2002 Conference Proceedings

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M.T. Joghataei, Ph.D. Associate Prof.

G.R. Haji Pour Nezhad, Ph.D. Assistant Prof.

How to deal with spasticity and flaccidity in the upper and lower limbs of the cerebral palsy child has always been a very unquenchably controversial issue in the field of rehabilitation of the cerebral palsy client. A demanding research area has been the comparison of various inhibitory and facilitatory techniques in dealing with tone disorders. The commonly practiced methodologies such as the Bobath Method are well known to the profession. More recent attempts have, however, turned toward the promotion of more active functioning on the part of the child, whose main premise is that sound rehabilitation depends less on passive or assistive measures and more on independence through the implementation of client-controlled self-initiated goals. The advent of sensory rooms has been a great revolution in the field. In such rooms, the child is presented with a multitude of sensory stimuli and feedbacks in order to receive compact sensory stimuli and provide proper responses to those various stimuli. However, a demerit of sensory rooms is that they demand general movement patterns (combinations of motions in different joints of the upper limb, for instance), which are not necessarily remedial to the pathological patterns and movements made by the child, but detrimental in many cases as the main goal of the use of sensory rooms is mere mobility and there is no strict control of the abnormal patterns, where the child tries to, for instance, touch a certain pad to have a specific sound heard, and may overtry and make the involved muscles more spastic than they actually are.

The present article is the report of the results of a two-year research project conducted at the University of Social Welfare and Rehabilitation Sciences in Iran to develop an electronic package which aimed to have the merits of a typical sensory room and dispose of its demerits. As regards the description of the package, it consists of an attachment kit, which is a combination of pads and straps attached to the neighboring levers of the given joint (for example, forearm and arm in the case of the elbow). The pads contain certain sensors which will record the initial posture of the joint and signal the flexion/extension attempts of the client after the "game" starts. The "brain of the package" consists of a keyboard which gets the orders from the therapist. Orders might include the assignment of the type of feedback to be presented when a certain motor attempt was reported. These include beeps, bells ringing, songs, and recorded messages such as "well-done" as auditory reinforcers and lights of different color to be displayed on the light-boards of the package mounted onto the wall in the child visual field as visual feedbacks (other accessory parts provide the child with tactile feedbacks such as a breeze blown out of a small fan). The keyboard also gets orders as to what movement patterns to reinforce (flexion or extension). Packs of different sizes have made the kit versatile for all the joints of the extremities.

Utilizing the above package as the instrument, a true experimental study was carried out to investigate the performance of this package compared with that of 1) traditional facilitatory/inhibitory techniques and 2) a typical sensory room. The study was designed for the following purposes:

  1. To find out the possible challenges to the use of the package.
  2. To compare the efficacy of the package with that of other measures in diminishing spasticity.
  3. To compare the efficacy of the package with that of other measures in increasing mobility.
  4. To cross-compare the effect of only auditory/only visual/ and auditory and visual feedbacks combined.

Ninety-six Spastic CP children of both sexes aged between 3 and 9 from twelve clinics located in southern and northern parts of the city were selected and assigned to the experimental group and the two control groups. The experimental group received a treatment of a three-month period of rehabilitation with the above package, while one control group received rehabilitation in a sensory room and the other by facilitatory and inhibitory techniques. The three groups were matched on mobility, spasticity/flaccidity, and normal patterns as the dependent variables of the study.

At the end of the treatment period, different scales of the above variables were then plotted, cross-compared, and interpreted. A variety of statistical techniques were employed to tackle the questions of the study. These ranged from simple correlations and ANOVAs through Factor and Regression Analyses to Structural Equation Modeling and path analysis.

Results showed that the mentioned package specifically significantly reduces spasticity, increases mobility, and enhances motor pattern normality differently from the two other measures of the study. Also, it was found that a combination of auditory and visual feedbacks proved more effective than the other two choices. Implications and applications are expounded.

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