Effect of Task-oriented Circuit Training on Gait Kinematics, Pelvic Symmetry and Endurance in Children With Hemiplegia
Condition: Cerebral Palsy, Spastic
MeSH terms: Cerebral Palsy; Hemiplegia
Study type: Interventional

Summary: 
      Statement of the problem:

      Does task-oriented circuit training have an effect on kinematic parameters of gait, pelvic
      symmetry and trunk endurance in children with hemiplegic CP?

      Purpose of the study:

      This study aims to:

        -  Investigate the effect of exercise-based task-oriented circuit training on gait
           kinematics including (Stride length, step length, cadence, walking speed, ankle
           dorsiflexion angle in initial contact, knee extension angle in midstance and hip
           extension angle in terminal stance) in children with hemiplegic CP.

        -  Determine the effect of task-oriented circuit training on pelvic symmetry including
           (Anterior and lateral pelvic tilting) in children with hemiplegic CP.

        -  Examine the effect of task-oriented circuit training on trunk endurance including (prone
           plank test, timed partial curl up test, front abdominal power test and unilateral supine
           bridge test) in children with hemiplegic CP.
    

Detailed description: 
      Children with CP have lowered physical fitness levels because their motor impairments
      restrict their participation in daily physical activities. Children with hemiplegic CP may
      experience a variety of concomitant health conditions including, movement difficulty,
      postural and balance instability, muscle spasticity, difficulty with motor planning and
      control, and cognitive impairments. They also have diminished force generation, debilitated
      proprioception around the core, lack of enough harmonization in core musculature, and
      diminished capacity to adjust coupling between the trunk, pelvis, and hip stabilizers leading
      to diminished proficiency of movement.

      According to the concept of motor learning, training is considered to be most effective when
      the training task is specific to the intended outcome, as optimal improvement in function
      involves the practice of task-specific activities. Due to the shift in focus on functional
      movements rather than muscle activity or movement patterns, there has been a task-oriented
      approach which is based on the system model of motor control providing motivation due to
      specific achievements that can be made.

      Task-oriented circuit training effectively provides various sensory stimulation and promotes
      functional activities for stroke patients; however, more attention is becoming directed to
      children with CP to examine the effect of the task-oriented circuit training program on
      functional performance in children with CP. Therefore, the aim of this study is to determine
      the effect of rehabilitation delivered as a task-oriented circuit exercise program on
      kinematic parameters of gait, pelvic symmetry, and trunk endurance in children with
      hemiplegic CP.
    

Intervention name(s): Task-oriented circuit training; Selected Physical therapy program
Intervention type(s): Other; Other
Intervention description(s): The task-oriented circuit training program consisted of 14 workstations. Time spent at each station will be 1.5 minutes. The children will complete the activity at one station and move to another station. The whole circuit will be completed in 21 minutes and it will be repeated twice per session with 3 minutes rest interval between the 2 circuits. Children will be encouraged to work as hard as possible at each workstation and will also be given verbal feedback and instructions aimed at improving performance. The progression of the task will be considered according to each child's ability and progressed as tolerated. Progressions include increasing the number of repetitions and increasing complexity of the exercise performed at each workstation, such as the distance reached in standing, reducing the height of the chair during sit-to stand, changing the height of blocks or by increasing speed of movement.; Facilitation of balance reactions from standing position including; standing on one leg, weight shifting from standing position, stoop and recover from standing, squat from standing and standing on balance board.
Facilitation of counterpoising mechanism through instructing the child to kick ball from standing position as well as catching and throwing ball with his hands.
Gait training activities including: walking using different obstacles (rolls, wedges, stepper) and walking up and down stairs.
Facilitation of protective reaction from standing position by pushing the child in different directions.
Facilitation of rising mechanism through changing position as well as returning back to the original position e.g.: from lying to standing and from sitting to standing.
Strengthening exercises for back and abdominal muscles as well as upper and lower limbs.
Jumping in place and jumping a board.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: two different groups received different interventions at the same time
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: hemiplegic cerebral palsy