Effect of Arm Cycling Cross Training and Visual Feedback on Modulation of Lower Limb Spasticity in Diaplegic Cerebral Palsy Children

Abstract

Spastic diaplegia is characterized by motor inco-ordination primarily in the lower extremities, that impairs many functional abilities, most notably ambulation. This study was conducted to determine the effect of arm cycling and visual feedback on controlling spasticity of the lower limbs, in spastic diaplegic cerebral palsied children. Thirty spastic diaplegic cerebral palsied children from both sexes, ranging in age from six to eight years represented the sample of the study. All subjects were ambulant with an abnormal gait pattern characterized by hip and knee flexion and ankle planter flexion. The subjects were divided randomly into two groups of equal number (A and B). Group A (control) received a designed physical therapy program in addition to arm pedaling using a reciprocate bicycle with an unloaded cycling for thirty ramps / minute for five minutes, repeated three times with five minutes rest in between. Group B (study) received the same program given to group A with applying the arm pedaling in front of a large mirror to produce visual feedback. Evaluation using 3D Motion Analysis was conducted to determine hip, knee and ankle joints' angles before and after three months of treatment. The results revealed significant improvement in all measuring variables of the two groups, when comparing their pre and post treatment mean values. Highly significant improvement was observed in favor of group B when comparing the post treatment results of the two groups. Improvement observed in the lower limbs joints' angles may be due to enhancement of the effect of cross education training using arm cycling via visual feedback, amelioration of motor learning which led to controlling spasticity of the lower limbs, in the diaplegic cerebral palsied children.

The Effects of Whole-Body Vibration Therapy in Weight-Bearing and Non-Weight-Bearing Positions for Upper and Lower Extremities on Balance and Function in Cerebral Palsy Children: A Randomized Controlled Trial

“…Green and Gabriel (2018) have described the rehabilitative benefits of cross-education, suggesting strength gains and prevention of strength loss through unilateral training, possibly via the cross-activation or bilateral access theories [ 28 ]. Kassem (2020) and El-Hadidy (2004) further supported cross-education's potential in improving functional recovery and upper extremity rehabilitation in CP patients [ 29 , 30 ].…”