Effects of Cuevas Medek Exercises on Postural Control and Balance in Children With Spastic Cerebral Palsy
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-Summary
This study aims to evaluate the effects of Cuevas Medek Exercises on postural control and balance in children with spastic cerebral palsy. Children meeting the eligibility criteria will be randomly allocated into two groups receiving Cuevas Medek Exercises or conventional therapy. The outcomes will be assessed before and after the intervention period to determine the effectiveness of the intervention.
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+Detailed description
Spastic cerebral palsy is a common condition characterized by impaired postural control, poor balance, and limitations in functional movement, which affect a child's ability to maintain stability during daily activities. Conventional physiotherapy is commonly used to address these impairments through strengthening, stretching, and task-based exercises, with variable functional outcomes.
Cuevas Medek Exercises is a dynamic therapeutic approach that focuses on activating automatic postural responses and balance reactions through progressively challenging activities with minimal external support. While this approach has shown potential benefits in improving motor control and postural responses, evidence comparing its effects on postural control and balance with conventional therapy in children with spastic cerebral palsy remains limited.
Therefore, a randomized controlled trial is needed to compare the effects of Cuevas Medek Exercises and conventional therapy on postural control and balance in children with spastic cerebral palsy, with the aim of providing evidence to support clinical decision-making in pediatric physiotherapy
+Arms and interventions
| Arm | Type | Interventions | Description |
|---|
| cuevas medek exercise | Experimental | Other: Cuevas medek exercises | Children in this group will receive Cuevas Medek Exercises focusing on activation of postural responses and balance control through progressively challenging activities during the intervention period |
| Conventional therapy | Active comparator | Other: Conventional Therapy | Children in this group will receive conventional physiotherapy including stretching, strengthening, and task-oriented activities aimed at improving postural control and balance |
- Cuevas medek exercises (Other), also known as CME: Children will receive Cuevas Medek Exercises 3 sessions per week, at an appropriate effort level guided by the therapist, each session lasting 30 minutes, focusing on dynamic postural activation, balance reactions, and functional movement tasks
- Conventional Therapy (Other): Children will receive conventional physiotherapy 3 sessions per week, at moderate effort suitable for age and condition, each session 30 minutes long, including stretching, strengthening, and task-oriented activities to improve postural control and balance
+Outcome measures
Primary outcomes
- Postural Control [At the end of 4 weeks of intervention]: Changes from baseline in postural control will be assessed using the Posture and Postural Ability Scale (PPAS). The scale evaluates the child's ability to maintain posture during functional tasks and measures automatic postural responses. The PPAS consists of several domains including trunk control, limb alignment, and dynamic balance. The scoring ranges from 0 to 30, where 0 indicates no disability and 30 indicates maximum postural impairment.
Secondary outcomes
- Balance [At the end of 4 weeks of intervention]: Changes from baseline in balance will be assessed using the Pediatric Balance Scale (PBS). The PBS evaluates balance in sitting, standing, and during functional tasks such as reaching and turning. The scale consists of 14 items, each scored from 0 to 4, giving a total score ranging from 0 (poor balance) to 56 (excellent balance).
+Eligibility
Sex: All, ages: 2 Years to 6 Years
Inclusion Criteria:
* Diagnosed with spastic diplegic cerebral palsy
* GMFCS Level III to V
* Modified Ashworth Scale ≤ 2
* Able to follow simple commands
Exclusion Criteria:
* Severe cognitive impairment
* Uncontrolled epilepsy or frequent seizures
* Visual or hearing impairment limiting treatment
* History of recent orthopedic or neurosurgical procedures
* Other neurological disorders (genetic syndromes, traumatic brain injury)
* Participation in other experimental therapies during the study period
+Locations (1)
| Facility | City | Country | Status |
|---|
| Tehsil Headquarter Bhalwal | Bhalwal, Punjab Province | Pakistan | |
+Publications
- Ferreira AD, Gerzson LR, de Almeida CS, Lopes GB. Cuevas Medek exercises a neurological rehabilitation for children, the effect in developmental hip dysplasia in a patient with cerebral palsy: case study. Arquivos de Neuro-Psiquiatria. 2023;81(S 01):A056.
- Mitroi S. Stimulation of triple extension tone and orthostatic balance in the child with cerebral palsy through exercises specific to Medek method. Physical Education, Sport and Kinesiology Journal. 2016;1(43):48-51
- Milne N, Neustaeter A, Thomas H, Ritter M, Macdonald K. Review Protocol: EXPLORING THE EFFECTIVENESS OF CUEVAS MEDEK EXERCISES (CME) IN PAEDIATRIC POPULATIONS: A SYSTEMATIC SCOPING REVIEW. 2023
- Yun G, Huang M, Cao J, Hu X. Selective motor control correlates with gross motor ability, functional balance and gait performance in ambulant children with bilateral spastic cerebral palsy. Gait Posture. 2023 Jan;99:9-13. doi: 10.1016/j.gaitpost.2022.10.009. Epub 2022 Oct 19. PMID 36283302
- Adiguzel H, Elbasan B. Effects of modified pilates on trunk, postural control, gait and balance in children with cerebral palsy: a single-blinded randomized controlled study. Acta Neurol Belg. 2022 Aug;122(4):903-914. doi: 10.1007/s13760-021-01845-5. Epub 2022 Jan 18. PMID 35040072
- Elnaggar RK, Ramirez-Campillo R, Azab AR, Alrawaili SM, Alghadier M, Alotaibi MA, Alhowimel AS, Abdrabo MS, Elbanna MF, Aboeleneen AM, Morsy WE. Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics. Children (Basel). 2024 Feb 15;11(2):243. doi: 10.3390/children11020243. PMID 38397355
- Crenshaw JR, Petersen DA, Conner BC, Tracy JB, Pigman J, Wright HG, Miller F, Johnson CL, Modlesky CM. Anteroposterior balance reactions in children with spastic cerebral palsy. Dev Med Child Neurol. 2020 Jun;62(6):700-708. doi: 10.1111/dmcn.14500. Epub 2020 Mar 2. PMID 32124436
- Bickley C, Linton J, Sullivan E, Mitchell K, Slota G, Barnes D. Comparison of simultaneous static standing balance data on a pressure mat and force plate in typical children and in children with cerebral palsy. Gait Posture. 2019 Jan;67:91-98. doi: 10.1016/j.gaitpost.2018.08.012. Epub 2018 Aug 16. PMID 30308334
- Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast. 2005;12(2-3):211-9; discussion 263-72. doi: 10.1155/NP.2005.211. PMID 16097489
- Paul S, Nahar A, Bhagawati M, Kunwar AJ. A Review on Recent Advances of Cerebral Palsy. Oxid Med Cell Longev. 2022 Jul 30;2022:2622310. doi: 10.1155/2022/2622310. eCollection 2022. PMID 35941906
- Gulati S, Sondhi V. Cerebral Palsy: An Overview. Indian J Pediatr. 2018 Nov;85(11):1006-1016. doi: 10.1007/s12098-017-2475-1. Epub 2017 Nov 20. PMID 29152685
- Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013 Oct;55(10):885-910. doi: 10.1111/dmcn.12246. Epub 2013 Aug 21. PMID 23962350
+Investigators