Effects of PNF and Rebound Therapy on Trunk Control in CP

Effects of Proprioceptive Neuromuscular Facilitation Techniques With and Without Rebound Therapy on Trunk Control in Children With Cerebral Palsy

Cerebral palsy is a group of upper motor neuron syndromes with acquired disorders of early brain development .It effects the person's ability to move and maintain balance and posture. It is the most common motor disability of childhood. Proprioceptive neuromuscular facilitation integration pattern stimulates the proprioceptors with in the muscle and tendon to enhance the performance flexibility, balance and helps in trunk mobility. The motor control movement pattern is facilitated by the dynamic and assistive active resistant progressions regaining motor control. Rebound therapy is used to facilitate movement, promote balance, helps in increase or decrease in muscle tone and promotes sensory integration.

This study will evaluate the effects of PNF techniques with and without rebound therapy on trunk control in children with cerebral palsy. It is randomized controlled trial.34 children with cerebral palsy will participate in this study. The participants will be randomized into control group A (n=17) and experimental group (n =17).Only those children will be included who fulfill inclusion criteria. That is both gender, age range 6 to 12 years, having GMFM score of I -II .Those having cognitive and learning difficulties, having age range out of 6 to 12 years. Data will be analyzed through SPSS 29. The control group will practice PNF techniques for trunk control while experimental group will practice rebound therapy along with PNF exercises for trunk control .Both group will receive 45 min session, 5 days a week for 6 weeks. TCMS and TUG scale will be used.

Study Overview

• Status: Completed
• Conditions: Cerebral Palsy
• Intervention / Treatment: Other: Proprioceptive neuromuscular facilitation techniques; Other: Rebound Therapy

Detailed Description

Intervention

GROUP A (experimental group)

After giving baseline therapy experimental group will be given PNF based exercises for trunk control along with rebound therapy .duration will be 45 minutes, 5 session per week for 6 weeks.

PNF exercises will be;

Resist the person's concentric contraction while they move into sitting .Resist the eccentric control as they lie down. Balancing using stabilizing reversals or rhythmic stabilization to increase trunk stability .Resist the shoulder pelvis and head. For Trunk exercises: use dynamic reversals (slow reversals) and combination of isotonic to increase patient trunk strength and coordination .Resist at scapula and lifting combinations to get added irradiation. Trunk flexion and extension. Reaching forward and to the side with return, this requires hip flexion, extension ,lateral motion and rotation with the trunk remaining stable Bridging exercises Lower trunk rotation .Weight shifting in long leg sitting.

REBOUND THERAPY

Rebound therapy session including lying down on trampoline bouncing created by therapist.

It will be 10 repetitions. .Hip kneeling bouncing with physio balls. Standing bouncing with physio balls .Jumping on trampoline. Learning front drops, seat drops, and other function movements will be given for 5 minutes.

GROUP B (control group)

The control group will only be given PNF based trunk exercises. PNF exercises will be; Resist the person's concentric contraction while they move into sitting .Resist the eccentric control as they lie down. Balancing using stabilizing reversals or rhythmic stabilization to increase trunk stability .Resist the shoulder pelvis and head. For Trunk exercises: use dynamic reversals (slow reversals) and combination of isotonic to increase patient trunk strength and coordination .Resist at scapula and lifting combinations to get added irradiation. Trunk flexion and extension. Reaching forward and to the side with return, this requires hip flexion , extension ,lateral motion and rotation with the trunk remaining stable Bridging exercises Lower trunk rotation .Weight shifting in long leg sitting.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Lahore, Punjab, Pakistan, 54000
      • Riphah International University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Both gender
• Children from 6 years to 12 years of age will be included
• Degree of spasticity ranged from 1 and 1+ according to modified Ashworth scale
• According to gross motor functional classification system children were categorized on level I -II
• Those children should understand and follow simple orders.

Exclusion Criteria:

• Child having any fixed deformity of both hands and feet.
• Having hearing or visual disability
• Having infectious disease or any open wound
• Seizures
• Other spinal deformities
• Any fracture
• Unstable cardiac status, Fever greater than 38 degrees Celsius, Any chest infection

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Proprioceptive neuromuscular facilitation techniques; GROUP A (experimental group) PNF based exercises for trunk control duration 45 min 5 session/week for 6 weeks; Resist person concentric contraction while move in sitting .Resist eccentric control as th lie down. Balance using stabilizing reversals or rhythmic stabilization .Resist shoulder pelvis ,head.Trunk exercises dynamic reversals and combination of isotonic to increase trunk strength and coordination .Resist at scapula and lifting combinations for irradiation. Trunk flexion and extension. Reaching forward and to side with return,for this hip flexion, extension ,lateral motion and rotation with the trunk remaining stable Bridging exercises Lower trunk rotation .Weight shifting in long leg sitting	Other: Proprioceptive neuromuscular facilitation techniques; Proprioceptive neuromuscular facilitation techniques
Active Comparator: Rebound Therapy; Rebound Therapy lying down on trampoline bouncing created.10 times.Hip kneeling bounce and Standing bouncing with physio balls .Jump on trampoline. Learning front drops, seat drops for 5 minutes. Resist person concentric contraction while move into sitting .Resist eccentric control as they lie down. Balance using stabilizing reversals to increase trunk stability .Resist shoulder pelvis, head.Trunk exercises: use dynamic reversals and combination of isotonic to increase trunk strength and coordination .Resist at scapula and lifting combination for irradiation. Trunk flexion and extension. Reaching forward and to side with return,for this hip flexion , extension ,lateral motion and rotation with trunk remaining stable Bridging exercises Lower trunk rotation .Weight shifting in long leg sitting	Other: Rebound Therapy; Rebound Therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Trunk control measure scale	Trunk control measuring scale TCMS: Trunk control measuring scale is highly reliable in children with various neuromuscular disorders .It is reliable for children 5 years and older. TCMS consist of static and dynamic sitting balance, the latter is divided into selective movement control and dynamic reaching. TCMS is a valid and reliable tool for assessing the trunk control in children and youth with CP. The TCMS scale assesses seated trunk control in three dimensions. The maximum score is 58 points where 20 points correspond to static balance, 28 to selective movement control and 10 to the ability to perform dynamic reaching. The items are scored 0 to 3 with 0 being the inability to perform the task and 3 being the complete task performance.	6 weeks
Timed Up and Go test	Timed Up and Go test (TUG) It is a performance measure designed to assess the speed of a functional walk. It included stand up, walk 3 min, turn around, walk back, and sit down .It assesses lower limb mobility and function. The TUG test is reliable and responsive measure of balance and mobility for children with CP between 3 and 10 years of age and with GMFM level I- III	6 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Maidah Aiman, MS*, Riphah International University

Publications and helpful links

General Publications

• Germain AM, Blackmore AM, Gibson N, Newell B, Williams SA. Effects of Adaptive Bungee Trampolining for Children With Cerebral Palsy: A Single-Subject Study. Pediatr Phys Ther. 2019 Apr;31(2):165-174. doi: 10.1097/PEP.0000000000000584.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2023
• Primary Completion (Actual): February 5, 2024
• Study Completion (Actual): February 6, 2024

Study Registration Dates

• First Submitted: December 26, 2023
• First Submitted That Met QC Criteria: December 26, 2023
• First Posted (Actual): January 9, 2024

Study Record Updates

• Last Update Posted (Actual): June 13, 2024
• Last Update Submitted That Met QC Criteria: June 11, 2024
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Keywords: Cerebral palsy, PNF, Rebound therapy,Trunk Control
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy
• Other Study ID Numbers: REC/RCR & AHS/23/0739

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No