Structured Home-Based Exercise Program for Ambulant Cerebral Palsy in Improving Ambulation Function

Structured home-based exercise program which comprises flexibility, aerobic and strengthening therapy. Information on structured home-based exercise program: Familiarization - 4 sessions of home-based exercise taught at the physiotherapist gym to parents/caregiver and participants supervised by physiotherapist. This is done one month prior to the start of intervention. a) duration of each session is 30 minutes up to 1 hr b) frequency of sessions, once weekly c) format - one to one session Intervention duration - 8 weeks , structured home-based program delivered at home supervised by parents, using the provided logbook which has all details with pictures of exercises and timetable as guidance. Investigators will follow up and check on logbook timetable during every visits for assessment. A. Materials & equipments during familiarization (training of exercise for 1 month before intervention started) and intervention ( 8 weeks home-based exercise program) 1) structured home-based exercise booklet which comprises flexibility, aerobic and strengthening therapy for both upper and lower limbs: a. flexibility - stretching of muscles that crossed two joints of both upper and lower limb example; biceps, wrist flexors, hamstrings, gastrocnemius b. Aerobic - for lower limb; moving up and down with ankle weights using stepping stool until achieved OMNI-RPE scale 6-7, for upper limb; throwing and playing balls until OMNI-RPE 6-7. c. strengthening - Using free weights to move upper and lower limbs repetitively until achieve OMNI-RPE 6-7 2) A timetable of frequency gradually increase from twice to 4 times a week included in the booklet for parents to monitor the exercises done for total of 8 weeks - participants will alternate sessions between flexibility and aerobic, and flexibility and strengthening for every. All session need to be supervised by parents or caregiver. 3) Intensity of exercise is monitored by parents using the OMNI-RPE scale (laminated), up to OMNI-RPE 6-7 (moderate intensity) 4) Equipments provided for participants, playground ball and step stool to perform aerobic exercises for upper and lower limbs respectively. Ankle & wrist weights (of 500g, 1 kg per pair) for performing strengthening exercise for upper and lower limbs respectively. 5) Exercise schedule: Frequency of exercise - alternate combination of flexibility and aerobic AND flexibility and strengthening. Week 1&2 (2 days per week). Week 3&4 (3 times per week). Week 5,6,7 & 8 (4 times per week). Duration- determines by how they achieve targeted intensity based on OMNI-RPE scale (6-7) for aerobic & strengthening exercises. Maximum aerobic exercise per session for both upper and lower limbs are 20 mins and maximum repetition of strengthening exercise is 8 repetitions each. For flexibility component, stretching of each specified areas of upper and lower limbs is advised for 15-30 seconds. B. Personnel involve in delivering intervention 1) Physiotherapists - 2 physiotherapists involve in training participants and parents during familiarisation of home-based exercise and monitoring outcome using 6-minute walking test and GMFM-66 (component D&E). They are experienced in handling cerebral palsy children in Paediatric Rehabilitation service for at least 3 years. 2) Occupational therapist (OT) - 2 OTs are involved to monitor outcome in activities of daily living using Paediatric Evaluation Disability Inventory (PEDI). OT involve are experienced in paediatric rehabilitation service at least minimum of 3 years. 3) Investigators & Research assistant - involve in the planning of intervention program and monitoring the whole participation of participants in the assessment schedule and help with keeping records and tabulating research's data.