Effects of Ankle Mobilization on Body Structure, Function, Activities and Participation of Children With Cerebral Palsy
Condition: Diplegic Cerebral Palsy With Spasticity
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      Cerebral palsy is the most common motor disability of childhood (Suvanand et al 1997). By
      definition CP is a static encephalopathy, but the musculoskeletal pathology is a major
      concern . Chronic neurologic impairment affects the development of bones and muscles. In
      spastic hemiplegia, the affected side demonstrates muscle atrophy and limb shortening,
      compared to the unaffected side. Thus, CP is a neuromusculoskeletal disorder .
      Musculoskeletal conditions of people with CP can develop or worsen across the lifespan as a
      consequence of the primary neuromotor impairments which will affect their physical activity
      and participation. In fact these complications can lead to lose the ability of walking in
      ambulatory children up to 30% . (Peterson 2015) Physical inactivity among regularly growing
      paediatric community has become a general health load.

      Neurological interventions are well documented, However, there is a gap of information and
      evidence documenting the orthopaedic intervention effect on orthopaedic secondary
      complications in CP. Even though the neurological pathology isn't progressive , the
      orthopaedic complication itself is progressive and affect the ability of the CP children to
      progress, and in so many cases they lose their functional achievements when their functional
      status can't meet their growth requirements any more, due to the neurological dysfunction and
      progressive secondary complications, that makes walking less efficient , less effective, and
      increased fatigue levels in gait. (Tosi et al. 2009).

      Little is known about the practice of Brian Mulligan's mobilization with movement (MWM) in CP
      patients in early ages, for the secondary complication of the ankle hypomobility and ROM.
      This study will be conducted to discover the immediate effect of MWM on the ankle to improve
      the range and mobility of ankle as a musculoskeletal (dysfunction) for the function of gait.
    

Detailed description: 
      Cerebral palsy is the most common motor disability of childhood (Suvanand et al 1997). By
      definition CP is a static encephalopathy, but the musculoskeletal pathology is a major
      concern . Chronic neurologic impairment affects the development of bones and muscles. In
      spastic hemiplegia, the affected side demonstrates muscle atrophy and limb shortening,
      compared to the unaffected side. Thus, CP is a neuromusculoskeletal disorder .
      Musculoskeletal conditions of people with CP can develop or worsen across the lifespan as a
      consequence of the primary neuromotor impairments which will affect their physical activity
      and participation. In fact these complications can lead to lose the ability of walking in
      ambulatory children up to 30% . (Peterson 2015) Physical inactivity among regularly growing
      paediatric community has become a general health load.

      Neurological interventions are well documented, However, there is a gap of information and
      evidence documenting the orthopaedic intervention effect on orthopaedic secondary
      complications in CP. Even though the neurological pathology isn't progressive , the
      orthopaedic complication itself is progressive and affect the ability of the CP children to
      progress, and in so many cases they lose their functional achievements when their functional
      status can't meet their growth requirements any more, due to the neurological dysfunction and
      progressive secondary complications, that makes walking less efficient , less effective, and
      increased fatigue levels in gait. (Tosi et al. 2009).

      Little is known about the practice of Brian Mulligan's mobilization with movement (MWM) in CP
      patients in early ages, for the secondary complication of the ankle hypomobility and ROM.
      This study will be conducted to discover the immediate effect of MWM on the ankle to improve
      the range and mobility of ankle as a musculoskeletal (dysfunction) for the function of gait.

      Research questions What is the effect of Ankle MWM in functional activities on gait function
      ? What is the effect of Ankle MWM in functional activities on balance function ? What is the
      effect of Ankle MWM in functional activities on quality of life? What is the effect of Ankle
      MWM in functional activities on fatigue?

      Research hypothesis Ankle MWM in functional activities improves gait function? Ankle MWM in
      functional activities improve balance? Ankle MWM in functional activities improves quality of
      life? Ankle MWM in functional activities increase happiness? Research objectives To
      investigate the effect of Ankle MWM in functional activities on gait function? To study the
      effect of Ankle MWM in functional activities on balance function? To highlight the effect of
      Ankle MWM in functional activities on quality of life? To study the effect of Ankle MWM in
      functional activities on happiness?
    

Intervention name(s): Intervention group
Intervention type(s): Other
Intervention description(s): 5 sets of functional activities each will be repeated for 3 times , while the therapist is performing mulligan mobilization techniques Sit to stand Squat Stand to sit Stairs stepping Bridging
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment