دانلود رایگان ترجمه مقاله تمرین تعادل Biodex در مقابل تمرین تعادل سنتی – الزویر ۲۰۱۷

تمرین تعادل بیودکس در برابر تمرین تعادل سنتی برای کودکان مبتلا به دی پلژی اسپاستیک

Biodex balance training versus conventional balance training for children with spastic diplegia

Abstract

Objective The purpose of this study was to compare the effectiveness of balance training using the Biodex balance system and a conventional balance training programme on balance score and on gross motor skills of children with spastic diplegia. Methods A randomized controlled study was conducted on 48 spastic diplegic children with cerebral palsy (26 boys and 22 girls) in the age range of 5–۸ years. The children were randomly allocated to two equal groups. The investigators performed balance and gross motor function assessments for every child using the paediatric Berg balance scale and the gross motor function measure −۸۸ scale (dimensions D and E) before and after the treatment programme. Passive repositioning sense was measured by a Biodex III isokinetic dynamometer. The study group received Biodex balance training and traditional physical therapy programme training, whereas the control group received conventional balance training in addition to the traditional physical therapy programme training, 3 times per week for 12 weeks. Results Significant improvement was observed in all outcome measures of the two groups, comparing their pre- and post-treatment mean values. Furthermore, the results revealed a significant (P < 0.05) improvement in mean post-treatment values for the Biodex balance training group. Conclusion Balance training using the Biodex balance system is superior to conventional balance training for improving the balance abilities and gross motor functions of children with cerebral palsy and spastic diplegia.

Introduction

Cerebral palsy (CP) is a term used to denote a group of chronic, non-progressive neurodevelopmental disorders caused by brain damage or malfunction originating early in life and persisting throughout the lifespan. CP affects posture, volitional movement and the ability to produce coordinated and purposeful movements. The wide spectrum of disorders affect motor skills, sensation, communication skills, cognitive abilities, perception and psychosocial behaviour.1 Molina et al.2 reported that motor imagery impairment is prevalent in children with diplegic CP and is spatially constrained by the covered distance, but that in general, children with CP tend to perform worse than typical children. Balance disorders constitute a major challenge for children with spastic diplegic cerebral palsy (SDCP) and cause difficulties in attaining and maintaining stability.3,4 Children with SDCP tend to have a limited capacity for perceptual neuromotor control, poor performance of stance stability under challenging sensory environments,5 delayed anticipatory adjustment and inconsistent preparatory activation.6,7 Lack of neuromotor control has been reported as a possible cause of poor performance in balance control,5e7 but it seems that conventional balance training falls short of adequately addressing the neuromotor aspect of balance disorders. Children with CP require multidisciplinary management to address the wide spectrum of cognitive and motor disabilities.8 Long-term muscle imbalance results in several deformities that increase disability with age.9 Moreover, children with spastic diplegia always have proprioception disorders. Knee joint proprioception disorders can be attributed to the increase in muscle tone and abnormal firing of muscles, in addition to abnormal weight bearing and posture.10 Researchers have used several conventional balance approaches to improve balance and motor abilities and recover stability in children with cerebral palsy.3,4,11 However, none, to the best of our knowledge, have investigated and compared the Biodex balance system with the conventional balance approach for improving balance and motor control in children with SDCP. Therefore, this study was designed to examine the effect of using the Biodex balance system for improving the balance scores and gross motor functions of children with SDCP.

Materials and Methods

Forty-eight children with spastic diplegic CP (26 boys and 22 girls) were recruited from the outpatient clinic of the rehabilitation centre, Almadinah Almunawwarah. Ethical Approval (approval No. CMR-PT-2016-007) was obtained from the College of Medical Rehabilitation, Taibah University, which is operated according to the Saudi regulations of the national bioethics committee and according to the Declaration of Helsinki. Inclusion Criteria: Children aged from 5 to 8 years who are able to independently maintain the standing position for balance training using the Biodex balance training system, who have a grade 1 to 1þ spasticity according to the modified Ashworth scale,12 who have a minimum height of one metre, and who are able to follow verbal commands were included in the study. Exclusion Criteria: Children with cognitive disorders, perceptual, visual or auditory problems, or significant tightness at any joint of the lower limbs were excluded from the study. Children were randomly allocated to group A (n = 24) and group B (n = 24).