Dual Task Training On Children With Ataxia After Medulloblastoma Resection
Condition: Medulloblastoma, Childhood; Childhood Cancer
MeSH terms: Medulloblastoma; Ataxia
Study type: Interventional

Summary: 
      Medulloblastoma is a rapidly-growing tumor of the cerebellum, this area controls balance,
      posture and sophisticated motor functions like finer hand movements, speech, and swallowing.
      With the goal of, complete resection, major complications during tumor removal are usually
      caused by damage to the brain stem and injury to the lower cranial nerves.It has been
      reported that those children present Ataxia after resection. So the purpose of this study is
      to investigate the effectiveness of using a selected dual-task- training program to improve
      postural stability in those Children.
    

Detailed description: 
      Most patients present with symptoms of hydrocephalus due to obstruction by tumor at the level
      of the fourth ventricle or cerebral aqueduct, and ataxia (Martin et al., 2014). If the tumor
      is large enough, the lesion itself can also cause mass effect and increased intracranial
      pressure. Furthermore, direct structural damage from the children can thus present with
      nausea, vomiting, ataxia,diplopia.

      Ataxia in children is a common clinical sign of various origins consisting of impaired
      coordination of movement and balance with a lack of muscle control during voluntary activity.
      Ataxia is most frequently caused by dysfunction of the complex circuitry connecting the basal
      ganglia, cerebellum and cerebral cortex, and this type of involvement is recorded as
      "cerebellar ataxia.

      Recently, the evidence for procedural memory training has advanced sophistication to suggest
      and ultimately prove that automaticity of a primary (motor task can be developed through
      exposure to massive repetitions practice) and the forced subconscious processing using dual
      task interference (Bermúdez, 2017).

      The Objectives of the Study:

      1- Aim of the Study: Determining the efficacy of "Dual Task Training in children with ataxia
      after Medulloblastoma Resection regarding "Static Balance" and "Dynamic Balance" as
      indicators of Postural Control

      2-Specific Objectives:

        1. Assess static balance by measuring center of pressure using force plate mode in the
           humac balance system.

        2. Assess dynamic balance by using tilt mode in the humac balance system .

        3. Evaluate the improvement on functional status and independence in ADL activities by
           functional independence measurement.

        4. Determine the more effective program for rehabilitation of children with ataxia

      3-Secondary Objectives:

        1. Assess the degree of ataxia in children after medulloblastoma resection by SARA scale.

        2. Detect the effect of cognitive interference on postural stability and balance.

        3. Detect if there is improvement in cognitve function after dual task training.
    

Intervention name(s): Dual Task Training Program Group; Control Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Fifteen patients will receive Dual Task Training Program. Total Period: 8 Weeks.; Each child in this group will receive the selected physical therapy program which include mobility exercises, strengthening exercises, balance exercises, gait training exercises, and exercises to improve physical conditioning for one-hour session three times weekly for 8 successive weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Experimental controlled randomization using Block Stratified Randomized Software program, after obtaining informed consent from illegible patient or his caregiver.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Ataxia; Medulloblastoma Resection; posterior fossa tumor; physical activity; Dual Task Training; Childhood Cancer