Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics

Ragab K Elnaggar; Rodrigo Ramirez-Campillo; Alshimaa R Azab; Saud M Alrawaili; Mshari Alghadier; Mazyad A Alotaibi; Ahmed S Alhowimel; Mohamed S Abdrabo; Mohammed F Elbanna; Ahmed M Aboeleneen; Walaa E Morsy

doi:10.3390/children11020243

Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics

Children (Basel). 2024 Feb 15;11(2):243. doi: 10.3390/children11020243.

Authors

Ragab K Elnaggar^{1

2}, Rodrigo Ramirez-Campillo³, Alshimaa R Azab^{1

2}, Saud M Alrawaili¹, Mshari Alghadier¹, Mazyad A Alotaibi¹, Ahmed S Alhowimel¹, Mohamed S Abdrabo^{4

5}, Mohammed F Elbanna^{2

6}, Ahmed M Aboeleneen^{4

6}, Walaa E Morsy^{2

7}

Affiliations

¹ Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
² Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt.
³ Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile.
⁴ Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt.
⁵ Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia.
⁶ Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
⁷ Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia.

Abstract

The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12-18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability-LoS), balance, and mobility (Community Balance and Mobility Scale-CB&M; Functional Walking Test-FWT; Timed Up and Down Stair test-TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.

Keywords: children; exercise therapy; motor function; physical conditioning; rehabilitation; spastic cerebral palsy; strength training.

Grants and funding

This study is supported via funding from Prince Sattam bin Abdulaziz University, project number (PSAU/2024/R/1445).