Comparison Between Schroth and Klapp Method in CP Children With Scoliosis

NCT ID: NCT06504550

Last Updated: 2024-08-14

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 22 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-05-14
• Study Completion Date: 2024-07-28

Brief Summary

Cerebral palsy, which occurs in two to three out of 1,000 live births, has multiple etiologies resulting in brain injury that affects movement, posture, and balance. Approximately one-third of children with CP are non-ambulant and subsequently spend prolonged periods of time in sitting or lying. Non-ambulatory patients with cerebral palsy (CP) bear a high risk of developing simultaneous progressive scoliotic spine deformities, loss of sitting balance and hip subluxation/dislocation.Treatments for the Spinal deformities associated with cerebral palsy are Schroth method. It is a scoliosis-specific exercise approach that uses postural, scoliosis-specific sensorimotor exercises. While another treatment approach Klapp method aimed to stretch and strengthen muscles by all fours positions, easily applied and that can be used in small groups.

A Randomized clinical trial will be conducted through convenient sampling. Inclusion criteria of this study is age between 8 to 12 years of either gender, with GMFCS level I and II and Trunk rotation angle (ATR) > 4 degree, who are able to understand and follow verbal instructions. Those patients who has been prescribed brace treatment, has scheduled or undergone any corrective surgical treatment of the spine before or during data collection process will be excluded. Patients who are unable to participate, or are reluctant to receive treatment are excluded. Study will be conducted on 22 patients who will be randomly allocated into two groups. One group will receive Schroth exercises. It consists of passive and active postural auto-correction exercises done repeatedly and based on kinesthetic and sensorimotor principles. While the other group with Klapp method includes stretching and strengthening muscles by all fours positions. Bunnell's scoliometer, Adams forward bend test, and Posture and postural ability scale (PPAS) will be used as outcome measure.

Detailed Description

Group A is Schroth Group (SG). The patients in the Schroth exercise group will start their exercise program under physiotherapist supervision. Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks. Schroth exercises will be performed in an asymmetric position to maximize correction to achieve trunk symmetry. These exercises include spinal elongation, de-rotation, de-flexion, stretching, strengthening and rotational breathing exercises to maintain vertebral alignment. The participants will be asked to combine these exercises with their daily living activities (ADLs). During the Schroth exercises, rice bags, foam blocks, a stool, and long sticks will be used to adjust the posture and give passive support. Exercises are progressed from lying, sitting, or standing positions and from most to least passive support per a review of the quality of the performance. Decreasing the amount or degree of passive support, changing the patient's position, and adjusting the sets and repetitions of exercises will depend on the patient's improvement in exercise performance Group B is Klapp group (KG).The patients in the Klapp exercise group will be treated with supervised klapp exercises. Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks. In each session, a sequence of 8 postures of Klapp Exercises will be carried out. Each posture will be maintained for 4-5 minutes with rest breaks when needed. Positions that will be held are: 1) Lateral crawl, 2) Horizontal sliding, 3) Crawl posture near the ground, 4) Bunny hopping, 5) Arm turn, 6) Big arch, 7) Lateral crawl near the ground, 8) Big curve

Conditions

Cerebral Palsy; Scoliosis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Schroth Exercise. Group A receive Schroth Exercises.

Group A: Schroth Group (SG). The patients in the Schroth exercise group will start their exercise program under physiotherapist supervision. Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks. These exercises include spinal elongation, de-rotation, de-flexion, stretching, strengthening to maintain vertebral alignment.The participants will be asked to combine these exercises with their daily living activities (ADLs).During the Schroth exercises, rice bags, foam blocks, a stool, and long sticks will be used to adjust the posture and give passive support.Exercises are progressed from lying, sitting, or standing positions and from most to least passive support per a review of the quality of the performance.Decreasing the amount or degree of passive support, changing the patient's position, and adjusting the sets and repetitions of exercises will depend on the patient's improvement in exercise performance

Group Type: EXPERIMENTAL

Schroth Exercises

Intervention Type: OTHER

The patients in the Schroth exercise group will start their exercise program under physiotherapist supervision.Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks.These exercises include spinal elongation, de-rotation, de-flexion, stretching, strengthening exercises to maintain vertebral alignment.The participants will be asked to combine these exercises with their daily living activities (ADLs).During the Schroth exercises, rice bags, foam blocks, a stool, and long sticks will be used to adjust the posture and give passive support.Exercises are progressed from lying, sitting, or standing positions and from most to least passive support per a review of the quality of the performance.Decreasing the amount or degree of passive support, changing the patient's position, and adjusting the sets and repetitions of exercises will depend on the patient's improvement in exercise performance

Klapp Exercise. Group B receive Klapp Exercises.

Group B: Klapp group (KG). The patients in the Klapp exercise group will be treated with supervised klapp exercises.Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks.In each session, a sequence of 8 postures of Klapp Exercises will be carried out.Each posture will be maintained for 4-5 minutes with rest breaks when needed.Positions that will be held are: 1) Lateral crawl, 2) Horizontal sliding, 3) Crawl posture near the ground, 4) Bunny hopping, 5) Arm turn, 6) Big arch, 7) Lateral crawl near the ground, 8) Big curve

Group Type: EXPERIMENTAL

Klapp Exercises

Intervention Type: OTHER

The patients in the Klapp exercise group will be treated with supervised klapp exercises. Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks.In each session, a sequence of 8 postures of Klapp Exercises will be carried out. Each posture will be maintained for 4-5 minutes with rest breaks when needed.Positions that will be held are: 1) Lateral crawl, 2) Horizontal sliding, 3) Crawl posture near the ground, 4) Bunny hopping, 5) Arm turn, 6) Big arch, 7) Lateral crawl near the ground, 8) Big curve

Interventions

Schroth Exercises

The patients in the Schroth exercise group will start their exercise program under physiotherapist supervision.Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks.These exercises include spinal elongation, de-rotation, de-flexion, stretching, strengthening exercises to maintain vertebral alignment.The participants will be asked to combine these exercises with their daily living activities (ADLs).During the Schroth exercises, rice bags, foam blocks, a stool, and long sticks will be used to adjust the posture and give passive support.Exercises are progressed from lying, sitting, or standing positions and from most to least passive support per a review of the quality of the performance.Decreasing the amount or degree of passive support, changing the patient's position, and adjusting the sets and repetitions of exercises will depend on the patient's improvement in exercise performance

Intervention Type: OTHER

Klapp Exercises

The patients in the Klapp exercise group will be treated with supervised klapp exercises. Exercise treatment program will consist of 18 sessions, 30 minutes each session, three times a week, for 6 weeks.In each session, a sequence of 8 postures of Klapp Exercises will be carried out. Each posture will be maintained for 4-5 minutes with rest breaks when needed.Positions that will be held are: 1) Lateral crawl, 2) Horizontal sliding, 3) Crawl posture near the ground, 4) Bunny hopping, 5) Arm turn, 6) Big arch, 7) Lateral crawl near the ground, 8) Big curve

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• 8 to 12 years of age
• Either gender.
• The level of gross motor function between levels I and II in accordance with the gross motor function classification system (GMFCS) .
• Angle of Trunk Rotation (ATR) > 4 degree .
• Ability to understand and follow verbal instructions

Exclusion Criteria

• Patients will be excluded if they have had been prescribed brace treatment
• Has received any previous corrective or surgical treatment of the spine
• Unable to participate, or are reluctant to receive treatment

• Minimum Eligible Age: 8 Years
• Maximum Eligible Age: 12 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Ayesha Khaliq, MS*

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Riphah International University

Lahore, Punjab Province, Pakistan

Countries

Pakistan

References

Agustsson A, Sveinsson T, Pope P, Rodby-Bousquet E. Preferred posture in lying and its association with scoliosis and windswept hips in adults with cerebral palsy. Disabil Rehabil. 2019 Dec;41(26):3198-3202. doi: 10.1080/09638288.2018.1492032. Epub 2018 Jul 16.

Reference Type: BACKGROUND

PMID: 30010440 (View on PubMed)

Other Identifiers

REC/RCR&AHS/23/0779

Identifier Type: -

Identifier Source: org_study_id