Effect of an intensive therapy protocol with therapeutic suits on the postural control of children with cerebral palsy

Abstract

Cerebral Palsy (CP) is a neuromotor disorder that severely impairs postural control. Intensive Neuromotor Therapies (INMTs), which use therapeutic garments, have 
shown to be a promising approach for strengthening muscle groups and improving postural balance. However, the literature still lacks qualitative and quantitative evidence on the effects of these garments on the motor control of children with CP, especially those with severe motor and functional impairment. Objectives: This thesis 
sought to fill this gap by investigating the effect of an INMT protocol with therapeutic garments on the postural control of children with CP, using qualitative and quantitative assessment instruments. Methods: This study consisted of three interconnected studies. Article I outlined the pilot clinical trial protocol for publication, detailing the methodology, eligibility criteria, and interventions to be tested. Article II reported a quasi-experimental, within-subject study that investigated the immediate effect of using the therapeutic garment. The primary outcome was static postural balance during 
sitting, quantified through accelerometry parameters that measured body displacement. Article III constituted the pilot clinical trial, which evaluated the effects of the TNMI protocol, with the TheraSuit and PediaSuit garments. The outcomes investigated included gross motor function, assessed by the Gross Motor Function Measure (GMFM) scale; strength by Functional Sitting Assessment (FSA); trunk balance with Scale for Assessment of Trunk Control (SatCO) and the Pediatric Balance Scale (PBS); and postural control, measured by accelerometry during sitting. Results: Article II showed that the use of the therapeutic garment reduced the size of body sway and altered its frequency, indicating changes in postural control during sitting in children with CP. Article III showed clinically relevant improvements in GMFM scale scores. Specifically, improvements were observed in dimensions C (Crawling and Kneeling Locomotion) and E (Standing, Walking, and Running Locomotion), which suggest significant functional improvements, such as increased ability for posture transitions, crawling, kneeling, standing, stepping, and maintaining balance while walking. Additionally, differences in postural stability measured by accelerometry were observed after intensive treatment. Conclusion: This thesis concludes that: (1) the therapeutic garment, as an isolated component, appears to alter postural control during its use; (2) the complete MITN protocol is feasible; (3) the preliminary chronic effects, measured by clinical scales and quantitative instruments, on postural control and motor function are clinically and statistically promising. They provide preliminary evidence of efficacy for intensive vest-based therapies, supporting continued investigation of this intervention in larger-scale clinical trials.