The effect of exercise therapy with Swiss ball on the trunk control and balance in children with spastic cerebral palsy

To determine the effect of exercise therapy with Swiss ball on the trunk control and balance in children with spastic cerebral palsy

This study is 2-armed, double-blind RCT with one to one allocation in two groups ( group 1: exercise with Swiss ball, group 2: trunk control exercise on the floor) in children with spastic cerebral palsy , where the person evaluating the outcome measures will be completely blind to the type of exercise each group will have receive. Additionally, participants will be blind because there is no difference between the two groups in terms of exercise positions, and duration treatment sessions.

The intervention is performed in the community rehabilitation and the finder. In this study, both the participants and the assessor are blind.

Inclusion criteria include diagnosis of spastic hemiplegia/ diplegia, Having age range between 6 and 12 years old and Having motor function at levels between 1 and 3 exclusion criteria include occurrence orthopedic events during treatment having body mass index above 25 and Ability to active straight leg raise and maintain the position until the abdominal muscle image is recorded

participants in intervention group, will receive "exercise with Swiss ball" and in control group, they will receive " trunk control exercise on floor" 5 weeks, three sessions per week.

trunk control score

In the inclusion criteria, the ability to raise the straight leg actively and maintain it when the ultrasound instrument records the abdominal muscle image is added. because during the study, it will be hard to record the image of the abdominal muscles in the hip flexion position by sonography instrument for children who do not have this ability. Moreover, Due to the decrease in the severity of the corona pandemic, the treatment at the patient's home is eliminated because the patients are referred to the Community Rehabilitation and the Finder for receiving physiotherapy services. Also, this center is added to the patient reception center. Additionally, in the sample randomization section, "cerebral palsy type" has been replaced by "gross motor function classification scale" because during the pilot study we realized that cerebral palsy children with moderate motor impairment severity (grade 3 of the gross motor function classification scale) who are able to perform hip flexion, and maintain it when the ultrasound instrument records the abdominal muscle image are rare.

Stratification and Random blocks with four blocks will be used for randomization. The randomization type using the stratification method will be performed in four classes: cerebral palsy type of diplegia and hemiplegia, the age range between 6 to 9 years and 9 to 12 years using 4 blocks. For concealment in the randomization process, a unique code will be used on each envelope.

In this study ,Assessor who evaluates the outcome measures of study and the participants in the study will be blind to the allocation of the two treatment groups. Additionally the data also will be evaluated by a person who is blind to the allocation and treatment of groups.