Cerebral Palsy
Conditions
Keywords
Cerebral Palsy, Exercise Therapy, Muscle Strength, Muscle Endurance, Constipation, Posture
Brief summary
This study aims to evaluate the effects of a Core Stability Program on abdominal endurance and constipation severity in wheelchair-bound children with cerebral palsy. It seeks to determine whether targeted core strengthening exercises can improve muscular endurance of the abdominal region while also alleviating constipation symptoms, thereby enhancing overall functional health and quality of life in this population.
Detailed description
Although core stability training has been extensively explored in children with cerebral palsy (CP), particularly for improving trunk control, balance, and overall gross motor function, there remains a notable gap in the literature regarding its effects on abdominal endurance and gastrointestinal outcomes such as constipation. Most of the available research has primarily focused on ambulatory children with CP, often overlooking those who are wheelchair-bound and typically present with more severe functional limitations. This creates an important gap, as non-ambulatory children may have different rehabilitation needs and may respond differently to therapeutic interventions. While the positive influence of core stability exercises on postural control and functional mobility is well established, their potential role in enhancing abdominal muscle endurance has not been thoroughly investigated. Abdominal endurance is particularly important in this population, as weak core musculature can contribute not only to poor posture but also to reduced intra-abdominal pressure, which may adversely affect bowel function. Constipation is a common and often chronic issue among children with CP, especially those who are wheelchair-dependent, due to factors such as limited mobility, reduced muscle tone, and impaired neuromuscular coordination. Existing research addressing constipation in children with CP has largely concentrated on pharmacological treatments and dietary modifications, with comparatively little emphasis on physiotherapy-based interventions. This highlights a missed opportunity to explore non-invasive, exercise-based strategies that could potentially address both musculoskeletal and gastrointestinal concerns simultaneously. To date, very few comprehensive studies have examined the combined effects of core stability training on both abdominal endurance and constipation severity in non-ambulatory children with CP. Therefore, this study aims to address this critical gap by investigating whether a structured core stability program can improve abdominal muscle endurance while also reducing constipation severity, ultimately contributing to better functional health and quality of life in this population.
Interventions
OTHERCore Stability Program
The intervention consists of a structured core stability program designed to improve trunk control and abdominal muscle function in wheelchair-bound children with cerebral palsy. The program includes targeted exercises focusing on strengthening deep abdominal and trunk muscles through progressive, age-appropriate, and functional activities performed under physiotherapist supervision over a defined period.
OTHERtraditional Physiotherapy
Participants in this arm will receive conventional physiotherapy focusing on improving abdominal endurance. The intervention will include exercises such as static and dynamic trunk strengthening, pelvic tilts, assisted sit-ups, breathing exercises, and postural control activities. Sessions will be conducted under the supervision of a trained physiotherapist, typically 3-5 times per week for a specified duration. The program aims to enhance core muscle strength, improve trunk stability, and support functional activities in wheelchair-bound children with cerebral palsy.
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Masking description
In this study, participant masking will be implemented by limiting participants' awareness of group allocation to reduce expectancy bias. Investigator masking will be applied by ensuring that the assessors responsible for measuring abdominal endurance and constipation outcomes are not informed about the participants' group assignments. This approach helps minimize assessment bias and improves the reliability and validity of the study results.
Intervention model description
This interventional study will employ a parallel design in which participants are assigned to two groups that receive different interventions or conditions simultaneously. Each group will be followed over the same study period, and outcomes will be assessed at baseline and after the intervention. This design allows comparison of effects between groups receiving the core stability program and the comparison Traditional physiotherapy, ensuring evaluation of the intervention's effectiveness under similar time conditions.
Eligibility
Sex/Gender
ALL
Age
6 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of cerebral palsy - particularly spastic or hemiplegic types * Regardless the cause of CP * Age range typically 6-12 years old * A motor function level IV as per the Gross Motor Function Classification System * Grade 1 / 1+ (mild spasticity) according to Modified Ashworth Scale (MAS) * Non-ambulatory or inability to ambulate * CP children with constipation ; Fewer than 3 defecations per week, History of hard stools or painful defecation * Defecation frequency measured less than three times a week is considered constipation using Rome IV * Parental/guardian permission (informed consent) and child assent of a minor if the patient was able to assent (35). * The ability to understand and follow instructions
Exclusion criteria
* Had visual impairments, extreme spasticity, uncontrolled convulsions, any other neuromuscular diseases, ataxia-telangiectasia, spinocerebellar ataxia, and/or Joubert syndrome * Children who received botulinum toxin injection within the last six months, had fixed contractures or deformities of the spine or the extremities, and had previous surgeries of the spine or the lower extremities within one year or visual, auditary or respiratory disorders * Children with any other systemic co morbidities, physical deformity in GIT, intellectual disability and recent traumatic brain injury * Participation in other intensive physical therapy programs simultaneously * Severe musculoskeletal deformities that limit participation in the training * Children with congenital anatomic abnormalities of the urogenital area, including Hirschsprung's disease, spina bifida, anorectal malformations, urethral strictures, down syndrome or hypothyroidism, gastrointestinal bleeding, intestinal perforation, ileus obstruction, inflammatory bowel disease, toxic megacolon, metal implants or pacemakers in the abdominal area, open wounds in the abdominal and thoracic region, history of surgery on the stomach, malignancy .
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Abdominal Muscle Endurance | 3 months | Abdominal muscle endurance will be assessed to evaluate the effect of a core stability program in wheelchair-bound children with cerebral palsy. The Modified Curl-Up Test will be used. Participants perform as many correct curl-ups as possible in 1 minute with standardized form and positioning. Time Frame: Baseline and 3 months Measurement: Number of correctly performed curl-ups in 1 minute. Higher number indicates better outcome. |
| Change in Constipation Severity | 3 months | Constipation severity will be assessed to evaluate the effect of a core stability program on bowel function in wheelchair-bound children with cerebral palsy. The Modified Bristol Stool Form Scale for Children \[mBSFS-C\] will be used. Parents/caregivers record stool type daily for 7 days. An average weekly score will be calculated. Time Frame: Baseline and 3 months Measurement: mBSFS-C score ranging from 1 to 7. Scores of 1-2 indicate constipation. Scores of 3-4 indicate normal stool form. Improvement toward scores of 3-4 indicates better outcome. |
Countries
Pakistan
Contacts
PRINCIPAL_INVESTIGATORJaveria Azeem, MS PPT
Riphah International University
Outcome results
None listed