Ann Rehabil Med.  2022 Feb;46(1):45-52. 10.5535/arm.21148.

Effect of Pilates Exercises on Standing, Walking, and Balance in Children With Diplegic Cerebral Palsy

• Abd-Elfattah HM
• Galal DOSM
• Aly MIE
• Aly SM
• Elnegamy TE

• KMID: 2527098
• DOI: http://doi.org/10.5535/arm.21148

Abstract

Objective
To analyze how Pilates exercises affect standing, walking, and balance in children with diplegic cerebral palsy throughout a 10-week program.
Methods
We included 40 children aged 7–9 years with diplegic cerebral palsy, and randomly allocated them into two groups of the same size: conventional therapy group (group A) and conventional therapy+Pilates group (group B). We administered the same conventional physical therapy program to both groups for 45 minutes, with group B receiving additional Pilates exercises for 45 minutes. Both groups attended the intervention program three times/week for 10 weeks. We used the Growth Motor Function Measure Scale (GMFM-88) to evaluate standing and walking (Dimensions D and E), and the Pediatric Balance Scale to evaluate balance function before and after treatment.
Results
Comparison of the average values of all measured variables before and after therapy showed a statistically significant difference (p<0.05) between the two groups. All measured variables showed a significant difference between groups A and B, in favor of group B (p<0.05).
Conclusion
Pilates exercise in addition to conventional therapy is more effective in improving balance and gross motor function in children with diplegic cerebral palsy than the conventional therapy alone.

Keyword

Cerebral palsy; Spastic; Diplegic; Therapy; Rehabilitation

Figure

• 

  Fig. 1. Children’s consort flow diagram.

Reference

1. Richards CL, Malouin F. Cerebral palsy: definition, assessment and rehabilitation. Handb Clin Neurol. 2013; 111:183–95.

2. Guy JA, Micheli LJ. Strength training for children and adolescents. J Am Acad Orthop Surg. 2001; 9:29–36.

3. Emara HA, El-Gohary TM, Al-Johany AA. Effect of body-weight suspension training versus treadmill training on gross motor abilities of children with spastic diplegic cerebral palsy. Eur J Phys Rehabil Med. 2016; 52:356–63.

4. Brien M, Sveistrup H. An intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy. Pediatr Phys Ther. 2011; 23:258–66.

5. Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised Pilates programme. J Bodyw Mov Ther. 2012; 16:549–54.

6. Mokhtari M, Nezakatalhossaini M, Esfarjani F. The effect of 12-week Pilates exercises on depression and balance associated with falling in the elderly. Procedia Soc Behav Sci. 2013; 70:1714–23.

7. Bernardo LM. Pilates for nurses. Pa Nurse. 2005; 60:27.

8. Keays KS, Harris SR, Lucyshyn JM, MacIntyre DL. Effects of Pilates exercises on shoulder range of motion, pain, mood, and upper-extremity function in women living with breast cancer: a pilot study. Phys Ther. 2008; 88:494–510.

9. Wells C, Kolt GS, Bialocerkowski A. Defining Pilates exercise: a systematic review. Complement Ther Med. 2012; 20:253–62.

10. Emery K, De Serres SJ, McMillan A, Cote JN. The effects of a Pilates training program on arm-trunk posture and movement. Clin Biomech (Bristol, Avon). 2010; 25:124–30.

11. Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012; 93:43–9.

12. Curnow D, Cobbin D, Wyndham J, Boris Choy ST. Altered motor control, posture and the Pilates method of exercise prescription. J Bodyw Mov Ther. 2009; 13:104–11.

13. da Fonseca JL, Magini M, de Freitas TH. Laboratory gait analysis in patients with low back pain before and after a Pilates intervention. J Sport Rehabil. 2009; 18:269–82.

14. Sekendiz B, Cug M, Korkusuz F. Effects of Swiss-ball core strength training on strength, endurance, flexibility, and balance in sedentary women. J Strength Cond Res. 2010; 24:3032–40.

15. Hennington G, Johnson J, Penrose J, Barr K, Mc-Mulkin ML, Vander Linden DW. Effect of bench height on sit-to-stand in children without disabilities and children with cerebral palsy. Arch Phys Med Rehabil. 2004; 85:70–6.

16. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987; 67:206–7.

17. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997; 39:214–23.

18. Chen CL, Shen IH, Chen CY, Wu CY, Liu WY, Chung CY. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. Res Dev Disabil. 2013; 34:916–22.

19. Franjoine MR, Darr N, Held SL, Kott K, Young BL. The performance of children developing typically on the pediatric balance scale. Pediatr Phys Ther. 2010; 22:350–9.

20. Safei I, Moeliono MA, Prabowo T. Loaded and unloaded sit-to-stand strengthening exercises effect to gross motor function measure in spastic diplegia cerebral palsy patients. Int J Integr Health Sci. 2016; 4:8–14.

21. Surbala L, Khuman PR, Trivedi P, Devanshi B, Mital V. Pilates versus conventional balance training on functional balance and quality of life in elderly individuals: a randomized controlled study. Sch J App Med Sci. 2014; 2(1B):221–6.

22. Eng J. Sample size estimation: how many individuals should be studied? Radiology. 2003; 227:309–13.

23. Brown TM. Power and sample size in clinical studies. J Nucl Cardiol. 2015; 22:1314–5.

24. Latey P. The Pilates method: history and philosophy. J Bodyw Mov Ther. 2001; 5:275–82.

25. Levine B, Kaplanek B, Scafura D, Jaffe WL. Rehabilitation after total hip and knee arthroplasty: a new regimen using Pilates training. Bull NYU Hosp Jt Dis. 2007; 65:120–5.

26. Liao HF, Liu YC, Liu WY, Lin YT. Effectiveness of loaded sit-to-stand resistance exercise for children with mild spastic diplegia: a randomized clinical trial. Arch Phys Med Rehabil. 2007; 88:25–31.

27. Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ther. 2006; 36:472–84.

28. Kish R. The functional effects of Pilates training on dancers [dissertation]. Long Beach, CA: California State University;1998.

29. Bahramizadeh M, Mousavi ME, Rassafiani M, Aminian G, Ebrahimi I, Karimlou M, et al. The effect of floor reaction ankle foot orthosis on postural control in children with spastic cerebral palsy. Prosthet Orthot Int. 2012; 36:71–6.

30. Dos Santos AN, Serikawa SS, Rocha NA. Pilates improves lower limbs strength and postural control during quite standing in a child with hemiparetic cerebral palsy: a case report study. Dev Neurorehabil. 2016; 19:226–30.

31. Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. Philadelphia, PA: F. A. Davis Company;2012.

32. Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G, Delvecchio D, et al. A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. Int Urogynecol J. 2010; 21:401–8.

33. Phrompaet S, Paungmali A, Pirunsan U, Sitilertpisan P. Effects of Pilates training on lumbo-pelvic stability and flexibility. Asian J Sports Med. 2011; 2:16–22.

34. Mohammadi M, Kaldirimci M, Kazemi SE, Mizrak O, Tugrulhansam C. The effect of Pilates exercise on gait speed and strength of lower limb in elderly male. Adv Appl Sci Res. 2015; 6:1–6.

35. Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls. J Sports Sci Med. 2011; 10:105–11.

36. Guclu-Gunduz A, Citaker S, Irkec C, Nazliel B, Batur-Caglayan HZ. The effects of Pilates on balance, mobility and strength in patients with multiple sclerosis. NeuroRehabilitation. 2014; 34:337–42.

37. van der Linden ML, Bulley C, Geneen LJ, Hooper JE, Cowan P, Mercer TH. Pilates for people with multiple sclerosis who use a wheelchair: feasibility, efficacy and participant experiences. Disabil Rehabil. 2014; 36:932–9.