account, but also the child’s willingness and comfort.

THE INFLUENCE OF COMPREHENSIVE REHABILITATION MEASURES COMBINED WITH THE OSTEOPATHIC TREATMENT ON THE BALANCE FUNCTION COEFFICIENT IN CHILDREN SUFFERING FROM CEREBRAL PALSY

The article highlights the study records on the infl uence of comprehensive rehabilitation measures combined with osteopathic treatment on the balance function quality in children suff ering from cerebral palsy. The study involved children aged 7 to 12 with spastic diplegia (level II according to GMFCS), intact intelligence, and the ability to move independently without technical devices. The study showed that, if the osteopathic treatment was included in the set of rehabilitation measures, the quality of life and postural control in the upright position improved in children, the latter manifested itself in an increased indicator of the balance function quality.