IJPR.2016.206

Type of Article:  Original Research

Volume 5; Issue 1 (February 2017)

Page No.: 1852-1862

DOI: https://dx.doi.org/10.16965/ijpr.2016.206

EFFICACY OF CONCURRENT COGNITIVE-MOTOR TRAINING ON GAIT IN HEMIPARETIC CEREBRAL PALSY: A RANDOMIZED CONTROLLED TRIAL

Nevein Mohammed Gharib *1, Gehan Mosaad Abd-El Maksoud 2, Salah Eldin Bassit Elsayed 3.

*1 Assistant Professor, Physical Therapy Department for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt.

2 Assistant Professor, Physical Therapy Department for Growth and Development Disorders for Children and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt.

3 Lecturer, Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Egypt.

Address for Correspondence:  Dr. Nevein Mohammed Gharib, PhD., Assistant Professor, Physical Therapy Department for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt

E-Mail: neveinmohammed@yahoo.com

ABSTRACT:

Background: Interference between cognitive tasks and motor control activities such as walking is crucial for functional enhancement in patients with neurological disorders. Therefore, both cognitive and motor training should be addressed in planning physical therapy programs.

Objective: To assess the efficacy of concurrent cognitive-motor training on gait in children with hemiparetic cerebral palsy.

Materials and Methods: Thirty children with hemiparetic cerebral palsy of both sexes (10–14  years) shared in this study. They were randomly assigned into two equal groups; experimental and control groups. Children in the experimental group received a traditional physical therapy exercise program in addition to a gait training program given concurrently with cognitive tasks. Those in the control group received the same traditional physical therapy and gait training programs without any concurrent cognitive tasks. Treatment was provided three times per week for three successive months. The participants received baseline and post-treatment assessments for dimension E of Gross Motor Function Measure (GMFM) and some gait parameters including: step length, walking speed, ambulation index and time of support on the affected side (% of gait cycle).

Results: Children in both groups showed significant improvement post treatment in GMFM scores and all measured gait parameters (p<0.05) with a higher improvement in the experimental group. After the intervention, between-group comparison revealed significant differences for ambulation index (t=3.16, p=0.004) and time of support on the affected side (t=3.61, p=0.001) in favour of the experimental group.  No significant between-group differences were found in GMFS scores, step length and walking speed (p˃0.05).

Conclusion: Concurrent cognitive-motor training increased the chance of improving walking ability in children with hemiparetic cerebral palsy as compared to the motor training alone.

Key words: Cognitive-Motor Intervention, Cerebral Palsy, Hemiparesis, Gait, Concurrent Tasks.

REFERENCES:

  1. Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil 2006;28(4):183-191.
  2. Tosun A, Gökben S, Serdaroğlu G, Polat M, Tekgül H. Changing views of cerebral palsy over 35 years: the experience of a center. Turkish J Pediatr 2013; 55:8-15.
  3. Wiklund LM, Uvebrant P: Hemiplegic cerebral palsy. Correlation between CT morphology and clinical findings. Dev Med Child Neurol 1991; 33(6): 512-523.
  4. Wang X, Wang Y. Gait analysis of children with spastic hemiplegic cerebral palsy. Neural Regen Res 2012;15(7):1578-1584.
  5. Katz-Leurer M, Rotem H, Meyer S. Effect of concurrent cognitive tasks on temporo-spatial parameters of gait among children with cerebral palsy and typically developed controls. Dev Neurorehabil 2014;17(6):363-367.
  6. Beurskens R, Bock O. The role of executive functions and memory in dual-task walking: a review. Neural Plasticity 2012;2012:1-9.
  7. Mulder T, Pauwels J, Nienhuis B. Motor recovery following stroke: towards a disability-orientated assessment of motor dysfunctions. In: Harrison M, ed. Physiotherapy in Stroke Management. Edinburgh: Churchill Livingstone; 1995:275-282.
  8. Schaefer S, Lövden M, Wieckhorst B, Lindenberger U. Cognitive performance is improved while walking: Differences in cognitive–sensorimotor couplings between children and young adults. Eur J Dev Psychol 2010;7(3):371-389.
  9. Woollacott M, Shumway-Cook A: Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture 2002;16:1–14.
  10. Bottcher L, Flachs EM, Uldall P. Attentional and executive impairments in children with spastic cerebral palsy. Dev Med Child Neurol 2010;52:e42–e47.
  11. Christ SE, White DA, Brunstrom JE, Abrams RA. Inhibitory control following perinatal brain injury. Neuropsychology 2003;77(1):171-178.
  12. Reilly DS, Woollacott MH, van Donkelaar P, Saavedra S. The interaction between executive attention and postural control in dual-task conditions: children with cerebral palsy. Arch Phys Med Rehabil 2008;89(5):834-842.
  13. Huang HJ, Mercer VS. Dual-task methodology: application in studies of cognitive and motor performance in adults and children. Pediatr Phys Ther 2001;13(3):133-140.
  14. Haggard P, Cockburn J, Cock J, Fordham C, Wade D. Interference between gait and cognitive tasks in a rehabilitating neurological population. J Neurol Neurosurg Psychiatry 2000;69:479-486.
  15. Silsupadol P, Siu KC, Shumway-Cook A, Woollacott MH. Training of balance under single- and dual-task conditions in older adults with balance impairment. Phys Ther 2006;86:269-281.
  16. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67(2):206-207.
  17. Palisano R, Cameron D, Rosenbaum P, Walter SD, Russel D. Stability of the Gross Motor Function Classification System. Dev Med Child Neurol 2006;48:424–28.
  18. Hagmann-von Arx P, Manicolo O, Perkinson-Gloor N, Weber P, Grob A, Lemola S. Gait in Very Preterm School-Aged Children in Dual-Task Paradigms. PLOS One 2015;10 (12): e0144363.
  19. Russell DJ, Rosenbaum PL, Avery LM, Lane M. Gross Motor Function Measure (GMFM-66 and GMFM-88) User’s Manual. London, United Kingdom: Mac Keith Press; 2002.
  20. Bjornson KF, Graubert CS, Buford VL, McLaughlin J. Validity of the gross motor function measure. Pediatr Phys Ther 1998;10:43-47.
  21. Brunton LK, Bartlett DJ. Validity and Reliability of Two Abbreviated Versions of the Gross Motor Function Measure. Phys Ther 2011;91(4):577-588.
  22. Russell DJ, Rosenbaum PL, Gowland C, Hardy S, Lane M, Plews N, et al. Gross Motor Function Measure manual, second edition. Hamilton, ON, Canada, McMaster University: Can Child Centre for Childhood Disability Research; 1993.
  23. Robinson BS, Cook JL, Richburg CM and Price SE. Use of an electrotactile vestibular substitution system to facilitate balance and gait of an individual with gentamicin-induced bilateral vestibular hypofunction and bilateral transtibial amputation. J Neurol Phys Ther 2009;33:150-159.
  24. Kisner C, Colby LA. Therapeutic exercise: Foundation and techniques, sixth edition. Philadelphia: F.A. Davis Company; 2012.
  25. Bloem BR, Valkenburg VV, Slabbekoorn M, van Dijk JG. The multiple tasks test. Strategies in Parkinson’s disease. Exp Brain Res 2001;137:478-486.
  26. Erikson C, Allert C, Carlberg EB, Katz-Salomon M. Stability of longitudinal motor development in very low birthweight infants from 5 months to 5.5 years. Acta Paediatr 2003;92:197-203.
  27. Dubost V, Kressig RW, Gonthier R, Herrmann FR, Aminian K, Najafi B, Beauchet O. Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults. Hum Mov Sci 2006;25:372-382.
  28. Leitner Y, Barak R, Giladi N, Peretz C, Eshel R, Gruendlinger L, Hausdorff JM. Gait in attention deficit hyperactivity disorder: effects of methylphenidate and dual tasking. J Neurol 2007;254:1330-1138.
  29. Yang YR, Chen YC, Lee CS, Cheng SJ, Wang RY. Dual-task-related gait changes in individuals with stroke. Gait Posture 2007;25:185-190.
  30. Cherng RJ, Liang LY, Chen YJ, Chen YJ. The effects of a motor and a cognitive concurrent task on walking in children with developmental coordination disorder. Gait Posture 2009;29:204-207.
  31. Muhaidat J, Kerr A, Evans JJ, Skelton DA. Exploring gait-related dual-task tests in community-dwelling fallers and non-faller: a pilot study. Physiother Theory Pract 2013;29:351-370.
  32. Friedman A, Diamond M, Johnston MV, Daffner C. Effects of botulinum toxin A on upper limb spasticity in children with cerebral palsy. Am J Phys Med Rehabil 2000;79(1):53-59.
  33. Cage JR, Novacheck TF. An update on the treatment of gait problems in cerebral palsy. J Pediatr Orthop Part B 2001;10:265-274.
  34. Pichierri G, Wolf P, Murer K, de Bruin ED: Cognitive and cognitive-motor interventions affecting physical functioning: a systematic review. BMC Geriatr 2011;11:29-48.
  35. Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff JM: The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Rev Neurother 2011;11(7):1057-1075.
  36. Adams MA, Chandler LS and Schuhmann K. Gait changes in children with cerebral palsy following a neurodevelopmental treatment course. Pediatr Phys Ther 2000;12:114-120.
  37. Dodd K, Taylor N and Graham H. A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Child Neurol 2003;45:652-657.
  38. Kamm K, Thelen E, Jensen J. A dynamical system approach to motor development. Phys Ther 2005;70(12):17-29.
  39. Seo TH, Lee BH, Baek JY: The effect of dual task training on the balance and gait of stroke patients. J Coaching Dev 2010;12:139-49.
  40. Kim GY, Han MR, Lee HG. Effect of dual-task rehabilitative training on cognitive and motor function of stroke patients. J Phys Ther Sci 2014;26(1):1-6.
  41. Plummer P, Villalobos RM, Vayda MS, Moser M, Johnson E. Feasibility of dual-task gait training for community-dwelling adults after stroke: a case series. Stroke Res Treat 2014;2014:1-12.
  42. Fitts PM, Posner MI. Human performance, 1st ed. Belmont: Brooks/Cole; 1967.
  43. Cockburn J, Haggard P, Cock J, Fordham C. Changing patterns of cognitive-motor interference (CMI) over time during recovery from stroke. Clinic Rehab 2003;17:167-173.
  44. Wulf G, Landers M, Lewthwaite R, Töllner T. External focus instructions reduce postural instability in individuals with Parkinson disease. Phys Ther 2009;89(2):162-168.
  45. Lewis MM, Slagle CG, Smith AB, Truong Y,Bai P, McKeown MJ, et al. Task specific influences of Parkinson’s disease on the striato-thalamo-cortical and cerebello-thalamo-cortical motor circuitries. Neuroscience 2007; 147 (1): 224-235.
  46. Holschneider DP, Yang J, Guo Y, Maarek JM. Reorganization of functional brain maps after exercise training: importance of cerebellar-thalamic-cortical pathway. Brain Res 2007;1184:96-107.
  47. Wright DL, Shea CH. Cognition and motor skill acqusition: Contextual dependencies. In Cognitive assessment: a multidisciplinary perspective. Edited by Reynolds CR. New York: Plenum; 1994:89-106.
  48. Anderson JR. Acqusition of cognitive skill. Psychol Review 1982;89(4):369-406.
  49. Wickens CD, Hollands JG, Banbury S, Parasuraman R. Engineering Psychology and Human Performance, 4th ed. New York: Pearson;
  50. Reason J, Mycielska K. Absent minded?: Psychology of mental lapses and everyday errors. Engle Wood Cliffs NJ: Prentice-Hall; 1982.
  51. Silsupadol P, Shumway-Cook A, Lugade V, van Donkelaar P, Chou LS, Mayr U, Woollacott MH. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Phys Med Rehabil 2009;90:381-87.

Cite this article: Nevein Mohammed Gharib, Gehan Mosaad Abd-El Maksoud, Salah Eldin Bassit Elsayed. EFFICACY OF CONCURRENT COGNITIVE-MOTOR TRAINING ON GAIT IN HEMIPARETIC CEREBRAL PALSY: A RANDOMIZED CONTROLLED TRIAL. Int J Physiother Res 2017;5(1):1852-1862. DOI: 10.16965/ijpr.2016.206