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this study will be conducted to investigate the relationship between muscle tone and dynamic stiffness during balance control and postural stability in children with spastic hemiplegia
Cerebral palsy (CP) is a neurodevelopmental disorder that affects muscle tone, posture and motor skills. It is the most common cause of motor disability in infants and children. It describes a group of permanent disorders resulting from non-progressive injury to the fetal or infant developing brain. Although the disorder itself is non-progressive, the clinical manifestations change over time as the brain matures.Children with hemiplegic CP often have difficulty performing voluntary movements due to decreased muscle strength and abnormal muscle tone. As a result, the child are unable to generate the necessary force to maintain their positions against gravity, leading to abnormal posture and balance. Myotonometers are compact, noninvasive tools that swiftly and efficiently gauge the biomechanical characteristics of soft tissues. In typically developing (TD) children, in children with developmental disabilities, and in individuals affected by stroke, it was found to be reliable.Balance is the capacity to preserve equilibrium against gravity during upright postures by maintaining the COM over the center of the BOS. It involves reacting to internal (voluntary movements) and external disturbing forces rapidly and effectively through different postural mechanisms to recover stability. It can be classified into static (maintaining the BOS with minimum movements), and dynamic (maintaining the BOS during different body movements). A comprehensive examination of muscle tone in UCP children can help us understand its impact on motor function and develop more targeted therapeutic interventions.
This understanding can have important clinical implications for treatment efficacy, rehabilitation strategies, and neurophysiological assessments. Addressing muscle tone abnormalities provides a more complete picture of the motor impairments and guides the development of individualized treatment plans, ultimately improving functional outcomes for children with UCP. Therefore, this study aimed to investigate the biomechanical properties, such as muscle tone and stiffness in the lower limb muscles of children with UCP compared with their TD peers. Additionally, investigators explored the associations between these properties and balance control in children with hemiplegia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| hemiplegic group | 20 children diagnosed with hemiplegic cerebral palsy |
| |
| normal group | 20 children of age-matched typically developing children with no history of neurological or musculoskeletal disorders |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| hemiplegic group | Other | twenty children with mild degree of spasticity ranged from 1 to 1+ according to Modified Ashworth Scale and Their motor function will be at level I and II according to Gross Motor Function Classification System.Their age will range from 6 to 12 years. |
| Measure | Description | Time Frame |
|---|---|---|
| oscillatory frequency | The MyotonPro (Myoton AS Tallinn, Estonia) device will be used to assess oscillation frequency. it introduces an innovative and non-invasive approach for comprehensively characterizing the biomechanical and viscoelastic properties of muscles.The device is applied under constant preload (0.18 N) to pre-compress subcutaneous tissues, and it exerts a brief (15 milliseconds) mechanical tap at a pre-determined force (0.4 Newtons), followed by quick release, causing damped oscillations that are recorded by the testing probe. This device is portable, inexpensive, easy to use, and convenient for re-cording the biomechanical and viscoelastic stiffness of myofascial tissues relatively quickly.A higher oscillation frequency indicates higher muscle tone, while increased stiffness reflects greater resistance to force application. | up to one day |
| Limits of stability | HUMAC balance system will be used to assess limits of stability.Limits of stability are known as the maximum distance a subject is able to move his/her COP in different directions while keeping the configuration of the BOS and while remaining stable.The test will be conducted at level 4, which represents the degree of distance to the farthest target. At this level, the task is considered relatively simple, as the distance between the center target and each surrounding target is minimal. Higher values obtained during the test indicate better performance. | up to one day |
| center of pressure | HUMAC balance system will be used to assess center of pressure | up to one day |
| Measure | Description | Time Frame |
|---|---|---|
| muscle dynamic stiffness | The MyotonPro (Myoton AS Tallinn, Estonia) device will be used to assess muscle dynamic stiffness. it introduces an innovative and non-invasive approach for comprehensively characterizing the biomechanical and viscoelastic properties of muscles.The device is applied under constant preload (0.18 N) to pre-compress subcutaneous tissues, and it exerts a brief (15 milliseconds) mechanical tap at a pre-determined force (0.4 Newtons), followed by quick release, causing damped oscillations that are recorded by the testing probe. This device is portable, inexpensive, easy to use, and convenient for re-cording the biomechanical and viscoelastic stiffness of myofascial tissues relatively quickly.A higher dynamic stiffness indicates greater resistance to force application. |
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Inclusion Criteria:
Exclusion Criteria:
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forty children with their ages from 6 to 12 years old. Twenty children were hemiplegic with a mild degree of spasticity and level I, II motor function.other twenty children were normal
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| keroles shenouda, master | Contact | 01013494753 | kerolesadel876@gmail.com |
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| ID | Term |
|---|---|
| D006429 | Hemiplegia |
| ID | Term |
|---|---|
| D010243 | Paralysis |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
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| normal group | Other | twenty normal children with no history of neurological or musculoskeletal disorders. |
|
| up to one day |
| The modified clinical test of sensory integration of balance | HUMAC balance system will be used to assess sensory integration of balance or stability score.This test begins with the participant standing on the HUMAC board with the middle of his/her feet lined up with the 7's on the horizontal axis, and the medial malleolus lined up with a letter along the vertical axis. The child will be instructed to stand in a neutral position with his/her arms beside the body for thirty seconds. As participants completed the test, the board monitored their COP to determine their stability score and path length. the score determined patient stability. A higher score indicates more stability, and a lower score indicates lower stability. | up to one day |
| muscle elasticity | the MyotonPro (Myoton AS Tallinn, Estonia) device will be used to assess muscle elasticity. it quantifies the dissipation of mechanical energy (damping) during natural oscillations of a muscle. lower values signify higher elasticity (i.e., better ability to recover from deformation), while higher values suggest lower elasticity. | up to one day |
| mechanical stree relaxation time | the MyotonPro (Myoton AS Tallinn, Estonia) device will be used to assess mechanical stree relaxation time with ms.It represents the duration of the muscle recovery process (or the relaxation time) from displacement.the higher tissue tension or stiffness, the faster tissue recovers its shape, meaning the lower the value. | up to one day |
| muscle viscoelastic property | the MyotonPro (Myoton AS Tallinn, Estonia) device will be used to viscoelastic properity. It represents the relationship between the time it takes for a tissue to undergo creep (gradual elongation) and the time it takes for it to recover or relax after being under constant deformation.Lower values: Indicate higher tissue tension, structural integrity, or increased stiffness (faster recovery).Higher values: Indicate greater viscoelasticity (slower recovery, more creep). | up to one day |
| D013568 |
| Pathological Conditions, Signs and Symptoms |