Impact of vestibular-based intervention on movement and postural stability in children with spastic cerebral palsy: a single-blind randomized controlled trial.

BACKGROUND AND OBJECTIVE: Cerebral Palsy (CP) is not only associated with neuromuscular impairments, but also with sensory processing alterations, due to disrupted thalamocortical projections caused by white matter lesions. This study aimed to evaluate the effectiveness of Conventional Therapy (CT) and Vestibular Stimulation Therapy (VST) on movement and body position processing, balance, and gross motor function in children with spastic CP. METHODS: A randomized, two-arm parallel-group clinical trial was conducted in the Pediatric Physiotherapy Outpatient Department (OPD) of Delhi Pharmaceutical Sciences and Research University (DPSRU). Children with spastic diplegic CP, Gross Motor Function Classification System (GMFCS) level III, aged 6-12, were recruited for the study and then randomized equally to a control group that received CT and an experimental group that received VST in addition to CT for a duration of 30 min, with 10 min of sensory preparation and 20 min of activities on the swing, along with a 20-min CT session respectively. Before and after intervention, all children performed a Gross Motor Function Measure-88 (GMFM-88), the Pediatric Balance Scale (PBS), and the Movement Processing and Body Position Processing of Child Sensory Profile-2 (CSP-2). Data were analyzed using appropriate parametric tests after a normality check (Kolmogorov-Smirnov test), with the significance level set at p < .05. RESULTS: A total of 80 children with spastic diplegic CP with GMFCS level III were recruited in the study. An average age of 8.44 ± 1.98 years was observed. Statistically significant improvements were observed in all domains of GMFM-88 (p < .001) post-intervention, in Body Position processing (-43.01 ± 5.56 vs. -27.50 ± 2.59), Movement processing domains (-19.00 ± 5.85 vs. -3.38 ± 2.81), and PBS (9.00 ± 2.66 vs. 2.08 ± 1.16) in the experimental group. DISCUSSION: Children with CP have balance and postural problems due to impaired proprioceptive and vestibular processing. This study discovered that in children with spastic diplegic CP (GMFCS level III), VST in conjunction with CT enhances sensory processing, balance, and gross motor performance. Its impact on gait characteristics in children with CP at GMFCS levels I and II should be investigated in future research.