EFFICACY OF BIOMECHANICAL ANKLE PLATFORM SYSTEM AND A STRENGTHENING EXERCISE PROGRAMME ON FUNCTIONAL PERFORMANCE OF CHILDREN WITH CEREBRAL PALSY

Abstract

Cerebral Palsy (CP), the most common neuropaediatric disorder, is characterised by impaired Functional Performance (FP) which may be associated with reduced muscular strength and poor balance. Improving balance and strength in children with CP can therefore enhance their FP. Biomechanical Ankle Platform System (BAPS) and Strengthening Exercise Programme (SEP) are physiotherapy modalities that can be used to improve balance and strength respectively. There is limited evidence on the efficacy of these two modalities in enhancing FP among children therefore this study was designed to compare efficacy of BAPS and SEP on FP among children with CP. Forty-four children with hemiplegic or diplegic CP were consecutively recruited into this quasi-experimental study. They were assigned into one of BAPS, SEP and Combined Training (CT) groups using a simple random assignment technique. Motor Function (MF), balance, and Walking Speed (WS) were measured as indices of FP at baseline using the Gross Motor Function Classification System (GMFCS), Berg Balance Scale (BBS) and Timed-Up and Go (TUG) respectively. The BAPS group performed perturbation exercise training involving lateral, antero-posterior, and diagonal shifts using a paediatric wobble board. The SEP group received bridging, side-stepping and wall slides exercise training while the CT group received a combination of BAPS and SEP. Progression was achieved by individualised increase in number of exercise bouts and decreased external support. All participants were treated using Bobath neurophysiotherapy technique. Training for each participant lasted 16 consecutive weeks; twice weekly for initial 8 weeks and then weekly for subsequent 8 weeks. Balance, MF and WS were re-evaluated at the 8th and 16th weeks of training and six weeks after cessation of the training (22nd week). Data were analysed using descriptive statistics, Wilcoxon signed rank, linear model of repeated measure ANOVA and Kruskal-Wallis at p=0.05. The mean age of participants was 7.7±2.8 years and they comprised 51.3% males; 53.8% hemiplegic; 46.2% diplegic CP children. The BBS scores in the BAPS group increased significantly by 15.8% from baseline to 8weeks, 25.3% at 16 weeks; and 25.8% at 22 weeks. Similar trends were observed for the SEP group which had 22% increase from baseline to 8 weeks, 43.4% at 16 weeks and 47% at 22nd week. Acrossgroup significant difference was noted for the TUG only at baseline with CT group (30.9± 10.3) obtaining lower score than the BAPS (38.7± 8.8) and SEP (37.1 ± 8.1). The TUG scores increased significantly within the BAPS group from 38.7± 8.8 at baseline to 44.7 ± 8.3 at 8th; 48.5±5.9 at 16th and 48.7 ±5.9 at 22nd weeks. Similar trends were observed for the SEP at baseline (37.1±8.1), 8th (37.7±9.4), 16th (44.3± 8.9) and 22nd weeks (45.4± 8.5) and for the CT at baseline (30.9±10.3), 8th (44.0±6.8), 16th (44.3± 7.1) and 22nd weeks (45.3±6.8). At baseline, the CT had significantly higher GMFCS (4.0) than BAPS (4.3) and SEP (3.8) groups. Biomechanical ankle platform system and strengthening exercise programme were both efficacious in improving functional performance of children with cerebral palsy.