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Preliminary Changes in Head Control and Segmental Trunk Control Following an Eight-Week Core Strengthening Program in
Afnan M Alkhateeb1, Shehab M Abd El-Kader1,2, Alanoud K Alsulami1
1Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia.
Insights
A core strengthening program significantly improved head and trunk control in children with severe cerebral palsy (bilateral spastic cerebral palsy, GMFCS IV-V). These findings suggest feasibility for enhancing motor function in children with profound motor deficits.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Motor Control Research
Background:
- Children with bilateral spastic cerebral palsy (BSCP) at Gross Motor Function Classification System (GMFCS) levels IV and V experience severe deficits in head and trunk control.
- These deficits significantly impact functional independence, safe feeding, and increase caregiver burden.
- Targeted interventions are needed to address these profound motor impairments.
Purpose of the Study:
- To evaluate within-subject changes in head and segmental trunk control.
- To assess the impact of an 8-week therapist-supervised core muscle strengthening program.
- To investigate these changes in children with BSCP classified at GMFCS levels IV and V.
Main Methods:
- A single-arm, quasi-experimental study design with 36 children (aged 4-10 years) with BSCP (GMFCS IV-V).
- Participants underwent a 24-session, manualized core strengthening program over 8 weeks.
- Assessments included the Head Control Scale (HCS) and Segmental Assessment of Trunk Control (SATCo) at baseline, mid-intervention, and post-intervention.
Main Results:
- Statistically significant improvements were observed across all outcome measures (HCS, SATCo Static, Active, Total) (Friedman p < 0.001).
- All pairwise interval comparisons demonstrated significance post-Bonferroni adjustment.
- Pre-to-post intervention changes exhibited large to very large effect sizes, corroborated by repeated-measures ANOVA.
Conclusions:
- The core strengthening program appears feasible and is associated with significant within-subject improvements in head and trunk control for children with severe BSCP (GMFCS IV-V).
- Preliminary findings support the program's potential for enhancing motor function at the body-functions level.
- Further controlled trials with follow-up are necessary to establish efficacy and determine translation to activity and participation.
Abstract:
Background: Children with bilateral spastic cerebral palsy classified at the more severe levels of the Gross Motor Function Classification System (GMFCS) exhibit profound deficits in head and trunk control that constrain functional independence, feeding safety, and caregiver burden. Objective: To characterize within-subject changes in head control and segmental trunk control following an eight-week, manualized, therapist-supervised core muscle strengthening program in children with bilateral spastic cerebral palsy at GMFCS levels IV and V. Methods: A single-arm quasi-experimental study with within-subject assessments at baseline, mid-intervention, and post-intervention (week 8) was conducted. Following removal of two participants at the data-cleaning stage for a baseline eligibility deviation, 36 children aged 4-10 years received a structured core strengthening program delivered three times weekly for eight consecutive weeks (24 sessions total, 45-50 min each). The two standardized outcome measures were the Head Control Scale (HCS) and the Segmental Assessment of Trunk Control (SATCo), the latter analyzed as Static subscale, Active subscale, and Total composite. Results: Statistically significant improvement over time was observed on every outcome (all Friedman p < 0.001; Kendall's W range 0.813-0.950), and every pairwise interval comparison was significant after Bonferroni adjustment. Pre-to-post change reached large to very large effect sizes. As a secondary robustness check, one-way repeated-measures analysis of variance corroborated effects of time on the HCS and the SATCo Static and Total composites (all p < 0.001; partial η2 range 0.722-0.792). Conclusions: These preliminary findings suggest that the program is feasible and associated with statistically significant within-subject improvements in head and trunk control in children with bilateral spastic cerebral palsy at GMFCS levels IV and V. Because the study had no control group, outcomes were confined to the body-functions level, and maintenance was not assessed, causal inference and translation to activity and participation remain undetermined; controlled trials with follow-up are required to determine efficacy.
