To Evaluate the Effectiveness of Weight Shifting Activities to Improve Trunk Control and Balance Among Children with Cerebral Palsy

Cerebral Palsy:

According to ICD-10. Cerebral palsy is a group of disorders that affect a person's ability to move, maintain balance, and control posture. ⁽¹⁾ Cerebral palsy (CP) is a group of non-progressive brain disorders affecting motor function, typically caused by brain damage before, during, or shortly after birth. Although the brain lesion doesn't worsen, the condition can impact movement and posture over time. Children with CP often have poor trunk control, delayed reaction time, and difficulty with movement planning and balance. These motor impairments limit their mobility, self-care, and social participation.

Trunk Control and Cerebral Palsy:

Trunk control refers to the ability to stabilise and manage the upper body, which is essential for maintaining balance and sitting upright. It plays a vital role in child development and typically begins to develop by around four months of age. ⁽³⁾ Trunk control issues are common in children with cerebral palsy due to neurological and motor impairments affecting core muscles. Poor trunk stability leads to motor dysfunction, impacting posture, balance, and functional activities. Trunk control is essential for coordinated limb movements and functional tasks like reaching and walking. It helps maintain posture, manage weight shifts, and keep balance through proper sensorimotor function. In children with cerebral palsy, impaired trunk control hinders gross motor development, but research shows it can be improved with targeted exercises. A study showed that 10 hours of additional trunk exercises improved the ability to control the trunk in subacute stroke patients. ⁽⁴⁾ A study showed that Children with cerebral palsy (CP) frequently show impaired trunk control. ⁽⁷⁾

Balance and Cerebral Palsy:

Balance is a vital skill that enables us to maintain our posture and move safely through our environment. ^{(8), (9)} Balance relies on visual, vestibular, and somatosensory systems to keep the body upright during rest and movement. In cerebral palsy, brain damage affects motor control, making balance crucial in rehabilitation. Static balance helps maintain posture, while dynamic balance prevents falls during movement. Developing both is essential for independence and daily activities.

Trunk Control and Balance:

Trunk control and balance are impaired to varying degrees in children with cerebral palsy, influenced by gender, topography, and severity of motor impairment. The study found a strong positive correlation between trunk control and balance in children with spastic CP. ⁽¹³⁾ Trunk stabilization can also have an immediate therapeutic effect on balance. It has been proven through many studies that trunk stabilization exercises immediately improve static and dynamic balance. [14] Activities that help to increase trunk control also affect balance and help to improve balance in children with cerebral palsy.

Weight Shifting in Cerebral Palsy:

Weight shift refers to the principle whereby the weight of the body is shifted from one supporting part of the body to another, such as from one leg to another. Weight shifting is an important skill for individuals with cerebral palsy as it can help in balance, stability, trunk control, posture, as well as mobility. In cerebral palsy due to muscle imbalance, spasticity, or weakness, weight shifting is often challenging. Improving weight shifting can help to improve trunk control and balance. Once the trunk control and balance are improved, the individual with cerebral palsy can enhance their mobility, independence, and quality of life. Various studies say that different weight-shifting activities can be used to improve trunk control and balance. ^{(4) (15)}

AIM AND OBJECTIVES:

AIM:

To evaluate the effectiveness of weight-shifting activities to improve Trunk control and Balance among children with cerebral palsy.

OBJECTIVES:

• To evaluate Trunk control and balance using Trunk Control Measurement Scale (TCMS) and Paediatric Balance Scale (PBS)[Pre-test].
• To provide intervention using weight-shifting activities.
• To re-evaluate Trunk control and Balance using TCMS and PBS [post-test].
• To compare the pre-test and post-test scores to establish the effectiveness of weight shifting activities.

Need of The Study

Cerebral palsy (CP) is one of the most common motor disabilities in children, significantly affecting trunk control and balance, which are crucial for daily activities and independence. Weight shifting has shown potential in improving trunk control and balance. This study aims to evaluate the effectiveness of weight-shifting activities to improve trunk control and balance in children with CP.

REVIEW OF LITERATURE

kyoungsim Jung et al. (2014) conducted a study to check “The effectiveness of weight shifting abilities in stroke patients to improve trunk, proprioception and balance abilities”. The study evaluated the effects of weight-shift training on an unstable surface in 18 chronic hemiparetic stroke patients, divided into a weight-shifting group and a control group. The weight-shifting group trained on a Balance Pad and Dynamic Ball Cushion for 30 minutes, five times a week for four weeks, while the control group followed conventional exercises. Assessments using trunk reposition error (TRE), Trunk Impairment Scale (TIS), and Timed Up and Go (TUG) test showed that weight shift training effectively improved balance, proprioception, and trunk control in stroke patients. ⁽⁴⁾  A study was conducted on “Impaired visually guided weight-shifting ability in children with cerebral palsy” by Laurent Ballaz et al. (2015). The results show that an active video game can be used as an engaging and effective method for evaluating visually guided weight-shifting abilities in children with motor impairments. ⁽²²⁾  Lieve Heyrman et al. (2013) conducted a study on” Clinical characteristics of impaired trunk control in children with spastic cerebral palsy". The study concluded that trunk control impairment varies by CP type and severity, highlighting the importance of targeted trunk-focused interventions to improve functional abilities. ⁽⁷⁾ Sivatejaa Panibatla et al. (2017) conducted a study on the “Relationship Between Trunk Control and Balance in Children with Spastic Cerebral Palsy”. It is a cross-sectional study. The study found a significant relationship between trunk control and balance in children with CP. ⁽¹³⁾ A study was conducted by Heba M Youssr El-Basatiny et al. (2015) on “Effect of Trunk Exercises on Trunk Control, Balance and Mobility Function in Children with Hemiparetic Cerebral Palsy”. The study found that trunk exercises improve trunk control, balance, and mobility in children with spastic hemiparetic cerebral palsy. ⁽²⁶⁾

METHODOLOGY

Research Design:

Quasi-experimental single-group (pre-test and post-test) study.

Study Setting:

The study was conducted in occupational therapy, Department of Therapeutics, National Institute for the Empowerment of Persons with Multiple Disabilities

(DIVYANGJAN), Muttukadu, Chennai.

Sampling Technique:

Convenient Sampling was used for the study.

Sampling Population:

Children diagnosed with cerebral palsy

Age Group:

5 to 15 years

Sampling Size:

This study included 12 children diagnosed with Cerebral Palsy.

Selection Criteria

Inclusion criteria:

• Both Genders
• Children with cerebral palsy between the age group of 5-15 years of age.
• Children with Cerebral Palsy with trunk control and balance impairment with TCMS scoring of static sitting balance more than 5 out of overall score 20.
• Able to do Upper Extremity Movements.

Exclusion criteria:

• Severe and profound Intellectual disability
• Seizures
• Other Spinal Deformities

Duration of the study:

The duration of the study was for 6 months. Intervention was given for 6 weeks. The length of each session was 30 minutes, conducted for five days a week. (30 sessions). ⁽⁴⁾

Variables:

• Independent variable: Weight-shifting activities
• Dependent variable: Trunk control and Balance

Tools Used

• Paediatric Balance scale. (PBS)
• Trunk control measurement scale. (TCMS)

Pediatric Balance Scale

The Pediatric Balance Scale (PBS), a modified Berg Balance Scale, assesses functional balance in children using 14 items scored 0–4 (max 56 points).

Psychometric properties:

• Reliability:

 Test-retest (ICC=0.998)

 Interrater reliability (ICC=0.997).

• Validity:

PEDI self-care (r=0.73, p<0.001) and mobility (r=0.82, p<0.001)

Selective Control Assessment of Lower Extremity (r=0.797, p<0.05)

Trunk Control Measurement Scale:

The Trunk Control Measurement Scale (TCMS) assesses static and dynamic trunk control in children with spastic CP. It includes 15 items (max 58 points)

Psychometric properties:

• Reliability: The TCMS demonstrates high reliability (ICCs > 0.90) across all subscales.
• Validity: The TCMS exhibits strong validity in assessing trunk control and motor functions, with high correlations confirming its construct and concurrent validity.

Intervention Protocol

A total of 9 weight-shifting activities were used as an intervention. The therapist gave needed support to the child while doing activities. An adequate break was given between each activity.

Name of The Activities:

1. Weight shifting on the balance cushion. ⁽⁴⁾
2. Weight shifting in long leg.⁽¹⁵⁾
3. Sequential weight shifting. ⁽¹⁶⁾
4. Activation of the trunk in all planes. ⁽¹⁷⁾
5. Swiss ball activity. ⁽¹⁸⁾
6. Bird dog. ⁽¹⁹⁾  
7. Multidirectional step. ⁽²⁰⁾
8. Walking, holding the wall. ⁽²⁰⁾
9. Reaching tasks on the table and chair. ⁽²¹⁾