Effect of Imaginary Resisted Therapy Versus Physical Resisted Therapy on Hemiplegic Cerebral Palsy

The purpose of this study is to compare the effects of imaginary resisted exercises versus physical resisted exercises on hand grip strength in hemiplegic cerebral palsy

Cerebral palsy (CP) is one of the most frequent causes of motor disability in children. CP is a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The risk factors for CP can be divided into pre-conception, prenatal, perinatal and postnatal ones. Twenty five percent of children with CP have spastic hemiplegia. Hemiplegic cerebral palsy falls in anatomic classification of cerebral palsy which affects only one side of body. Children who have hemiplegic cerebral palsy have absolutely no use of one side of the body. This means their shoulder; arm, hand, leg and foot are all completely paralyzed. So, in order to improve strength in upper extremity and hand, resistance exercises are used.

The study will be a randomized control trial. Patients will be recruited into two groups using simple random assignment. Non probability convenient sampling will be used. Data will be collected from patients with hemiplegic cerebral palsy by using Jamar dynamometer which is consider as a gold standard in measuring repetitive gripping, goniometer for range of motion and Finger to nose test to access the upper extremity function in stroke patient Those who will meet the inclusion criteria will be recruited. Group A will receive imaginary resisted exercise therapy Five types of different resistances will be imagined by patients by watching their own videos in VR box, which will be recorded on day one to make them familiar with the resistive objects and the resistance experienced from them by asking patients to perform 15-15 repetitions of each object. Group B will receive physical resisted exercise therapy in which 5 different types of resistances will be given to patients for making themselves familiarize themselves with the type of resistance applied by each object, that they will experience in further sessions, by asking them to perform 15-15 repetitions of each object. Every physical resistance exercise will have 15 repetitions. At the end of each session patient will perform finger to nose test and Purdue peg board test. After collecting data from the defined setting, it will be entered and analyzed using statistical package for social sciences (SPSS) for Windows Software, version 21.

Eligibility Criteria:
Inclusion Criteria:

* Congenital infantile hemiplegia.
* Aged between 6 and 12 years.
* Lack of use of the affected upper limb.
* Level I-III of the Manual Ability Classification System (MACS).
* Students scoring of Modified Ashworth Scale should be 3 or less than 3 out of 5 for the same muscle groups of previously mentioned movements.

Exclusion Criteria:

* Low cognitive level compatible with attending a special education school.
* Presence of contractures in the affected upper limb affecting the functional movement.
* Surgery in the six months previously to the treatment.
* Botulinum toxin in the two months previously to or during the intervention.
* Pharmacologically uncontrolled epilepsy