Clinical trial NCT06504550: Comparison Between Schroth and Klapp Method in CP Children With Scoliosis
Official title: Comparison Between Schroth AND Klapp Method On Postural Stability AND Trunk Rotation Angle In CP Children With Scoliosis
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cerebral Palsy
Scoliosis
Keywords: Cerebral Palsy
Klapp
Postural Stability
Schroth
Scoliosis
Trunk Rotation Angle
Lead sponsor: Riphah International University
Sponsor class: OTHER
First posted: 2024-07-16
Enrollment: 22
Sex: ALL
Minimum age (years): 8
Maximum age (years): 12
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: It will be Randomized clinical trial in which non probability convinient sampling will be used.Two groups of 8 to 12 years of age will be formed in which participants will be randomly divided.In Group A Schroth exercises will be conducted that consist of passive and active postural auto-correction exercises done repeatedly and based on kinesthetic and sensorimotor principles.In Group B Klapp group will be treated with klapp exercises. In each session, a sequence of 8 postures of Klapp method will be carried out
Primary purpose: TREATMENT

Brief summary: Cerebral palsy, which occurs in two to three out of 1,000 live births, has multiple etiologies resulting in brain injury that affects movement, posture, and balance. Approximately one-third of children with CP are non-ambulant and subsequently spend prolonged periods of time in sitting or lying. Non-ambulatory patients with cerebral palsy (CP) bear a high risk of developing simultaneous progressive scoliotic spine deformities, loss of sitting balance and hip subluxation/dislocation.Treatments for the Spinal deformities associated with cerebral palsy are Schroth method. It is a scoliosis-specific exercise approach that uses postural, scoliosis-specific sensorimotor exercises. While another treatment approach Klapp method aimed to stretch and strengthen muscles by all fours positions, easily applied and that can be used in small groups.

A Randomized clinical trial will be conducted through convenient sampling. Inclusion criteria of this study is age between 8 to 12 years of either gender, with GMFCS level I and II and Trunk rotation angle (ATR) \> 4 degree, who are able to understand and follow verbal instructions. Those patients who has been prescribed brace treatment, has scheduled or undergone any corrective surgical treatment of the spine before or during data collection process will be excluded. Patients who are unable to participate, or are reluctant to receive treatment are excluded. Study will be conducted on 22 patients who will be randomly allocated into two groups. One group will receive Schroth exercises. It consists of passive and active postural auto-correction exercises done repeatedly and based on kinesthetic and sensorimotor principles. While the other group with Klapp method includes stretching and strengthening muscles by all fours positions. Bunnell's scoliometer, Adams forward bend test, and Posture and postural ability scale (PPAS) will be used as outcome measure.

Detailed description: Group A is Schroth Group (SG). The patients in the Schroth exercise group will start their exercise program under physiotherapist supervision. Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks. Schroth exercises will be performed in an asymmetric position to maximize correction to achieve trunk symmetry. These exercises include spinal elongation, de-rotation, de-flexion, stretching, strengthening and rotational breathing exercises to maintain vertebral alignment. The participants will be asked to combine these exercises with their daily living activities (ADLs). During the Schroth exercises, rice bags, foam blocks, a stool, and long sticks will be used to adjust the posture and give passive support. Exercises are progressed from lying, sitting, or standing positions and from most to least passive support per a review of the quality of the performance. Decreasing the amount or degree of passive support, changing the patient's position, and adjusting the sets and repetitions of exercises will depend on the patient's improvement in exercise performance Group B is Klapp group (KG).The patients in the Klapp exercise group will be treated with supervised klapp exercises. Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks. In each session, a sequence of 8 postures of Klapp Exercises will be carried out. Each posture will be maintained for 4-5 minutes with rest breaks when needed. Positions that will be held are: 1) Lateral crawl, 2) Horizontal sliding, 3) Crawl posture near the ground, 4) Bunny hopping, 5) Arm turn, 6) Big arch, 7) Lateral crawl near the ground, 8) Big curve

Eligibility criteria: Inclusion Criteria:

* 8 to 12 years of age
* Either gender.
* The level of gross motor function between levels I and II in accordance with the gross motor function classification system (GMFCS) .
* Angle of Trunk Rotation (ATR) \> 4 degree .
* Ability to understand and follow verbal instructions

Exclusion Criteria:

* Patients will be excluded if they have had been prescribed brace treatment
* Has received any previous corrective or surgical treatment of the spine
* Unable to participate, or are reluctant to receive treatment

Primary outcomes:
measure: Posture and Postural Ability Scale (PPAS)
timeFrame: 6 weeks
measure: Bunnell's Scoliometer
timeFrame: 6 weeks
Secondary outcomes:
Other outcomes:
Locations:
city: Lahore
country: Pakistan
facility: Riphah International University
state: Punjab
Study officials:
affiliation: Riphah International University
name: Ayesha Khaliq, MS*
role: PRINCIPAL_INVESTIGATOR
References:
citation: Agustsson A, Sveinsson T, Pope P, Rodby-Bousquet E. Preferred posture in lying and its association with scoliosis and windswept hips in adults with cerebral palsy. Disabil Rehabil. 2019 Dec;41(26):3198-3202. doi: 10.1080/09638288.2018.1492032. Epub 2018 Jul 16.