Efficacy of Lower Extremity Mirror Therapy on Balance in Children With Hemiplegic Cerebral Palsy

Overview

The study will be conducted to assess the efficacy of mirror therapy on balance in children with hemiplegic cerebral palsy.

Full Title of Study: “EFFICACY OF LOWER EXTREMITY MIRROR THERAPY ON BALANCE IN CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY: A Randomized Controlled Trail”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: March 1, 2020

Detailed Description

Hemiplegic cerebral palsy in the most common type of cerebral palsy that has permanent motor disorders and associated with life-long disability. the aim of study to assess the efficacy of mirror therapy on balance in children with hemiplegic cerebral palsy. Seventy child with hemiplegic cerebral were enrolled in this study and were assessed for eligibility. Their aged ranged from eight to twelve years. The children were assigned randomly into two equal groups. Group (a) control group received traditional physical therapy program. And group (b) study group received the same traditional physical therapy program in addition to mirror therapy three times / weak for three successful months. Biodex balance system was used to assess balance pre and post treatment. All children were assisted before and after three months of intervention.

Interventions

  • Other: MIRROR THERAPY
    • The children were instructed to sitting on chair and a mirror is placed in midsagittal plane of the child, with the normal limb in front of mirror and the affected limb is blocked so the patient see only the reflected movement of the sound limb (non affected).

Arms, Groups and Cohorts

  • No Intervention: the control group
    • Group (a) control group received traditional physical therapy program.
  • Experimental: the study group
    • group (b) study group received the same traditional physical therapy program in addition to mirror therapy three times / weak for three successful months.

Clinical Trial Outcome Measures

Primary Measures

  • Antro-posterior stability index
    • Time Frame: Antro-posterior stability index will be assessed at day 0.
    • the ability of child to maintain his balance from forward to backward direction
  • Antro-posterior stability index
    • Time Frame: Antro-posterior stability index will be assessed at day 90.
    • the ability of child to maintain his balance from forward to backward direction
  • Over All Stability Index
    • Time Frame: Over All Stability Index will be assessed at day 0.
    • the ability of child to maintain his balance in all directions
  • Over All Stability Index
    • Time Frame: Over All Stability Index will be assessed at day 90.
    • the ability of child to maintain his balance in all directions
  • Mediolateral Stability Index
    • Time Frame: Mediolateral Stability Index will be assessed at day 0.
    • the ability of child to maintain his balance from side to side directions
  • Mediolateral Stability Index
    • Time Frame: Mediolateral Stability Index will be assessed at day 90.
    • the ability of child to maintain his balance from side to side directions

Participating in This Clinical Trial

Inclusion Criteria

  • Children`s aged ranged from eight to twelve years.
  • Children participated in this study will from both sexes.
  • Their degree of spasticity will ranged from mild to moderate according to Modified Ashworth Scale.
  • Children with stable medical and psychological status.
  • Children able to follow the verbal commands or instructions.

Exclusion Criteria

  • children with visual or auditory problems.
  • Children with history of epilepsy.
  • Children with history of surgical interference in lower limbs less than one year.
  • Medically unstable children especially with cardiovascular disorders.
  • Mentally retarded children.
  • un-cooperative children.

Gender Eligibility: All

Minimum Age: 8 Years

Maximum Age: 12 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • South Valley University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Mohammed E. Ali, Ph. D Candidate., Assistant Lecturer – South Valley University
  • Overall Official(s)
    • Nehad A. Abo-zaid, PhD, Principal Investigator, South Valley University, Faculty of Physical Therapy
    • Mohammed E. Ali, PhD student, Principal Investigator, South Valley University, Faculty of Physical Therapy

References

Gstöttner M, Neher A, Scholtz A, Millonig M, Lembert S, Raschner C. Balance ability and muscle response of the preferred and nonpreferred leg in soccer players. Motor Control. 2009 Apr;13(2):218-31.

Zeng W, Guo Y, Wu G, Liu X, Fang Q. Mirror therapy for motor function of the upper extremity in patients with stroke: A meta-analysis. J Rehabil Med. 2018 Jan 10;50(1):8-15. doi: 10.2340/16501977-2287.

Garry MI, Loftus A, Summers JJ. Mirror, mirror on the wall: viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability. Exp Brain Res. 2005 May;163(1):118-22. Epub 2005 Mar 8.

McInnes K, Friesen C, Boe S. Specific Brain Lesions Impair Explicit Motor Imagery Ability: A Systematic Review of the Evidence. Arch Phys Med Rehabil. 2016 Mar;97(3):478-489.e1. doi: 10.1016/j.apmr.2015.07.012. Epub 2015 Aug 5. Review.

Citations Reporting on Results

Kenis-Coskun O, Giray E, Eren B, Ozkok O, Karadag-Saygi E. Evaluation of postural stability in children with hemiplegic cerebral palsy. J Phys Ther Sci. 2016 May;28(5):1398-402. doi: 10.1589/jpts.28.1398. Epub 2016 May 31.

El-Shamy SM, Abd El Kafy EM. Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy. Disabil Rehabil. 2014;36(14):1176-83. doi: 10.3109/09638288.2013.833312. Epub 2013 Sep 13.

Altschuler EL, Hu J. Mirror therapy in a patient with a fractured wrist and no active wrist extension. Scand J Plast Reconstr Surg Hand Surg. 2008;42(2):110-1. doi: 10.1080/02844310701510355.

Funase K, Tabira T, Higashi T, Liang N, Kasai T. Increased corticospinal excitability during direct observation of self-movement and indirect observation with a mirror box. Neurosci Lett. 2007 May 29;419(2):108-12. Epub 2007 Apr 19.

Cattaneo L, Rizzolatti G. The mirror neuron system. Arch Neurol. 2009 May;66(5):557-60. doi: 10.1001/archneurol.2009.41. Review.

Summers JJ, Kagerer FA, Garry MI, Hiraga CY, Loftus A, Cauraugh JH. Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study. J Neurol Sci. 2007 Jan 15;252(1):76-82. Epub 2006 Nov 28.

Sütbeyaz S, Yavuzer G, Sezer N, Koseoglu BF. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007 May;88(5):555-9.

Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004 Nov 9;4:26.

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