Effects of Trunk-Focused Rehabilitation on Spinal Mobility, Trunk Control, and Hand Functions in Cerebral Palsy

Saglik Bilimleri Universitesi

Status: Enrolling

Conditions: Trunk; Adolescent; Cerebral Palsy (CP); Exercise

Treatments: Other: Trunk Focused Rehabilitation (TFR); Other: Conventional Rehabilitation (CR)

Study type: Interventional

Funder types: Other

Identifiers

NCT06781047

0000-0002-4321-2332 (Registry Identifier)

0000-0001-9120-7071 (Registry Identifier)

Saglik Bilimleri U, 26848

Details and patient eligibility

About

Main Purpose: This study aims to investigate the effects of trunk-focused rehabilitation on trunk control, spinal mobility, and manual skills in adolescents with cerebral palsy (CP).

Secondary Purpose: To investigate its effects on functional health.

Full description

Muscle weakness in the trunk; reducing the support of children with CP, may cause increased distal tone and decreased function in their daily practices. When the effectiveness of interventions that can improve postural control is evaluated, trunk-focused training is one of the 5 interventions supported by a moderate level of evidence. In an intervention study where trunk training was structured individually, there may be an improvement in erector spinae muscle group scores when evaluated with sEMG. A study of 28 cases, including all subtypes of CP, aimed to evaluate the inter-rater reliability of Spinal Mouse (SM) and the effect on the spinal column with 4 hours a day, 1 week of intensive clinical rehabilitation application. In this population, SM was evaluated with therapeutic interventions, it has been reported that it may show significant posture differences, especially in total spinal inclination and spine length. In children aged 5-12 years with Gross Motor Function Classification System (GMFCS) Level 1, 2 CP, there are significant improvements in the Trunk Control Measurement Scale (TCMS) score after only Trunk Focused Rehabilitation (TFR). It is emphasized that with TFR, which is described as a unique approach, postural control of the whole body can be improved by the use of intermediate postures and postural activities involving the trunk and better participation of the affected muscles. Only after TFR intervention, the findings of improvement in the assessments on a 3D force platform were highlighted in postural sway, early sternal and sacral decelerations. It is carried out with active participation, individualized, intensive, and time-limited, considering possible content limitations and the needs and preferences of the adolescent and the family. It is stated that trunk-targeted interventions can be given together with conventional physical therapy programs to support functional improvements.

Enrollment: 40 estimated patients

Sex: All

Ages: 12 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Levels 1 and 2 according to Gross Motor Function Classification System (GMFCS)
2. Viking Speech Scale Turkish version/(VSS-T) 1-2 level, understood to speak and able to take commands
3. Adolescents with CP between the ages of 12-18
4. Those whose guardian / legal representative and themselves have received an Informed Voluntary Consent Form
5. No hip dislocation
6. Scoliosis below 25 degrees according to the radiographic evaluation made in the last 6 months

Exclusion criteria

1. Having had any surgery related to the intrathecal baclofen pump
2. Having botulinum toxin injection treatment or orthopedic surgery within the last 6 months
3. Having severe vision, hearing, and cognitive deficiencies
4. Acute medical illness

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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40 participants in 2 patient groups

Trunk Focused Rehabilitation (TFR) plus Conventional Rehabilitation (CR) Group

Experimental group

Description:

1. Abdominal stabilization progression for TFR is applied to all cases with simultaneous breathing exercises for 8 weeks (24 sessions in total) (8). Exercises are performed 3 days a week, 45 minutes a day, starting from warm-up and recumbent position respectively, and the intensity is adjusted individually by observing tone and motivation. The experimental group's routine physiotherapists also gave them a conventional rehabilitation program (the same protocol as in the active comparison arm) for 40 minutes per day, 2 days per week.

Treatment:

Other: Conventional Rehabilitation (CR)

Other: Trunk Focused Rehabilitation (TFR)

Conventional Rehabilitation (CR) Group

Active Comparator group

Description:

The control group is the group that receives conventional treatment 2 days a week, 40 minutes per session. Conventional Rehabilitation Program Content: All sessions include the following rehabilitation program, supervised by a physiotherapist and individualized according to tolerance. Number of exercise repetitions: 10-20. The intensity is adjusted by observing motivation.

Treatment:

Other: Conventional Rehabilitation (CR)