DOI: https://doi.org/10.53350/pjmhs22166800 ORIGINAL ARTICLE 800 P J M H S Vol. 16, No. 06, Jun 2022 Effects of Vestibular Stimulation on Balance in Children with Quadriplegic Cerebral Palsy ASMA BASHIR 1 , HIRA ARSHAD 2 , AMBER SHABBIR 3 , FARWA ABID 4 , MUHAMMAD USMAN KHALID 5 , REHAN RAMZAN KHAN 6 1 Senior Physiotherapist, Mobility Quest Rehabilitation Center, Lahore, Pakistan 2 Senior Lecturer, Lahore Medical and Dental College, Lahore, Pakistan 3 Senior Lecturer, Islamabad Medical and Dental College, Islamabad, Pakistan 4 Lecturer, University of Sialkot, Sialkot, Pakistan 5 Physiotherapist, Sahiwal Teaching Hospital, Sahiwal, Pakistan 6 Assistant Professor, Multan College of Physiotherapy, Multan Medical & Dental College, Multan, Pakistan Correspondence to: Rehan Ramzan Khan, Email: rehan99physio@gmail.com, Cell: 0334- 3074756 ABSTRACT Objective: The objective of the study was to determine the effects of vestibular stimulation on balance in quadriplegic cerebral palsy. Methodology: This was quasi experimental study in which total 44 quadriplegic cerebral palsy children were included who have no associated neurogenic conditions which may be aggravated with vestibular stimulation such as epilepsy or other orthopedic or functional complication. The children were assessed by an independent assessor before and after 6 weeks of vestibular stimulation. The assessment was made on gross motor measure and pediatric evaluation disability index. The data was analyzed using SPSS 20.0. Paired sample t test was used for pre-post testing. Results: The descriptive statistics of paired samples regarding Gross Motor Function Measure showed mean and standard deviation to be 49.61±1.75 and 64.54±1.04 before and after treatment, respectively. Paired sample testing for pre-post treatment measurement of mean score of Gross Motor Function Measure (GMFM) showed that mean difference and standard deviation found to be 14.93±1.90 with a significant p value 0.00. The descriptive statistics of paired samples regarding Total PEDI score showed mean and standard deviation to be 42.88±0.86 and 51.47±1.24 before and after treatment, respectively. Paired sample testing for pre-post treatment measurement of mean score of total Pediatric Evaluation Disability Inventory (PEDI) showed that mean difference and standard deviation found to be 8.59±1.48 with a significant p value 0.00. Conclusion: The findings of study concluded that vestibular stimulation has significant effect of vestibular stimulation on balance in quadriplegic cerebral palsy. Moreover, there were seen significant improvement in other domains such as behavior, emotions, psychology and interactive learning approach. Keywords: Cerebral Palsy, Quadriplegia, Child, Vestibular Stimulation INTRODUCTION Cerebral palsy is a non-progressive disorder. It is an umbrella term used for any type of damage to the immature brain. It may result in a wide range of neurological disorders involving both motor and sensory systems. It happens in the first 3 years of age. Cerebral palsy results in damage to the development of the brain which control balance, posture, and motor control.(1, 2) The problem leading to cerebral palsy is main actor in pregnancy. However, it may occur during birth or short time after birth. Mostly the cause of cerebral palsy is unknown. There are many risk factors which include preterm birth or difficult labor or delivery process. Any underlying maternal infection may lead also lead to cerebral palsy.(3) Several classifications exist based on neurological signs and topography, on motor function loss, on associated impairments, on severity of the clinical pattern and on the neuroimaging findings. For example if a child have stiff muscles it is called spastic cerebral palsy, if there is problem with balance and coordination it is called ataxic cerebral palsy. If the child has flaccid muscle tone it is labeled as flaccid cerebral palsy which is very uncommon. All the symptoms and pattern of cerebral palsy may get worse over time but the damage to the brain is permanent and do not progress with time. Cerebral palsy can be further divided into hemiplegia, diplegia and quadriplegia.(4) Quadriplegic cerebral palsy which is also called tetraplegia is a form of cerebral palsy. In this type of cerebral palsy all four limbs, trunk and face is affected. As compared to other forms quadriplegia it is not total paralysis, instead all four limbs present with every movement associated with non-coordinated, jerky, or stiff patterns. Therefore, it is more like hypertonia as compared to typical paralysis. Even among all four limbs, some limb may present with most variety of movements as compared to the other in the same patient.(5) Although the exact cause CP cannot be traced town, however, the reasons which may lead to quadriplegic CP include hypoxia, bleeding in the brain, abnormal development of brain and damage to the developing brain. Spastic quadriplegia can be diagnosed in the early days of development. A presence of primitive reflexes or delays in a baby milestone such as rolling or sitting may be suggestive of spastic quadriplegia. MRI and CT scans can detect the damaged areas in the brain and can be correlated with clinical presentations. Cerebral palsy can result in a number of associated complications. These complications include issues with balance, gait, bone development, eating disorders, language disorders, and sleep disorders.(6, 7) Balance is the fundamental component of motor control which enables to maintain a functional posture both static and dynamic. So whether it is standing or sitting or any static posture it is related to dynamic activities such as walking and running. Therefore a well-placed balance system should be there to achieve this. It is the system to maintain the center of gravity into base of support. There are many factors that contribute in establishing balance. Among these, the mechanical and neural systems are most important. In quadriplegic cerebral palsy the neural system is affected due to brain damage. Therefore, it is very important to improve or rehabilitate the balance issues in order to achieve any level of static or dynamic posture.(8, 9) The mechanical system of balance mainly includes the vestibular system. The vestibular system is very important to achieve balance and any kind of coordinated movement. In cerebral palsy due to damage to the brain it is very unlikely that there can be any progress in damaged brain and so does its supply. However, the condition can be improved by minimizing complications and stimulating the mechanical system which is the vestibular system to enhance available bsalance and coordination. Therefore vestibular rehabilitation or vestibular stimulation becomes a very important parameter for improvement in quadriplegic cerebral palsy.(10-12) METHODOLOGY It was quasi experimental study. There was single group with a pre-post testing approach. It was made ensured that all assessors where masked from treatment protocols the patients were receiving. So, it was a single blind study. The study was conducted