Effect of Motor Imagery Training on Gait and Balance in Children With Spastic Hemiplegia

This study aims to:

* Investigate the effect of motor imagery training on gait kinematics in children with spastic hemiplegia.
* Determine the effect of motor imagery training on balance in children with spastic hemiplegia.
* Assess the effect of motor imagery training on trunk endurance in children with spastic hemiplegia.

Children with spastic hemiplegia 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.

Postural and balance disturbances occur due to the difficulty in maintaining the body segments aligned on narrow base of support and there is limitation in balance recovery in hemiplegic children contributing to delayed responses of ankle muscles, inappropriate sequencing, and increased coactivation of agonists/ antagonists muscles.

Treatment will vary depending on the severity of impairments, level of activity, participation, and on the priorities highlighted by the patient. Walking is often identified as a main goal, and there is evidence that children with hemiplegia can take steps before regaining standing balance, which would support early walking. Many advanced treatment approaches are used to help improve motor function and gait in patients with hemiplegic CP.

Rehabilitation techniques are predominantly focused on alleviating the compromised motor execution facet of action performance, and have not specifically targeted the motor preparation or planning processes. Motor imagery is proposed to be a backdoor mechanism to access the motor system. It being a theoretically feasible method to activate the immature networks involved in motor control. Therefore, for individuals with motor planning problems this cognitive MI training may be useful to improve motor skills.

Although it has been shown to be beneficial in adult patients with stroke, and it still awaits empirical testing in young children with CP.

Despite the potential benefits of motor imagery training, clinical use of motor imagery training for improving walking and balance abilities is not yet common compared with other conventional modalities in rehabilitation of children with hemiplegia. Consequently, more research and further confirmation are needed regarding the impact of motor imagery training on the gait performance, balance and trunk endurance in children with hemiplegia. Therefore, the purpose of this study to investigate the effect of motor imagery training on balance and kinematic parameters of gait in children with hemiplegia.

Eligibility Criteria:
Inclusion Criteria:

* Their chronological age will be ranged from 7-10 years.
* Their motor function will be at level I according to according to Gross Motor Function Classification System GMFCS (Palisano et al., 2008).
* The degree of spasticity for these children will ranged from grade 1 to 1+ according to Modified Ashworth Scale (Bohannon and Smith, 1987).
* They will be able to follow instructions during evaluation and treatment.

Exclusion Criteria:

Children will be excluded from the study if they have:

* Cardiovascular or respiratory disorders.
* Botulinium muscular injection in the last 6 months
* Surgical interference in lower limbs.
* Musculoskeletal problems or fixed deformities in the spine and/or lower extremities.
* Seizures.
* Visual or hearing impairment.
* Mentally retarded children