Tasnim Hassan Albarakati |439002583

CP Spastic Diplegia
Cerebral palsy defined as :grope of permanent disorders in posture and movement attributed to non-
progressive brain damage children with CP experience altered muscle function cause balance and walking
leading also to developmental delay and joints contractor ,impaired coordination, decrease proprioception
and epilepsy also by secondary musculoskeletal problems .
Spastic Diplegia most common type of CP this type affects both body sides but lower limbs affected more .

The selected problem: child’s suffering from difficulties in maintaining his

balance &posture during activities .
It can be said that balance is one of the main components of movement and increase functional skills ,
balance deficits lead to difficulties in functional activities because balance skills an integral part of gross
motor any deficit in balance leading to reduced quality of life.
If the trunk muscles has low tone it cause balance and mobility problems .
If there is spasticity in the legs it will affect mobility of lower body and inhibit motor development to stand
and walking independently .
Impaired postural control in CP children due to : musculoskeletal problems like , contracture , limited range
of motion and shifts in alignment . Motor components of CP
disturbance of spatial aspect and temporal of postural muscle
response.

Assessment :
- segmental assessments of trunk control (SATCO):
It’s provides detailed assessment of trunk in-depth segments by
figure 1
segment assessment so it’s different from other assessment tools
because it doesn’t treat the trunk as one unit allowing therapist a greater specificity in assessing trunk
control and providing therapist with valuable information to creat an effective rehabilitation program.
It assesses all three aspects of trunk control :
- Static .
- Active control.
- Reactive control .
To perform this test 2 testers will be needed to support the trunk and
other to monitor the child’s posture when he seated ,therapist should
encircle the trunk by his hands horizontally directly under the
segment wants to be test fig1-DON’T MOVE WITH CHILD YOU
HAVE TO HOLD THE SEGMENT STEADY -.
- Materials needed :
- Test form table 1.
- Bench with Y-strap . figure 2
- Toy or any object that will get child’s attention .
 - Instructions
- Child’s Hands /arm: for test head control the child arms should be supported at shoulder level
manually or on a table , to test other segments the arm should be free not contacting the bench or
any part of the body .
- fig 2 manual support placement and segment , there is 7 support level : shoulder girdle,
Axilla ,inferior scapula, over lower ribs , pelvis and no support (even the Y-strap) , the therapist
applies manually support horizontal sufficient to ensure trunk is in natural vertical posture
- When you start test starting from the shoulder(highest support level) and the go down .
- Scoring:
- Static here therapists will encourages child to sit up and lift his arms maintenance a
natural vertical trunk posture for 5 seconds if there is head turn but vertical position
maintained , still scored as presence of control .
- Active by turning the head slowly to each side using toys to get child’s attention there
may be slight displacement but immediately realigns
- Reactive Remaining stable during brisk from front ,behind and each side by using
fingertip trying to disturb balance child will move away but get back in natural vertical
position quickly.
- Tasks :
- sitting without arm support.
- sitting while moving the head.
- sitting with perturbations.

- Pediatric Balance Scale PBS: modification of Berg Balance Scale . It contains 14 different activities
(table2) to test balance e.g.sitting to standing , getting more complex like retrieving object frame floor .
- Tasks:table 2.
Deferential analysis of equilibrium in all planes should be done before planning for any modality
of treatment that helping therapists to design effective treatment program .

Table 2 : Items from the Brazilian version of the Pediatric Balance Scale adapted
from Ries (2012).
 Treatment :
To get the most from any exercises use it in sequence to help child progress in
coordination and balance .
From sitting independently to kneeling to standing supported and unsupported to taking
step finally .
Think about toy child can use during session
Prepare child .if their any legs tightness stretch the muscles before to insure the most
effective movement.squeeze their legs to wake up their muscles or brushing along their
skin to give them lots of stimulation. These can help child to be aware of their legs .
Be sure that child is successful in activity before moving on to another activity that’s may
dishearten them and get upset .

- Games and virtual reality : recent studies shows that VRG therapy can improve the balance ,strength
and coordination . By using PlayStation with subjects maintained a standing during the training session.

- Swiss ball training : let the child set on the ball don’t let him touch the ground . Hold child hip and slightly
give him side to side movements then away and towards you gradually if he able to hold his balance ,leave his
hip and hold his thighs makes it more challenging:
- let the child sit on the ball and roll the ball side to side that will help in developing the postural control
in child
- Giving extension and flexion rotation to child by this you will facilitate trunk rotation
- Peanut ball chops :let the child sit on the peanut ball in stride sitting position give him toys or another
small ball in his hand instruct him to touch the ground on sides carrying ball overhead in between.
- Rotation on the ball : stride sitting ,therapist or one of the parents sit behind the child ,child pass the
ball to the parent by rotating the trunk and receive ball by same way.

- Whole-body vibration combined with physical therapy:WBV improve postural control and muscle
strength , child need to stand on oscillating platform which generates mechanical vibrations that also
constitute sensory stimulation and induced reflex muscles activation , further affects of WBV
modification of tracking movements,increase postural sway and gait modification . Combination of
exercises and WBV shows increase of voluntary control of lower limbs and trunk affected muscles ,
decrease unnecessary muscles activity and improve balance.

- Kinesio Taping : is a new technique, stimulates peripheral sensory system of the skin . Applied taping
on ankles and tibialis muscles that will improve dorsi flexion , to improve knee extension but it on recuts
femoris and , on hamstrings will inhibit flexion of knee kinesio taping a applies a tension on knees and
ankles to improve walking position and contact the feet with ground that’s leading to improved balance
also it induced central nervous sensory system which leads to decreased postural fluctuation and
improved balance .
 Static Active Reactive
Functional
Level of manual Maintain vertical neutral position of head and trunk
Client Name: Level
support above manual support level
Ref #: Arms and
Pelvic / thigh Comments
Tester Name: hands in air while
strap used except Maintain / quickly
Date: except as minimum of 5 turning
as indicated regain following
indicated seconds head with
brisk nudge
arms lifted

Shoulder girdle Head control

Testers hand Arms may be NOT Tested for
position may vary supported Head Control
from horizontal throughout

Upper
Axillae Thoracic
Control

Mid Thoracic
Inferior scapula
Control

Lower
Over lower ribs thoracic
Control

Upper lumbar
Below ribs
Control

Lower lumbar
Pelvis
Control

No support given
Full trunk
and pelvic/thigh
control
straps removed

Fixed spinal deformity? Yes_____No_____Comments__________

Limitation of Cervical Rotation __Left__Right Comments__________

Table 1 : SATCo form , from Refinement, Reliability and Validity of the Segmental Assessment of Trunk Control (SATCo).
 Reference
- Rathi, N., Multani, P., & Armarkar, A. V. (2022). Physical Rehabilitation of a Spastic Diplegic Cerebral
Palsy Patient - A Case Study. International Journal of Health Sciences and Research, 12(3), 119–122.
https://doi.org/10.52403/ijhsr.20220315
- Allah, N. E. A., Kamal, H. M., & El-Nabie, W. a. E. A. (2023b). Association between pelvic inclination
and balance in children with spastic diplegia. Bulletin of Faculty of Physical Therapy, 28(1). https://
doi.org/10.1186/s43161-022-00115-6
- Rose, J., Wolff, D. R., Jones, V. P., Bloch, D., Oehlert, J., & Gamble, J. G. (2002). Postural balance in
children with cerebral palsy. Developmental Medicine & Child Neurology, 44(01), 58. https://doi.org/
10.1017/s0012162201001669
- Cerebral Palsy General Assessment. (n.d.). Physiopedia. https://www.physio-pedia.com/
Cerebral_Palsy_General_Assessment
- Segmental Assessment of Trunk Control (SATCo). (n.d.). Physiopedia. https://www.physio-pedia.com/
Segmental_Assessment_of_Trunk_Control_%28SATCo%29
- Franjoine, M. R., Gunther, J. S., & Taylor, M. (2003). Pediatric Balance Scale: A Modified Version of
the Berg Balance Scale for the School-Age Child with Mild to Moderate Motor Impairment. Pediatric
Physical Therapy, 15(2), 114–128. https://doi.org/10.1097/01.pep.0000068117.48023.18
- Tabatabaee, M., Shamsoddini, A., & Cheraghifard, M. (2019). Effects of Lower Limbs Kinesio Taping
on Balance Ability in Children With Cerebral Palsy: A Pilot Randomized Clinical Trial. Iranian
Rehabilitation Journal. https://doi.org/10.32598/irj.17.2.157
- Suharto, S., Leksonowati, S. S., Erawan, T., & Arpandjam’an, A. (2022). The Effectiveness Of Pilates
Exercises On Sitting And Standing Balance In Children With Cerebral Palsy. International Journal of
Health and Pharmaceutical, 3(2), 254–258. https://doi.org/10.51601/ijhp.v3i2.158
- Rathi, N., Multani, P., & Armarkar, A. V. (2022b). Physical Rehabilitation of a Spastic Diplegic Cerebral
Palsy Patient - A Case Study. International Journal of Health Sciences and Research, 12(3), 119–122.
https://doi.org/10.52403/ijhsr.20220315
- El-Shamy, S. M. (2014). Effect of Whole-Body Vibration on Muscle Strength and Balance in Diplegic
Cerebral Palsy. American Journal of Physical Medicine & Rehabilitation, 93(2), 114–121. https://
doi.org/10.1097/phm.0b013e3182a541a4
- Hamed, S. (2022). Effect of virtual reality games on motor performance level in children with spastic
cerebral palsy. Termedia.pl. https://doi.org/10.5114/pq.2021.108681
- Butler, P. B., Saavedra, S., Sofranac, M., Jarvis, S., & Woollacott, M. H. (2010). Refinement, Reliability,
and Validity of the Segmental Assessment of Trunk Control. Pediatric Physical Therapy, 22(3), 246–
257. https://doi.org/10.1097/pep.0b013e3181e69490
- Lee, K., Oh, H., & Lee, G. (2022). Fully Immersive Virtual Reality Game-Based Training for an
Adolescent with Spastic Diplegic Cerebral Palsy: A Case Report. 9(10), 1512. https://doi.org/
10.3390/children9101512
- El-Shamy, S. M., & Kafy, E. M. a. E. (2014). Effect of balance training on postural balance control and
risk of fall in children with diplegic cerebral palsy. Disability and Rehabilitation, 36(14), 1176–1183.
https://doi.org/10.3109/09638288.2013.833312