The purpose of this study is to determine if there is an effect of eye movement training exercises on gait kinetic variables in cerebral palsy spastic diplegic children.
Cerebral palsy is often accompanied by a dysfunction of the visual system consisting of an anterior part both eyes and the optic nerves up to the optic chiasm and a posterior part--the optic tracts, the lateral geniculate nuclei, the optic radiations and the occipital cortex. among children with cerebral palsy, 49.6% had ophthalmological disorders. The eye movement disorders are most common showing functional abnormalities such as gaze, saccade, and smooth pursuit in addition to strabismus and abnormal eye movements. In other words, the aspects of cerebral palsy are based not only on motor dysfunction characteristics and local anatomy but also on neuro-ophthalmology. The visual perception system has a great influence on postural control and motor development by engaging in spatial association, identifying object characteristics, and distinguishing objects and their backgrounds, and eye movement function to place the image of nearby objects in the center also acts as an important factor in postural control and motor development. Eye movement control is the most basic type of visual perception, and lack of eye movement control often occurs in patients suffering from central nervous system diseases. In order to achieve balance during normal gait, diverse brain regions, such as the cerebral cortex, cerebellum, and brain stem are involved. There are three crucial functional factors: the supporting action of the musculoskeletal system, the coordination of functional eye movement, and the integration of sensory function with action. Eye movement training, in which movement patterns are adjusted through visual feedback, has been studied recently. Visual field and visual accuracy affect balance and movement ability, and in particular, patients with problems in the visual system often develop problems with balance ability. The vestibular system contributes to postural stability and visual stabilization through the vestibulo-spinal reflex (VSR) and the vestibulo-ocular reflex (VOR). The vestibulo-ocular reflex is a reflex eye movement that stabilizes images on the retina during head movement. A rotation of the head is detected, which triggers an inhibitory signal to the extraocular muscles on one side and an excitatory signal to the muscles on the other side. The result is a compensatory movement of the eyes. the vestibulo-ocular reflex does not depend on visual input and works even in total darkness or when the eyes are closed. There is lack in research regarding the area improve eye ex. Its effect on motor ability as in gait, most eye movement studies have been focused on balance, and studies relating eye movement training to gait have been insufficient, so this study will be conducted in hope evidence this area.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
All children in both groups will receive selected gait training (treadmill) sessions for five times per week over 6 successive months.
All children in the experimental group will receive eye training exercises for five times per week over 6 successive months. The exercises include tasks to improve visual focus and tracking. Children search for a specific card among 20 while covering one eye, repeated 10 times. They follow a pencil moving vertically, horizontally, in circles, and in a figure 8, maintaining a 1m distance. Exercises include shifting gaze between two pencils, recognizing letters on a shaking card, and tracking a pencil from 5cm to 50cm. Tasks are done with each eye covered separately. Another task involves walking while focusing on a fixed target 1m away at eye level for 5 minutes.
Cairo University
Giza, Egypt
Step Length
Using the foot print, the distance from the heel of one foot-strike to the heel of the opposite foot-strike will be measured in centimeters before and after treatment for all participants in both groups.
Time frame: 6 months
Step Width
Using the foot print, the distance between the centers of the feet during the double limb support portion of the gait cycle will be measured in centimeters before and after treatment for all participants in both groups.
Time frame: 6 months
Stride Length
Using the foot print, the distance between heels of two consecutive foot-strikes of the same foot (distance of a whole gait cycle) will be measured in centimeters before and after treatment for all participants in both groups.
Time frame: 6 months
Cadence
Using the foot print, the number of steps per minute will be measured before and after treatment for all participants in both groups.
Time frame: 6 months
Step Time (s)
Using the foot print, the time elapsed from initial contact of one foot to initial contact of the opposite foot will be calculated in seconds before and after treatment for all participants in both groups.
Time frame: 6 months
Stride Time
Using the foot print, the time of one whole gait cycle (right foot hitting the ground, left foot hitting the ground, then right foot hitting the ground again) will be calculated in seconds before and after treatment for all participants in both groups.
Time frame: 6 months
Stance Time Stance Time
Using the foot print, the time from heel strike to toe off on the same foot will be calculated in seconds before and after treatment for all participants in both groups.
Asmaa Osama Sayed, PhD
CONTACT
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Time frame: 6 months
Swing Time
Using the foot print, the time from toe off to heel strike on the same foot will be calculated in seconds before and after treatment for all participants in both groups.
Time frame: 6 months
Single Support Time
Using the foot print, the time in one gait cycle in which only one foot is on the ground will be calculated in seconds before and after treatment for all participants in both groups.
Time frame: 6 months
Double Support Time
Using the foot print, the time in one gait cycle in which both feet are on the ground will be calculated in seconds before and after treatment for all participants in both groups.
Time frame: 6 months
Ocular motor score (OMS)
It will be assessed for all participants in both group before and after treatment. It is a new clinical test protocol for evaluating ocular motor functions in children and young adults. OMS is a set of 15 important and relevant non-invasive ocular motor function parameters derived from clinical practice. The subtests are scored as 0 (normal) 0.3 or 0.5 (subnormal) and 1 (pathological).
Time frame: 6 months