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The goal of this Randomized control trial was to evaluate the outcome of limb intensive functional training (LIFT) on gait and balance in spastic diplegic cerebral palsy children with age 3-7 years.
The main questions this study has answered were:
GMFCS level 3 and MAS level 2 children were eligible to participate in study and Gross Motor Functional Measure (GMFM-88) was used to access Motor Capacity. 10-meter walk test, timed up and go test and 30 sec chair rise tests was used to access Motor Performance.
Method and Procedures of the research were explained to the patients earlier to data collection. Any query was explicated on the spot.
Group A: The Control group received conventional physical therapy (Stretching followed by Strengthening program and traditional gait training) at clinical setting.63 Stretching muscles were hip flexors, hip adductors, hamstrings and calf and stretching applied for 30 sec with 30 sec rest for 3-5 times for each muscle group with in pain limit followed by strengthening exercise for week muscle which includes the strengthening of anti-gravity muscles of lower limb they are: Quadriceps, Gluteus maximus and soleus performed in 3 groups. Each group contain 10 rep for each week muscle group. Conventional Physical therapy applied 5 days/week for consecutive 20 weeks. They were also guided to perform activities at home but they're unbound to do the designed activities freely.
Group B: The experimental group received Lower limb intensive functional training (LIFT) at home environment and conventional physical therapy at clinical setting. LIFT was provided at home environment for 3 hours/day, 5days/week for 5 months.31 A log book was maintained and the goals and strategies were guided to child's parents. 3 hours' treatment was performed in intervals at different time of the day. LIFT helped child in motor learning, skill progression and resistance training to target the strength, proprioception and coordination impairments of the lower extremities.64 Motor learning was based on Strength domain (Cycling) and progression from smooth to rough surface. Balance and Coordination domain involves activities such as (ball kicking with alternate legs and Static standing) and progression was done by increasing accuracy and complexity. Proprioception domain (Vertical jumping, sit to stand and cursing) while knee-immobilizers applied if needed and progression number of repetitions and sets was increased over time. Skill progression was used to challenge the LIFT and make it intensive enough to obtain changes in motor skills and function. AFO's were required during therapy session if needed.
Caregiver were provided proper guidelines before implementing the treatment at home. 3 training sessions was given prior to treatment. A log book was also provided to get the structured record of the treatment. Further videos and mode of tele-rehabilitation was used for supervision and guidance throughout the study. Therapist closely monitored the activities by checking daily logs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Group | Experimental | Control group will receive Conventional physical therapy and traditional gait training at clinical setting. |
|
| Intervention Group | Experimental | Experimental group will receive LIFT and conventional physical therapy at home settings provided by their caregivers. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lower limb Intensive Functional Training | Other | LIFT will help the child in motor learning, skill progression and resistance training to target the strength, proprioception and coordination impairments of the lower extremities. Motor learning will be based on Strength domain (Cycling) . Balance and Coordination domain involves activities such as (ball kicking with alternate legs and Static standing) Proprioception domain (Vertical jumping, sit to stand and cursing) while applying knee-immobilizers if needed. |
| Measure | Description | Time Frame |
|---|---|---|
| Gross motor function measure | GMFM-88 version and clause C, D and E will be used in this study. | at baseline and after 20 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| 10 Meter Walk Test (10mwt) | 10 MWT accesses performance and used for measurement of walking speed over short duration in meter/sec. It is used to calculate the functional mobility and gait | at baseline and after 20 weeks |
| Timed Up and Go Test (Tug) |
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Inclusion Criteria:
Children with Spastic diplegic CP with aged 3-7 years Children of both gender Children with MAS level-2 Children with GMFCS level-3 The ability of caregivers to provide one-on-one attention to the child during dailyactivities
Exclusion Criteria:
Visual problems preventing performance of interventions and testing tasks59 Any orthopedic or neuro-surgery done in last 1 year60 Children with any other neurological conditions61 Children with uncontrolled seizures62
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| Name | Affiliation | Role |
|---|---|---|
| Umair Ahmed, PhD | University of Lahore | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Husna Albab | Lahore | Punjab Province | 54000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | 1. Khumlee N, Suriyaamarit D, Boonyong S. Effects of sensory cues on dynamic trunk control in children with spastic diplegic cerebral palsy. Physiotherapy Theory and Practice 2021: 1-8. 2. Ma Y, Liang Y, Kang X, Shao M, Siemelink L, Zhang Y. Gait characteristics of children with spastic cerebral palsy during inclined treadmill walking under a virtual reality environment. Applied bionics and biomechanics 2019; 2019. 3. Zarkou A, Lee SC, Prosser LA, Jeka JJ. Foot and ankle somatosensory deficits affect balance and motor function in children with cerebral palsy. Frontiers in Human Neuroscience 2020; 14: 45. 4. Tatemoto T, Tanaka S, Maeda K, Tanabe S, Kondo K, Yamaguchi T. Skillful cycling training induces cortical plasticity in the lower extremity motor cortex area in healthy persons. Frontiers in Neuroscience 2019; 13: 927. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP_ICF | Yes | Yes | Yes | Study Protocol, Statistical Analysis Plan, and Informed Consent Form | Jan 10, 2023 | Mar 29, 2024 | Prot_SAP_ICF_000.pdf |
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| ID | Term |
|---|---|
| D002547 | Cerebral Palsy |
| D020233 | Gait Disorders, Neurologic |
| ID | Term |
|---|---|
| D001925 | Brain Damage, Chronic |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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|
| Conventional physical therapy | Other | Stretching followed by Strengthening program and traditional gait training at clinical setting. Stretching muscles were hip flexors, hip adductors, hamstrings and calf and stretching applied for 30 sec with 30 sec rest for 3-5 times for each muscle group with in pain limit followed by strengthening exercise for week muscle which includes the strengthening of anti-gravity muscles of lower limb they are: Quadriceps, Gluteus maximus and soleus performed in 3 groups. Each group contain 10 rep for each week muscle group. |
|
TUG test evaluates balance, anticipatory postural control, functional mobility and agility in ambulatory children with CP. TUG can be used for differentiation in performance with different types of CP and different levels of GMFCS
| at baseline and after 20 weeks |
| 30-sec chair rise test | The 30-sec chair rise test is used to access leg strength and endurance. 30 sec CRT accessed either by a specific number of sit-ups done in 30 second (e.g.; 10 reps, 5 reps etc.) or total repetitions of sit-ups and down done in 30 sec periods | at baseline and after 20 weeks |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |