RAJIV GANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
2.
Name of the Candidate
MANKODI SHAILJA JAYESHBHAI
AndAddress
(in block letters):
LAXMI COLLEGE OF
PHYSIOTHERAPY, A.J.TOWERS,
BALMATTA, MANGALORE.
Name of the Institute :
LAXMI COLLEGE OF
PHYSIOTHERAPY, A.J. TOWERS,
BALMATTA, MANGALORE.
3.
Course of study and subject :
MASTERS OF PHYSIOTHERAPY
(MPT)
2 YEARS DEGREE COURSE
PEDIATRICS PHYSIOTHERAPY.
4.
Date of Admission to Course :
14/07/2012
5.
Title of the topic:
“EFFECT OF CORE STABILITY
EXERCISE ON BALANCE IN
CHILDREN WITH SPASTIC DIPLEGIC
CEREBRAL PALSY”
6.
Brief Resume of the Intended Work:
6.1 NEED FOR THE STUDY
Cerebral palsy (CP) is a group of non-progressive,1,2 non-contagious motor conditions that
cause physical disability in human development, chiefly in the various areas of body movement
problem.3 Cerebral palsy is caused by damage to the motor control centers of the developing brain
and can occur during pregnancy, during childbirth or after birth up to about age three.4,5 Resulting
limits in movement and posture cause activity limitation and are often accompanied by disturbances
of sensation, depth perception, and other sight-based perceptual problems, communication ability;
impairments can also be found in cognition, and epilepsy is found in about one-third of cases. CP, no
matter what the type, is often accompanied by secondary musculoskeletal disorders that arise as a
result of the underlying disorder.6
Spastic diplegia, historically known as Little's Disease, is a form of cerebral palsy (CP) that is
a chronic neuromuscular condition of hypertonia and spasticity — manifested as an especially high
and constant "tightness" or "stiffness" — in the muscles of the lower extremities of the human body,
usually those of the legs, hips and pelvis8.
Core muscle strengthening for children is very beneficial for their development. It improves
the child’s overall endurance, strength, self-image, socialization and function, especially in school.
Strengthening core musculature in children helps regulate their muscle tone and increase their trunk
control, thereby improving their balance skills so they can negotiate obstacles safely.11
The spastic cerebral palsy children due to their week core muscles are not able to maintain
their balance in standing posture and also to reduce the spasticity plays an important role in this.14
In children with spastic CP only independent walkers, non-walkers have stepping reactions It
therefore seems that balance function is also correlated with independent walking performance in
children with CP. Balance function and walking ability have various parameters. Balance control
ability includes static balance. Dynamic balance, sensory organization, and movement coordination.
Walking performance also has several kinetic and kinematic components.19
Poor posture is one of the biggest problems facing people’s health in modern life. However,
regular core stability exercise can improve core strength and posture.
So the need of my study is to find that whether the core stability exercise is effective or not to
improve the balance in spastic cerebral palsy children.
HYPOTHESIS
Null Hypothesis (H0):
There may be no effect of core stability exercise on balance in children with spastic diplegic cerebral
palsy.
Alternate Hypothesis (H1):
There may be effect of core stability exercise on balance in children with spastic diplegic cerebral
palsy.
6.2 REVIEW OF LITERATURE
Woollacott et. al (2005) conducted a study on postural dysfunction during standing and walking in
children with cerebral palsy :what are the underlying problems and what new therapies might
improve balance. Results demonstrated that the efficiency of balance recovery can be improved in
children with cerebral palsy indicated by both a reduction in total center of pressure path during
balance recovery and in the time to restabilize balance after training7.
Woollacott , M.H. et.all (1996) studied neural and musculoskeletal contributions to the development
of stance balance control in typical children with CP. Well organized responses were seen with the
onset of independent stance and walking, along with reduction of antagonist in co activation7.
Burtner et. al (2007) studied the capacity to adapt to changing balance threats and compared in
children with cerebral palsy and typically developing children. Results demonstrated that children
with cerebral palsy had lower platform velocity thresholds, greater percentage of loss of balance
trials, increased distances and increased frequency of directional changes in center of pressure
trajectories than control children8.
Rose J.wolff et. al (2002) conducted a study to find out postural balance in children with cerebral
palsy and suggested that there was no increase in abnormal values with eyes closed compared with
eyes open for participants with cerebral palsy, indicating that most participants with cerebral palsy
had normal dependence on visual feedback to maintain balance9.
Donker , S.F, Ledebt et. al (2008) conducted a study to show that children with cerebral palsy
exhibit greater and more regular postural sway than typically developing children and concluded that
cerebral palsy children might benefit from therapies involving postural tasks with an external
functional context for postural control10.
Kane K, Bell A. conducted a study on core stability group program for children with developmental
co ordination disorder. The result showed that there was improvement in motor skills, self efficacy of
physical activity and core stability outcome measures11.
Franjoine et.al conducted a study to determine the reliability of pediatric balance scale and
concluded that pediatric balance scale has good test-retest interrater reliability when used with school
aged children with mild to moderate motor impairments12.
Carlberg , E.B. and Hadders-Algra M.(2005) studied postural dysfunction in children with CP and
some implications for therapeutic guidance and showed that typical characteristics of adaptation in
children with cerebral palsy is recruitment of postural muscle, excessive activation of antagonistic co
activation and incomplete adaptation of the EMG amplitude to task specific constraints13.
Cherng R J et. al conducted a study on performance of static standing balance in children with
spastic diplegic CP under altered sensory environment.14
Hof et al (2008) has shown that challenging propriocepsis during training activities, for example, by
making use of unstable surfaces, leads to increased demands on trunk muscles, thereby need to
improve core stability and balance.15
Haas et al. 1989 The ability to control posture while standing is developed early in life. This ability
includes in core stability in different sensory conditions, more organized muscle responses to external
perturbation, and better feed forward control.16 Waters et al. 1983 At the same time the child
walking performance is also developing. With increasing age children walk faster at less
physiological cost and with a more mature gait. It therefore seems that the balance functions are
correlated with walking performance in cerebral palsy children.17
Hwang JH et. al conducted a study to determine the validity of pediatric balance scale in children
with spastic cerebral palsy and concluded that pediatric balance scale can be considered a simple,
valid scale for examining functional balance capacity in children with spastic cerebral palsy.18
6.3 OBJECTIVES OF STUDY

To find out the effects of core stability exercise on balance in children with spastic diplegic
cerebral palsy.
7
MATERIALS AND METHODS:
STUDY DESIGN: Experimental study design
7.1 SOURCE OF DATA:
1. AJIMS, Kuntikana, Mangalore.
2. OPD of Laxmi Memorial College of Physiotherapy. Balmatta. Mangalore.
SAMPLE SIZE : 20
7.2 METHOD OF COLLECTION OF DATA
SAMPLING TECHNIQUE:
INCLUSION CRITERIA:

Age group 8 to 13 years

Sex: Both boys and girls

Patients diagnosed with Spastic Diplegic cerebral palsy by a certified pediatrician.

Gross motor function system level 1

Having good IQ
EXCLUSION CRITERIA:

Cerebral Palsy with Flaccid tone.

If BOTOX given.

Subject having pain in lower limbs related to muscle tightness.

Cardiac surgery or brain surgery.

Surgeries related to sensory or motor part.

Mentally retarded children

Congnitive deficits children

Sensory Integration dysfunction children
MATERIALS AND TOOLS REQUIRED:

Bean bag

MAT

Wobble board

Exercise ball
TECHNIQUE OF APPLICATION:
20 children diagnosed with spastic diplegic CP within the age group of 8 to 13 years of both gender
will be included in the study after the informed consent will be taken after explaining the procedure..
Core stability exercise on floor
1. Snake curl: ask the child to lie down on floor, with his legs together, knees bent and feet flat
on floor put a bean bag between his knees to encourage him to keep his knees together. His
hands should be on thighs. Ask the child to raise his knees and holds the position until you
give the signal for him to go back down slowly.
2. Bridging: Instruct the child to lie on his back with knees bent and feet on floor, pull the belly
button tightly and lift so that only the head, shoulders and feet are on the ground. The body
should be straight like a board. Hold this for 3 to 5 seconds and lower. Begin with 1 to 5
repetitions and increase to 15 repetitions are able to be performed.
3. Stand on one foot and balance as long as possible. Switch to the other foot and repeat.
Repetition 10 times each leg.
4. Stand in the center of a wobble board and try to keep the edges from hitting the ground. This
can be performed forward and back, as well as side to side. Begin with the goal of balancing
for 10 seconds with the goal of one full minute.
Core stability exercise on ball
1. Abdominal crunch with stability ball:
Place a stability ball on the floor, then sit top of it with both feet on ground place your feet
at approximately the width of your hips. Cross your arms, engage the abs as leaning back,
keeping the back straight. Hold this position for 3 counts, then use the abs to bring the
back up to your original position. Repeat 5 times.
2. Bridge: place your stability ball on the floor, then lie down on your back and place your
feet on top of the ball. Tense the abs raising the butt and hips off the floor. Hold the
position for 3 counts then lower. Repeat 5 times.
3. Sitting on ball lift the right knee and left arm up toward the ceiling being careful to keep
the ball in place. Switch and lift the left knee and right arm. Repeat this in a marching
fashion 10 repetitions, increasing to 25 repetitions.
STUDY DURATION: 6 months
OUTCOME MEASURES:
Pediatric Balance Scale(PBS)
STATISTICAL ANALYSIS:
Wilcoxon Signed Rank test
RESEARCH QUESTION:
Do you find any effect of core stability exercise on balance in children with spastic diplegic cerebral
palsy?
7.3Does the study require any investigations or interventions to be conducted on
Patients or other humans or animals? If so, please describe briefly.
Yes, the study requires the interventions to be done on children with spastic diplegic cerebral palsy.
7.4Has ethical
clearance been obtained from your
7.3
Yes, the ethical clearance has been obtained from the institution.
institutions in case of
8
List of References:
1.
Bax, M. Goldstein, M. Rosenbaum, P. Leviton, A. Proposed definition and classification of
cerebral palsy. Developmental Medicine and Child Neurology 2005;47(8):571.
2.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M: A report: the definition and
classification of cerebral palsy April 2006. Dev Med Child Neurol 2006, 49:8-14.
3.
Odding E, Roebroeck M, Stam H: The epidemiology of cerebral palsy: incidence,
impairments and risk factors. Disabil Rehabil 2006, 28:183-191.
4.
Scrutton D, Damiano DL, Mayston M: Management of the motor disorders of children with
cerebral palsy. 2nd edition. Cambridge, Cambridge University Press; 2004:191.
5.
Kasper, D.L. et al. (2005), Harrison's Principles of Internal Medicine, McGraw-Hill
6.
"A report: The definition and classification of cerebral palsy April 2006". Developmental
medicine and child neurology. Supplement 109: 8–14.
7.
Woollacott , M.H and Shumway-cook , A (2005). Postural dysfunction during standing and
walking in children with cerebral palsy: what are the underlying problems and what new
therapies might improve balance? Neural plasticity 12 (2-3) 211-219.
8.
Burtner , P.A , Woollacott , M.H. , Craft , G.L. and Roncesvalles , M.N. (2007). The
capacity to adopt to changing balance threats : A comparison of children with cerebral palsy
and typically developing children. Developmental rehabilitation 10 (3),249-260.
9.
Rose J. wolff, D.R, Jones, V.K. bloch, D.A, oehlert, J.W. & Gamble, J.G.(2002). Postural
balance in children with cerebral palsy. Developmental medicine and child neurology,44(1),
58-63.
10. Donker, S.F., Ledebt, A, Roerdink M. savelsbergh, G.J. & Beek, P.J.(2008). Children with
cp exhibit greater sway than typically developing children. Experimental Brain Research,
184(3), 363-370.
11. Kane K Bell, A core stability group programme for children with developmental
coordination disorder.Pediatric physical therapy winter 2009 21 (4): 375-382,.
12. Franjoin, Mary Rose , Gunther , Joan S , Mary jean. Pediatric balance scale: A modified
version of the Berg balance scale for school age children with mild to moderate impairment.
spring (2004) Pediatric physical therapy 16 (1): 54-55.
13. Carlberg , E.B. and Hadders – Algra , M (2005). Postural dysfunction in children with
cerebral palsy: Some implications for therapeutic guidance. Neural plasticity , 12 (2-3), 221.
14. Chern RJ,SU FC, Chen JJ, Kuan TS. Department of physical therapy, National Cheng Kung
University, Tainan, Taiwan, Republic of China.
15. Hof et al. Borghuis, Jan; ; Lemmink, Koen A.P.M. The Importance of Sensory-Motor
Control in Providing Core Stability: Implications for Measurement and Training Sports
Medicine, Volume 38, Number 11, 2008 , pp. 893-916(24)
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control of upright stance. Developmental medicine and Child Neurology 31:481 -8.
17. Sutherland DH. (1984) Gait Disorders in Childhood and Adolescence.
Baltimore . MD:Williams & Wilkins. p 128- 45.
18. Hwang JH, Yi SH, Kim SJ Kwon JY Validity of pediatric balance scales in children with
spastic cerebral palsy Neuropediatrics;43(6):307-13.
19. Gunsolus P Welsh C, Houser C. Equilibrium reactions in the feet of children with spastic
cerebral palsy and of norrnal children. Developmental Medicine and Child Neurology. 1995.
17: 580-91