Effects of Motor Imagery Training After Muscle Lengthening Surgery in Children With Cerebral Palsy

Summary

In children with cerebral palsy (CP), spasticity occurs in the muscles due to upper motor neuron lesions. The muscle groups that are mostly spastic in the lower extremity are; the hip adductor and flexors, hamstrings, and ankle plantar flexors. Spasticity in the ankle plantar flexor muscles of these muscle groups causes contracture over time and restricts ankle dorsiflexion. Limitations in ankle dorsiflexion present as toe walking problems, balance loss, and various functional difficulties in children. Children with spasticity of the ankle plantar flexor muscles gastrocnemius and soleus are initially treated conservatively with exercise and positioning. However, after contracture occurs, treatment is performed using surgical methods. Surgical release of plantar flexor muscles is a method that has been proven to be effective and is frequently applied in the clinic. This surgery aims to remove the ankle dorsiflexion joint range of motion restriction, prevent toe walking, and improve the functional status of the child. However, since the plantar flexor muscles are in the antigravity muscle group, excessive release of these muscles can cause loss of balance and crouch gait. Therefore, it is important for this surgery to be performed by an experienced surgical team at the right time and to provide an exercise protocol aimed at stabilization by working both muscle groups in the postoperative period. In addition, after these surgeries, the patient is immobilized with a cast and orthosis for a while and the patient's active and passive movements are restricted with these devices. Motor Imagery; It is the process of learning a new movement or improving the quality of a known movement by visualizing it in a planned and intensive way in the mind of the person without performing any motor activity. This study hypothesized that the motor imagery training in the early rehabilitation process with movement restrictions after plantar flexor muscle relaxation operations will be effective on the patient's balance, walking, and quality of life.

Conditions

• Rehabilitation
• Cerebral Palsy (CP)
• Exercise
• Tenotomy
• Motor Imagery Training
• Orthopedic Surgery

Interventions

PROCEDURE

Motor Imagery Training

The study group will receive motor imagery training in addition to control group's exercise program. This process will proceed as follows; In motor imagery training videos taken with a 9-year-old healthy child will be watched.• The content of the videos will include exercises such as ankle dorsiflexion, heel tapping while walking, climbing and descending stairs, walking on a ramp, standing on a ramp, walking on soft ground, and walking on a treadmill.• The patients will watch these videos and then the relaxation, imagination and return to environment phases of motor imagery will be applied respectively.

PROCEDURE

Conventional Post-operative Exercises

This group will receive conventional exercises in the post-op process. The exercises included in the conventional exercise program are; * Balance board exercises * Balance disc exercises * Bosu exercises * Balance pad exercises * Wobble board exercises * Walking on soft ground * Balance exercises on soft ground * Apraximations and tractions * Target angle exercise for ankle * General standing balance exercises (Eyes open and closed - single foot, double foot) * Ankle bidirectional ROM * Ankle bidirectional strengthening * Exercises to increase foot intrinsic muscle strength and balance * Functional exercises

Sponsors & Collaborators

• Saglik Bilimleri Universitesi

  lead OTHER

Principal Investigators

• Zuhal Didem Takinacı, PhD · Saglik Bilimleri Universitesi

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

7 Years

Max Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-03-01

Primary Completion

2024-05-05

Completion

2025-03-15

Countries

• Turkey (Türkiye)

Study Locations