Associated Disorders of Locomotion and Postural Control of Axial Segments in Cerebral Palsy

Union de Gestion des Etablissements des Caisses d'Assurance Maladie - Nord Est

Status: Completed

Conditions: Cerebral Palsy, Spastic

Treatments: Other: Rehabilitation involving strongly the trunk

Study type: Interventional

Funder types: Other

Identifiers

NCT04287673

IRR-2015-1

Details and patient eligibility

About

Gait abnormalities, which occur in Cerebral Palsy (CP), are characterized usually by a toe-to-floor or a plantar-to-floor initial contact (equinus gait), followed by an early braking of the tibia's forward progression (during ankle dorsiflexion). This causes consequently a trunk deceleration. Moreover, children with CP have difficulties to stabilize the trunk and the head in the space, and that could have impact on gait. If equinus gait is often attributed to the triceps surae spasticity, recent works suggest rather that this early braking of the dorsiflexion could be a motor adaptation to axial postural control difficulties. This thesis project aims firstly to attest that locomotor disorders are related to these difficulties in the stabilization of the axial body segments in children with CP and, secondly, to show that improving the trunk and head postural control with a specific rehabilitation protocol could reduce the early braking of the dorsiflexion and, consequently, the gait abnormalities observed in CP.

Enrollment: 17 patients

Sex: All

Ages: 5 to 12 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Gross Motor Function Classification System I or II
• no or minimal contracture of the triceps surae
• presence of soleus spasticity

Exclusion criteria

• botulinum toxin injections or surgery in the lower limb respectively in the 6 and 12 months preceding the study
• any modification of the physical or orthopaedic therapy within the last two months
• minimal hip flexion above 20° in a clinical examination
• pain in the lower legs when standing or walking

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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17 participants in 3 patient groups

RIST-UR

Experimental group

Description:

Group having performed the rehabilitation involving strongly the trunk for the first 3 months and then having performed its usual rehabilitation for the last 3 months. Before and after each 3-months period, an evaluation of the postural control of the trunk (using the Trunk Control Measurement Scale and a dynamic posturography on an unstable sitting device) and a clinical gait analysis were performed.

Treatment:

Other: Rehabilitation involving strongly the trunk

UR-RIST

Experimental group

Description:

Group having performed its usual rehabilitation for the first 3 months and then having performed the rehabilitation involving strongly the trunk for the last 3 months. Before and after each 3-months period, an evaluation of the postural control of the trunk (using the Trunk Control Measurement Scale and a dynamic posturography on an unstable sitting device) and a clinical gait analysis were performed.

Treatment:

Other: Rehabilitation involving strongly the trunk

Typically Developing children

No Intervention group

Description:

Typically developing children who served as a control group in the first assessment (Trunk Control Measurement Scale, dynamic posturography on an unstable sitting device, clinical gait analysis)