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| Name | Class |
|---|---|
| Fenerbahce University | OTHER |
| Istanbul University - Cerrahpasa | OTHER |
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This project aims to develop an accessible, learning-oriented model based on gamified breathing and posture training that emphasizes active participation for children with cerebral palsy (CP), their families, and educators. Since current practices are largely clinic-centered, there is a growing need for game-based, motivational and widely discernible programs. In this context, the project aims to provide an inclusive model that enhances breathing and postural awareness through digital technology, thereby increasing motivation and adherence.
Within the scope of the project, gamified hands-on workshops including breathing exercises and postural imagery techniques supported by visual and auditory stimuli, such as candle blowing, boat floating, and triflo simulations, will be conducted twice a week for eight weeks at the Spastic Children's Foundation of Turkey (TSÇV) with the guidance of an instructor. Additionally, educational digital games and storytelling videos will be developed to support home-based programs participation.
An initial awareness education session will be held to provide children with CP, families, and educators with foundational knowledge on breathing and postural awareness in children with CP. Throughout the project, gamified videos will be shared on the project's website to reach a wider population. Furthermore, a workshop for educators and a closing seminar for families will be organized.
The target groups include children with CP, their families, and educators involved in educational processes. 40 children with CP aged 6-18 years, receiving rehabilitation at TSÇV, with literacy skills and parental consent, will participate. The effects of the N.E.F.E.S.-CP model to be developed on respiratory functions, body awareness, posture, social participation, and quality of life will be evaluated using standardized assessment methods.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental Group | Experimental | All 40 children with cerebral palsy aged 6-18 years included in the study will receive the N.E.F.E.S.-CP gamified breathing and postural awareness education model. The training program will be conducted twice a week for 8 weeks at the Spastic Children's Foundation of Turkey (TSÇV). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| N.E.F.E.S.-CP Education Model | Behavioral | Gamified breathing and postural awareness training, including hands-on workshops with exercises such as candle blowing, boat floating, and triflo simulations, alongside postural imagery techniques supported by visual and auditory stimuli. The program will be conducted twice a week for 8 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Spirometry Assessment FVC | Spirometric variables will be measured using a calibrated spirometer (Medical International Research Spirodoc®) to evaluate respiratory function. Participants will be instructed to perform maximal inhalation followed by a forceful and complete exhalation into the spirometer in accordance with standardized spirometry guidelines. To minimize measurement error and ensure accuracy, three valid trials will be performed, and the highest recorded values will be used for final analysis. Spirometry is a well-established, reliable, and objective method for assessing pulmonary function in clinical settings. | 8 weeks (from baseline to post-intervention) |
| Spirometry Assessment FEV1 | Spirometric variables will be measured using a calibrated spirometer (Medical International Research Spirodoc®) to evaluate respiratory function. Participants will be instructed to perform maximal inhalation followed by a forceful and complete exhalation into the spirometer in accordance with standardized spirometry guidelines. To minimize measurement error and ensure accuracy, three valid trials will be performed, and the highest recorded values will be used for final analysis. Spirometry is a well-established, reliable, and objective method for assessing pulmonary function in clinical settings. | 8 weeks (from baseline to post-intervention) |
| Measure | Description | Time Frame |
|---|---|---|
| Postural assessment | Posture will be evaluated using the New York Posture Rating Test. This assessment method divides the body into distinct regions according to anatomical alignment, allowing for a comprehensive evaluation of posture in the sagittal and frontal planes. Each body region is scored based on standardized criteria, and the total score provides an objective measure of postural alignment. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rasmi Muammer, Prof., PhD | Contact | +90 505 650 28 27 | rasmi.muammer@yeditepe.edu.tr | |
| Turgay Arik | Contact | 0542 646 5394 | turgayarik@tscv.org.tr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Spastic Children's Foundation of Turkey (TSÇV) | Istanbul | İ̇stanbul | 34755 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40509926 | Background | Winther L, Milther C, Schroll SM, Nielsen ET, Gjaerde LK, Curtis DJ, Sorensen JL, Stahlhut M. Digital play and rehabilitation for children and adolescents in hospitals, outpatient departments and rehabilitation centres: A scoping review. J Pediatr Rehabil Med. 2025 Aug;18(3):177-188. doi: 10.1177/18758894251341153. Epub 2025 Jun 13. | |
| 17209977 |
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Individual participant data will not be shared to protect the privacy and confidentiality of the participants, particularly children with cerebral palsy. The data collected will be used strictly for the purposes of this scientific study and will be stored securely by the research team in accordance with ethical guidelines and institutional policies.
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| ID | Term |
|---|---|
| D002547 | Cerebral Palsy |
| D053120 | Respiratory Aspiration |
| ID | Term |
|---|---|
| D001925 | Brain Damage, Chronic |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| 8 weeks (from baseline to post-intervention) |
| Quality of Life (CPQOL-Child) | Quality of life will be assessed using the Cerebral Palsy Quality of Life Questionnaire (CPQOL-Child). This condition-specific measure is designed to capture the unique perspectives and experiences of children with cerebral palsy, covering various domains such as physical well-being, social participation, and emotional functioning. | 8 weeks (from baseline to post-intervention) |
| Thoracic Mobility Assessment | Thoracic mobility will be assessed through chest circumference measurements to determine thoracic expansion capacity. To ensure the reliability and clinical accuracy of the data, measurements will be taken at three standardized anatomical levels: the axillary, the nipple/xiphoid process, and the sub-xiphoid levels. Participants will be instructed to perform maximal inspiration and maximal expiration while in a seated position. All measurements will be recorded using a tape measure. To control for measurement error, each measurement will be repeated three times, and the mean value will be used for final analysis. Thoracic expansion will be calculated as the quantitative difference between the chest circumference values obtained during maximal inspiration and maximal expiration. This measurement technique is recognized as a reliable and clinically feasible approach for evaluating thoracic mobility in pediatric populations. | 8 weeks (from baseline to post-intervention) |
| Waters E, Davis E, Mackinnon A, Boyd R, Graham HK, Kai Lo S, Wolfe R, Stevenson R, Bjornson K, Blair E, Hoare P, Ravens-Sieberer U, Reddihough D. Psychometric properties of the quality of life questionnaire for children with CP. Dev Med Child Neurol. 2007 Jan;49(1):49-55. doi: 10.1017/s0012162207000126.x. |
| 15715691 | Background | Waters E, Maher E, Salmon L, Reddihough D, Boyd R. Development of a condition-specific measure of quality of life for children with cerebral palsy: empirical thematic data reported by parents and children. Child Care Health Dev. 2005 Mar;31(2):127-35. doi: 10.1111/j.1365-2214.2004.00476.x. |
| 38244393 | Background | Tas SA, Cankaya T. Effects of structured training on spinal posture and selective motor control in children with unilateral spastic cerebral palsy. Gait Posture. 2024 Mar;109:22-27. doi: 10.1016/j.gaitpost.2024.01.007. Epub 2024 Jan 11. |
| 35161508 | Background | Szturm T, Parmar ST, Mehta K, Shetty DR, Kanitkar A, Eskicioglu R, Gaonkar N. Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial. Sensors (Basel). 2022 Jan 19;22(3):761. doi: 10.3390/s22030761. |
| Background | 10.16965/ijpr.2016.197 |
| 38803793 | Background | S R, Kanniappan V, Santhosh Kanna BS, T S V. Comparing the Effects of Virtual Reality Breathing Exercise and Incentive Spirometry Exercise on Improving Pulmonary Function in Children with Spastic Diplegic Cerebral Palsy. Cureus. 2024 Apr 27;16(4):e59149. doi: 10.7759/cureus.59149. eCollection 2024 Apr. |
| 11002433 | Background | Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, Raina PS, Galuppi BE. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000 Oct;80(10):974-85. |
| 9183258 | Background | Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997 Apr;39(4):214-23. doi: 10.1111/j.1469-8749.1997.tb07414.x. |
| 41691324 | Background | Cemali O, Tiryaki AY, Cemali M, Torpil B. Effects of feeding behavior training on sensory processing and developmental areas in children with cerebral visual impairment: a randomized controlled study. Ital J Pediatr. 2026 Feb 14;52(1):42. doi: 10.1186/s13052-026-02213-w. |
| 236066 | Background | Palmer KN, Kelman GR. Pulmonary function in asthmatic patients in remission. Br Med J. 1975 Mar 1;1(5956):485-6. doi: 10.1136/bmj.1.5956.485. |
| 29636305 | Background | Keles MN, Elbasan B, Apaydin U, Aribas Z, Bakirtas A, Kokturk N. Effects of inspiratory muscle training in children with cerebral palsy: a randomized controlled trial. Braz J Phys Ther. 2018 Nov-Dec;22(6):493-501. doi: 10.1016/j.bjpt.2018.03.010. Epub 2018 Apr 4. |
| 36376558 | Background | de Lima Crispim TR, Neto MG, Crispim TRL, Dias RB, de Albuquerque MDM, Saquetto MB, Magalhaes PAF. Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis. World J Pediatr. 2023 Apr;19(4):340-355. doi: 10.1007/s12519-022-00642-1. Epub 2022 Nov 15. |
| 27346860 | Background | Debouche S, Pitance L, Robert A, Liistro G, Reychler G. Reliability and Reproducibility of Chest Wall Expansion Measurement in Young Healthy Adults. J Manipulative Physiol Ther. 2016 Jul-Aug;39(6):443-449. doi: 10.1016/j.jmpt.2016.05.004. Epub 2016 Jun 23. |
| 12186831 | Background | American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624. doi: 10.1164/rccm.166.4.518. No abstract available. |
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |