Effect of Hydrotherapy Versus Aerobic Exercise on Pulmonary Function on Hemiplegic Cerebral Palsied Children

Study Overview
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Brief Summary
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Cerebral palsy (CP) is the most common motor disability in childhood. Respiratory muscle weakness and a low upper to lower chest diameter ratio are common respiratory dysfunction manifestations in those children which negatively affect their quality of life..

Detailed Description
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Objective: To compare the effectiveness of hydrotherapy versus aerobic exercise on pulmonary function in hemiplegic children with cerebral palsy. Methods: Sixty hemiplegic children (both genders) took part in this research, they were between the ages of 8 to 16, moreover, they were split equally between three groups (A, B and C). The three groups participated in the same conventional physical therapy, group (A) received conventional physical therapy only, group (B) received hydrotherapy, while group (C) received aerobic exercise. Pulmonary function tests are measured by Six-minute walk test (6-MWT) and Spirometer to measure Forced vital capacity (FVC), Forced expiratory volume in the first second (FEV1) as well as FEV1/FVC ratio for all children before the beginning and after the end of this study, the treatment program was applied three sessions per week for 12 consecutive weeks.

Official Title
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Improvement of Pulmonary Function in Hemiplegic Cerebral Palsied Children by Using Hydrotherapy and Aerobic Exercises

Conditions
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To Compare the Effectiveness of Hydrotherapy Versus Aerobic Exercise on Pulmonary Function in Hemiplegic Children With Cerebral Palsy

Intervention / Treatment
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* Other: Conventional physical therapy
* Other: Hydrotherapy
* Other: Aerobic exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ages ranged from 8 to 16 years. Belonged to levels I to II of the Gross Motor Function Classification System (GMFCS). Spasticity ranged from grade 1 to grade 1+ according to Modified Ashwarth Scale. - Able to walk, no impairment of sensation or other neurological or psychological problems. Clinically and medically stable and able to understand and follow the instructions Exclusion Criteria: i) Visual and/or auditory defects. ii) Significant shortening and/or deformity of lower extremities. iii) Other neurological problems that affect balance or mentality (e.g. epilepsy) iv) Advanced radiographic alterations comprise (bone destruction, bony ankylosis, knee joint sublaxation as well as epiphysial fracture). v) Lower extremity skeletal abnormalities (whether congenital or acquired). vi) Cardiopulmonary dysfunction.

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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
Interventional Model Description: random
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Conventional physical therapy group<br>Strengthening exercises, stretching exercises for the weak and tightened muscles respectively, facilitation of equilibrium and protective reactions and breathing exercises in form of Deep breathing, Diaphragmatic breathing and Pursed lip breathing exercises | Other: Conventional physical therapy<br>* Deep breathing exercise. Diaphragmatic breathing exercise. Pursed lip breathing exercise.<br>* Other names: Physical therapy;|
| Experimental: Hydrotherapy and conventional physical therapy group<br>Strengthening exercises, stretching exercises for the weak and tightened muscles respectively, facilitation of equilibrium and protective reactions and breathing exercises in form of Deep breathing, Diaphragmatic breathing and Pursed lip breathing exercises in addition to hydrotherapy | Other: Conventional physical therapy<br>* Deep breathing exercise. Diaphragmatic breathing exercise. Pursed lip breathing exercise.<br>* Other names: Physical therapy;Other: Hydrotherapy<br>* Water walking exercise. Forward lunges exercise. Single leg balance exercise. Side stepping exercise. Push ups exercise. Standing knee lifts exercise.<br>* Other names: Physical therapy;|
| Experimental: Aerobic exercise and conventional physical therapy group<br>Strengthening exercises, stretching exercises for the weak and tightened muscles respectively, facilitation of equilibrium and protective reactions and breathing exercises in form of Deep breathing, Diaphragmatic breathing and Pursed lip breathing exercises in addition to aerobic exercise | Other: Conventional physical therapy<br>* Deep breathing exercise. Diaphragmatic breathing exercise. Pursed lip breathing exercise.<br>* Other names: Physical therapy;Other: Aerobic exercise<br>* Aerobic exercise in form of treadmill training when each child was standing on the treadmill, should be ensure that this standing in an upright position, and according to each child, the therapist corrected the height of the handrails. Ask the child to keep looking forwards along the walking on the treadmill aiming to encourage the setting of walking free. The treadmill training would be completed for each child when the child completes three stages in 1-min training cycles. First stage: the child grasped on to the rails with both hands in first 15 s of every 1-min. Second stage: the child grasped on to the railings with one hand in the second 15 s. And final stage: the child didn't grasp on to the railings in last 30 s. Every child performed this procedure twenty times<br>* Other names: Physical therapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Forced vital capacity (FVC) | Pulmonary function test | 12 consecutive weeks | 
| Pulmonary function tests Forced expiratory volume in the first second (FEV1) | Pulmonary function test | 12 consecutive weeks | 
| FEV1/FVC ratio | Pulmonary function test | 12 consecutive weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Six-minute walk test (6-MWT) | It assesses exercise capacity objectively and determine prognosis in many respiratory (such as COPD, idiopathic pulmonary fibrosis, and pulmonary hypertension) and non-respiratory conditions (such as heart failure) | 12 consecutive weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Aerobic exercise; Cerebral palsy; Children; Hemiplegia; Pulmonary function