BACKGROUND

In spastic diplegia, lower extremities are more involved than the upper extremities. Children have major weakness in trunk. Postural disturbances in CP are major difficulty in maintaining body segments aligned on narrow base of support. Such children retain an anterior pelvic tilt, due to the tightness of the iliopsoas muscle as well as the weakness in the trunk flexors and hip extensors. Crouch gait is the most common locomotor disability among children with spastic diplegic CP. The activation of gluteus maximus muscle leads to improve crouched posture and gait in CP.

OBJECTIVE

To determine the combined effect of gluteal activation along with MFR and MFR only on crouch posture in children with spastic diplegia to improve standing posture and gait.

METHODOLOGY

Nature of the Study

The study will be Randomized Controlled Trial in which the effect of gluteal activation on crouch posture in spastic diplegic CP children will be observed.

SELECTION CRITERIA

Inclusion criteria

Children with Spastic Diplegia, age group 6-12 years, Both males and females, GMFCS level 1,2,3.

Exclusion criteria

·         Those currently on any medication for CP.

·         Who had received botulinum toxin injection.

·         Who had undergone lower limb surgery within 6 months of study enrolment so as to avoid confounding results secondary to iatrogenic weakness.

·         Children with history of head injury or loss of consciousness, who has contracture, other co-morbid disorders such as Autism Spectrum disorder.   

·         GMFCS level 4,5 

OUTCOME MEASURES

1. Hamstring flexibility test

2. APECS (A1 Posture Evaluation and Correlation System) app

3. Edinburg Visual Gait Score

4. Pediatrics Balance Scale

Procedure

The experimental group will be given MFR of iliopsoas + tDCS + Gluteal Activation exercises i.e. single leg bridging and step up exercises + Conventional Physiotherapy. The control group will be given MFR of iliopsoas and tDCS with conventional physiotherapy. After the administration of intervention, scores for Hamstring flexibility, standing posture analysis and gait analysis, Pediatric Balance Score will be recorded.