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Neuro developmental techniques versus functional
electrical stimulation on quality of upper extremity
function in children with hemiplegic cerebral palsy: An
experimental study
Guide: Dr. Namrata, Principal, HOD
Co - Guide: Dr. Swadeep, Mpt Neuro
Presented By
Madhuri Dubey
NEURO, MPT 2nd Year
Introduction
The internationally recognized definition of CP is "Cerebral palsy (CP) describes a group of
permanent disorders of the development of movement and posture, causing activity limitation,
that are attributed to non-progressive disturbances that occurred in the developing fetal or infant
brain. " CP is a chronic mental disorder, not a continuous disorder. This means that the disruption or
process of the disease will not get worse as time goes on.3-4 The incidence and spread of CP are
2/1000 live births. In addition to the lack of vehicles, other related illnesses are more likely to include
visual impairment, hearing and speech impairment, mental retardation, mental retardation,
learning disabilities, and general social and emotional problems.
Hemiplegic CP: It is a spastic unilateral paresis where the upper limbs are more affected than the
lower limbs. It is most commonly seen in newborns (56%) and newborns (17%). It has a multifactorial
pathogenesis. It results from premature brain damage, including CP, per ventricular brain lesions,
cerebral artery infarction, and non-progressive brain damage after childbirth.
Aim of the Study
 The main aim of the study will be to investigate the effect of Neuro developmental
techniques and functional electric stimulation, when used in NDT alone and
conventional physical therapy with functional electric stimulation on the quality of
upper extremity functions in hemiplegic CP children.
 The purpose of the study will be to indicate that neuro developmental therapy may
show beneficial effect compare to functional electric stimulation.
Procedure and Study Design
Group A – Experimental Group
Group B – Control Group
Pre Treatment
Ax
•MTS
•MACS
•QUEST
Treatment
•NDT
•Conventional
Therapy
Post Treatment
Ax
•MTS
•MACS
•QUEST
Statistical
Analysis
Study Result Conclusion
Pre Treatment
Ax
•MTS
•MACS
•QUEST
Treatment
•Conventional
Therapy
•FES
Post Treatment
Ax
•MTS
•MACS
•QUEST
Statistical
Analysis
Study Result Conclusion
Objective
 To assess the additional effects of NDT v/s FES on gross motor, fine motor functions and
spasticity on quality of upper extremity functions in hemiplegic CP children.
 To compare the effect of NDT v/s FES and conventional therapy statistically on the
quality of upper extremity functions in hemiplegic CP children.
Hypothesis
 The research hypothesis of this study would be that NDT will significantly improve the
quality of upper extremity functions in hemiplegic CP children comparative to FES
and conventional therapy.
Material & Method
 Type of Study: Experimental study
 Study Design: This study will be an experimental study in which the additional effects of NDT v/s FES on
gross motor and good motor functions and spasticity.
 Duration of treatment: 5 days in a week for 4 Weeks. Each session will be an hour and half.
 Selection of study subjects: The study's sample size will be 30 of the 15 in each control and experimental
group. Subjects will be randomly divided into two groups.
 Inclusion Criteria:
 Spastic Hemiplegic CP children
 A group of 4-8 years
 Children with MACS level 4 or less also
 Children with MAS 3 or less of the Upper Extremity tissue will be included in the study.
 Exclusion Criteria:
 Failure to understand the required instructions for the process
 Children have received Botulinum toxin treatment in the last six months.
 Visible and audible deficits
 UE fixed disability / contracts
 Pre-orthopeadic surgery
Outcome Measures
 Modified Tardieu scale (MTS)
 The Manual Ability Classification System (MACS)
 Quality of Upper Extremity Skills Test (QUEST)
References
 Colver A, Fairhurst C, Pharoah PO. Cerebral palsy. Lancet 2014;383:1240-9.
 Graham HK, Rosenbaum P, Paneth N, et al. Cerebral palsy. Nat Rev Dis Primers 2016;2:15082
 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control
and Prevention. Data and statistics for cerebral palsy.
 Stavsky M, Mor O, Mastrolia SA, et al. Cerebral palsy trends in epidemiology and recent
development in prenatal mechanisms of disease, treatment, and prevention. Front Pediatr
2017;5:21
 Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of
cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007;109:8-14
 Pakula, A.T.; Van Naarden Braun, K.; Yeargin-Allsopp, M. Cerebral palsy: Classification and
epidemiology. Phys. Med. Rehabil. Clin. N. Am. 2009, 20, 425–452.
 Macnamara, J. Early ascertainment of and prevention of deformity from cerebral palsy.
Publ. Health 1949, 62, 121–122
 Chiu H, Ada L. Constraint-induced movement therapy improves upper limb activity and
participation in hemiplegic cerebral palsy : a systematic review. J Physiother [Internet]
2016;62(3):130-7.
References
 Wu YN, Hwang M, Ren Y, Gaebler-Spira D, Zhang LQ.Combined passive stretching and active
movement rehabilitation of lower-limb impairments in children with cerebral palsy using a portable
robot. Neuro rehabil nerve repair. 2011 ;25(4):378-85
 Ohrvall AM, Eliasson AC. Parents’ and therapists’ perceptions of the content of the Manual Ability
Classification System, MACS. Scand J Occup Ther 2010; 17: 209–16.
 Krumlinde-Sundholm L Berg M, Aamodt G, Stanghelle J, Hussain A. The stability of manual ability
classification system over time. Dev Med Child Neurol. 2014;56(2):185–189.
 Alahmari KA, Kakaraparthi VN, Reddy RS, Silvian PS, Ahmad I, Rengaramanujam K. Percentage
difference of hand dimensions and their correlation with hand grip and pinch strength among school
children in Saudi Arabia. Niger J Clin Pract. 2019;22(10):1356–
 Hansen AB, Price KS, Heidi M (2001) Feldman Myofascial structural integration: A promising
complementary therapy for young children with spastic cerebral palsy. Journal of Evidence Based
Complementary & Alternative Medicine 1-5.
 Vijal Mewada1, K Barot, Charmi Patel, Vidhya Solanki, Priyanka Chaudhari.Effectiveness of Surged
Faradic Current and Myofascial Release Technique on Lower Limb Muscles in Spastic Cerebral Palsy
Patient” - A Case Study JMSCR 2021 Volume 09 Issue 03 March 239-242.
 Thrasher TA, Zivanovic V, McIlroy W, et a1. Rehabilitation of reaching and grasping function in severe
hemiplegic patients using functional electrical stimulation therapy. Neurorehahil Neural Repair 2008;
22: 706-714
Thank You

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MadhuriDubey_Synopsis - 2.pdf

  • 1. Neuro developmental techniques versus functional electrical stimulation on quality of upper extremity function in children with hemiplegic cerebral palsy: An experimental study Guide: Dr. Namrata, Principal, HOD Co - Guide: Dr. Swadeep, Mpt Neuro Presented By Madhuri Dubey NEURO, MPT 2nd Year
  • 2. Introduction The internationally recognized definition of CP is "Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. " CP is a chronic mental disorder, not a continuous disorder. This means that the disruption or process of the disease will not get worse as time goes on.3-4 The incidence and spread of CP are 2/1000 live births. In addition to the lack of vehicles, other related illnesses are more likely to include visual impairment, hearing and speech impairment, mental retardation, mental retardation, learning disabilities, and general social and emotional problems. Hemiplegic CP: It is a spastic unilateral paresis where the upper limbs are more affected than the lower limbs. It is most commonly seen in newborns (56%) and newborns (17%). It has a multifactorial pathogenesis. It results from premature brain damage, including CP, per ventricular brain lesions, cerebral artery infarction, and non-progressive brain damage after childbirth.
  • 3. Aim of the Study  The main aim of the study will be to investigate the effect of Neuro developmental techniques and functional electric stimulation, when used in NDT alone and conventional physical therapy with functional electric stimulation on the quality of upper extremity functions in hemiplegic CP children.  The purpose of the study will be to indicate that neuro developmental therapy may show beneficial effect compare to functional electric stimulation.
  • 4. Procedure and Study Design Group A – Experimental Group Group B – Control Group Pre Treatment Ax •MTS •MACS •QUEST Treatment •NDT •Conventional Therapy Post Treatment Ax •MTS •MACS •QUEST Statistical Analysis Study Result Conclusion Pre Treatment Ax •MTS •MACS •QUEST Treatment •Conventional Therapy •FES Post Treatment Ax •MTS •MACS •QUEST Statistical Analysis Study Result Conclusion
  • 5. Objective  To assess the additional effects of NDT v/s FES on gross motor, fine motor functions and spasticity on quality of upper extremity functions in hemiplegic CP children.  To compare the effect of NDT v/s FES and conventional therapy statistically on the quality of upper extremity functions in hemiplegic CP children.
  • 6. Hypothesis  The research hypothesis of this study would be that NDT will significantly improve the quality of upper extremity functions in hemiplegic CP children comparative to FES and conventional therapy.
  • 7. Material & Method  Type of Study: Experimental study  Study Design: This study will be an experimental study in which the additional effects of NDT v/s FES on gross motor and good motor functions and spasticity.  Duration of treatment: 5 days in a week for 4 Weeks. Each session will be an hour and half.  Selection of study subjects: The study's sample size will be 30 of the 15 in each control and experimental group. Subjects will be randomly divided into two groups.  Inclusion Criteria:  Spastic Hemiplegic CP children  A group of 4-8 years  Children with MACS level 4 or less also  Children with MAS 3 or less of the Upper Extremity tissue will be included in the study.  Exclusion Criteria:  Failure to understand the required instructions for the process  Children have received Botulinum toxin treatment in the last six months.  Visible and audible deficits  UE fixed disability / contracts  Pre-orthopeadic surgery
  • 8. Outcome Measures  Modified Tardieu scale (MTS)  The Manual Ability Classification System (MACS)  Quality of Upper Extremity Skills Test (QUEST)
  • 9. References  Colver A, Fairhurst C, Pharoah PO. Cerebral palsy. Lancet 2014;383:1240-9.  Graham HK, Rosenbaum P, Paneth N, et al. Cerebral palsy. Nat Rev Dis Primers 2016;2:15082  National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Data and statistics for cerebral palsy.  Stavsky M, Mor O, Mastrolia SA, et al. Cerebral palsy trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Front Pediatr 2017;5:21  Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007;109:8-14  Pakula, A.T.; Van Naarden Braun, K.; Yeargin-Allsopp, M. Cerebral palsy: Classification and epidemiology. Phys. Med. Rehabil. Clin. N. Am. 2009, 20, 425–452.  Macnamara, J. Early ascertainment of and prevention of deformity from cerebral palsy. Publ. Health 1949, 62, 121–122  Chiu H, Ada L. Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy : a systematic review. J Physiother [Internet] 2016;62(3):130-7.
  • 10. References  Wu YN, Hwang M, Ren Y, Gaebler-Spira D, Zhang LQ.Combined passive stretching and active movement rehabilitation of lower-limb impairments in children with cerebral palsy using a portable robot. Neuro rehabil nerve repair. 2011 ;25(4):378-85  Ohrvall AM, Eliasson AC. Parents’ and therapists’ perceptions of the content of the Manual Ability Classification System, MACS. Scand J Occup Ther 2010; 17: 209–16.  Krumlinde-Sundholm L Berg M, Aamodt G, Stanghelle J, Hussain A. The stability of manual ability classification system over time. Dev Med Child Neurol. 2014;56(2):185–189.  Alahmari KA, Kakaraparthi VN, Reddy RS, Silvian PS, Ahmad I, Rengaramanujam K. Percentage difference of hand dimensions and their correlation with hand grip and pinch strength among school children in Saudi Arabia. Niger J Clin Pract. 2019;22(10):1356–  Hansen AB, Price KS, Heidi M (2001) Feldman Myofascial structural integration: A promising complementary therapy for young children with spastic cerebral palsy. Journal of Evidence Based Complementary & Alternative Medicine 1-5.  Vijal Mewada1, K Barot, Charmi Patel, Vidhya Solanki, Priyanka Chaudhari.Effectiveness of Surged Faradic Current and Myofascial Release Technique on Lower Limb Muscles in Spastic Cerebral Palsy Patient” - A Case Study JMSCR 2021 Volume 09 Issue 03 March 239-242.  Thrasher TA, Zivanovic V, McIlroy W, et a1. Rehabilitation of reaching and grasping function in severe hemiplegic patients using functional electrical stimulation therapy. Neurorehahil Neural Repair 2008; 22: 706-714