Comparison of the Effects of Vojta and Bobath Treatment on Gait and Balance in Diplegic Cerebral Palsy

Primary outcomes

1. Gross Motor Functional Classification System (GMFCS)

   Time frame: 8 weeks

   The Gross Motor Functional Classification System (GMFCS) is the assessment tool to measure motor function in children with cerebral palsy. GMFCS is a five-level classification that differentiates children with Level I:Walks independently, Level II: Walks with limitations, Level III: Walks with hand- held mobility, Level IV: Self mobility with limitations, may use powered mobility &amp; Level V: Transported in a manual wheelchair. The inter-rater reliability of GMFCS have a moderate agreement with a kappa (k) of 0.55 in children <2 years of age and excellent agreement with a kappa of 0.75 in children 2-12 years of age. This strong inter-rater reliability supports the use of the GMFCS as a classification of gross motor function in children ages 2-12 years.

2. Goniometer

   Time frame: 8 weeks

   The Goniometer measures the angle created at a joint by the adjacent bones of the body. Goniometer measurement represent the actual joint range of motion. There are multiple types of goniometer but universal goniometer is widely used in physiotherapy settings.

3. Paediatric Berg Balance Scale

   Time frame: 8 weeks

   The Paediatric Berg Balance Scale is used to assess functional balance skills in school-aged children. The scale consists of 14 items that scored from 0 points (lowest function) to 4 (highest function) with a maximum score of 56 points. Concurrent validity between Pediatric Balance Scale and GMFM at baseline (r=0.095), follow-up (r=0.44-0.87). Predictive validity of Pediatric validity and GMFM at follow-up (r=0.90-0.92) The test retest reliability is extremely high [(ICC3, 1=0.9987)].

4. Step Length

   Time frame: 8 weeks

   Step length is typically measured in centimeters (cm) or inches. Step length is used in clinical settings to assess gait abnormalities and has implications for rehabilitation. Adequate step length contributes to effective ambulation and helps maintain stability and momentum during walking.

5. Stride Length

   Time frame: 8 weeks

   Stride length is a key parameter in gait analysis that refers to the distance covered in one complete cycle of walking or running, specifically the distance between the initial contact point of one foot and the initial contact point of the same foot on the next step. Stride length is typically measured in units such as centimeters (cm) or inches. Stride length is critical in clinical assessments for identifying gait abnormalities.

6. Cadence

   Time frame: 8 weeks

   Cadence refers to the number of steps a person takes per unit of time, typically expressed as steps per minute (spm). It is a critical metric in gait analysis, providing insights into walking or running patterns and overall locomotion efficiency. A normal cadence (generally between 100 to 130 steps per minute for walking) is important for maintaining stability and rhythm during locomotion. Abnormal cadence can lead to increased fall risk and affect overall mobility.

7. Walking Base

   Time frame: 8 weeks

   Walking base, also known as base of support or stance width, refers to the distance between the feet when a person is walking. Specifically, it is the lateral distance between the heel centers of both feet during the walking cycle. A wider walking base indicates that the feet are positioned farther apart, while a narrower walking base means they are closer together. Walking base is typically measured in centimeters (cm).Walking base is a significant parameter in the assessment of gait and balance, providing insights into an individual's stability and mobility.