A Study to Find Out the Effect of Arm Movement through Sensory Based Game on Improving Postural Control in Spastic Diplegic Cerebral Palsy

INTRODUCTION: Poor control of trunk postural muscles and sensory disturbance is the key feature of children with cerebral palsy. These impairments affect the activities of daily living. It has been hypothesized that arm movement through sensory based game enhance proprioceptive and vestibular integration, resulting in improvement of spatial awareness, cocontraction, postural stability and anticipatory motor or postural control. OBJECTIVE: To enhance postural control following arm movement through sensory based game. DESIGN: Pre test/post test experimental design SETTING: Occupational Therapy department, Swami Vivekanand National Institute of Rehabilitation Training and Research, Olatpur, Odisha, 754010 PARTICIPANTS: 30 children with spastic diplegic cerebral palsy randomly allocated into two groups each with 15 subjects in experimental group(mean age=4.9 years) and control group(mean age=5.36 years). Baselines were collected for all subjects by using GMFCS, GMFM-88 and TCMS. INTERVENTION: Subjects of both the group were provided therapy sessions for 45 minutes per day, 5 days in a week for 6 weeks. Both groups had received convensional occupational therapy for 45 minutes. The experimental group had received conventional occupational therapy for 15 minutes and sensory based game for 30 minutes. Sensory based game includes 5 games. They were intermittently structured according to sensory requirements. Post test measurements were assessed after 6 weeks. OUTCOME MEASURE: TCMS,88GMFM,88 GMFCS RESULT: From the statistical result of this study, it is seen that the subjects with spastic diplegic cerebral palsy improved in their GMFM and TCMS score on both the groups. However, the subjects in the experimental group have shown better effect than control group. CONCLUSION: It can be concluded that conventional occupational therapy can include sensory based game which enhance active participation of children and ultimately increase motor control leads to postural control. KEYWORD: Cerebral palsy, postural control, standing balance, arm training, sensory disturbance in cerebral palsy, sensory based game How to cite this paper: Abhirupa Chakraborty | Mrs. Anurupa Senapati "A Study to Find Out the Effect of Arm Movement through Sensory Based Game on Improving Postural Control in Spastic Diplegic Cerebral Palsy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1, December 2020, pp.1017-1022, URL: www.ijtsrd. com/papers/ijtsrd38159.pdf Copyright © 2020 by author(s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) INTRODUCTION Cerebral palsy is the most common physical disability in childhood. It is a disorder resulting from sensory and motor impairments due to perinatal brain injury(1,2), with lifetime consequences that range from poor adaptive and social function to communication and emotional disturbances(3), Infants with cerebral palsy have fundamental disadvantage in recovering motor function; they do not receive accurate sensory feedback from their movement. Estimated incidence of cerebral palsy is 2.11 per births(4). To date, it is known that children with cerebral palsy show deficits in anticipatory postural adjustments(5), reactive postural adjustment(6), muscular components(7) and sensory components(8) of postural control, compared with typical development. This dysfunction hampers in providing balance which is required to achieve gross motor skills such as sitting or standing(9). Especially gait and upper limb activities such as reaching(10) and other activities. Postural control can be defined as the ability to control the body’s position in space for the purposes of stability and IJTSRD38159 International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd. com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38159 | Volume – 5 | Issue – 1 | November-December 2020 Page 1018 orientation(11). Postural stability or balance is the ability to maintain and/or regain the centre of mass within the BOS where gravity is the vector(12). The trunk, centre of our body, plays a crucial role in postural control and the organization of balance reaction(13). During sitting and standing humans voluntarily move their arm; their postural muscles of the lower limb and trunk that control posture are activated in advance of the focal muscles that move the arm voluntarily(14). This type of posture known as, Anticipatory Postural Adjustment (APA). APA, is believed to reduce the effects of forthcoming perturbations caused by voluntary movement on posture and equilibrium(15). APA, probably play an important role in adequately performing various voluntary movement while standing(16). This ‘’anticipatory’’ contraction of the abdominal ones is thought to contribute to preparatory stabilization of the spine against reactive forces resulting from limb movement. Disturbances in the processing of sensory information exists in cerebral palsy children(18). An physical adaptive response might be an increase in physical postural control(19). Anticipatory postural control and voluntary arm movement are thought to be controlled by different but parallel descending pathways. There parallel control mechanisms need to be integrated for effective activity completion without loss of postural control or a fall. Hence, arm movement through sensory based game, enhance proprioceptive and vestibular integration, resulting in improvement of spatial awareness, co-contraction, postural stability and anticipatory motor or postural control. Because, sensory feedback is only used to refine the skill, hence it is postulated that with the use of this strategy, it may be helpful in enhancing Anticipatory Postural Control. Upto date, no such studies that defines the postural control improvement in spastic diplegic cerebral palsy using arm movement through sensory based game. So, we want to find the effects of arm training through sensory based game in sitting, kneeling and standing position in spastic diplegic crebral palsy. AIMS:  To evaluate the effect of arm movement through sensory based game on postural control in spastic diplegic cerebral palsy. OBJECTIVES:  To enhance postural control following arm movement through sensory basedgame. ALTERNATE HYPOTHESIS:  Arm movement through sensory based game will be effective on postural control. NULL HYPOTHESIS:  There will be no effect onpostural control following arm movement through sensory based game. METHODOLOGY Study Design: Pre test / Post test experimental design Sample size: 30 children with spastic cerebral palsy were taken. 15 children were taken in control group and 15 in experimental group. Inclusion criteria:  Spastic diplegic cerebral palsy children who does not have fixed hip, knee, ankle deformity  Age – 4-10 years  GMFCS-2,3  Able to follow simple command  Have gross grasp Exclusion criteria:  Children with mental retardation  Chidren with athetoid, ataxic, hemiplegic and flaccid cerebral palsy  Any congenital deformity Independent Variables:  Conventional exercises  Sensory based game Dependent variables:  Motor Functional Measurement Scale (GMFM) -88  Gross Trunk Control Measurement Scale (TCMS) PROCEDURE  Subjects were collected from department of Occupational Therapy, SVNIRTAR.  Parents of subjects were explained about the study and informed consent were taken from them.  Baseline data were collected for all subjects by using GMFCS, GMFM-88 and TCMS.  Before beginning the intervention each subjects were randomly divided into two groups as control and experimental group.  Subjects of both groups were provided therapy sessions for 45 minutes per day, 5days in a week for 6 weeks.  The subjects of control group had received conventional Occupational Therapy for 45 minutes such as trunk strengthening exercise  Whereas subjects in experimental group had received conventional Occupational Therapy for 15 minutes and sensory based game for 30 minutes.  Sensory based game, it includes 5 games, these were intermittently structured according to sensory requirements.  At the end of 6 weeks, all the subjects were administered GMFM-88 and TCMS and were collected as pre and post intervention data.  Both pre and post data will be taken for statistical analysis. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd. com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38159 | Volume – 5 | Issue – 1 | November-December 2020 Page 1019 PROTOCOL 30 subjects were included as per inclusion criteria Informed consent were taken Outcome variables were measured using GMFM-88, TCMS