Effect of Vestibular Rehabilitation on Postural Sway and Energy Expenditure in Children With Spastic Diplegia

this study will be conducted To determine the effect of vestibular rehabilitation training on postural sway and energy expenditure in children with spastic cerebral palsy and To determine any relation between postural sway and energy expenditure in children with spastic cerebral palsy.

Study Overview

• Status: Not yet recruiting
• Conditions: Spastic Diplegia
• Intervention / Treatment: Other: vestibular rehabilitation; Other: conventional physical therapy

Detailed Description

Cerebral palsy leads to postural asymmetries and balance impairments, primarily due to central vestibular dysfunction. Children aged 7-12 with gross motor function classification system levels I-III exhibit poor visual and vestibular interactions, impacting their ability to resolve sensory conflicts and manage reflexes. Excessive lateral trunk lean in cerebral palsy, prevalent in 72% of affected children, increases locomotion costs. Energy expenditure during walking rises with declining motor function, particularly in spastic cerebral palsy where vestibular dysfunction affects nearly 48% of cases. The relationship between balance control efforts and metabolic energy expenditure is complex, especially during dynamic activities like walking. This study will assess the impact of vestibular rehabilitation on postural sway and energy expenditure in children with spastic cerebral palsy, aiming to elucidate their interrelationship.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nesma Abdelrhman Farag, assistant lecturer; Phone Number: 01016612043; Email: nesmafarag2018@gmail.com

Study Locations

• Egypt
  • Cairo, Egypt
    • outpatient clinic, faculty of physical therapy, Cairo university
    • Contact: Nesma Abdelrhman Farag, assistant lecturer; Phone Number: 01016612043; Email: nesmafarag2018@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. The age of the selected children will be ranged from 8 to 12 years old.
2. Degree of spasticity is ranging from 1+to 2 according to modified Ashworth scale
3. The level of motor function of the children will be levels I-II according to Gross Motor Function Classification System
4. They are able to follow instructions and understand commands.

Exclusion Criteria:

1. Bone and tendon lengthening surgeries within last 6 months.
2. Lung and heart diseases and disorders.
3. Vision or hearing problems
4. Children with fixed deformities.
5. Children with epilepsy.
6. Recent intramuscular Botulinum toxin injection or orthopedic surgery within last 6 months.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: vestibular rehabilitation; Fifteen children will receive conventional physical therapy program for 1 hour and vestibular rehabilitation for 30 minutes 3 times per week for 8 weeks	Other: vestibular rehabilitation; Bouncing-jumping activities from standing.; linear swinging activities: using swinging platform (standing walking) scooter activity (kneeling, standing), hanging lower limb activities and climbing swinging robe ladder.; By pushing-pulling activities, displacement of the center of gravity is created.; These are activities which enable active equilibrium on steep surfaces such as stairs.; Walking on ramps.; Walking unfamiliar surfaces such as balance disc, balance boards and balance beam; Other: conventional physical therapy; Balance exercise.; Gait training (forward, backward and side way).; Gait training with obstacles of different sizes.; Gait training in stepper.; Gait training on wooden ramp.; Gait training on balance board.; Training up and down steps different heights.; Stretching exercise for upper limbs and lower limbs.; Strengthening exercises for lower limbs muscles.; Trunk control exercises like abdominal and back exercises.
Active Comparator: conventional physical therapy; Fifteen children will receive conventional physical therapy program only for 1 hour 3 times per week for 8 weeks.	Other: conventional physical therapy; Balance exercise.; Gait training (forward, backward and side way).; Gait training with obstacles of different sizes.; Gait training in stepper.; Gait training on wooden ramp.; Gait training on balance board.; Training up and down steps different heights.; Stretching exercise for upper limbs and lower limbs.; Strengthening exercises for lower limbs muscles.; Trunk control exercises like abdominal and back exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
assessment of postural sway	The process for measuring frontal plane lateral trunk tilt angle during gait involves several steps as per the studies. First, three circular adhesive dots are placed on the sternal notch and the anterior superior iliac spine. A video camera is set up to capture the child's full body while walking. The recorded video is analyzed using Kinovea, dividing the gait cycle into 11 frames at 10% intervals. The angle of trunk deviation from vertical is calculated in these frames by connecting the anterior superior iliac spine markers and the sternal notch to determine the longitudinal axes of the trunk, with the angle measured against a vertical line.	at base line and after 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
assessment of Energy Expenditure	Heart rate expressed per distance walked provides information on energy economy as dose oxygen uptake expressed per distance walked because resting heart rate is known to increase with decreased body size and level of fitness, the resting heart rate is subtracted from the walking heart rate, and this value is divided by the walking speed. The following calculation of an energy expenditure index (energy expenditure index; beats/minute) energy expenditure index heart rate = (exercise heart rate-resting heart rate)/speed measured in m·min	at base line and after 8 weeks

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): August 30, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: May 24, 2026
• First Submitted That Met QC Criteria: May 24, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 24, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy
• Other Study ID Numbers: Nesma-phd

Drug and device information, study documents

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