Postural problems of children with CP based on hemiparesis

Małgorzata Domagalska, Krzysztof Czupryna, Andrzej Szopa, Janusz Nowotny

Małgorzata Domagalska, Krzysztof Czupryna, Andrzej Szopa, Janusz Nowotny – Postural problems of children with CP based on hemiparesis. Fizjoterapia Polska 2008; 8(3); 253-259

Abstract
Background. Injury to the immature brain leads to impaired development of the antigravity mechanism. The adoption of progressively higher body positions is only possible due to compensatory mechanisms. The aim of the study was to diagnose postural disorders in children with CP with respect to the adopted compensatory mechanisms. Material and methods. Eighteen children with advanced hemiparesis, aged from 5 to 14, took part in the study. Objective posturometric measurements were taken while the patients maintained a standing position without assistance. Photogrammetric measurements was used to evaluate the spatial arrangement of individual body segments, with pressure forces on the support base being assessed simultaneously using a baroresistive platform. Results. Patients demonstrated two types of postural patterns: a progravity pattern and an antigravity pattern, which differed mainly in terms of the patient habitually overloading or unloading one of the lower limbs, changing the position of the centre of gravity projection on the support base and a characteristic relation of the shoulder and pelvic lines. Conclusions. The nature of postural disorders in CP children depends on the anti- or progravitational nature of the paresis. The development of postural disorders in CP children is predictable and should therefore be taken into account from the very beginning of rehabilitation
Key words:
cerebral palsy, compensatory antigravity mechanism, postural problems
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The Usefulness of Hippotherapy in the Rehabilitation of Cerebrally Palsied Children. Pilot Study

Dariusz Białoszewski, Izabela Korabiewska, Monika Lewandowska, Katarzyna Wasiak

Dariusz Białoszewski, Izabela Korabiewska, Monika Lewandowska, Katarzyna Wasiak – The Usefulness of Hippotherapy in the Rehabilitation of Cerebrally Palsied Children. Pilot Study. Fizjoterapia Polska 2011; 11(2); 175-181

Abstract
Zootherapy has been introduced in recent years as an adjunct approach to traditional physiotherapy in patients with cerebral palsy (CP). Hippotherapy is less popular in Poland compared to other European countries or the USA, with few reports of investigations carried out in accordance with the EBM paradigm. The aim of the present study was to evaluate the usefulness of hippotherapy in comprehensive rehabilitation of children with cerebral palsy.The study involved 40 cerebrally palsied children who were randomly divided into two equal-sized groups (A and B). Both groups received home-based rehabilitation according to the Proprioceptive Neuromuscular Facilitation (PNF) method. Group A additionally received hippotherapy. The children’s motor function was determined using the Gross Motor Function Measure (GMFM).In Group A was 0.02 for ChP=5.226, 1 df. The parameter determined in the study exceeded this critical value, thus allowing the conclusion that the effect of home-based rehabilitation combined with hippotherapy on overall health improvement was statistically significant (p<0.05). In Group B, the right-tailed critical value (p) was 0.429 for Chi2=0.625, 1 df. The parameter determined in the study did not exceed the critical value, thus not allowing the statement that home-based rehabilitation had a significant effect on overall health improvement.1. The study shows significantly better results of rehabilitation in children treated with combination of PNF and hippotherapy. 2. The results indicate the need for randomized prospective studies involving larger test groups.
Key words:
Cerebral Palsy, Rehabilitation, hippotherapy, physiotherapy
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The application of the Balance Trainer parapodium in the therapy of children with cerebral palsy

Agata Michalska, Jolanta Dudek, Mieczysława Bieniek, Anna Tarasow-Zych, Kamila Zawadzka

Agata Michalska, Jolanta Dudek, Mieczysława Bieniek, Anna Tarasow-Zych, Kamila Zawadzka – The application of the Balance Trainer parapodium in the therapy of children with cerebral palsy. Fizjoterapia Polska 2011; 11(3); 273-285

Abstract
Inconstant clinical image and functional state of patients with cerebral palsy as well as difficulties in achievements of intended therapy aims put forward the need for constant searching for new improvement methods by the physiotherapists. The Balance Trainer – static-dynamic parapodium equipped with Balance-Soft computer program – is the device which can be applied in the therapy and diagnostics of persons with cerebral palsy. The aim of the thesis is to estimate the possibilities to apply the Balance Trainer device in the therapy of the children with cerebral palsy. Children and youth (7 subjects) with different forms of ICP, assessed using GMFCS (levels I-IV) scale were qualified for the study. The subjects were initially examined using Balance Trainer parapodium. The tests involved assessment of gravity centre location (balance test), deflection test and the assessment of the ability to perform intended movements in the frontal and sagittal plane. Next, their posture was controlled in standing position and the initially performed tests were repeated. All the results were statistically analysed. In children with lower GMFCS levels (I-II) the treatment brought about better results than in these with higher levels of impairment (III-IV), although a therapeutic success was achieved in each case.Using the Balance Trainer device in the treatment of children with cerebral palsy one can improve both the postural control and movement coordination. The improvement level depends on the form of cerebral palsy and the functional deficiency.
Key words:
Cerebral Palsy, Postural control, static-dynamic parapodium
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Robotic-assisted locomotor training in a 7-year-old child with hemiplegia. Case study

Ewelina Żak, Grzegorz Sobota, Jacek Durmała

Ewelina Żak, Grzegorz Sobota, Jacek Durmała – Robotic-assisted locomotor training in a 7-year-old child with hemiplegia. Case study. Fizjoterapia Polska 2012; 12(2); 159-168

Abstract
Background. The aim of the study was to assess the effectiveness and influence on gait parameters of a 4 – week automated training by a driven gait orthosis. Material and methods. Treadmill training with a driven gait orthosis was used for a 7 year with hemiplegia. Her disability represented 1 level in the GMFCS scale. The child received 18 sessions over 4-week period (5sessions/week, mean therapy duration was 45 minutes per session). Pre and post-training evaluations were performed on kinematics gait parameters using motion capture system (BTS-Smart). Results. After therapy were observed return or approximate value of the evaluated parameters to a normative level of control group. Conclusions. Even small changes in temporal and distance parameters of gait could improve comfort and quality of the patient’s gait. After therapy, there was noted improvement in most of the gait parameters pointing to positive impact of this form of therapy in patient with impaired gait described.
Key words:
Cerebral Palsy, gait analysis, locomotor training, three-dimensional motion analysis
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Assessment of the Impact of Hippotherapy on the Level of Satisfaction with Life and Acceptance of Illness Among Parents of Children with Cerebral Palsy

Dariusz Białoszewski, Monika Lewandowska, Izabela Korabiewska, Witold Rongies, Marta Woińska, Joanna Gotlib

Dariusz Białoszewski, Monika Lewandowska, Izabela Korabiewska, Witold Rongies, Marta Woińska, Joanna Gotlib – Assessment of the Impact of Hippotherapy on the Level of Satisfaction with Life and Acceptance of Illness Among Parents of Children with Cerebral Palsy. Fizjoterapia Polska 2012; 12(2); 141-146

Abstract
Background. The parents’ satisfaction with life and their acceptance of their child’s illness are important factors that directly and / or indirectly influence the process of rehabilitation of children with cerebral palsy. The aim of this study was to evaluate the effect of hippotherapy on the level of satisfaction with life and acceptance of illness among parents of children with cerebral palsy. Material and methods. The study was conducted in 2008-2010 among 94 parents of cerebrally palsied (CP) children partici­pating in hippotherapy sessions in Warsaw. The study used an original questionnaire with questions dealing with the effect of hippotherapy on selected psychological factors in the parents. The questionnaire was completed by the parents twice: before and after a one-year hippotherapy course. Two psychometric scales: the Satisfaction with Life Scale (SWLS) and the Acceptance of Illness Scale (AIS), were also used, both adapted for Polish by Juczyński. The results were analyzed statistically.Results. Overall satisfaction with life among the parents increased significantly (p<0.05) during the year-long hippotherapy course. There was also a statistically significant increase in the parents’ acceptance of their children’s condition. Conclusion. Hippotherapy in CP children significantly increases their parents’ satisfaction with life and acceptance of their children’s illness.
Key words:
hippotherapy, Satisfaction with Life, acceptance of illness, Cerebral Palsy, Parents
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ffect of locomotor training with a robotic-gait orthosis (lokomat) In Spasticity Modulation of Spastic Hemiplegic Children: A Randomized Controlled Trial

Mohamed Serag Eldein Mahgoub, Wagdy William Amin, Samah Saad Zahran

Mohamed Serag Eldein Mahgoub, Wagdy William Amin, Samah Saad Zahran – Effect of locomotor training with a robotic-gait orthosis (lokomat) In Spasticity Modulation of Spastic Hemiplegic Children: A Randomized Controlled Trial. Fizjoterapia Polska 2020; 20(4); 94-101

Abstract
Background. Studying of robotic-assisted locomotor training (lokomat) in spasticity modulation on cerebral palsied hemiplegic children is a strategy for determining its efficacy in reducing spasticity.
Objective. To investigate the efficacy of robotic-assisted locomotor training (lokomat) in spasticity modulation. Methods. Thirty spastic hemiplegic cerebral palsied children of both genders ranged in age from 7 to 14 years contributed in this study, they were being randomly selected from comprehensive rehabilitation center and assigned into two equal groups (15 children each). Control group (A) underwent traditional exercise treatment, while Study group (B) underwent lokomat gait training in addition to traditional exercise program. Lokomat training was performed 3 days/week for 4 weeks with up to 45 minutes of training per session. The 3-D kinematics gait analysis was carried out before and after intervention and used as an indicator for improvement and reduction of spasticity.
Results. there was a statistically significant improvement in the study group in comparison to control group. Conclusion. Lokomat gait training is an effective additional tool for physical therapy program in treatment of hemiparetic C.P. children as it plays an important role in decreasing spasticity and improving patient gait pattern.

Key words:
cerebral palsy, spasticity, 3-D measurement, Lokomat gait training

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Programy terapii domowej dla dzieci z mózgowym porażeniem dziecięcym ukierunkowane na poprawę funkcji ręki spastycznej

Weronika Cyganik, Jolanta Taczała, Piotr Majcher

W. Cyganik, J. Taczała, P. Majcher – Home-based therapy programmes for children with cerebral palsy aimed at improving spastic hand function. Fizjoterapia Polska 2020; 20(3); 24-31

Streszczenie
Cel pracy. Przedstawienie aktualnej wiedzy dotyczącej możliwości zastosowania terapii domowej w celu poprawy funkcji ręki spastycznej u dzieci z mózgowym porażeniem dziecięcym (MPD).
Podstawowe założenia. W aktualnym piśmiennictwie można znaleźć opisy wielu metod terapii ręki spastycznej w warunkach domowych. Najważniejsze z nich to: CIMT (Constraint Induced Movement Therapy), H-HABIT (Hand arm bimanual intensive therapy), Mitii (Move It To Improve It), Wii Sports Resort training, You Grabber system, AOT system (Action observation training), Tele UPCAT platform (The UPper Limb Children Action Observation Training), TeleReh. Pomimo różnic metodologicznych, we wszystkich dostrzegana jest bardzo ważna rola opiekunów dzieci z MPD. Wsparcie merytoryczne ze strony terapeutów jest istotne w zapewnieniu wiarygodności procesu usprawniania. Trening domowy poprawia sprawność i funkcjonalność dzieci w życiu codziennym, umacnia więź pomiędzy rodzicem / opiekunem a dzieckiem. Możliwość kontynuowania terapii w domu to często ogromne ułatwienie dla rodzin mieszkających daleko od ośrodka.

Słowa kluczowe:
ręka spastyczna, terapia domowa, mózgowe porażenie dziecięce

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Impact of Hand-Arm Bimanual Intensive Therapy Versus Shock Wave Therapy on Hand Function and Grip Strength in Children with Hemiplegic Cerebral Palsy

Amr A. Abo Gazya, Abdel Aziz A. Serief, Ayman Gouda Matar, Wael Shendy, Hamada Ahmed Hamada

Amr A. Abo Gazya, Abdel Aziz A. Serief, Ayman Gouda Matar, Wael Shendy, Hamada Ahmed Hamada – Impact of Hand-Arm Bimanual Intensive Therapy Versus Shock Wave Therapy on Hand Function and Grip Strength in Children with Hemiplegic Cerebral Palsy. Fizjoterapia Polska 2020; 20(1); 92-98

Abstract
Background and purpose. Children with hemiplegic cerebral palsy have impairments in fine motor skills above and beyond their unilateral impairments. The current study was conducted to compare the effect of hand-arm bimanual intensive therapy (HABIT) versus shock wave therapy on the affected upper extremity in children with hemiplegic cerebral palsy. Materials and methods. Thirty hemiplegic children ranged in age from 4 to 8 years with hand spasticity ranged between 1 and 1+ grades according to the Modified Ashworth Scale participated in this study. They were assigned randomly into two equal study groups. Group A received a designed physical therapy program and shock wave therapy one session 2000 shock, while the group B received the same physical therapy program in addition to bimanual arm therapy. Both groups received treatment sessions three times per week for three successive moths. Each child in the two groups was evaluated before and after the suggested treatment duration for detecting the level of hand performance using the Peabody Developmental Test of Motor Proficiency while, hand grip strength by a hand held dynamometer and active abduction and external rotation range of motion were measured by a standard universal goniometer. Results. The results revealed non-significant differences when comparing the pre-treatment mean values of all measuring variables for the two groups (p > 0.05), while significant improvement was observed in the two groups when comparing their pre and post treatment mean values. Also, significant differences were observed when comparing the post treatment results of the two groups in favor of the group B (p < 0.05). Conclusion. The results suggested that, hand-arm bimanual intensive therapy appears to have a positive impact on hand function in children with hemiplegic cerebral palsy.

Key words:
Cerebral palsy, Hemiplegic, Hand-arm bimanual intensive therapy, shock wave therapy

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The Influence of the Soft Torso Orthosis on Motor Functions of Children with Cerebral Palsy – Preliminary Research

Anna Kosiecz, Agnieszka Zdzienicka-Chyła, Jolanta Taczała, Krzysztof Krasowicz, Marta Kuśmierz, Jarosław Napiórkowski

A. Kosiecz, A. Zdzienicka-Chyła, J. Taczała, K. Krasowicz, M. Kuśmierz, J. Napiórkowski – The Influence of the Soft Torso Orthosis on Motor Functions of Children with Cerebral Palsy – Preliminary Research. Fizjoterapia Polska 2020; 20(1); 86-91

Abstract
Introduction. Soft orthopaedic equipment is increasingly used in therapy of children with cerebral palsy. The primary goal of using soft orthoses is to improve the patient’s functioning – their contribution to central stabilization and postural control is emphasized. The principal aim of applying soft orthotics is to enhance the patient’s functioning in everyday life.
Objective. Examination of the influence of using soft torso orthoses on motor skills of children with cerebral palsy.
Material and methods. Four children with cerebral palsy who could walk independently – level I or II according to the Gross Motor Function Classification System (GMFCS) – were qualified for the preliminary research. Motor skills were evaluated in accordance with the Gross Motor Function Measure (GMFM). Evaluation of the functional condition was repeated every 3 months for half a year. The children used soft torso orthoses for about 4 hours a day and participated in rehabilitation exercises with the same frequency as before the study.
Results: Improvement on motor functions, confirmed with an increase in GMFM score by 2.5% on average, was observed in all the children during 6 months.
Conclusions. A positive influence of using soft torso orthoses on improvement in the patients’ functional condition was observed, confirmed with higher GMFM scores.

Key words:
soft orthoses, cerebral palsy, gross motor skills, GMFM

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Effect of Functional Trunk Training Program on Gait Harmony in Children with Spastic Diplegia: A Randomized Controlled Trial

Rasha Atef Saad El Metwally, Kamal El Sayed Shoukry, Amira El Sayed El Bagalaty

Rasha Atef Saad El Metwally, Kamal El Sayed Shoukry, Amira El Sayed El Bagalaty – Effect of Functional Trunk Training Program on Gait Harmony in Children with Spastic Diplegia: A Randomized Controlled Trial. Fizjoterapia Polska 2019; 19(4); 162-170

Abstract
Purpose. To determine the effect of functional trunk training on gait harmony in children with spastic diplegic CP by using the core stability and gait training program through strengthen the core area and the modified walker tool. Design. Single blind randomized controlled trial. Methods. Thirty children with CP spastic diplegia participated in this study with ages between four to seven years. They were randomly and equally divided into two groups (A and B), the control and study group respectively. Group A received selected physical therapy program for two hours aiming to improve functional gait ability while group B received the same as group A for only one hour plus the intervention program. The intervention program which is aiming to improve gait harmony consists of two fundamental parts. Firstly, core training and mobility exercises for half an hour. Secondly, gait training on different surfaces by using Modified walker for half an hour. Treatment was conducted for 3 times per week for a successive 3 months for both groups (control A & study B). Modified Ashworth scale (MAS) was used for sample selection. Gait harmony was measured by golden ratio equations which determine the spatiotemporal data from tracker motion analysis program version 5.0.6. Results. By using descriptive analysis to show mean ± standard deviation (SD) for all comparative variables, non-parametric test (chi square) to express the MAS values pretreatment for selection, paired t-test for measuring the pre and post treatment results within group and independent t-test between both groups (control and study) for measuring the results of Gross Motor Function Measure score (GMFM) for walking domain that showed a significant difference between both groups (A & B) post treatment. Usage of multivariate analysis (MANOVA) multivariate to determine the effect of independent variables (side, time and the intervention in both groups A&B) on the dependent variables equation (a, b, and the difference between both equations). There was a significant difference in the following: the proportion of stance/ swing phase time (equation a), the proportion of gait cycle/ stance phase time (equation b) and the difference between the values of both proportions (equation a and b) between both groups. Conclusion. It can be concluded that functional trunk training program in conjunction with a selected physical therapy program improved the gait harmony significantly in children with spastic diplegic CP. Which is obvious in gait harmony equations.

Key words:
cerebral palsy, spastic diplegia, gait harmony, golden ratio, GMFM, MAS

 

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