C10.228.140.140.254 Clinical Trial
Official title:
The Factors as Socioeconomic Status and Child Characteristics That May Impact on the Progress of Development After Physical Therapy Interventions in Children With Spastic Cerebral Palsy
The main outcome of physical therapy interventions is the progress of gross motor functions which result from the interactions between many factors not limited to physical, medical or surgical interventions but also including child characteristics and socializing agents. Aim of the study: To determine the effect of socioeconomic status (SES), child characteristics (age, sex, severity, and type of cerebral palsy) on the progress of gross motor functions in children with cerebral palsy. Methods: Prospective cohort study on eighty children (44 boys, 36 girls) aging 3.11 ± 0.88 years old, diagnosed as spastic cerebral palsy. The gross motor function measure (GMFM-88) between two-time intervals with follow-up time 6 months Results: The median of the mean difference for the GMFM scores was related to socioeconomic status, age, sex, severity, and type of CP.
This study had four stages, the first one make registry from a computer database of
outpatient clinic faculty of physical therapy Cairo university for all children with cerebral
palsy under four years old age. In the second stage the files of 100 children registered were
studied to select spastic cerebral palsy without the following; associated disorders,
congenital anomalies, perceptual disorders, IQ below 80%, or another diagnosis ( nerve
lesion, genetic disorders). Before the evaluation stage, every parent of each selected child
was aware with the purpose of the study and signed the written informed consent that was
approved by the ethical committee faculty of Physical Therapy Cairo University.Evaluation
The 83 selected children were evaluated as follow:
1. Muscle tone assessment Modified Ashworth scale is a valid and reliable test for measure
muscle tone (Mutlu, 2008) table 1. Then evaluate the tone distribution throughout the
body to determine its type diplegia, quadriplegia, or hemiplegia.
2. Severity The gross motor function classification system (GMFCS) is a reliable and valid
system to classify the children with CP according to their age- specific motor activity
(Palisano, 2000). GMFCS is a time-independent variable and it has five levels of
severity (I, II, III, IV &V). The children with level I& II grouped as mild cases,
children with level III were moderate cases, and those with IV & V levels were sever
cases.
3. The gross motor function measure The Gross motor function measure (GMFM-88) is a valid
clinical assessment tool designed to evaluate gross motor function, and its change over
time in children with cerebral palsy (Russell, 2013). (GMFM-88) consists of 88 items in
five dimensions A: Lying and Rolling (17 items), B: Sitting (20 items), C: Crawling and
Kneeling (14 items), D: Standing (13 items), and E: Walking, Running and Jumping( 24
items). Each item was scored as 0 - does not initiate, 1 - initiates, 2 - partially
completes, and 3 - completed, or not tested. The GMFM total scores are a summation of
the scores for all dimensions and dividing by 5. A percentage score was calculated for
the total score so it ranges from 0 to 100.
4. Socioeconomic status (SES) SES was evaluated by a valid and updated of the socioeconomic
status scale for health research in Egypt scale (El-Gilany, 2012). It includes 7 domains
with a total score of 84 ; 1- education and cultural domain(for both husband & wife)
(score = 30); 2- family domain (score = 10); 3- occupation domain(for both husband &
wife) (score = 10); 4- Family possessions domain (score = 12); 5- home sanitation domain
(score = 12); 6- health care domain (score = 5); 7- economic domain(score = 5).
According to the quartiles of the score calculated, the socioeconomic level is
classified into very low, low, middle and high levels.
Physical therapy program The trained physiotherapists did the physical therapy interventions
based on neurodevelopmental technique (NDT) and strength training for all participated
children in the study for three times per week along sex months. During the study, the
parents were asked to be adhering to the sessions Follow up After 6 months of the physical
therapy program, the GMFM88 for 80 children were evaluated again to determine the progress of
motor functions.
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