The Effect of the combination of active vestibular intervention and occupational therapy on Balance in Children with Bilateral Spastic Cerebral Palsy: A pilot randomized Controlled trial
Iranian Journal of Child Neurology,
Vol. 14 No. 4 (2020),
1 October 2020
This study aimed to examine the effect of the combination of active vestibular interventions and occupational therapy on balance, and the relationship between balance changes and Activity of Daily Living in school-aged children with cerebral palsy (CP).
Materials & Methods
Twenty-four children with Spastic CP, at level I and II according to the “Gross Motor Function Classification System aged 7-12 years were enrolled and randomly assigned into control and intervention groups. Pediatric Balance Scales, Bruininks-Oseretsky Test of Motor Proficiency II were employed to assess the functional balance changes, as well as Force Plate (during eyes closed and open) to assess the parameters of balance changes (e.g., center of pressure excursion), Activity of Daily Living was assessed by “Activity Scales for Kids (performance version)”. Participants in the intervention group received active vestibular intervention for 20 min and regular occupational therapy program for 25 min, and the control group received regular occupational therapy program for 45 min. Interventions were provided 3 d/week for 6 weeks in each group. The participants were assessed in three stages: baseline, immediately after and eight weeks after intervention. Data were analyzed by ANOVA and linear regression.
The results demonstrated that only functional balance according to Pediatric Balance Scales scores was significantly increased in the active vestibular interventions group (p=0.02). There was no significant relationship between functional balance and Activity of Daily Living (P>0.05).
The combined administration of active vestibular interventions and occupational therapy could improve the functional balance in children with spastic CP. It may be related to the reorganization of the vestibular system with a controlled and precise application of stimuli.
- Cerebral Palsy
- Vestibular Intervention
- Activity of Daily Living
- Occupational Therapy
How to Cite
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(8-14).
Shumway-Cook A, Woollacott MH. Motor Control: Translating Research Into Clinical Practice. Lippincott Williams & Wilkins; 2012. p. 161-94.
Szopa A, Domagalska-Szopa M. Postural stability in children with hemiplegia estimated for three postural conditions: Standing, sitting and kneeling. Research in developmental disabilities. 2015;39:67-75.
Rine RM. Managment of the Pediatric Patient with Vestibular Hypofunction. In: Herdman S, editor. Vestibular Rehabilitation: F.D. Davis Company; 2007. p. 360-75.
Kelly G. Vestibular Stimulation as a Form of Therapy. Physiotherapy. 1989;75(3):136-40.
Kelly C, Foxe JJ, Garavan H. Patterns of normal human brain plasticity after practice and their implications for neurorehabilitation. Archives of physical medicine and rehabilitation. 2006;87(12):20-9.
Helt D, Foulds R, editors. Vestibular stimulation and its effects on muscle tone. Bioengineering Conference, 2004 Proceedings of the IEEE 30th Annual Northeast; 2004: IEEE.
Cullen KE, Roy JE. Signal processing in the vestibular system during active versus passive head movements. Journal of neurophysiology. 2004;91(5):1919-33.
Fife T, Tusa R, Furman J, Zee D, Frohman E, Baloh R, et al. Assessment: Vestibular testing techniques in adults and children. Neurology. 2000;55(10):1431-41.
Ayres AJ, Robbins J. Sensory integration and the child: Understanding hidden sensory challenges: Western Psychological Services; 2005.
Tseng S-H, Chen H-C, Tam K-W. Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy. Disability and Rehabilitation. 2013;35(2):89-99.
Shumway-Cook A, Hutchinson S, Kartin D, MSME RP, Woollacott M. Effect of balance training on recovery of stability in children with cerebral palsy. Developmental Medicine & Child Neurology. 2003;45(9):591-602.
Prieto TE, Myklebust J, Hoffmann R, Lovett E, Myklebust B. Measures of postural steadiness: differences between healthy young and elderly adults. Biomedical Engineering, IEEE Transactions on. 1996;43(9):956-66.
Yi S-H, Hwang JH, Kim SJ, Kwon J-Y. Validity of pediatric balance scales in children with spastic cerebral palsy. Neuropediatrics. 2012;43(06):307-13.
Bruininks RH. Bruininks-Oseretsky Test of Motor Proficiency, (BOT-2). Minneapolis, MN: Pearson Assessment. 2005.
Wood E, Rosenbaum P. The gross motor function classification system for cerebral palsy: a study of reliability and stability over time. Developmental medicine and child neurology. 2000;42(5):292-6.
Mutlu A, Livanelioglu A, Gunel MK. Reliability of Ashworth and Modified Ashworth scales in children with spastic cerebral palsy. BMC Musculoskeletal Disorders. 2008;9(1):44.
Young NL, Williams JI, Yoshida KK, Wright JG. Measurement properties of the activities scale for kids. Journal of clinical epidemiology. 2000;53(2):125-37.
Dehghan K S, Rassafiani M, Akbar fahimi
N, Farahbod M, Salehi M. Validity and reliability
of Activities Scale for Kids (ASK) in children
with cerebral palsy. Journal of Research in
Labaf S, Shamsoddini A, Hollisaz MT, Sobhani V, Shakibaee A. Effects of neurodevelopmental therapy on gross motor function in children with cerebral palsy. Iranian Journal of Child Neurology. 2015;9(2):36.
Hosseini SA, Ghoochani BZ, Talebian S, Pishyare E, Haghgoo HA, Meymand RM, et al. Investigating the Effects of Vestibular Stimulation on Balance Performance in Children with Cerebral Palsy: A Randomized Clinical Trial Study. Journal of Rehabilitation Sciences and Research. 2015;2(2):41-6.
Herdman S. Vestibular Rehabilitation. F.A. Davis; 2007. p. 32-53.
Winter DA, Prince F, Frank J, Powell C, Zabjek KF. Unified theory regarding A/P and M/L balance in quiet stance. Journal of neurophysiology. 1996;75(6):2334-43.
Zadnikar M, Kastrin A. Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta‐analysis. Developmental Medicine & Child Neurology. 2011;53(8):684-91.
Haehl V, Giuliani C, Lewis C. Influence of hippotherapy on the kinematics and functional performance of two children with cerebral palsy. Pediatric Physical Therapy. 1999;11(2):89.
Lee C-W, Kim SG, Na SS. The Effects of Hippotherapy and a Horse Riding Simulator on the Balance of Children with Cerebral Palsy. Journal of physical therapy science. 2014;26(3):423.
Novak I, Mcintyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine & Child Neurology. 2013;55(10):885-910.
Siebes RC, Wijnroks L, Vermeer A. Qualitative analysis of therapeutic motor intervention programmes for children with cerebral palsy: an update. Developmental medicine and child neurology. 2002;44(9):593-603.
- Abstract Viewed: 485 times