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Combining the advantages of both Neuromuscular electrical stimulation and lower limb serial casting to a selected physical therapy program in children with spastic diplegic cerebral palsy to overcome the adverse effects during the period of casting and the long period of rehabilitative interventions, providing a new multimodal treatment approach.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group (A) | Active Comparator | will receive a selected physical therapy program. |
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| Group (B) | Active Comparator | will receive interrupted progressive serial casting in addition to a modified selected physical therapy program during casting. |
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| Group (C) | Active Comparator | will receive interrupted progressive serial casting and the modified selected physical therapy as group (B) in addition to neuromuscular electrical stimulation for ankle dorsiflexors and knee extensors muscles through cast windows |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Selected physical therapy program | Other | Selected physical therapy program one hour three times weekly for six successive weeks including stretching, strengthening, balance, and gait training. |
| Measure | Description | Time Frame |
|---|---|---|
| Change of knee and ankle passive range of motion (ROM) | Digital Goniometer will be used to measure the passive ROM of ankle dorsiflexion and the popliteal angle (PA) | At the beginning and after six weeks of intervention |
| Change of strength of knee extensors and ankle dorsiflexors muscles | Hand-held dynamometers (HHDs) " Lafayette manual muscle tester" (MMT) Will be used for quantitative assessment of maximal voluntary isometric contraction for knee extensors, and ankle dorsiflexors. | At the beginning and after six weeks of intervention |
| Change of tone of hamstring and gastrocnemius muscles | The Modified Tardieu Scale (MTS) will be used for analysis of dynamic spasticity of gastrocnemius and hamstring muscles. Measuring R1 (the fast velocity movement of the ankle or knee through the full ROM to determine the point of catch in the ROM), R2 (the passive ROM), and R2-R1 (dynamic component of spasticity). | At the beginning and after six weeks of intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Change in sagittal kinematics parameters of gait pattern | The Observational Gait Scale (OGS) will be used for analysis of gait kinematics through 2 D videography with slow motion and split-screen video. Six sections will be tested to evaluate knee and ankle kinematics (Knee position in mid stance, Initial foot contact, Foot contact at mid stance, Base of support, Gait assistive devices, degree of change) with a total score of 17 on each limb. the minimum score is -2 and maximum score is 17. The higher scores mean a better outcome. |
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Inclusion Criteria:
Exclusion Criteria:
children will be excluded from the study if they have any problems of the following:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yasser M Abd Elmonem, MSC | Contact | +201099259395 | yasserelhawary131@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Physical Therapy | Recruiting | Cairo | Egypt |
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| ID | Term |
|---|---|
| D002547 | Cerebral Palsy |
| ID | Term |
|---|---|
| D001925 | Brain Damage, Chronic |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| Interrupted serial casting | Procedure | Interrupted casting for 5 days a week for six successive weeks using a dual cast which consists of a standard short leg cast and a circular cast from below the knee to above the knee. |
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| Neuromuscular electrical stimulation | Device | Neuromuscular electrical stimulation in form of faradic current with frequency of 50 Hz, and intensity of maximum tolerable intensity to produce a visible contraction but as tolerated by the child for ankle dorsiflexors and knee extensors muscles through cast windows over the motor points of these muscles for 30 min 3 times weekly for six successive weeks |
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| At the beginning and after six weeks of intervention |