Cerebral Palsy, Spastic
Conditions
Keywords
Trunk control, Postural Control, Cerebral Palsy, Rehabilitation, Axial segments
Brief summary
Gait abnormalities, which occur in Cerebral Palsy (CP), are characterized usually by a toe-to-floor or a plantar-to-floor initial contact (equinus gait), followed by an early braking of the tibia's forward progression (during ankle dorsiflexion). This causes consequently a trunk deceleration. Moreover, children with CP have difficulties to stabilize the trunk and the head in the space, and that could have impact on gait. If equinus gait is often attributed to the triceps surae spasticity, recent works suggest rather that this early braking of the dorsiflexion could be a motor adaptation to axial postural control difficulties. This thesis project aims firstly to attest that locomotor disorders are related to these difficulties in the stabilization of the axial body segments in children with CP and, secondly, to show that improving the trunk and head postural control with a specific rehabilitation protocol could reduce the early braking of the dorsiflexion and, consequently, the gait abnormalities observed in CP.
Interventions
OTHERRehabilitation involving strongly the trunk
The Rehabilitation involving strongly the trunk (RIST) leaded by a physiotherapist was based on exercises in different postures performed by the child each day that strongly involve the trunk to cope with balance.
Sponsors
Union de Gestion des Etablissements des Caisses d'Assurance Maladie - Nord Est
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
5 Years to 12 Years
Healthy volunteers
Yes
Inclusion criteria
* Gross Motor Function Classification System I or II * no or minimal contracture of the triceps surae * presence of soleus spasticity
Exclusion criteria
* botulinum toxin injections or surgery in the lower limb respectively in the 6 and 12 months preceding the study * any modification of the physical or orthopaedic therapy within the last two months * minimal hip flexion above 20° in a clinical examination * pain in the lower legs when standing or walking
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of the center of pressure sway area during unstable sitting posturography | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | In mm² |
| Change of the peak of trunk's anterior deceleration during the weight acceptance phase of gait | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | In m/s² |
| Change of the peak of the center of mass downward deceleration during the weight acceptance phase of gait | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | In m/s² |
| Change of the score of the Trunk Control Measurement Scale (TCMS) | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | Score from 0 to 58. The higher the score, the better the trunk control. |
| Change of the center of pressure velicoty during unstable sitting posturography | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | In mm²/s |
| Change of the peak of ankle negative power during the weight acceptance phase of gait | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | In watts per kg. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change of the Dimensionless walking speed | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | Walking speed normalized to the length of the lower limb |
| Change of the dimensionless step width | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | Step width during walking normalized to the width of the pelvis |
| Change of the center of pressure sway area during quiet standing | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | In mm² |
| Change of the center of pressure velicoty during quiet standing | Change from baseline to the end of the first 3-months period of rehabilitation and from this latter to the end of the second 3-months period of rehabilitation | In mm²/s |
Countries
France
Outcome results
None listed