Effect of the Dynamic Orthotic Garment on Postural Control, and Endurance in Children with Spastic Diplegic Cerebral Palsy: A Randomized Controlled Trial.

Purpose: To investigate the effect of dynamic orthotic garments (Thera togs) on foot pressure distribution, postural control, and endurance in children with spastic diplegic CP. Patients and Methods: This is a single-blind randomized controlled clinical trial involving 34 (8-10 years) with spastic diplegic CP. The control group received conventional physical therapy (CPT), whereas the study group received CPT in addition to wearing TheraTogs. We recorded foot pressure distribution, trunk control measurement scale, trunk position sense, Pediatric Berg Balance Scale (PBS), and six-minute walking distance (6MWD). Results: Both groups showed improvement. The study group had significant improvement in foot pressure distribution (p-value 0.003, 0.001, <0.001 for forefoot, midfoot, and rearfoot mean pressures respectively, and 0.005, <0.001, and 0.005 for forefoot, midfoot, and rearfoot peak pressures respectively), Pediatric balance scale, The trunk control measurement scale, and Trunk position sense (p-value < 0.001) and six-minute walking distance (p-value 0.029). Our data suggest that adding TheraTogs to conventional physiotherapy improves foot pressure, postural control, and endurance in children with spastic diplegic cerebral palsy. Conclusion: Both TheraTogs and conventional physical therapy corrected foot pressure distribution, trunk control, improved balance, and increased 6MWD in children with spastic diplegic CP but the improvement was more significant in TheraTogs group. Clinical Trial Registration: NCT05271149.

Effect of extracorporeal shock wave therapy on spastic equinus foot in children with unilateral cerebral palsy.

Objectives: This study aims to investigate the effects of radial extracorporeal shock wave therapy on selective motor control, spasticity, gross motor function, and balance in children with unilateral cerebral palsy. Methods: This randomised controlled study recruited 34 children aged 7-9 with spastic unilateral cerebral palsy. They were randomly allocated to either the control or study group. Both groups undertook traditional exercises for 12 weeks. The study group received shock waves (one session/week) on the calf muscle (1500 shocks, frequency of 4 Hz, energy of 0.030 mJ/mm2). All children were evaluated at baseline and after 12 weeks using the Modified Ashworth Scale, a Biodex System 4 isokinetic dynamometer, dimensions D (standing) and E (walking) of the Gross Motor Function Measure - 88, the Trost Selective Motor Control test, and the single leg standing test. Results: Mixed analysis of variance and Mann-Whitney results showed significant improvement in eccentric peak torque, torque threshold angles, gross motor function, selective motor control, and balance in the study group compared with the control group (p < 0.05). Conclusions: Shock wave therapy may be a valuable instrument for reducing spasticity, improving the ability to isolate and control movement, and consequently, improving balance and gross motor function in children with unilateral cerebral palsy.

Effects of behavioural therapy versus interferential current on bladder dysfunction in multiple sclerosis patients; a randomised clinical study.

OBJECTIVES: This study examines the effect of behavioural therapy (biofeedback) and interferential current on bladder dysfunction in multiple sclerosis patients. METHODS: Fifty patients with secondary progressive type multiple sclerosis (SPMS) suffering from bladder dysfunction were divided equally into two groups randomly. Group A (GA) received behavioural therapy (biofeedback training), while Group B (GB) received interferential current training. Both groups were assessed by urodynamics for detrusor pressure and maximum flow rate before and after eight weeks of behavioural therapy and interferential training. RESULTS: Both groups, GA and GB, showed significant increase in the detrusor pressure and maximum flow rate after eight weeks of training. There was no significant difference between both methods. However, GA showed more improvement by close observation. CONCLUSIONS: Both behavioural therapy and interferential current training effectively managed bladder dysfunction in patients with SPMS, with more evident effects in behavioural therapy patients by close observation.

Isokinetic trunk muscle performance in adolescents with different body mass indices.

OBJECTIVE: This study aims to evaluate the isokinetic performance for the peak torque and average power of the spinal flexor and extensor muscles in adolescents aged 12 to 18 years. The study also analyses the differences between the trunk muscle peak torque and average power with body mass index (BMI). METHOD: The peak torque and average power of the trunk flexor and extensor muscles were measured in 180 adolescents (aged 12-18 years). The participants were classified into four groups according to BMI. The Biodex isokinetic dynamometer in concentric mode at speeds of 60° and 120°/sec was used for assessment. RESULTS: One-way multivariate analysis of variance MANOVA results demonstrated a significant difference in trunk muscle peak torque and average power with different BMI (F = 14.692, p = 0.0005). A Pearson's correlation analysis demonstrated a significantly negative correlation between weight and peak torque of trunk flexors and extensors (r = - 0.43, p = 0.0001; r = -0.31, p = 0.007, respectively). Finally, the results showed a negative correlation between weight and average power of trunk flexors and extensors (r = -0.54, p = 0.0001; r = -0.31, p = 0.007). CONCLUSION: In this study, overweight and obese adolescents are found to be correlated with decreased trunk muscle torque and power. Thus, therapeutic interventions for overweight and obese adolescents, along with exercise training programmes, may help improve muscle performance including peak torque and power. Finally, these measures may enhance the quality of life of such adolescents.

Peak torque substantially varies between patients with non-specific low back pain; belong to directional preference classification, and healthy individuals-clinical biokinesiologic perspectives.

[Purpose] To compare flexion and extension peak torque of patients with nonspecific-chronic low back pain who were classified as directional preference subgroups, and their matched healthy controls. [Participants and Methods] Fifty male volunteers (25 with non-specific chronic low back pain and 25 healthy-matched controls) consented to participate. The investigator collected all demographic data, hips, knees and spinal mobility in addition to the peak torque using the Biodex isokinetic dynamometer. The measurement protocol consisted of 2 sets of 10 consecutive flexion-extension efforts performed at 120°/sec and 60°/sec angular velocity. A two minutes rest period was given between sets. The preset 50° range of motion included 20°(+20°) of trunk extension and 30°(-30°) of trunk flexion. [Results] A 2 × 2 mixed-design ANOVA showed a significant group X isokinetic velocity interaction. The main effect of isokinetic velocity was also significant. In reference to the peak torque of the flexors of the trunk, the main effect of group was significant. [Conclusion] The extension peak torque significantly depends on the velocity of the isokinetic dynamometer; however the flexion peak torque significantly depends on the participants' group attribution.

Total assessment-reassessment & evaluation using bioKinesiologic (TAREK) approach: case presentation for theoretical formulation.

[Purpose] To introduce a new systematic physical therapy evaluation aiming to facilitate the process of examining complicated musculoskeletal cases. [Subject and Methods] The patient was a 20 years old male college student who had major motor vehicle accident one year ago. The patient was poorly responding to physical therapy and he felt that his case was worsening. The complexity of the case dictated a new evaluation with a different approach to resolve the barriers hindering the patient from showing functional improvements. [Results] The new evaluation approach explained many undetermined and stubborn symptoms experienced by the patient. The expert confirmed that the traditional evaluations methods utilized were insufficient to address patient's complaints. [Conclusion] Total Assessment-Reassessment & Evaluation using bioKinesiologic (TAREK) approach is comprehensive evaluation strategy using systematic pathway that guides clinicians to pinpoint the contribution of pathoanatomical structures in producing pathomechanical mobility and poor functional outcomes.

Right versus left side bridge static endurance ability among healthy collegiate students at Taibah University.

BACKGROUND: Spinal muscles endurance is fundamental for providing adequate trunk stability. OBJECTIVE: The purpose of this study was to compare the side bridge static endurance ability of the right versus left side. METHODS: Forty right hand dominant students, aged between 18 and 25 years, were recruited from Taibah University. Every participant had to lie down on his side and bear trunk weight on the arm with shoulder abducted to 90∘ and elbow flexed to 90∘. Every participant had to lift off his trunk of the supporting surface, keeping the trunk straight in neutral position, breathing normally and holding on that position as long as tolerated. RESULTS: A paired sample t test was calculated. The mean score, in seconds, for right side bridge was 41.6 (SD = 30.08), and for left side bridge was 38.00 (SD = 26.93). No significant difference was found between right and left side bridge endurance ability [t (39) = 1.67, p> 0.05]. Pearson correlation showed high positive correlation [r (38) = 0.89, p< 0.001]. CONCLUSIONS: Among healthy participants, clinicians should expect very close endurance profile for the musculature of the two sides of trunk. Clinicians should equally train both sides of trunk muscles stabilizers in order to enhance tolerance.

Biodex balance training versus conventional balance training for children with spastic diplegia.

OBJECTIVE: The purpose of this study was to compare the effectiveness of balance training using the Biodex balance system and a conventional balance training programme on balance score and on gross motor skills of children with spastic diplegia. METHODS: A randomized controlled study was conducted on 48 spastic diplegic children with cerebral palsy (26 boys and 22 girls) in the age range of 5-8 years. The children were randomly allocated to two equal groups. The investigators performed balance and gross motor function assessments for every child using the paediatric Berg balance scale and the gross motor function measure -88 scale (dimensions D and E) before and after the treatment programme. Passive repositioning sense was measured by a Biodex III isokinetic dynamometer. The study group received Biodex balance training and traditional physical therapy programme training, whereas the control group received conventional balance training in addition to the traditional physical therapy programme training, 3 times per week for 12 weeks. RESULTS: Significant improvement was observed in all outcome measures of the two groups, comparing their pre- and post-treatment mean values. Furthermore, the results revealed a significant (P < 0.05) improvement in mean post-treatment values for the Biodex balance training group. CONCLUSION: Balance training using the Biodex balance system is superior to conventional balance training for improving the balance abilities and gross motor functions of children with cerebral palsy and spastic diplegia.

Effect of body-weight suspension training versus treadmill training on gross motor abilities of children with spastic diplegic cerebral palsy.

BACKGROUND: Suspension training and treadmill training are commonly used for promoting functional gross motor skills in children with cerebral palsy. AIM: The aim of this study was to compare the effect of body-weight suspension training versus treadmill training on gross motor functional skills. DESIGN: Assessor-blinded, randomized, controlled intervention study. SETTING: Outpatient rehabilitation facility. POPULATION: Twenty children with spastic diplegia (7 boys and 13 girls) in the age ranged from 6 to 8 years old were randomly allocated into two equal groups. All children were assessed at baseline, after 18-session and after 36-session. METHODS: During the twelve-week outpatient rehabilitation program, both groups received traditional therapeutic exercises. Additionally, one group received locomotor training using the treadmill while the other group received locomotor training using body-weight suspension through the dynamic spider cage. Assessment included dimensions "D" standing and "E" walking of the gross motor function measure, in addition to the 10-m Walking Test and the five times sit to stand test. Training was applied three times per week for twelve consecutive weeks. RESULTS: No significant difference was found in standing or walking ability for measurements taken at baseline or after 18-session of therapy. Measurements taken at 36-session showed that suspension training achieved significantly (P<0.05) higher average score than treadmill training for dimension D as well as for dimension E. No significant difference was found between suspension training and treadmill training regarding walking speed or sit to stand transitional skills. CONCLUSIONS: Body-weight suspension training is effective in improving walking and locomotor capabilities in children with spastic diplegia. After three month suspension training was superior to treadmill training. CLINICAL REHABILITATION IMPACT: Body-weight suspension training promotes adequate postural stability, good balance control, and less exertion which facilitates efficient and safe gait.