Combined Cognitive and Functional Strength Training in Children With cp

Study Overview
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Brief Summary
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Cerebral palsy is primarily a disorder of movement and posture however; it often involves disorder of different aspects of cognitive function.

Detailed Description
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This study evaluated the effect of FST and cognitive intervention and their combined effect on motor and cognitive functions in children with spastic diplegia. A convenient sample of spastic diplegic CP children, with their age ranging from 8 to 12 years were assigned randomly into four treatment groups

Official Title
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Synergistic Effect of Functional Strength Training and Cognitive Intervention on Motor and Cognitive Functions in Children With Cerebral Palsy

Conditions
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Diplegic Cerebral Palsy

Intervention / Treatment
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* Other: functional strength training
* Other: cognitive training
* Other: conventional physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: chronological age ranged from 8 to 12 years, spasticity grade in affected lower limbs ranged between 1 + and 2 according to MAS can follow instructions given to them, their intelligence level ranged from 65 to 80 according to Stanford Binet intelligence scale, - -- their motor function ranged between Level II & III according to Gross Motor Functional Classification System Expanded and Revised (GMFCS E&R). Exclusion Criteria: children who had visual or auditory problems children who took any medicine affecting alertness fixed deformities in the joints of upper & lower limbs any orthopedic surgery in lower limbs within 6 months before study epileptic children.

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Functional strength training<br> | Other: functional strength training<br>* children in this group received FST. Each training session started with 10 minutes dynamic warm-up period and ended with 5 minutes cool down in the form of muscle stretching and aerobics. The warm up was followed by gait training in addition to 4 functional lower limb exercises; sit to stand exercise, forward/ lateral step-up exercise, half knee rise exercise, and bridging exercise.<br>|
| Active Comparator: Cognitive training<br> | Other: cognitive training<br>* Children in this group received cognitive training by RehaCom cognitive rehabilitation software. Training was applied for four cognitive domains of function; attention / concentration, figural memory, reaction behavior and logical reasoning.<br>|
| Active Comparator: Combined treatment<br> | Other: functional strength training<br>* children in this group received FST. Each training session started with 10 minutes dynamic warm-up period and ended with 5 minutes cool down in the form of muscle stretching and aerobics. The warm up was followed by gait training in addition to 4 functional lower limb exercises; sit to stand exercise, forward/ lateral step-up exercise, half knee rise exercise, and bridging exercise.<br>Other: cognitive training<br>* Children in this group received cognitive training by RehaCom cognitive rehabilitation software. Training was applied for four cognitive domains of function; attention / concentration, figural memory, reaction behavior and logical reasoning.<br>|
| Placebo Comparator: Conventional physical therapy<br> | Other: conventional physical therapy<br>* including reinforcement of normal motor development, reflex inhibiting patterns, balance exercises, stretching exercises and gait training<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in GMFM-88 measures | criterion-referenced scale that measure gross motor function in children with CP. | The assessment was performed 3 times; at baseline, 6 months (post-treatment) and at 6 months follow up | 
| change in attention / concentration measures | Computer based RehaCom software used to assess attention / concentration cognitive domain of function. It is clinically proven and evidence-based software. minimum reaction time ( in seconds) of attention / concentration program was assessed | The assessment was performed 3 times; at baseline, 6 months (post-treatment) and at 6 months follow up | 
| change in figural memory measures | Computer based RehaCom software used to assess figural memory cognitive domain of function.It is clinically proven and evidence-based software. minimum reaction time ( in seconds) of figural memory program was assessed | The assessment was performed 3 times; at baseline, 6 months (post-treatment) and at 6 months follow up | 
| change in reaction behavior measures | Computer based RehaCom software used to assess reaction behavior cognitive domain of function. It is clinically proven and evidence-based software. - minimum reaction time ( in seconds) of reaction behavior program was assessed | The assessment was performed 3 times; at baseline, 6 months (post-treatment) and at 6 months follow up | 
| change in logical reasoning measures | Computer based RehaCom software used to assess logical reasoning cognitive domain of function. It is clinically proven and evidence-based software. - minimum reaction time ( in seconds) of logical reasoning program was assessed | The assessment was performed 3 times; at baseline, 6 months (post-treatment) and at 6 months follow up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in Five times sit to stand test (FTSST) measure | measure the time spent for completing five sequential sit to stand to sit cycles. It is a reliable and valid measure of functional muscle strength and balance in CP children. | The assessment was performed 3 times; at baseline, 6 months (post-treatment) and at 6 months follow up | 
| change in Timed up and go test (TUG)measure | A reliable and valid test used for assessing dynamic balance and functional mobility in the children. | The assessment was performed 3 times; at baseline, 6 months (post-treatment) and at 6 months follow up |