Effects of Pediatric Aquatic Therapy in Children With Spastic Cerebral Palsy

Aquatic intervention had been applied in children with neuromotor impairment for years, yet there has been little progress toward objective identifications of therapy goals, interventions, and outcomes. Thus, we attempt to design aquatic intervention activity for children with cerebral palsy to evaluate the effect of hydrotherapy.

Purpose:

To evaluate the effects of pediatric aquatic therapy on motor performance, daily activity and social participation in children with spastic cerebral palsy.

Method:

The study enrolled 27 children with spastic cerebral palsy aged from 4 to 12 years old.These children were dived into two groups: traditional rehabilitation therapy (control group), and hospital based pediatric aquatic therapy program. We evaluate the motor performance, daily activity and social participation before and after the intervention and compared the difference in improvement between groups. The measurements include modified Ashworth score, Gross Motor Function Measure (GMFM -66), Vineland Adaptive Behavior Scale (VABS) , and Cerebral Palsy Quality of Life Questionnaire for Children (CPQOL).

Expect effect:

We suppose pediatric aquatic therapy in spastic cerebral palsy children could improve motor function and daily activity.Children could improve self-esteem and we hypothesize this could improve social participation.

Study Overview

• Status: Completed
• Conditions: Spastic Cerebral Palsy
• Intervention / Treatment: Procedure: aquatic therapy

Detailed Description

• We conducted a well-designed study to investigate the effectiveness of PAT on motor function, activities of daily living (ADL),and health related quality of life(HRQOL) perspectives for children with CP.
• A convenience sample of 27 children was recruited for the study from the outpatient clinics of the Department of Physical Medicine and Rehabilitation of two tertiary hospitals: Chang Gung Memorial Hospital and Taipei Veterans General Hospital.
• The study was designed as a single blinded, prospective, case control study.
• The pediatric aquatic therapy group got more improvementon motor performance measured by GMFM-66.

• Study Type: Interventional
• Enrollment (Actual): 27
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan
    • Chang Gung Memorial Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 years to 12 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Children diagnosed as cerebral palsy, spastic type
2. Gross Motor Functional Classification (GMFCS) level II-IV
3. Age: 4-12 y/o
4. Informed consent by parents
5. Modified Ashworth score 2 or3
6. If participant history of epilepsy ,well controlled by medication

Exclusion Criteria:

1. History of psychiatric diseases
2. Poor controlled epilepsy
3. Received botox injection or surgery in recent three months
4. Children diagnosed as attention deficit hyperactivity disorder(ADHD) or autism
5. Severe mental retardation
6. Active infection (Body temperature > 100°F)
7. Communication problems
8. Bowel incontinence
9. Bladder incontinence
10. Severe cardiovascular disease
11. Infectious skin conditions and open wound
12. Nasogastric tubes or gastrostomy tubes
13. Colostomy ,urostomy or ileostomy bags
14. Acute orthopedic injury with pain and instability
15. Diabetes
16. Chlorine sensitivity
17. Latex allergies
18. Tracheostomy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: pediatric aquatic therapy; The children of the PAT group participated in a 1 hour/time, twice-per-week, 12-week, PAT program in addition to conventional rehabilitation programs	Procedure: aquatic therapy; two hours per week, one hour per time, total 12 weeks; Other Names: physical therapy
No Intervention: conventional therapy; The children included in the control group continued with their original rehabilitation programs

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Unit on Gross Motor Function Measure Scale (GMFM)	The GMFM is a standardized observational instrument designed and validated to measure change in gross motor function over time in children with cerebral palsy. The scoring key is meant to be a general guideline. However, most of the items have specific descriptors for each score. It is imperative that the guidelines contained in the manual be used for scoring each item. The score ranges from 0 to 100 and the higher represent the better gross motor function in children with cerebral palsy	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Daily Living Subscale of Vineland Adaptive Behavior Scale	Vineland Adaptive Behavior scale was developed by Sara et al at 1984 and was used to measure adaptive and maladaptive behavior in children age form 3-12 years-old. The daily living subscale range from 0 to 198 and the higher the score represent the better captive behavior.	3 months
Subscale on Cerebral Palsy Quality of Life Questionnaire for Children	This questionnaire was developed for Children and was a condition-specific quality of life (QOL) questionnaire for children with cerebral palsy aged 4 to 12 years. It contains social , functioning, participation , emotional ,access, pain and disability, and family health components. Participation is the main component in this study. This sub score ranges from 0 to 81 , higher scores represent better participation	3months

Collaborators and Investigators

• Sponsor: Chang Gung Memorial Hospital
• Investigators: Study Director: ChiaLing Chen, Chang Gung Memorial Hospital

Study record dates

Study Major Dates

• Study Start: October 1, 2009
• Primary Completion (Actual): July 1, 2010
• Study Completion (Actual): November 1, 2010

Study Registration Dates

• First Submitted: January 4, 2010
• First Submitted That Met QC Criteria: January 12, 2010
• First Posted (Estimate): January 14, 2010

Study Record Updates

• Last Update Posted (Estimate): February 11, 2015
• Last Update Submitted That Met QC Criteria: February 10, 2015
• Last Verified: February 1, 2010

More Information

Terms related to this study

• Keywords: spastic cerebral palsy; Gross motor function performance; pediatric aquatic therapy
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Brain Damage, Chronic; Musculoskeletal Diseases; Muscular Diseases; Neuromuscular Manifestations; Muscle Hypertonia; Cerebral Palsy; Paralysis; Muscle Spasticity
• Other Study ID Numbers: 981947B