Whole-body Vibration in Spastic Hemiplegic Cerebral Palsy
Whole-body Vibration in Spastic Hemiplegic Cerebral Palsy
To target spasticity, balance and mobility whole body vibration exercises along with selected
 physical therapy is given to experimental group. Control group will receive only selected
 physical therapy that includes sstretching exercises, gait training, ffacilitation of
 postural reactions, ffacilitation of standing and weight shift and facilitation of standing
 balance by using a balance board.
Cerebral palsy is the most common childhood disabilities affecting individual's posture and
 movement. Cerebral palsy is a disorder that causes activity limitations attributed to
 non-progressive disturbances of the foetal or infant brain that may also affect sensation,
 perception, cognition, communication, and behavior. Cerebral palsy (CP) results from damage
 to the developing central nervous system while in utero, during delivery, or during the first
 two years of life.

 The most common movement disorder in Cerebral palsy is a spastic paresis, defined as a
 posture and movement-dependent tone regulation disorder.The most common signs of the disorder
 are spasticity, rigidity, muscle weakness, ataxia, balance and movement disorders. Compared
 to the typically developed children, these children have impaired sensation and increased
 muscle tone therefore they have trouble voluntarily controlling their muscles. Cerebral Palsy
 can be grouped based on the motor effects it has on the individual, these can include spastic
 Cerebral palsy or non-spastic Cerebral palsy. Spastic Cerebral Palsy is the most common type
 and is associated with tight or contracted muscles.

 Cerebral Palsy is more prevalent in more deprived socio-economic populations. Cerebral palsy
 is a disease that globally has a prevalence of 2 to 3 cases per 1,000 live born neonates. An
 increase in the prevalence of CP was also seen in low birth weight survivors from the Mersey
 region of the United Kingdom for the same period. Pilot studies of severe mental retardation
 conducted in selected populations in Pakistan and India have reported extraordinarily high
 prevalence estimates in the range of 12-24 /1,000 Spasticity may be defined as a motor
 disorder characterised by a velocity-dependent exaggeration of stretch reflexes resulting
 from abnormal intraspinal processing of primary afferent input. The impaired sensation and
 increase in tone leads to wide range in movement dysfunction. About seventy to eighty percent
 of children with Cerebral Palsy demonstrate spastic clinical features. Many children with
 cerebral palsy (CP) have poor walking abilities and manipulation skills. One contributing
 factor to their problems with gait and reaching movement is poor balance control. Balance
 control is important as it helps a child to recover from unexpected balance
 disturbances.Currently, there are many options for the management of spasticity, balance
 disturbances and risk of fall that includes physical modalities, oral pharmacologic agents,
 peripheral injectables, intrathecal agents, and surgical interventions, however mostly
 physical therapy is commonly preferable treatment that includes stretching, NDT,
 Proprioceptive neuromuscular facilitations,strength training and gait training.

 Dynamic mechanical loading of the skeleton is an arduous task and troublesome to induce in
 children who suffer from severe cerebral palsy. The lack of dynamic weight bearing in this
 population predisposes them to reduced bone mineral density (BMD) and pre-mature
 osteoporosis. These children are also more prone to muscle weakness, which contributes to
 pain, deformity and functional loss. Whole-body vibration training was proposed as a new
 therapeutic modality for the treatment of the gross motor function, balance and functional
 performance Whole body vibration (WBV), for which the participant stands on a vibrating
 platform, delivers low-frequency, low-amplitude mechanical stimuli that enter the human body
 via the feet. The vibrations stimulate the muscle spindles and alpha motor neuron sending
 nerve impulses to initiate muscle contractions according to the tonic vibration reflex.
 Compared to the repetitive passive movement, this WBV protocol adds a muscle strengthening
 component to the anti-spastic effects. Activity restrictions in spastic cerebral palsy are
 mainly due to poor postural control. Many interventions like resisting exercises, therapeutic
 horseback riding, electrical stimulations leads to short term posture and balance
 improvement. Training using vibration platforms adjunct to exercise has shown to be effective
 in increasing strength resulting in improved balance and coordination. Whole body vibration
 has shown to be effective in reducing lower limb spasticity after first application of WBV
 with a vibration frequency of 12 Hz to 18 Hz ( 2-3 m of amplitude ) for 9 minutes and a
 significant decrease in tone is observed and even the functional mobility and balance is
 improved.. During all of the vibration-training sessions, the children will wear the
 gymnastic shoes to standardize the damping of the vibration due to footwear.

 There is paucity in the literature regarding evidence for the safe and effective use of
 vibration intervention in children with or without pathology and has great effects in
 spasticity, mobility and improving balance.Chia-Ling Chen concluded that the WBV is an
 effective intervention for controlling spasticity and improving ambulation. Villarreal et
 al.showed that 20-week WBV therapy had positive effects on the balance of DS adolescents,
 although only under specific conditions, with vision and somatosensory input altered.

 In previous studies high dosage of whole body vibration has both positive and negative
 effects. Because this type of treatment seems to improve bone health, The purpose of this
 intervention is to ensure functional independence in cerebral palsy patients. Whole Body
 Vibration Therapy has proven to be effective in improving balance by reducing spasticity and
 improving muscle strength. It is essential to explore new interventions for patients
 specially for cerebral palsy in whom functional independence is impaired thus their mobility
 is restricted leading to secondary complications. In my study my goal is to use combination
 of conventional physical therapy with whole body vibration which can control spasticity and
 enhance ambulatory performance.
Inclusion Criteria:

 -  Ashworth scale score +1-3

 -  age between 6 and 13 years,

 -  able to accept and follow verbal instructions,

 -  Gross Motor Function Classification System [GMFCS] levels I-III),

 Exclusion Criteria:

 -  unstable seizures, any treatment for spasticity or surgical procedures from 3 months
 (for botulinum toxin type A injections)

 -  Suffering from any other condition that interfered with physical activity.