Whole-body Vibration in Spastic Hemiplegic Cerebral Palsy
Condition: Cerebral Palsy, Spastic
MeSH terms: Muscle Spasticity; Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      To target spasticity, balance and mobility whole body vibration exercises along with selected
      physical therapy is given to experimental group. Control group will receive only selected
      physical therapy that includes sstretching exercises, gait training, ffacilitation of
      postural reactions, ffacilitation of standing and weight shift and facilitation of standing
      balance by using a balance board.
    

Detailed description: 
      Cerebral palsy is the most common childhood disabilities affecting individual's posture and
      movement. Cerebral palsy is a disorder that causes activity limitations attributed to
      non-progressive disturbances of the foetal or infant brain that may also affect sensation,
      perception, cognition, communication, and behavior. Cerebral palsy (CP) results from damage
      to the developing central nervous system while in utero, during delivery, or during the first
      two years of life.

      The most common movement disorder in Cerebral palsy is a spastic paresis, defined as a
      posture and movement-dependent tone regulation disorder.The most common signs of the disorder
      are spasticity, rigidity, muscle weakness, ataxia, balance and movement disorders. Compared
      to the typically developed children, these children have impaired sensation and increased
      muscle tone therefore they have trouble voluntarily controlling their muscles. Cerebral Palsy
      can be grouped based on the motor effects it has on the individual, these can include spastic
      Cerebral palsy or non-spastic Cerebral palsy. Spastic Cerebral Palsy is the most common type
      and is associated with tight or contracted muscles.

      Cerebral Palsy is more prevalent in more deprived socio-economic populations. Cerebral palsy
      is a disease that globally has a prevalence of 2 to 3 cases per 1,000 live born neonates. An
      increase in the prevalence of CP was also seen in low birth weight survivors from the Mersey
      region of the United Kingdom for the same period. Pilot studies of severe mental retardation
      conducted in selected populations in Pakistan and India have reported extraordinarily high
      prevalence estimates in the range of 12-24 /1,000 Spasticity may be defined as a motor
      disorder characterised by a velocity-dependent exaggeration of stretch reflexes resulting
      from abnormal intraspinal processing of primary afferent input. The impaired sensation and
      increase in tone leads to wide range in movement dysfunction. About seventy to eighty percent
      of children with Cerebral Palsy demonstrate spastic clinical features. Many children with
      cerebral palsy (CP) have poor walking abilities and manipulation skills. One contributing
      factor to their problems with gait and reaching movement is poor balance control. Balance
      control is important as it helps a child to recover from unexpected balance
      disturbances.Currently, there are many options for the management of spasticity, balance
      disturbances and risk of fall that includes physical modalities, oral pharmacologic agents,
      peripheral injectables, intrathecal agents, and surgical interventions, however mostly
      physical therapy is commonly preferable treatment that includes stretching, NDT,
      Proprioceptive neuromuscular facilitations,strength training and gait training.

      Dynamic mechanical loading of the skeleton is an arduous task and troublesome to induce in
      children who suffer from severe cerebral palsy. The lack of dynamic weight bearing in this
      population predisposes them to reduced bone mineral density (BMD) and pre-mature
      osteoporosis. These children are also more prone to muscle weakness, which contributes to
      pain, deformity and functional loss. Whole-body vibration training was proposed as a new
      therapeutic modality for the treatment of the gross motor function, balance and functional
      performance Whole body vibration (WBV), for which the participant stands on a vibrating
      platform, delivers low-frequency, low-amplitude mechanical stimuli that enter the human body
      via the feet. The vibrations stimulate the muscle spindles and alpha motor neuron sending
      nerve impulses to initiate muscle contractions according to the tonic vibration reflex.
      Compared to the repetitive passive movement, this WBV protocol adds a muscle strengthening
      component to the anti-spastic effects. Activity restrictions in spastic cerebral palsy are
      mainly due to poor postural control. Many interventions like resisting exercises, therapeutic
      horseback riding, electrical stimulations leads to short term posture and balance
      improvement. Training using vibration platforms adjunct to exercise has shown to be effective
      in increasing strength resulting in improved balance and coordination. Whole body vibration
      has shown to be effective in reducing lower limb spasticity after first application of WBV
      with a vibration frequency of 12 Hz to 18 Hz ( 2-3 m of amplitude ) for 9 minutes and a
      significant decrease in tone is observed and even the functional mobility and balance is
      improved.. During all of the vibration-training sessions, the children will wear the
      gymnastic shoes to standardize the damping of the vibration due to footwear.

      There is paucity in the literature regarding evidence for the safe and effective use of
      vibration intervention in children with or without pathology and has great effects in
      spasticity, mobility and improving balance.Chia-Ling Chen concluded that the WBV is an
      effective intervention for controlling spasticity and improving ambulation. Villarreal et
      al.showed that 20-week WBV therapy had positive effects on the balance of DS adolescents,
      although only under specific conditions, with vision and somatosensory input altered.

      In previous studies high dosage of whole body vibration has both positive and negative
      effects. Because this type of treatment seems to improve bone health, The purpose of this
      intervention is to ensure functional independence in cerebral palsy patients. Whole Body
      Vibration Therapy has proven to be effective in improving balance by reducing spasticity and
      improving muscle strength. It is essential to explore new interventions for patients
      specially for cerebral palsy in whom functional independence is impaired thus their mobility
      is restricted leading to secondary complications. In my study my goal is to use combination
      of conventional physical therapy with whole body vibration which can control spasticity and
      enhance ambulatory performance.
    

Intervention name(s): Group 1 Experimental group; Group 2 Control group
Intervention type(s): Other; Other
Intervention description(s): Stretching exercises for Achilles tendon, hamstrings, hip flexors and adductors of lower limbs, upper abdominal and pectoralis muscles.
Facilitation of postural reactions, including: facilitation of righting, equilibrium and protective reactions from sitting on ball.
Facilitation of standing and weight shift. Facilitation of standing balance by tilting the child from standing to different directions (forward, back-ward and side-way) using a balance board.
Gait training: by forward, backward, and side-way walking between parallel bars.
Whole body vibration.; Stretching exercises for Achilles tendon, hamstrings, hip flexors and adductors of lower limbs, upper abdominal and pectoralis muscles.
Facilitation of postural reactions, including: facilitation of righting, equilibrium and protective reactions from sitting on ball.
Facilitation of standing and weight shift. Facilitation of standing balance by tilting the child from standing to different directions (forward, back-ward and side-way) using a balance board.
Gait training: by forward, backward, and side-way walking between parallel bars.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Cerebral Palsy; Spastic; Whole body vibration