EFFECT OF VIBRATORY PLATFORM THERAPY ON POSTURE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY

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1 EFFECT OF VIBRATORY PLATFORM THERAPY ON URE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY Pierina MAGNA a, Natalia JERIA a, Carlos ALVAREZ a,b, Chiara RIGOLDI c & Manuela GALLI c a Departamento de Kinesiología TELETÓN, Chile b Escuela de Kinesiología Universidad Andrés Bello, Chile c Dipartimento di Bioingegneria Politecnico di Milano BACKGROUND Within the wide spectrum of CP symptoms and related disabilities, postural control deficits have been suggested to be a major component of gait disorders. Literature reported that both static and dynamic balance strategies and reactions of children with CP are poorer when compared with those of typically developing children. Postural control plays a central role in motor disorders of children with CP, as the capability of maintaining stable postural orientation is essential for performing activities of daily life. Impaired muscle tone and abnormal bone development have been claimed as major causes of CP deficits during locomotion, both affecting functional balance capacity. 1

2 BACKGROUND CP future research is aiming towards the functional recovery of muscle weakness and bone fragility A m e t h o d f o r muscle strengthening t h a t i s increasingly used in a variety of clinical situations is whole body vibration (WBV) WBV is practiced on a vibrating platform on which the user is standing in a static position or moving in d y n a m i c movements AIM OUTCOMES??? DETERMINE THE EFFECTS THAT WBV TREATMENT AND SPECIFIC PHYSICAL THERAPY PROGRAM HAVE ON URAL CONTROL IN CHILDREN WITH CEREBRAL PALSY 2

3 SUBJECTS 16 Subjects (10 male, 6 female) Age mean 13 yrs (SD 2,4 yrs) Weight mean 48,8 Kg. (SD 13 Kg. ) PATHOLOGICAL GROUP Height mean 1,53 m ( SD 0,08 m) Inclusion Criteria: - Diagnosis: Cerebral Palsy. - Type: Spastic Diplegia. Spastic Hemiplegia, Choreoathetosis, Ataxia. - Independent Walking with and/ or without orthoses. - G.M.F.C.S: I- II- III - Range of age: x to x yrs. - Able to maintain the standing position at least 60 sec. - Able to follow order and without mental illness. - Sign of informed consent. Exclusion Criteria - G.M.F.C.S: III, IV, V. - Mental illness. SUBJECTS SUBJECT DIAGNOSIS GENDER AGE (YRS/MONTH) GMFCS 5 ETIOLOGY 1 SPASTIC DIPLEGIA F 10 /1 II PVL 2 SPASTIC DIPLEGIA F 13/10 III SCHIZENCEPHALY 3 CHOREOATETOSIS M 10/7 I NATAL STROKE 4 CHOREOATETOSIS F 12/5 I PVL 5 SPASTIC DIPLEGIA F 15/9 II NATAL STROKE 6 SPASTIC DIPLEGIA M 12/8 II CEREBRAL ATROPHY 7 SPASTIC DIPLEGIA M 11/1 II PVL 8 SPASTIC DIPLEGIA M 15/7 II PVL 9 SPASTIC DIPLEGIA F 10 II PVL 10 SPASTIC DIPLEGIA M 16/1 II SCHIZENCEPHALY 11 SPASTIC DIPLEGIA M 9/10 III CEREBRAL ATROPHY 12 ATAXIA M 16/2 I PVL 13 SPASTIC DIPLEGIA M 16/7 II NATAL IVH 14 SPASTIC DIPLEGIA M 11/6 II NATAL STROKE 15 SPASTIC DIPLEGIA M 12/8 II PVL 16 SPASTIC DIPLEGIA F 14/2 II NATAL STROKE M: Male / F: Female/ / AGE: calculated at july 2010 / GMFCS: Gross Motor Classification System/ PVL: Periventricular Leukomalacia / IVH: Interventricular hemorrage 5- Palisano RJ, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B: Development and validation of a Gross Motor Function Classification System for children with cerebral palsy. Developmental Medicine and Child Neurology 1997;39:

4 SUBJECTS 8 CP CONTROLS (GROUP A) Specific physical theapy program No WBV treatment 8 CP WBV (GROUP B) WBV treatment 7 Healthy children Age matched CONTROL GROUP PROTOCOL DESIGN PROTOCOL GROUP A PROTOCOL GROUP B SESSION 1: GMFM Assessment SESSION 1: GMFM Assessment SESSION 2-10 PARATION ACTIVITY(5 min) Walking at self- selected speed over treadmill PHYSICAL THERAPY Sit- to- stand transfer Lateral walking over rails 20 m Frontal walking over rails 20 m SESSION 2-10 PARATION ACTIVITY(5 min) Walking at self- selected speed over treadmill VIBRATION THERAPHY( 15 min) 5 series of 2 min 1 min of rest between each series. Total time : 15 min. Frecuency: 12 Hz 4

5 GROSS MOTOR FUNCTION MEASURE The subjects were evaluated using GMFM-66 and GMFM-88 (DIMENSION D and E), the scores of the GMFM were obtained using GMAE (Gross Motor Ability Estimator) PROCEDURE The subjects were evaluated according to the instruction manual of the GMFM PLATFORM DATA COLLECTION 60 seconds Sampling freq 100 Hz 3 trials for each patient Open eyes 5

6 PLATFORM DATA ELABORATION: TEMPORAL PARAMETERS ROM Px Spostamento A/P Spostamento M/L Normalized to participant s height PLATFORM DATA ELABORATION Detrended Fluctuation Analysis (DFA) α-scaling exponent (ALPHA) fractal dimension Regularity property 6

7 PLATFORM DATA ELABORATION Stabilogram Diffusion Analysis Diffusion Scaling Exponent (H), describing the persistence of the COP position to change or to continue along the same direction If >0.5 If <0.5 If =0.5 the tendency for the COP to continue moving on the same direction over the next dt (persistence) the COP tends to reverse its direction during the next dt (anti-persistence) increments in displacement are statistically independent, thus not correlated STATISTICS GROUP A Vs GROUP B Wilcoxon signed-rank test to evaluate the effect of the WBV treatment in a pre-post comparison 7

8 RESULTS GMF GROUP A MEAN DIMENSION D GROUP A 80 79, ,5 70,4 70,3 70,2 70, ,9 69,8 MEAN SCORE GMFM-66 GROUP A 70, , , , , ,5 77,24375 MEAN DIMENSION E GROUP A 69,7 69,6 71,4 71, ,8 70,6 70,4 70, ,8 69,6 70, ,17875 RESULTS GMF GROUP B MEAN SCORE DIMENSION D GROUP B 77 76, , ,5 MEAN SCORE GMFM-66 GROUP B 76,795 74, , , , , ,5 89, ,86 MEAN SCORE DIMENSION E GROUP B 74 73, , ,

9 RESULTS TEMPORAL PARAMETERS *p<0.05 DYNAMICS OF THE SIGNAL *p<0.05 9

10 CONCLUSION In the present study, WBV was found not to have greater effects on equilibrium in patients with CP than conventional balance exercises: a steady effect may be argued in the CP group before and after the WBV sessions. Sway excursion (ML sway range, RMS COP distance, 95% CEA) was significantly increased in control participants compared with participants with CP treated with WBV. Such a spatial-spreading trend for COP always showed a progressive alienation from the normality range, greater for the control group treated without WBV. The observed difference in posturographic measures is not likely to indicate superior clinical efficacy of WBV because all postural ratings did not show a coherent tendency through normality and because of the limited number of subjects CONCLUSION the available evidence is still insufficient to prove or to refute effectiveness of WBV to improve balance Further study should take into account The acquisition of a normative band treated with WBV To enlarge the numbers of participants 10