Effects of Balance, Plyometric, and Combined Plyometric-Balance Training in Pediatric Burn Survivors (PlyoBurn)

Effects of Balance, Plyometric, and Combined Plyometric-Balance Training on Balance and Physical Performance in Pediatric Burn Survivors During Long-Term Rehabilitation

Children who sustain burn injuries often develop long-term physical and psychological complications that limit their ability to move, exercise, and participate in daily activities. These problems commonly include reduced balance, muscle weakness, fatigue, and impaired physical performance, which may persist for several years after injury and require prolonged rehabilitation.

This study aims to investigate the effects of three different exercise-based rehabilitation programs-balance training, plyometric (jump-based) training, and a combined balance and plyometric training program-on balance and physical performance in children recovering from burn injuries. A total of 84 children aged 10 to 17 years with healed lower-limb burns will be randomly assigned to one of the three training groups. Each group will participate in supervised exercise sessions three times per week for eight weeks.

Balance, muscle strength, power, and agility will be assessed before and after the training period using standardized physical performance tests. The findings of this study are expected to help identify the most effective rehabilitation approach for improving functional abilities and physical performance in pediatric burn survivors during long-term recovery.

Study Overview

• Status: Completed
• Conditions: Burn; Pediatric Burns; Burn Rehabilitation
• Intervention / Treatment: Other: Plyometric Exercise Training Program; Other: Balance Training Program; Other: Combined Plyometric and Balance Training Program

Detailed Description

Burn injuries in children are frequently associated with long-lasting impairments in balance, muscle strength, coordination, and physical performance. These limitations may persist long after wound healing due to sensory disturbances, muscle wasting, fatigue, prolonged inactivity, and reduced physical activity levels. Such functional deficits can restrict participation in daily activities and negatively influence long-term recovery, emphasizing the need for effective rehabilitation strategies.

This randomized, single-blind, parallel-group clinical trial is designed to evaluate and compare the effects of three different rehabilitation training programs on balance and physical performance in pediatric burn survivors. Eighty-four children aged between 10 and 17 years with healed burn injuries affecting more than 30% of total body surface area and involving the lower extremities will be recruited. All participants will be at least one year post-injury and medically stable.

Following baseline assessments, participants will be randomly allocated to one of three intervention groups: balance training, plyometric training, or combined plyometric and balance training. Each group will undergo supervised exercise sessions three times per week for a total duration of eight weeks. All training sessions will begin with a standardized warm-up to ensure consistency across groups.

Outcome assessments will be conducted before and after the training period to evaluate changes in static and dynamic balance, lower-limb muscle strength, muscular power, and agility using standardized and validated physical performance tests.

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Outpatient Rehabilitation Clinic

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Children aged 10 to 17 years.
• History of burn injury involving more than 30% of total body surface area (TBSA).
• Burn injury involving the lower extremities.
• At least one year has elapsed since the burn injury.
• Completion of acute medical management and participation in outpatient rehabilitation programs.
• Medically stable and able to participate in supervised exercise training.
• Written informed consent provided by parents or legal guardians.

Exclusion Criteria:

• Presence of unhealed or open burn wounds.
• Any neurological disorder, unrelated to burn injury.
• Any musculoskeletal disorder, unrelated to burn injury.
• Any orthopedic disorder that may interfere with exercise participation or outcome assessment.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Plyometric Training Group; Participants assigned to this group will receive an 8-week supervised plyometric exercise program, performed three times per week on non-consecutive days.	Other: Plyometric Exercise Training Program; This intervention consists of a structured plyometric exercise program delivered over eight weeks, with three supervised sessions per week on non-consecutive days. The program focuses on lower-extremity jumping and explosive movements designed to enhance neuromuscular performance, power, and coordination. Exercises emphasize proper posture, controlled landings, minimal ground contact time, and rapid stretch-shortening cycle actions. Training intensity and complexity progressively increase throughout the intervention period. Each session begins with a standardized warm-up.
Experimental: Balance Training Group; Participants in this group will complete an 8-week supervised balance training program, conducted three times per week on non-consecutive days.	Other: Balance Training Program; This intervention consists of an eight-week supervised balance training program conducted three times per week on non-consecutive days. The program includes progressive static and dynamic stabilization exercises aimed at improving postural control, coordination, and balance performance. Exercise difficulty is gradually increased based on participant progression to provide appropriate challenge. Each training session begins with a standardized warm-up.
Experimental: Combined Plyometric and Balance Training Group; Participants assigned to this group will undergo an integrated training program combining balance and plyometric exercises within the same session. Training is conducted three times per week for eight weeks.	Other: Combined Plyometric and Balance Training Program; This intervention integrates balance and plyometric exercises within a single training session over an eight-week period, with three supervised sessions per week. Approximately half of each session focuses on balance exercises performed using slow, controlled movements, followed by plyometric exercises emphasizing rapid stretch-shortening cycle actions. Training progression involves gradual increases in exercise intensity, complexity, repetitions, and sets. Each session begins with a standardized warm-up. Total training volume and frequency are matched to those of the single-modality training groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Static Balance Performance (Standing Stork Test)	Static balance will be evaluated using the Standing Stork Test.	Baseline (pre-intervention)
Static Balance Performance (Standing Stork Test)	Static balance will be evaluated using the Standing Stork Test.	Week 8 (Post-Intervention)
Dynamic Balance Performance (Y-Balance Test Composite Score)	Dynamic balance will be assessed using the Y-Balance Test. Participants will stand on the dominant leg and reach in three directions (anterior, posteromedial, and posterolateral) with the contralateral limb. Reach distances will be normalized to leg length, and a composite score will be calculated. The highest values obtained across three trials for each direction will be used for analysis.	Baseline (pre-intervention)
Dynamic Balance Performance (Y-Balance Test Composite Score)	Dynamic balance will be assessed using the Y-Balance Test. Participants will stand on the dominant leg and reach in three directions (anterior, posteromedial, and posterolateral) with the contralateral limb. Reach distances will be normalized to leg length, and a composite score will be calculated. The highest values obtained across three trials for each direction will be used for analysis.	Week 8 (Post-Intervention)
Lower-Limb Muscle Strength (Knee Extensor and Flexor)	Maximal voluntary isometric contraction of the dominant-leg knee extensors and flexors will be measured using a handheld dynamometer. Participants will perform maximal contractions lasting 3-5 seconds. The highest value from three trials will be recorded for analysis.	Baseline (Pre-Intervention)
Lower-Limb Muscle Strength (Knee Extensor and Flexor)	Maximal voluntary isometric contraction of the dominant-leg knee extensors and flexors will be measured using a handheld dynamometer. Participants will perform maximal contractions lasting 3-5 seconds. The highest value from three trials will be recorded for analysis.	Week 8 (Post-Intervention)
Agility Performance	Agility will be assessed using the 4 × 9 m shuttle run test.	Baseline (Pre-Intervention)
Agility Performance	Agility will be assessed using the 4 × 9 m shuttle run test.	Week 8 (Post-Intervention)
Lower-Limb Power - Countermovement Jump Height	Lower-limb explosive power will be assessed using the countermovement jump test by centimeters Participants will perform maximal vertical jumps according to standardized procedures.	Baseline (Pre-Intervention)
Lower-Limb Power - Countermovement Jump Height	Lower-limb explosive power will be assessed using the countermovement jump test by centimeters Participants will perform maximal vertical jumps according to standardized procedures.	Week 8 (Post-Intervention)
Lower-Limb Power - Standing Long Jump Distance	Explosive lower-limb performance will be evaluated using the standing long jump. The longest distance by centimeters across three trials will be recorded.	Baseline (Pre-Intervention)
Lower-Limb Power - Standing Long Jump Distance	Explosive lower-limb performance will be evaluated using the standing long jump. The longest distance by centimeters across three trials will be recorded.	Week 8 (Post-Intervention)
Lower-Limb Power - Triple Hop Test Distance	Lower-limb power will be measured by centimeters the triple hop test performed on the dominant leg. The maximum distance from three trials will be recorded.	Baseline (Pre-Intervention)
Lower-Limb Power - Triple Hop Test Distance	Lower-limb power will be measured by centimeters the triple hop test performed on the dominant leg. The maximum distance from three trials will be recorded.	Week 8 (Post-Intervention)

Collaborators and Investigators

• Sponsor: Qassim University
• Collaborators: Cairo University

Publications and helpful links

General Publications

• Abouzeid CA, Wolfe AE, Ni P, Carrougher GJ, Gibran NS, Hammond FM, Holavanahalli R, McMullen KA, Roaten K, Suman O, Stewart BT, Wolf S, Zafonte R, Kazis LE, Ryan CM, Schneider JC. Are burns a chronic condition? Examining patient reported outcomes up to 20 years after burn injury-A Burn Model System National Database investigation. J Trauma Acute Care Surg. 2022 Jun 1;92(6):1066-1074. doi: 10.1097/TA.0000000000003547. Epub 2022 Jan 25.
• Grice KO, Barnes KJ, Vogel KA. Influence of burn injury on activity participation of children. J Burn Care Res. 2015 May-Jun;36(3):414-20. doi: 10.1097/BCR.0000000000000105.
• Cuijpers MD, Baartmans MGA, van Zuijlen PPM, Ket JCF, Pijpe A. Children's growth and motor development following a severe burn: a systematic review. Burns Trauma. 2023 Aug 30;11:tkad011. doi: 10.1093/burnst/tkad011. eCollection 2023.
• Chaouachi A, Othman AB, Hammami R, Drinkwater EJ, Behm DG. The combination of plyometric and balance training improves sprint and shuttle run performances more often than plyometric-only training with children. J Strength Cond Res. 2014 Feb;28(2):401-12. doi: 10.1519/JSC.0b013e3182987059.
• Brink Y, Brooker H, Carstens E, Gissing CA, Langtree C. Effectiveness of resistance strength training in children and adolescents with >/=30% total body surface area: A systematic review. S Afr J Physiother. 2016 Jun 29;72(1):303. doi: 10.4102/sajp.v72i1.303. eCollection 2016.

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2025
• Primary Completion (Actual): January 20, 2026
• Study Completion (Actual): January 25, 2026

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 26, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 26, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Balance training; Plyometric training; Burn rehabilitation; Pediatric burns; Exercise therapy in children
• Additional Relevant MeSH Terms: Wounds and Injuries; Burns
• Other Study ID Numbers: P.T.REC/012/005690

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no plan to share individual participant data.

Drug and device information, study documents

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