Cerebral Palsy (CP)
Conditions
Keywords
cerebral palsy, upper extremity, strengthening
Brief summary
This study aims to compare the effects of two different upper extremity strengthening exercise approaches-bilateral strengthening exercises based on Proprioceptive Neuromuscular Facilitation (PNF) patterns and plyometric exercises-on muscle thickness, joint range of motion, muscle strength, and functional performance in children with unilateral spastic cerebral palsy (USCP). Although strengthening exercises targeting the affected upper limb in children with USCP have been investigated in numerous studies, to our knowledge, no previous research has directly compared the effects of bilateral PNF-based strengthening exercises and plyometric training. Incorporating PNF patterns into upper extremity rehabilitation programs has been previously recommended, and examining the efficacy of these exercises in comparison with plyometric training may contribute valuable insights to the literature and inform clinical practice.
Interventions
OTHERExercise
Strengthening Exercises Based on Proprioceptive Neuromuscular Facilitation Patterns
Sponsors
Biruni University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Double blinded
Intervention model description
Randomized control
Eligibility
Sex/Gender
ALL
Age
5 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Aged between 5 and 12 years * Diagnosed with unilateral spastic type cerebral palsy * Classified as Level I or II according to the Gross Motor Function Classification System (GMFCS) * Classified as Level I or II according to the Manual Ability Classification System (MACS) * Upper extremity muscle tone ≤2 on the Modified Ashworth Scale * Willing to suspend other upper extremity therapeutic interventions during the study period * Able to cooperate and follow instructions provided by the researcher * Voluntarily willing to participate in the study
Exclusion criteria
* History of any upper extremity surgery or Botulinum toxin (Btx) injection within the past 6 months * Presence of an additional neurological disorder other than cerebral palsy * Having visual and/or hearing impairments * Having severe contractures that limit participation in functional activities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Muscle Thickness Measurement by Ultrasonography | Baseline and after 8-weeks | Ultrasonographic measurements will be performed using the Esaote Mylab 60 device with a linear probe. Muscle thickness will be assessed in the upper trapezius, rhomboid major, anterior deltoid, lateral triceps brachii, long head of biceps brachii, extensor carpi radialis brevis, extensor digitorum communis, and flexor digitorum superficialis. Measurements will be taken with the elbow flexed at 70°, in standardized resting positions, with forearm in pronation or supination depending on the muscle group. To ensure reliability, three separate images per muscle will be taken, with the probe repositioned each time. Anatomical landmarks will be palpated and marked. Muscle thickness will be measured as the distance between the subcutaneous fat-muscle and muscle-bone interfaces. |
| Range of Motion Assessment | Baseline and after 8-weeks | Joint range of motion (ROM) will be assessed before and after treatment using a universal goniometer. Active ROM measurements will include shoulder flexion and abduction (measured in standing), elbow flexion and extension (in supine), and forearm pronation-supination and wrist flexion-extension (in sitting). Movements will first be demonstrated on the unaffected limb, then performed with the affected limb. Active ROM values will be recorded. Each movement will be measured three times, and the mean value in degrees will be documented. Measurements will follow Kendall-McCreary criteria to ensure standardization and accuracy. |
| Muscle Strength Assessment | Baseline and after 8-weeks | Muscle strength of shoulder flexion-abduction, elbow flexion-extension, forearm pronation-supination, and wrist flexion-extension will be assessed before and after treatment using a hand-held dynamometer (HOGGAN microFET2). A towel will be placed between the limb and device to ensure full contact and minimize sensitivity caused by surface hardness. The "make method," accepted for pediatric use, will be applied: the physiotherapist will ask the child to push maximally against the fixed device. The test will first be demonstrated on the unaffected limb. Two practice trials will be conducted on the affected side to ensure comprehension, followed by three test measurements. A rest interval will be given between trials. The mean of the three tests will be recorded in kilograms (kg). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Upper Extremity Skills Test-QUEST | Baseline and after 8-weeks | The Quality of Upper Extremity Skills Test (QUEST) is designed to assess upper extremity movement quality and hand function in children with cerebral palsy. It includes subtests for dissociated movements, grasp, weight-bearing, protective extension, hand function rating, spasticity grading, and cooperation. Each item is scored on a 3-point scale (0-2), based on whether the movement is successfully performed. The total score reflects the functional quality of the affected upper limb. The administration time is approximately 20-30 minutes. |
| ABILHAND- Kids | Baseline and after 8-weeks | ABILHAND-Kids is a functional scale used to assess manual ability in children with cerebral palsy and other pediatric neurological disorders. It supports treatment planning and goal setting by evaluating the child's ability to perform daily activities requiring hand use. The scale consists of 21 items, most involving bimanual tasks, and measures the perceived difficulty of these activities as reported by parents. Each item is rated on a 3-point ordinal scale: 0 = impossible, 1 = difficult, and 2 = easy. The scale provides insight into hand performance in self-care tasks from the caregiver's perspective. |
Countries
Turkey (Türkiye)
Outcome results
None listed