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Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular
Soráia Kazon1, Luanda A C Grecco, Hugo Pasini
1Post Graduate Program in Reabilitation Sciences, Nove de Julho University, UNINOVE, Sao Paulo, Brazil.
Insights
This study protocol investigates if neuromuscular electrical stimulation (NMES) combined with physical therapy improves balance in children with cerebral palsy (CP) after botulinum toxin A (BT-A) injections. The findings will guide future therapeutic strategies for enhancing motor function in pediatric CP.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Biomedical Engineering
Background:
- Lower limb spasticity in children with cerebral palsy (CP) is commonly treated with botulinum toxin A (BT-A).
- Muscle imbalance, specifically spastic agonists and weak antagonists, contributes significantly to balance deficits in children with CP.
- Neuromuscular electrical stimulation (NMES) shows potential for enhancing muscle strength in this population.
Purpose of the Study:
- To describe a study protocol for evaluating the effects of NMES on dorsiflexors combined with physical therapy.
- To assess the impact on static and functional balance in children with CP undergoing BT-A treatment.
- To compare the efficacy of physical therapy with and without NMES.
Main Methods:
- Prospective, randomized, controlled trial with a blinded evaluator.
- Participants: Children aged 5-12 years with CP (GMFCS Levels I-III) receiving BT-A for lower limb spasticity.
- Intervention groups: Motor physical therapy + NMES on tibialis anterior vs. motor physical therapy alone.
- Outcome measures: Modified Ashworth and Tardieu Scales for spasticity, Medicapteurs Fusyo for static balance, Berg Balance Scale for functional balance.
Main Results:
- This section is not applicable for a protocol study description.
Conclusions:
- The study protocol outlines a randomized controlled trial to compare motor physical therapy with and without NMES.
- The intervention targets the tibialis anterior muscle to improve static and functional balance in children with CP post-BT-A treatment.
- The methodology includes detailed procedures and outcome measurements for assessing treatment effects.
Background:
The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT- A.
Methods/Design:
Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.
Discussion:
The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results.
Trial Registration:
RBR5qzs8h.
