1. Evaluation by Gross Motor Function Measure of a pilot aquatic exercise program for children with Cerebral Palsy
Luca Labianca, MD, Research Fellow; Maria C. Vulpiani, MD, Assistent Professor; Mirco Fava, Therapist; Antonello Montanaro, MD; Francesco Turturro, MD; Andrea Ferretti, MD,Full Professor
Orthopaedic and Traumatology Unit, S. Andrea Hospital, Faculty of Medicine and Psychology “Sapienza” University of Rome, Italy
BACKGROUND
Fig.1 Stretching and water proprioceptive action.
Light gravity help the operator and allows the patient to use his or her weak muscles.
MATERIALS AND METHODS
Descriptive measures and characteristics, such as age, gender, body weight, length, type of CP and the expanded and revised Gross Motor Function Classification Scale level (GMFCS), were recorded for all study participants.
Prevalence of Cerebral Palsy is increasing due to improving in results of the neonatal intensive care units.
It is because there are more prematurely newborn babies, but in the same time higher is the risk of neurologic damage.
Children affected by cerebral palsy have charateristic conditions and problems in neurologic, motor and cognitive areas. This due to a substantial isolation because people don’t know how to socialize and communicate with them.
25 children affected by Cerebral Palsy were recruited aged 5 to 14yo
Each participant was taught by one therapist
Each patient underwent therapy one hour two times a week for 6 months
EACH CHILD WAS
Classificated by ICF-CY and GMFCS
Evaluated by Gross Motor Function Measure at the begginning and every 3 months
Treated by a new rehabilitation program (AIHM ) developed in the water
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Gross Motor Function Classification System (GMFCS)
Fig.2 Active motor exercises, swimming and tactile, hearing, proprioceptive, interactivity with the therapist, increase children skills
It is a 5 level clinical classification system that describes the gross motor function of people with cerebral palsy on the basis of self-initiated movement abilities for each of the 4 age-bands from 2 to 18 yo.
RESULTS
Gross Motor Function Measure (GMFM)
Mean Gross Motor Function Measure value of the two groups after every evaluation
Children were randomly assigned at Control (11) or AIHM method (14) Group
No significant difference for mean age(AG: 9.21 yo ± 2.45, CG: 9.92 yo ±2.32), height or weight between the 2 groups
Statistical significant difference (P<0,05)was found in improvement of GMFM at the end of treatment (as shown in the graph 1)
The GMFM-88/66 is a standardised 88/66-item observational instrument developed to measure changes in gross motor function over time.
AIM of THE STUDY
The Active Induced Hydrostimulating Multisensorial method
The GMFCS classifies the motor skill level following the age band. The GMFM tool has been used to investigate changes in gross motor function after a new aquatic protocol in children with cerebral palsy,
In this way iit is possible (matching the GMFM final results with GMFCS age-band) to evaluate the importance of early rehabilitation for children with severe neuro-motor disabilities.
Therapy consist in a first phase of about 15 min with set stretching exercises, using water resistance and specific operations performed by the therapist, 30 min of active exercise or active induced exercises (in patients with poor ability to understand instructions) and 10 min of playSpecific active and induced-active exercises and stimulating activities (as touch, hearing, contact with operator) are developed in the method.
GRAPH 1
Properties of aquatic rehab
CONCLUSIONS
Water rehabilitation
Respiratory function
Gross Motor Function
Multi-sensorial experience
Joint flexibility improvement
Social integration
The present study found significant effects following a 6-months aquatic intervention on the gross
motor function of children with CP
Moreover we registered that the multi-sensorial approach not only seems to have a therapeutic effect on children with CP (decreasing muscle tonus, increasing motor function, increasing walking efficiency, functional abilities), but also to have a psycho-social effect (increasing quality of life, life habits, socialization) in patients that most of time are isolated with no chance to have any kind of experience.
Improved muscle strength and tone - resistance of the water aids in gentle muscle strengthening.
Increased range of motion and flexibility - the support of the water allows effective stretching.
Increased balance and coordination - balance can be challenged in a safe environment.
Pain modulation - turbulence and the support of the water decrease pain.
Improved posture and trunk stability.
Promotes relaxation.
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