Effectiveness of Progressive Resistance Training for theChildren with Spastic Diplegic Cerebral Palsy: A ControlledExperimental study

INTRODUCTION : Cerebral Palsy (CP) is defined as a group of permanent disorders of the development of movement and posture causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal (or) infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication and behaviour by epilepsy and secondary musculoskeletal problems. The incidence of CP is well raised above 2.0 per 1,000 live birth in the past 40 years. The Fetal brain injury that occurs during the prenatal, postnatal and neonatal period ends up in CP. The causes can be specified as: intra uterine exposure to infection, inflammation, disorders of coagulation, interruption of oxygen supply during birth, low APGAR score, seizures, low birth weight, pre term and non specific indicators of neonatal illness. CP can be classified based on the movements as hypertonic or spastic, ataxic, dyskinetic, mixed and hypotonic6. Based on the function, CP is classified as quadriplegic, diplegic, hemiplegic and monoplegic7. Spasticity is the most common movement disorder among the patients with CP 8. Spastic diplegia is most prevalent form of CP. AIM OF THE STUDY : The study was aimed to find out the effect of PRE training on the functional out come in the spastic diplegic CP children. OBJECTIVES : 1. To find out the effect of PRE training in the spastic diplegic CP on the gross motor function in the experimental group. 2. To find out the effect of conventional therapy in the spastic diplegic CP on the gross motor function in the control group. 3. To find out the effect of PRE training in the spastic diplegic CP on the mobility function in the experimental group. 4. To find out the effect of conventional therapy in the spastic diplegic CP on the mobility function in the control group. 5. To find out the effect of PRE training in the spastic diplegic CP on the strength in the experimental group. 6. To find out the effect of conventional therapy in the spastic diplegic CP on the strength in the control group. 7. To find out the effect of PRE training in the spastic diplegic CP on the spasticity in the experimental group. 8. To find out the effect of conventional therapy in the spastic diplegic CP on the spasticity in the control group. 9. To compare the gross motor functional outcome difference between the experimental and control group. 10. To compare mobility functional outcome difference between the experimental and control group. 11. To compare the strength gain between the experimental and control group. 12. To compare the change in spasticity between the experimental and control group. METHODOLOGY : Study Design : A controlled Experimental study. Study Setting : Physiotherapy Outpatient Department, and Pediatric Inpatient Department of Sri Ramakrishna Multi Specialty Hospital, Coimbatore. Sampling Technique : A Convenience sampling. Sample Size : A total of 30 spastic diplegic CP children was selected on the basis of the selection criteria and conveniently allocated in two groups. The group A (experimental group) consist of 15 children and the other group B (control group)consist of 15 children. Study Duration : The study was conducted over a period of 1 year. Treatment Duration : The treatment duration was 12 weeks. Selection Criteria : a) Inclusion criteria : • Age: 4-10 years. • Both gender. • Able to accept and follow verbal instructions. • Ability to walk independently in indoors and outdoors with (or) without mobility aids. • Children with spastic diplegic CP under the Gross Motor Functional Classification System (GMFCS) level I-III. b) Exclusion criteria : • Unstable seizures. • Any surgical procedures up to 3 months prior to the study. • Botulium toxin injection up to 6 months prior to the study. • Other cardio vascular and pulmonary disease which interferes the resisted training exercise. RESULTS : The results confirmed the effect of PRE training was effective than the conventional therapy in the improvement of the gross motor function, mobility function and strength without the adverse effects of increasing spasticity. The result supported the previous studies which stated the PRE can improve the functional status without the adverse effect. Result of the study showed the relationship with the muscle strength and gross motor function25. The study determined that there was significant strength gain in the muscle targeted in the lower limbs, which was also stated in the other studies showed the direct relationship between the lower limb muscle strength and gait parameters. The gained strength of the lower limb muscles can improve the function by strengthened hip muscle stabilizing the pelvic motions in walking, the strengthened knee muscle can improved the degree of crouch gait and increased fast walking, the strengthened ankle muscle can improve the propulsive action of the foot in terminal stands phase34, decreased energy consumption by normalizing the abnormal joint position, and cardiovascular fitness gained after the PRE training36. All these factors contributed for the improvement in the gait parameters such as increased speed, increased stride length, increased cadence and increased single limb balancing during walking. CONCLUSION : The study confirmed the effect of PRE training in the functional status of the spastic diplegic CP who are ambulating. The result of the study showed that the PRE for spastic dipelgic CP can increase the strength of the muscle thus improve gross motor function and mobility without the adverse effect of increased muscle tone.