UNIVERSAL EXERCISE UNIT, SPIDER CAGE

INTRODUCTION:

Cerebral Palsy:

Cerebral palsy can be defined as disorder of movement and posture caused by lesion in immature brain [1]. Brain injury can occur in fetal life or during the first year of life by hypoxia, asphyxia, neonatal jaundice, traumatic brain infections and prematurity [2]. Brain lesion leads to abnormal sensory motor development along with visual, cognitive and hearing impairments [3]. Exact cause of cerebral palsy is still unknown; however brain damage can occur before birth, during the birth and after the birth. Pregnancy disorders are considered leading cause before birth [4]. Birth asphyxia, prematurity, neonatal infections and traumatic brain injury are some important causes in cerebral palsy [5]. Cerebral palsy has different types like spastic, athetoid, ataxic, hypotonic and some tome mixed type [6]. Cerebral palsy can be divided depending upon parts of body involve like monoplegia, diplegia, hemiplegia and quadriplegia, this is called topographical classification of cerebral palsy [7]. Gross motor functional classification categorized the children into level I (least disability) to level V (severe disability) depending upon the abilities and disabilities of child [8].

Motor Control:

Motor control in normal individual is developed as body come under the influence of higher centers [9]. At the time of birth body is controlled by reflexive movements [10]. Neonatal reflexes make the backgrounds of postures [11, 12]. At the age of six month most of reflexive movements come under the control of higher centers due to integration of neonatal reflexes [13]. Normal motor development and control is very important in the treatment of cerebral palsy because there is difficulty in execution of normal movements due to increase tone and spasticity. Normal reflexes develop the normal movements but in cerebral palsy there are a number of abnormal reflexes that develop abnormal movement patterns. Training and retraining of a motor activity play a dominant role in neuroplasticity [14]. There are motor areas in human brain that control the movements of body parts. Damage to these motor areas lead to paralysis and some time partial paralysis (paresis). Brain has ability to reorganize itself with practice of a motor task, when it performed again and again [9]. This process continues in normal brain throughout the life, and we learnt new skills in our daily life. Similarly in cerebral palsy and stroke, with repetitions of task we can reorganize the damage brain.

Universal Exercise Unit:

Intensive protocols in pediatric physical therapy are getting popularity in cerebral palsy centers [15]. Universal exercise unit, spider web, therasuit, functional training and repetitions of body transitions are used in these protocols. Therapy sessions are extended from three to four hours. It can be used with children and adults with different neurological conditions like stroke, cerebral palsy, spinal cord injury and spina bifida. Spider cage is made of metal with equal length, width and height, size of cage can be different depending upon type of population pediatric or adults. Cage consists of elastic cords and belts, which are used to support the patients in the cage. Different activities of functional training can be practice in this cage easily. Elastic resistance of cords can be used to strengthen the weak muscles. Initiation of a particular posture can be easily trained in this cage.

Universal exercise unit can be used in different therapeutic posture (fig. 01, 02, 03, 04). Continuous training of a specific posture in universal exercise unit enables the child to adopt that posture in participation.

Universal exercise unit can be used in adjunct to various different traditional physical therapy treatments like strength training, stretching, functional training and weight bearing on joints [16-18]. In intensive therapy session universal exercise unit is frequent part of treatment. Therapist has batter control of body and easy to induce the posture in this unit.

CONCLUSION:

Therapies and techniques are discovered over the time to treat patients with cerebral palsy. Although use of universal exercise unit in rehabilitation is not new, however in cerebral palsy it can be used with new concept. Sciencetific research literature is limited on its effectiveness. Universal exercise can be used to train motor control in patients with brain lesion like cerebral palsy, stroke and other neurological issues.

REFERENCES:

1.         Sindhurakar, A. and J.B. Carmel, Neonatal Brain Injury, in Common Neurosurgical Conditions in the Pediatric Practice. 2017, Springer. p. 47-59.

2.         MEYERS, R.C., S.J. BACHRACH, and V.A. STALLINGS, NEUROLOGICAL AND DEVELOPMENTAL. Pediatric and Adult Nutrition in Chronic Diseases, Developmental Disabilities, and Hereditary Metabolic Disorders: Prevention, Assessment, and Treatment, 2017: p. 85.

3.         Ismail, F.Y., A. Fatemi, and M.V. Johnston, Cerebral plasticity: windows of opportunity in the developing brain. European Journal of Paediatric Neurology, 2017. 21(1): p. 23-48.

4.         Wu, C.W., et al., Risk of stroke among patients with cerebral palsy: a population‐based cohort study. Developmental Medicine & Child Neurology, 2017. 59(1): p. 52-56.

5.         Pacella, M.J., et al., Stem Cell Therapy for Brain Injury in Neonates. Frontiers in Stem Cell and Regenerative Medicine Research: Volume: 3, 2017. 3: p. 68.

6.         Miller, F. and S.J. Bachrach, Cerebral palsy: A complete guide for caregiving. 2017: JHU Press.

7.         Porretta, D.L., Cerebral palsy, traumatic brain injury, and stroke. Adapted Physical Education and Sport, 6E, 2016: p. 271.

8.         Palisano, R., et al., Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 1997. 39(4): p. 214-223.

9.         Shumway-Cook, A. and M.H. Woollacott, Motor control: translating research into clinical practice. 2007: Lippincott Williams & Wilkins.

10.       Van der Meer, A., F. Van der Weel, and D.N. Lee, The functional significance of arm movements in neonates. Science, 1995. 267(5198): p. 693.

11.       Afzal, F., Role of neonatal reflexes in development of tone, posture, skills and integration of reflexes in cerebral palsy.

12.       Afza, F., S. Manzoor, and A. Afzal, How the Development of Tone and Posture Occured in New Borns. 2017.

13.       Thorn, J., Development, Behavior, and Mental Health. The Harriet Lane Handbook E-Book, 2017.

14.       Avrsekar, P., TO ASSESS THE EFFECTIVENESS OF HAND ARM BIMANUAL INTENSIVE THERAPY (HABIT) IN IMPROVING THE FINE MOTOR FUNCTION IN SPASTIC CEREBRAL PALSY CHILDREN. 2010.

15.       Bailes, A.F., K. Greve, and L.C. Schmitt, Changes in two children with cerebral palsy after intensive suit therapy: a case report. Pediatric Physical Therapy, 2010. 22(1): p. 76-85.

16.       Afzal, F., et al., Effects Of Universal Exercise Unit Combined With Conventional Combination Therapy On Gross Motor And Functional Skills In Spastic And Athetoid Cerebral Palsy Children.

17.       Khalid, M., et al., OUTCOMES OF UNIVERSAL EXERCISE UNIT (UEU) IN COMBINATION WITH CONVENTIONAL PHYSICAL THERAPY ON TRUNK CONTROL IMPROVEMENT IN SPASTIC AND ATHETOID TYPE CEREBRAL PALSY CHILDREN.

18.       Liaqat, S., M.S. Butt, and H.M.W. Javaid, EFFECTS OF UNIVERSAL EXERCISE UNIT THERAPY ON SITTING BALANCE IN CHILDREN WITH SPASTIC AND ATHETOID CEREBRAL PALSY: A QUASI-EXPERIMENTAL STUDY. Khyber Medical University Journal, 2017. 8(4): p. 177.