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      Effects of Task-oriented Activities Based on Neurodevelopmental Therapy Principles on Trunk Control, Balance, and Gross Motor Function in Children with Spastic Diplegic Cerebral Palsy: A Single-blinded Randomized Clinical Trial

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          A bstract

          Purpose:

          To examine the effects of task-oriented activities based on neurodevelopmental therapy (TOA-NDT) principles on trunk control, balance, and gross motor function in children with spastic diplegic cerebral palsy (SDCP).

          Materials and Methods:

          Forty-four children with SDCP, aged 7–15 years, were recruited to participate in the randomized clinical trial. After random allocation, twenty-two ( n = 22) children with SDCP participated in TOA-NDT principles and twenty-two ( n = 22) in conventional physiotherapy (CPT) program. Each group underwent the treatment for a duration of 60min per day, 6 days a week for 6 weeks. Gross motor function measure-88 (GMFM-88), postural assessment scale (PAS), pediatric balance scale (PBS), and trunk impairment scale (TIS) were the outcome measures used to document the pre- and post-intervention effect.

          Results:

          The mean difference of GMFM-88, PAS, PBS, and TIS was 8.53 (5.84–11.23), 0.90 (5.84–11.23), 4.86 (2.93–6.79), and 1.45 (0.30–2.60), respectively. TOA-NDT group showed improvement in all the outcomes.

          Conclusion:

          TOA-NDT principles are more beneficial in improving the trunk control, balance, and gross motor function parameters than CPT.

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          Most cited references34

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          Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment.

          The Pediatric Balance Scale (PBS), a modification of Berg's Balance Scale, was developed as a balance measure for school-age children with mild to moderate motor impairments. The purpose of this study was to determine the test-retest and interrater reliability of the PBS. To determine test-retest reliability, 20 children (aged five to 15 years) with known balance impairments were tested by one examiner on the PBS. Ten pediatric physical therapists independently scored 10 randomly selected videotaped test sessions. There was no significant difference in total test scores [intraclass correlation coefficient (ICC) model 3,1 = 0.998] or individual items (Kappa Coefficients, k = 0.87 to 1.0; Spearman Rank Correlation Coefficients, r = 0.89 to 1.0) measured by one therapist on two occasions. No significant difference among ratings by different physical therapists was found on the PBS for total test score (ICC 3,1 = 0.997). The PBS has been demonstrated to have good test-retest and interrater reliability when used with school-age children with mild to moderate motor impairments.
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            Development of Postural Control in Healthy Children: A Functional Approach

            From a set of experimental studies showing how intersegmental coordination develops during childhood in various posturokinetic tasks, we have established a repertoire of equilibrium strategies in the course of ontogenesis. The experimental data demonstrate that the first reference frame used for the organization of balance control during locomotion is the pelvis, especially in young children. Head stabilization during posturokinetic activities, particularly locomotion, constitutes a complex motor skill requiring a long time to develop during childhood. When studying the emergence of postural strategies, it is essential to distinguish between results that can be explained by biomechanical reasons strictly and those reflecting the maturation of the central nervous system (CNS). To address this problem, we have studied our young subjects in situations requiring various types of adaptation. The studies dealing with adaptation of postural strategies aimed at testing short and long-term adaptation capacity of the CNS during imposed transient external biomechanical constraints in healthy children, and during chronic internal constraints in children with skeletal pathologies. In addition to maintenance of balance, another function of posture is to ensure the orientation of a body segment. It appears that the control of orientation and the control of balance both require the trunk as an initial reference frame involving a development from egocentric to exocentric postural control. It is concluded that the first step for children consists in building a repertoire of postural strategies, and the second step consists in learning to select the most appropriate postural strategy, depending on the ability to anticipate the consequence of the movement in order to maintain balance control and the efficiency of the task.
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              The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review.

              The purpose of this study was to review published research on the use of the Gross Motor Function Measure (GMFM-88) and (GMFM-66) as outcome measures to determine if these tools detect changes in gross motor function in children with cerebral palsy (CP) undergoing interventions. A comprehensive literature search was conducted using Medline and PubMed to identify studies published from January 2000 through January 2011 that reported the accuracy of GMFM-88 and GMFM-66 to measure changes over time in children with CP undergoing interventions. The keywords used for the search were "GMFM" and "CP". Two of the authors (M.A. and S.B.) reviewed the titles and abstracts found in the databases. The methodological quality of the studies was assessed by using the Critical Review Form-Quantitative Studies. Of 62 papers initially identified, 21 studies fulfilled the inclusion criteria. These articles consist of three longitudinal studies, six randomized controlled trials, four repeated measure design, six pre-post test design, a case series and one non-randomized prospective study. The included studies were generally of moderate to high methodological quality. The studies included children from a wide age range of 10 months to 16 years. According to the National Health and Medical Research Council, the study designs were level II, III-2, III-3 and IV. The review suggests that the GMFM-88 and GMFM-66 are useful as outcome measures to detect changes in gross motor function in children with CP undergoing interventions. Implications for Rehabilitation Accurate measurement of change in gross motor skill acquisition is important to determine effectiveness of intervention programs in children with cerebral palsy (CP). The Gross Motor Function Measure (GMFM-88 and GMFM-66) are common tools used by rehabilitation specialists to measure gross motor function in children with CP. The GMFM appears to be an effective outcome tool for measuring change in gross motor function according to a small number of randomized control studies utilizing participant populations of convenience.
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                Author and article information

                Journal
                J Pediatr Neurosci
                J Pediatr Neurosci
                JPN
                Journal of Pediatric Neurosciences
                Wolters Kluwer - Medknow (India )
                1817-1745
                1998-3948
                Jul-Sep 2019
                27 September 2019
                : 14
                : 3
                : 120-126
                Affiliations
                [1]Chitkara School of Health Sciences, Chitkara University, Punjab, India
                Author notes
                Address for correspondence: Dr. Gandhi Karunanithi Balaji, Department of Physiotherapy, Chitkara School of Health Sciences, Chitkara University, Punjab 140401, India. E-mail: balaji.gandhi@ 123456chitkara.edu.in
                Article
                JPN-14-120
                10.4103/jpn.JPN_35_19
                6798271
                31649770
                6fb65376-2dcf-48c7-b61c-3ee8504456f8
                Copyright: © 2019 Journal of Pediatric Neurosciences

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 04 March 2019
                : 19 April 2019
                : 03 June 2019
                Categories
                Original Article

                Neurosciences
                cerebral palsy,neurodevelopmental therapy,spastic diplegia,task-oriented training,trunk control

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