One of the main motor control issues in hemiplegic CP is spasticity, which affects the flexor muscles of the upper limb. This spasticity causes the limb to adopt a flexed posture, limiting the range of motion and contributing to a decreased ability to perform tasks that require precise movement and controlled muscle activation. Several studies have demonstrated that EMG biofeedback can significantly improve upper limb function in children with hemiplegic CP. Also, mirror therapy has gained recognition as an innovative and effective rehabilitation method for children with hemiplegic CP
Ethics statement: The current study was approved by the local Ethical Committee at the Faculty of Physical Therapy Cairo University (No: P.T.REC/012/005590). Study Design: Comparative randomized study. Sample size estimation Sample size calculation was done using the comparison of QUEST scale as a marker for upper limb functional performance between children with hemiplegic cerebral palsy treated with electromyography biofeedback training and those treated with mirror therapy. As reported in a previous publication, the mean ± SD of length of QUEST scale in Smart Glove group was 328 ± 52, while in conventional group it was 265.4 ± 45.5. Accordingly, we calculated that the minimum proper sample size was 18 participants in each group to be able to reject the null hypothesis with 80% power at α = 0.05 level using Student's t test for independent samples. Sample size calculation was done using PS Power and Sample Size Calculations Software, version 3.1.2 for MS Windows (William D. Dupont and Walton D., Vanderbilt University, Nashville, Tennessee, USA). Randomization Forty hemiplegic children will be randomly assigned into two equal groups; group A and group B. The way of randomization will be using sealed envelopes; each envelope contains a sheet of paper that will show where the child will be assigned; either into group A or group B. The process of randomization will be performed by an independent person who will be blinded to the purpose or protocol of the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
40
This intervention has been assigned to 'Group A.'. The Neurotrac Simplex device has been developed to enhance the understanding of muscle activity and to improve muscle conditioning. It stands upright on a flat surface, enabling the user to carry out specific exercises and at the same time view the biofeedback by way of bright LED lights on the front of the unit; the LCD screen will automatically display the average muscle readings for the session. Then using training programs in the NeuroTrac software for facilitation of the desired muscle. This software will be used in training the program for group A.
This intervention has been assigned to 'Group B.'A mirror (20 cm × 70 cm) on a movable stand will be used to provide a mirror therapy training program for group B. It stands on mobile wheels surrounded by a frame made of wood, with the main reflective surface likely being a standard glass mirror. The affected limb will be situated in a safe and preferably comfortable position behind the mirror. The non-affected limb will be positioned in a similar position as the affected limb, which would result in facilitating the intensity of the mirror illusion. The therapist will repeatedly remind the child to focus on the movement of the unaffected limb in front of the mirror, which helped to increase the mirror illusion. Under the supervision of the physiotherapist, children observed the reflection of their unaffected limb while performing the following movement: flexion of the shoulder, elbow extension, and wrist extension.
This intervention has been assigned to both groups. A designed physical therapy program for 30 minutes three times per week for three successive months 1. Active resisted exercises: A. Shoulder flexion and abduction. B. Elbow extension. C. Wrist extension. 2. Hand weight-bearing exercises: A. Quadriped position B. Side-sitting position C. Hand support standing 3. Reaching exercise with shoulder flexion, elbow and wrist extended. 4. Throwing the ball overhead by the affected hand and by both hands. 5. Protective extensor thrust from sitting on the roll and from the standing position. 6. Wheelbarrow walking (walking on hands).
Faculty of Physical Therapy, Cairo University
Giza, Giza Governorate, Egypt
muscle activity of deltoid, elbow extensor, and wrist extensor muscles
The Neurotrac Simplex EMG biofeedback device (model ESS102, manufactured by Verity Medical Ltd., UK) is a single-channel EMG device that has been designed to be used with a variety of applications. It acts as a diagnostic tool to measure the muscle activity, which is measured in microvolts (μV). The Neurotrac Simplex is an accurate and sensitive device that measures muscle activity down to as low as 0.2 μV and up to 2000 μV. The diverse range enables the device to measure very weak muscle activity
Time frame: The treatment period will be 3 times per week for 3 successive months
ROM of shoulder, elbow, and wrist joints
A goniometer is an instrument that either measures an angle or allows an object to be rotated to a precise angular position. The baseline digital goniometer is used to measure a patient's ROM and incorporates integral absolute vertical and horizontal levels in one arm for ease of use. The device weighs 0.45 kg. The device displays 0 to 180 degrees on an LCD screen for viewing readings and has the ability to freeze angle measurements for reference. The goniometer has a durable powder-coated steel exterior with inch/cm marks screened onto its arms and is powered by one 9V battery (included). (L is length, the horizontal distance from left to right; W is width, the horizontal distance from front to back; H is height, the vertical distance from the lowest to highest point.) These ROM measurements can be taken at any joint, and they typically involve some knowledge about the anatomy of the body, particularly bony landmarks
Time frame: The treatment period will be 3 times per week for 3 successive months
quality of upper limb movement
The Quality of Upper Extremity Skills Test is a descriptive, impairment-based, and evaluative measure designed to evaluate movement patterns and hand function in CP children separately for each arm. It has been validated for children who exhibit neuromotor dysfunction with spasticity. Quality of movement is assessed in four domains: dissociated movements (19 items), grasp (6 items), weight bearing (5 items), and protective extension (3 items), including 33 items. The total testing time, including administration and scoring, is approximately 45 minutes
Time frame: The treatment period will be 3 times per week for 3 successive months
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