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To Compare two Strengthening Protocols to Improve Gait in Spastic Diparetic Cerebral Palsy Subjects

Niraj Kumar, Associate Professor, Dept. of Physiotherapy, Shri Guru Ram Rai Institute of Medical & Health Sciences, Patel Nagar Dehradun, Uttrakhand 248001, India. , Kshitij Uniyal1 , Niraj Kumar2 , Nishu Sharma3 , Anirban Patra4

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Physiotherapy and Occupational Therapy Journal 11(4):p 119-128, Oct-Dec 2018. | DOI: DOI: http://dx.doi.org/10.21088/potj.0974.5777.11418.2

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Abstract

  Introduction: Cerebral palsy is the most common neurological condition in pediatric age group. The worldwide incidence being 1.5 to 2.5 per 1000 live births [4,7,8]. Cerebral palsy in developing countries in most often attributed to birth asphyxia and birth Trauma and indeed birth asphyxia is still a leading cause of cerebral palsy in India [4]. Gait is one of the most important functional activity. It may be described as translatory progression of body as whole produced by coordinated rotatory movement of the body segment. Normal gait is rhythmic and characterized by alternating propulsion and retropulsion motions of the lower extremity and depends on the muscle strength of the lower extremities [1]. Need for Study: To compare two strengthening protocols to improve gait in spastic diparetic cerebral palsy subjects. Methods: 30 spastic diparetic cerebral palsy children took part in the study. The subjects were divided into two groups, group A and group B. Group A was given both closed kinematic and open kinematic chain exercise and group B was given only open kinematic chain exercise. Spasticity was evaluated by the Modified Ash worth scale. Following this, the subjects were asked to perform in randomized order. Discussion: Some studies proved that both closed kinematics chain and open kinematics chain strengthening exercise improve function in children and adolescents with Spastic cerebral palsy. Therefore, selecting different activities for training in both open and closed kinematics chain exercise improve more gait variables that using similar activities only in one kinematics chain exercise. Conclusion: The study concluded that although both groups group A and group B improves gait parameters, but Group A exercises shows better improvement in gait parameters as compared to Group B. Thus, the hypothesis that there is significant effect in improvement of gait parameters by using combined closed and open kinematic chain exercise in spastic diparetic cerebral palsy children holds true. Limitation of study: 1. Duration of gait training was small i.e. 5 weeks. 2. Time constrains meant that patients were only followed up for one month. Future research: 1. Further studies can be done with wider sample size including different subjects with different age groups. 2. Closed and open kinematic chain exercises can be applied in patient with different neurological condition such as muscular dystrophy, stroke, and multiple sclerosis. 3. Study can be conducted on cerebral palsy subjects with spasticity more than 1+. 

Keywords: CP; Closed Kinematic & Open Kinematic Chain Exercise; Stop Watch; Marker; Measuring Tape; Oil and Socks; Paper Walkway & Rowing Machine 

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DOI: DOI: http://dx.doi.org/10.21088/potj.0974.5777.11418.2

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