Effects of Motor Imagery Training After Muscle Lengthening Surgery in Children With Cerebral Palsy
NCT ID: NCT06838858
Last Updated: 2025-03-12
Study Results
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Basic Information
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ACTIVE_NOT_RECRUITING
NA
28 participants
INTERVENTIONAL
2024-03-01
2025-03-15
Brief Summary
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Detailed Description
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Spasticity that occurs in the affected areas of the body after upper motor neuron lesions directly negatively affects the child's muscle and joint functions. The muscle groups where spasticity is commonly and frequently seen in the lower extremities are the hip adductor muscles, hamstrings, and ankle plantar flexor muscles. Ankle plantar flexor muscle spasticity can be seen in children of all GMFCS levels and negatively affects the child's functional status and reduces compliance with orthosis use. Increased ankle plantar flexor spasticity causes contracture in the ankle plantar flexors over time, which restricts ankle dorsiflexion. This condition often causes toe walking in children. Toe walking disrupts the child's general body balance and also negatively affects other upper segments, especially the knee joint.
The primary treatment option in the presence of ankle plantar flexor muscle spasticity is conservative treatment. Conservative treatment includes positioning the ankle in dorsiflexion and strengthening the dorsiflexor muscles, stretching the ankle plantar flexor muscles, performing relaxation exercises on the same muscle group, transferring weight in the appropriate position, and walking exercises.
In addition, in the presence of dynamic spasticity, the effectiveness of botulinum neurotoxin injection applied to the ankle plantar flexor muscles in cases where conservative treatment is inadequate has been shown in the literature. In cases where all these methods are inadequate, plantar flexor muscle contracture is present, and the child is functionally negatively affected, lengthening surgeries performed on the plantar flexor muscles are indicated. This operation can be performed only on the gastrocnemius muscle or on the Achilles tendon, which includes both the gastrocnemius and soleus muscles.
The ankle plantar flexor muscles are included in the antigravity muscle group and have an important role in general body balance. The length and strength of these muscles at a certain rate provide stabilization of the body segments. While the increased tone of these muscles disrupts this stabilization, the inability of the elongated muscle to provide sufficient core support after relaxations results in excessive dorsiflexion and suggests that it may cause walking problems and ultimately loss of balance. Therefore, when deciding on plantar flexor muscle relaxation operations applied to children with CP, it is thought that the right timing should be provided and the surgery should be performed with an experienced team in sufficient and correct amounts, and post-operative rehabilitation protocols that include intensive studies on gaining balance and stabilization in the post-operative period will increase balance and walking control.
Motor Imagery; It is the process of learning a new movement or increasing the quality of a known movement by visualizing it in a planned and intensive manner in the mind without performing any motor activity. In imagery, while not actually doing any activity; it is possible to experience it through mental imagery by seeing the image in the mind, feeling the movement as in the image, sensing the taste or smell of the image, and hearing its sound. The effectiveness of motor imagery training has been shown in children with CP. There is no study on its effectiveness in the postoperative period.
This study hypothesizes that motor imagery training, which will be applied in addition to the post-operative rehabilitation program, is effective on balance, walking, and quality of life, especially in children with CP, in the rehabilitation process where there is a mandatory restriction with plaster and orthosis after ankle plantar flexor muscle lengthening surgeries. The primary aim of this study is to examine the effect of motor imagery training, which will be applied in addition to post-operative rehabilitation after ankle plantar flexor muscle release operations in individuals with CP, on balance, gait, and quality of life.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Motor Imagery Training Group in Addition to Post-Operative Exercise
The study group will receive motor imagery exercises in addition to the post-op rehabilitation received by the comparison group. The exercises will given in a hibrit method (a face to face therapy session and 2 telerehabilitation session in an online platform in a week).
The telerehabilitation sessions will given under the supervision of a remote physiotherapist. This group will take therapy sessions during 8 weeks. All the patients will have totally 8 face to face therapy sessions and 16 telerehabilitation sessions.
Motor Imagery Training
The study group will receive motor imagery training in addition to control group's exercise program. This process will proceed as follows; In motor imagery training videos taken with a 9-year-old healthy child will be watched.• The content of the videos will include exercises such as ankle dorsiflexion, heel tapping while walking, climbing and descending stairs, walking on a ramp, standing on a ramp, walking on soft ground, and walking on a treadmill.• The patients will watch these videos and then the relaxation, imagination and return to environment phases of motor imagery will be applied respectively.
Conventional Post-operative Exercises
This group will receive conventional exercises in the post-op process. The exercises included in the conventional exercise program are;
* Balance board exercises
* Balance disc exercises
* Bosu exercises
* Balance pad exercises
* Wobble board exercises
* Walking on soft ground
* Balance exercises on soft ground
* Apraximations and tractions
* Target angle exercise for ankle
* General standing balance exercises (Eyes open and closed - single foot, double foot)
* Ankle bidirectional ROM
* Ankle bidirectional strengthening
* Exercises to increase foot intrinsic muscle strength and balance
* Functional exercises
Post-Operative Exercise Group
This group will be included in a conventional post-operative rehabilitation program that includes intensive foot intrinsic muscle balance, bilateral ankle strengthening and range of motion exercises, and general body balance studies after plantar flexor muscle relaxation operations. In the rehabilitation program of the case group, exercises are planned under the supervision of a remote physiotherapist, with the telerehabilitation method (online live sessions) 2 days and 1 face to face therapy session will be done in a week. face therapy sessions and 16 telerehabilitation sessions.
Conventional Post-operative Exercises
This group will receive conventional exercises in the post-op process. The exercises included in the conventional exercise program are;
* Balance board exercises
* Balance disc exercises
* Bosu exercises
* Balance pad exercises
* Wobble board exercises
* Walking on soft ground
* Balance exercises on soft ground
* Apraximations and tractions
* Target angle exercise for ankle
* General standing balance exercises (Eyes open and closed - single foot, double foot)
* Ankle bidirectional ROM
* Ankle bidirectional strengthening
* Exercises to increase foot intrinsic muscle strength and balance
* Functional exercises
Interventions
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Motor Imagery Training
The study group will receive motor imagery training in addition to control group's exercise program. This process will proceed as follows; In motor imagery training videos taken with a 9-year-old healthy child will be watched.• The content of the videos will include exercises such as ankle dorsiflexion, heel tapping while walking, climbing and descending stairs, walking on a ramp, standing on a ramp, walking on soft ground, and walking on a treadmill.• The patients will watch these videos and then the relaxation, imagination and return to environment phases of motor imagery will be applied respectively.
Conventional Post-operative Exercises
This group will receive conventional exercises in the post-op process. The exercises included in the conventional exercise program are;
* Balance board exercises
* Balance disc exercises
* Bosu exercises
* Balance pad exercises
* Wobble board exercises
* Walking on soft ground
* Balance exercises on soft ground
* Apraximations and tractions
* Target angle exercise for ankle
* General standing balance exercises (Eyes open and closed - single foot, double foot)
* Ankle bidirectional ROM
* Ankle bidirectional strengthening
* Exercises to increase foot intrinsic muscle strength and balance
* Functional exercises
Eligibility Criteria
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Inclusion Criteria
* Being between the ages of 7-18
* Being able to walk with or without support
* Not having received botulinum toxin injections into the ankle plantar flexor muscles in the last 6 months
* Being at the GMFCS level of 1,2 or 3
* Having an indication for ankle muscle release surgery and having a surgical plan
* Being receiving a developmental rehabilitation program
* Being able to follow given commands
Exclusion Criteria
* Having any neurosurgery before
* Having any bone surgery for the foot or ankle before
* Having a bone surgery in the same session
* Mental retardation and not being able to take commands
7 Years
18 Years
ALL
No
Sponsors
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Saglik Bilimleri Universitesi
OTHER
Responsible Party
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Meltem Çelik
Principal Investigator
Principal Investigators
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Zuhal Didem Takinacı, PhD
Role: STUDY_DIRECTOR
Saglik Bilimleri Universitesi
Locations
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University of Health Sciences
Istanbul, , Turkey (Türkiye)
Countries
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References
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Other Identifiers
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MCDT-2025
Identifier Type: -
Identifier Source: org_study_id
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