الفهرس 
CEREBRAL PALSYOnly 14 pages are availabe for public view
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Abstract
Cerebral palsy (CP) describes a group of disorders of posture and movement that occur as a result of a non-progressive disturbance in the developing fetal or infant brain .Balance is an important element of a children with spastic CP which describe the ability of the child to safely and independently function in a variety of environments. Environmental adaptation and social participation of children CP is influenced by both their functional skills and environmental factors despite these children generally participate in less physical activity than their able-bodied peers but still better environment and that a supportive, accessible environment is a predictor of better life. Measures normed for children with cerebral palsy (CP) enable families and professionals to monitor development based on expectations for children of the same age and functional level. CP refers to a group of neurological disorders affecting the development of posture and movement that are often accompanied by disturbances of sensation, cognition, communication, perception, and behavior .Children with CP demonstrate considerable variation in development as evidenced by the gross motor function manual ability and communication function classification systems.
Cerebral palsy is the most common cause of motor disability in childhood that restricts children’s participation in daily life. Several associated impairments with CP often present include sensory disturbance, cognitive function impairment, disorders of communication, and perception. Seizures and behavioral disorders are also common .
Unfortunately, The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems
The underlying etiology, timing of injury, manifestations of the motor disorder and associated conditions can vary greatly.
Balance deficits are one of the most common problems for spastic cerebral palsy .Children with cerebral palsy (CP) have limitations with postural control and anticipatory postural adjustments. Their capacity to sit,stand and walk independently are delayed which interfere with daily life activities. Balance is the basis of motor function. can be defined as the ability to control the body’s position in space for the purposes of stability and orientation.
Postural stability, or balance, is the ability to maintain and/or regain a controlled body position while performing tasks or activities .children need the ability to maintain controlled positions during both static and dynamic activities the centre of mass within the base of support where gravity is the key vector. During movement center of mass is appoint which substitute the whole body stability .
Stability tasks can be considered static, when the body is static without moving (e.g. when sitting or standing on a stable surface) , or dynamic , when the body is moving, either during self-initiated internal stimuli (e.g. walking ) , or in response to external stimuli initiated by other people or objects (e.g. being pushed, or maintaining a stance on a moving bus).
Postural orientation is the ability to attain and maintain an optimal functional relationship between body segments, a task, and the environment (e.g. for writing, reaching, or looking).
Environmental adaptation and environmental factors are the master on functioning and disability processes Despite this children with a disability generally participate in less physical activity than their able-bodied peers and it is critical to identify interventions that create meaningful long-term change in child and family physical activity behaviours .
Several studies have shown that some environmental factors such as lack of physical and emotional support, inaccessibility of the physical environment, and negative attitudes affect participation of children with CP, This also found that the physical, social, and attitudinal environment influences participation of children with CP, understood as their involvement in diverse life areas.
Aim of work:
To assess balance and quality of life in children with spastic CP
Methodology:
The study was conducted on children with spastic cerebral palsy attending the clinics of Faculty of Postgraduate Childhood Studies Ain Shams University and in the clinics of Childhood Disabilities Center Al-Azhar University from 1 st of January 2018 till 30 th of June 2019 .
Total number of fifty six spastic cerebral palsy children from both sexes participated in this study . All participants were subjected to full clinical examination, neurological examination, functional motor skills by GMFMCS anaGMFM-66 , balance assessment by PBS and SCALE and to assess the effect of level of motor impairments and quality of life in children with spastic CP.
Results:
there was statistically significant correlation between GMFM-66 and PBS at P value =0.01, r=0.89, very strong association. Also statistically significant correlation between GMFM-66 and SCALE p value =0.01 =0.65,
strong association. There is statistically significant correlation between GMFM-66 and QOL p value =0.01 r=0.534 strong association .That SCALE and PBS tools as regard GMFM-66 can distinguish between different functional balance and different levels motor impairments in children with CP and are considered a simple, valid scale for examining functional balance in children with spastic CP. In addition, Quality of life (QOL) of children with spastic cerebral palsy was affected by level of motor impairments and more effective tool in children with CP above seven years old
Conclusion:
PBS and SCALE are valid tools to assess balance in children with spastic CP. Environmental adaptation and social participation of children CP is influenced by both their functional skills and affect quality of life
Recommendations
-The results of this research program will be of interest to many different researches to Evaluate the treatment effect, improve the health care processes and improve health, quality of life, and social participation in this population .