Gross Motor Abnormalities in Relation to Balance and Weight Indicators in Diplegia

Spastic diplegia is the most common type of CP that results in problems with posture, balance, as well as gait control. For children suffering from spastic diplegic CP, balance problems provide a significant difficulty since they make it difficult for them to achieve and maintain balance . Additionally, they commonly demonstrate delayed development of gross motor function that has been connected to functional outcomes, such as daily living tasks . The prevalence of obesity in the CP population has risen over the last decade from 7.7 to 16.5 %. . Obesity is associated with health risks and difficulties in balance and walking. this cross-sectional-correlation study was conducted at the Outpatient Clinic at the Faculty of Physical Therapy, Cairo University. The study included 104 diplegic children aged from 5-10 years, 53 in normal weight group and 51 in overweight group. Dynamic balance was evaluated by overall stability index (OSI) in biodex balance system and gross motor capacities (GMC) were evaluated by standing \&walking dimensions in GMFM

Primary outcomes

• BMI [9 months]: Standardized height-weight measuring scale for measurement of weight and height, to be able to calculate BMI Growth charts were used to plot BMI and age separately for girls and boys. Then, each subject was given a percentile and put into one of two categories: normal (5th to 85th percentile) and overweight, obese (85th and above percentile).
• balance assessment [9 months]: Biodex balance system SD with movable platform was used .The overall stability index (OSI) will be measured as indicator of dynamic balance. The higher the OSI values, the lower the dynamic balance stability. Bilateral stance (standing on both legs), eyes open, stability level 5 (12 is the most stable level), and three repeated trials (for more accuracy) for 20 seconds (test time for each trial) were the test conditions

Secondary outcomes

• gross motor capacities [9 months]: GMC assessed by using dimensions D and E of the Gross Motor Function Measure (GMFM-88) which measures respectively activities in standing, and walking, running, and jumping. . A 4-point scale was used and scores were expressed as percentages

Sex: All, ages: 5 Years to 10 Years

Inclusion Criteria:

Children selected according to the following criteria:

* Diagnosed with diplegic CP
* Their ages will range between 5 and 10 years
* Subjects will participate according to BMI classification ; normal weight in the first group and (obese , overweight) in the second group .
* They must be able to stand independently.
* Have minimum height of 100 cm.
* Have a developmental level of grade I or II according to gross motor function classification system GMFM.
* Able to understand and follow instructions.

Exclusion Criteria:

* Auditory defects.
* Visual defects.
* Cognitive or vestibular defects.
* Use of an assistive device.
* Fixed deformity, bony or joint limitation.
* Surgery (tendon lengthening).

• khaled A Mamdouh, Principal investigator, Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University
• Hoda A Eltalawy, Study director, Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University
• Radwa s Abdulrahman, Study director, Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University