Effects of Circuit Training and Task Oriented Training on Balance and Quality of Life in Children With Spastic Diplegic Cerebral Palsy

Ibadat International University, Islamabad25 enrolled

Overview

Cerebral palsy (CP) is a group of permanent disorders affecting movement and posture, caused by non-progressive disturbances in the developing fetal or infant brain. Circuit training and task-oriented training are two emerging approaches in pediatric rehabilitation. Circuit training focuses on structured exercises performed in sequence to improve strength, agility, and balance, while task-oriented training emphasizes repetitive practice of meaningful, functional activities relevant to daily life.

The purpose of this study is to compare the Circuit Training and Task Oriented Training for upgrading Balance and Paediatric Quality of Life in Children with Spastic Diplegic Cerebral Palsy, focusing on improvements in balance, functional mobility and activity performance. Implemented a single-blinded randomized controlled trial at paediatric rehabilitation centres in Rawalpindi and Islamabad, it will include children aged 6 to 12 years male and females with GMFCS levels I-II who can walk with or without aids. The intervention will last for eight weeks, with both groups receiving standard physiotherapy three times weekly. In the period of eight weeks, result will be measured at baseline and three sessions using validated tools such as the Peadiatric Balance scale, and Peadiatric Quality of life Inventory. Ethical consideration comprise confidentiality, informed consent, and make certain that participation has no effect on medical care. Supporting evidence are its well defined intervention, clear methodology, and use of proven evaluation methodologies, with a purpose to evaluate long term benefits, sustainability of gains, and generalisability through randomised sampling and potential multi-centre recruiting. It also design to address activity and participation elements and classify participants based on age and functional levels for broader applicability. The data will be analysed using SPSS27.0.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Interventions

Group A Circuit TrainingOTHER

Warm-up 5 minutes such as stretching and basic active range of motion (AROM) exercises. Group A (Circuit Training Group) Circuit stations (35 min\] Station 1Obstacle standing balance \[cones, foam pads\] → challenges weight shifting. Station 2 Gym ball sitting Balance training \[child sit on a gym ball with feet flat on floor\] alternating foot lifts Station 3 Step-ups with resistance band \[forward /lateral\] build lower limb strength and promotes symmetrical movement. Station 4 Ball toss while standing on foam to increase challenge Station 5 Tandem walking on a straight line (forward / backward) improve heel to toe gait and posterior chain activation. Cool down (5 min) Static stretching and, breathing exercises. Progression: increase difficulty weekly \[narrower bases of support, added weights\]

Group B Task-Oriented TrainingOTHER

Warm-up (5 min) Gentle Stretching (hamstring and gastrocnemius) Light aerobic activities (marching in place, stepping over low objects) Task oriented Training (35 min) Stride stand on the mat and slight tuck by therapist Sit to stand with ball tasks (no walking\] Stepping over soft obstacles (soft cushions, foam blocks for child to step over) Walking on foam surface Stepping over soft obstacles Step up and down using a bar Cool down (5 min) Static stretching for major lower limb muscles. Deep breathing exercises. Progression: increase difficulty by adding distance, height, resistance, or unstable surfaces

Eligibility

Sex: ALLMin age: 6 YearsMax age: 12 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Children (both gender) aged between 6 to 12 years. * Diagnosed with non-progressive motor impairments \[cerebral palsy GMFCS I-II\] * Capable to understand and follow verbal instructions. * Children demonstrating stable sitting and standing balance or with minimum assistance. Exclusion Criteria: * Children with severe cognitive impairments. * Recent orthopedic surgery \[within last 6 months\]. * Uncontrolled seizures or cardiopulmonary conditions. * Any condition contraindicating physical activity. (19)

Outcomes

Primary Outcomes

Pediatric Balance Scale PBS

A clinical test called Pediatric Balance Scale \[PBS\] is used to examine children's balance skills, especially in those with developmental delays or motor impairments. It is modified version of the adult berg balance scale, intended for use with children. Asses functional balance in children between 5 and 15 years of age, often utilized for children with conditions like cerebral palsy, developmental coordination disorder, or after neurological injury. Structure: Consists of 14 tasks that assess static and dynamic balance, such as sitting to standing, standing unsupported, reaching forward, turning, and standing on one foot. Scoring: Each item is scored on a scale from 0 to 4, where 0 indicates inability to perform the task and 4 indicates independent and steady outcome. The highest possible score is 56. Clinical Use: Helps to identify balance deficits, monitor progress over time, and guide rehabilitation planning. Advantages: Simple

Time frame: Assessed at Baseline (0 week ), Mid-intervention ( 4 week) and Post-Intervention (8 week)

Paediatric Quality of Life Inventory-CP Module (PedsQL-CP)

To asses quality of life specific to children with cp from both physical and psychosocial perspectives. Contains age-appropriate versions with domain including daily activities, school participation, and mobility. 5-points Likert scale \[0 =never, 4 =almost always\], transformed to a 0-100 scale; higher score indicates better Quality of life. 10 to 15 min

Time frame: Assessed at Baseline ( Week 0) , Mid-intervention ( Week 4 ) and Post-intervention ( Week 8)