This study will be conducted to investigate the combining effect of weight-bearing exercises program with neuromuscular electrical stimulation on balance and functional abilities in children with hemiplegic cerebral palsy.
Children diagnosed with hemiplegic cerebral palsy.
Their age will range from 6-10 years.
Both sexes will be included.
All participants will be able to follow simple commands.
Children with any neurological conditions other than hemiplegic cerebral palsy will be excluded from the study.
Musculoskeletal problems or congenital deformity.
Children with fixed contracture.
Lower limb surgery in the last one year.
Parallel
traditional physical therapy and weight-bearing exercise
Other interventionThey will receive 60 minute session, 3 times/ week for 8 weeks as following: * 30 minutes of traditional physical therapy program : Includes: Strengthening, Stretching, Balance, Postural Control, Functional Mobility and Gait Training. * 30 minutes of seven different weight-bearing exercises program of exercises with three of those being repeated on the left and right sides to make a total of ten exercises, each held for 3 minutes, the exercises include: hamstring stretch, calf stretch, half kneeling balance, static squat, bridge, four point kneeling and four point kneeling with leg extension the exercises include: : Hamstring stretch,Calf stretch , Half kneeling balance , Static Squat, Bridge, Four point kneeling with leg extension, and Four point kneeling.
neuromuscular electrical stimulation , traditional physical therapy and weight-bearing exercise
Other interventionThey will receive 60 minute session, 3 times/ week for 8 weeks as following: * 30 minutes of the same traditional physical therapy as the control group. * 30 minutes of the same weight-bearing exercises program as the control group adding to it the neuromuscular electrical stimulation on: Tibialis anterior, Quadriceps, Paraspinal muscles. * NMES Parameters : * Device: Everyway-EV-906. * Frequency: 30-35 Hz (to optimize muscle endurance and motor unit recruitment). * Pulse Width: 250-300 µs. * Intensity: Adjusted to elicit visible muscle contraction without discomfort (submaximal, (25-30 mA). * Electrode Placement: * Lower Limb: Tibialis anterior (for dorsiflexion) and quadriceps (for knee stability) during weight-bearing (El-Shamy and El Kafy, 2021). * Trunk: Paraspinal muscles (for postural control) during static squats and bridging
Balance
The HUMAC Balance System (HUMAC2015® Version: 15.000.0103; Computer Sports Medicine, Inc.) will assess pediatric postural balance before and after treatment. This system, featuring a force plate and specialized software, provides precise and reliable measurements of static and dynamic balance, supported by established reliability in pediatric studies.
The Gross Motor Function Measure GMFM
The GMFM Will be used for functional abilities evaluation for all children participating in the study before and after treatment procedures. Including the 88-item (GMFM-88) and 66-item (GMFM-66) versions, assesses gross motor function changes in children with cerebral palsy. Both demonstrate high validity and reliability . An adapted GMFM-88 version shows excellent test-retest and inter observer reliability
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