Effects of Modified Pilates Training on Hemodynamic Responses
Condition: Cerebral Palsy; Physical Inactivity; Gait Disorders in Children; Gait, Spastic
MeSH terms: Cerebral Palsy; Gait Disorders, Neurologic
Study type: Interventional

Summary: 
      Cerebral Palsy (CP) is a non-progressive neurodevelopmental disorder that starts in the early
      stages of life, causes activity limitation, and consists of movement and posture
      deficiencies. Children with CP usually have difficulties in mobility, transfer and social
      participation due to many motor and sensory disorders such as muscle weakness, decreased
      postural control, balance, spasticity. Core stability maintains posture and provides support
      for extremity movements by connecting with the deep abdominal muscles, spine, pelvis and
      shoulder girdle muscles. During reaching, walking and sudden perturbations in the body, the
      Transversus Abdominus (TrAb) muscle is activated primarily than other trunk and extremity
      muscles, creating a core stability. Core activity includes not only spinal stability and
      power generation, but also many upper and lower extremity movements. By focusing on the TrAb
      muscle with Pilates, the stabilization of the trunk muscles can be increased by creating
      control thanks to the core stabilization training. In addition, the TrAb muscle works
      together with the diaphragm muscle, which is the main respiratory muscle. The expected
      increased respiratory capacity with training may also affect hemodynamic responses.
    

Detailed description: 
      Children with CP usually have difficulties in mobility, transfer and social participation due
      to many motor and sensory disorders such as muscle weakness, decreased postural control,
      balance, spasticity. Abnormal motor patterns and tone, poor trunk control, and postural
      disorders adversely affect the physical development of these children. Children with CP show
      deficits in proximal muscle co-contraction and posture stabilization, which leads to
      limitations in postural reactions and antigravity movements. Dysfunctions are also observed
      in antisipatory and reactive postural adjustments, and limitations occur especially in upper
      extremity functions such as walking, reaching, and eating. Although these limitations
      associated with postural control dysfunctions are known, optimal intervention methods have
      not yet been determined. Because of these dysfunctions, many individuals with CP have
      difficulty walking independently, walking on slopes/uneven ground, and performing daily
      physical functions. Trunk control, which is formed by the activation of the core muscles, is
      the determinant of postural control, automatic postural reactions, balance, walking and
      functional activities from the early period.By focusing on the TrAb muscle with Pilates, the
      stabilization of the trunk muscles can be increased by creating control thanks to the core
      stabilization training. In addition, the TrAb muscle works together with the diaphragm
      muscle, which is the main respiratory muscle. The expected increased respiratory capacity
      with training may also affect hemodynamic responses. Proximal extremity muscles around the
      hip are also important for maintaining upright posture and maintaining mobility. Studies have
      shown that hip abductor muscle strength is more associated with gait variables and motor
      functions in children with CP compared to knee and ankle muscles. Although the importance of
      this in terms of gait has been determined, studies investigating the activation patterns of
      trunk and hip muscles during walking of individuals with CP are limited.For this reason, it
      is thought that pilates training can be applied in terms of muscle strength and postural
      control in selected individuals with CP who can walk, stand independently, but need to
      develop some components for controlled movement.Although there are a limited number of
      studies investigating the effects of modified pilates exercises (MPE) in individuals with CP
      in different clinical types, their effects on trunk control, core muscle endurance,
      hemodynamic responses and gait have not been investigated. It is known that most children
      with CP have significantly lower performance in cardiorespiratory and metabolic tests than
      their healthy peers.For many of these children, these mobility limitations associated with
      physical activity adversely affect musculoskeletal and cardiovascular function and increase
      the risk for secondary medical conditions. Therefore, viable, effective interventions are
      needed to improve the mobility and cardiorespiratory performance of children with CP. For
      example, bodyweight supported treadmill training has been used to address these children's
      walking and fitness goals. However, its routine use in smaller clinics, schools and home
      settings is often not feasible given the physical requirements associated with helping a
      child with significant weakness, spasticity or cardiovascular endurance deficiencies keep
      pace.For this purpose, it is noteworthy that the effects of MPE training targeting the TrAb
      muscle on gait and hemodynamic responses have not been investigated, especially in children
      with CP.This study aims to determine the effects of modified pilates exercises (MPE) and
      traditional neurodevelopmental therapy (NDT-Bobath) on hemodynamic responses in children with
      CP.
    

Intervention name(s): exercises
Intervention type(s): Other
Intervention description(s): Group 1 will be given MPEs for 45 minutes, 3 days a week for 8 weeks. In the second group, traditional Neurodevelopmental Treatment (NGT-Bobath) approach will be applied for 45 minutes a day, 3 days a week for 8 weeks. Treatments will be carried out by the same physiotherapist. Evaluations will be made twice, before and after the treatment.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The intervention will be rehabilitation methods applied with different exercise trainings, Neurodevelopmental Therapy (NGT-Bobath) will be applied to one group and Modified Pilates Exercises (MPE) (non-invasive) will be applied to the other group.
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Cerebral Palsy; modified pilates exercises; neurodevelopmental therapy; hemodynamic responses