Documente Academic
Documente Profesional
Documente Cultură
To the
By
Arquillano, Aleck L.
Enopia, Kathlene Mae N.
Lee, Aecarah S.
Remilla, Christelle Faye T.
Villamor, Bryan Jomer G.
TABLE OF CONTENTS
Page
TITLE PAGE i
TABLE OF CONTENTS ii
CHAPTER
INTRODUCTION
Rationale 1
Theoretical Background 2
Conceptual Framework 11
THE PROBLEM
12
RESEARCH METHODOLOGY
Research Design 15
3
Research Environment 15
Research Respondents 15
Research Instruments 16
Research Procedures
Gathering of Data 18
Treatment of Data 19
DEFINITION OF TERMS 20
REFERENCES 22
APPENDICES
D RESEARCH INSTRUMENT 30
F RESEARCH BUDGET 41
G RESEARCH DOCUMENTATION 42
H RESEARCH LOCALE 43
CURRICULUM VITAE
1
Chapter 1
INTRODUCTION
Rationale
malformation that occurs while the childs brain is under developed is called
Cerebral Palsy (CP). This condition primarily affects the body movement and
muscle coordination of a child (Stern, 2017). The most common type of Cerebral
Palsy is the Spastic Cerebral Palsy, which has been reported to be over 70% of
all CP diagnosis. This is caused by the damage to the motor cortex and the
pyramidal tracts, which connects the motor cortex to the spinal cord (Bocheck,
dysfunction, which is an ability to control the facial and neck muscles which can
Although CP does not directly affect the respiratory system, this may cause
diagnosed with Cerebral Palsy. This is more than the number of patients
identified to have been diagnosed with polio, spinal lesions, and other movement
the Philippine Institute for Development Studies (PIDS), 14.63% of the population
in Batangas alone has CP (Reyes et al., 2010). Despite this condition, only the
children with cerebral palsy have decreased respiratory muscle strength and
muscle training in the lung function and the quality of life in children with Cerebral
Theoretical Background
Palsy Critical Elements of Care, 2011). Two main groupings of this disorder
resistant to flexing. Usually, the legs and the arms are the ones that are affected.
However, the mouth, the pharynx, and the tongue can also be affected; thus,
impairing the patients ability to swallow, eat, breathe, and talk. On the other
hand, in non spasticity the muscle tone is reduced. The main characteristic of
3
this type of Cerebral Palsy is the involuntary movement; it can be fast or slow
Spastic cerebral palsy is usually described by what parts of the body are
affected. Spastic Diplegia is described as the type of Cerebral Palsy with muscle
stiffness in the legs, arms less affected or not affected at all. Usually they have a
difficulty in walking because their tight hips and leg muscles causes their legs to
pull together. The second type, Spastic Hemiplegia, affects only one side of a
persons body in which the arm is more affected than the leg. The third type,
Spastic Quadriplegia, is the most severe form of Spastic Cerebral Palsy. It affects
all four limbs, the trunk, and the face. People with this type of Spastic Cerebral
Palsy often cannot walk and usually have other developmental disabilities such
vision, hearing, or speech (Center for Disease Control and Prevention, 2015).
Normally in the pharyngeal phase, food passes through and the airways
close for a moment then opens again to allow breathing. In the esophageal
phase, the food is swallowed, and the esophageal passage is recoiled and
relaxed while lower esophageal sphincter helps hold the food down. A child may
not be able to cough due to the obstructed airways. Retained secretions can
cause infection and bacterial colonization. These conditions can either lead to
lung infections or pneumonia and can further cause a lethal cycle of recurrent
If the child has a more serious case of Cerebral Palsy, the formation of the
curved spine. Deformities can make breathing and proper lung expansion
difficult, and it can affect the oxygen and nutrient consumption that can lead to
(2013), the changes associated with respiratory functions were assessed through
pressure (MIP). Mirco Direct Inc., Lewiston, ME, USA adopted the maximal
inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as a tool for
These tests assess the highest pressure that respiratory muscles are able to
in or out against the occluded mouthpiece with maximal voluntary effort and as
much force as possible while keeping the lips sealed tightly around the
breathing exercise for lung expansion therapy (2017). Many different lung
patients. However, the precise method to provide in a given situation is often not
clear because no advantage of any one method has been established. The
effective use of resources is a primary concern with any plan to apply lung
by encouraging patients to take slow, deep breaths. Moreover, the use of these
5
devices to provide visual cues to patients when the desired inspirations flow or
volume had been achieved is called Incentive Spirometry (Egans 10th edition).
bronchiectasis, sleep apnea, pneumonia, and chronic lung diseases due to the
fact that they have weak respiratory muscle strength and lower pulmonary
functions than normal healthy children and weak respiratory muscle strength.
training would improve the pulmonary functions and respiratory muscle strength
of Children with Cerebral Palsy. The study had twenty-two (22) participants with
cerebral palsy, which were assigned into two (2) randomized groups (an
experimental group and a control group). The experimental group was instructed
to perform respiratory training while the control group was put through
rehabilitation therapy for a duration of four (4) weeks, three (3) times a week.
Their forced vital capacity (FVC), peak expiratory flow rate (PEFR), forced
expiratory volume at one second (FEV1), vital capacity (VC), inspiratory reserve
volume (IRV) and expiratory reserve volume (ERV) were measured before and
after the 4-week program. The results showed improvements of the vital capacity
by 50% and 40% on the forced expiratory volume in one second of the
6
participant in the experimental group, whereas the control group had little to no
training can improve the pulmonary function of children with cerebral palsy
(2014).
development, as studied by Kwon and Lee (2015). In line with this, a study was
conducted by Kim and Lee wherein MIP was used in measuring the differences
between groups, respectively divided into an independent walking group and non
differences in MIP and MEP were found in children in the independent walking
group compared to the children in the non - independent walking group (2014). In
addition, a study was conducted by Lee and Nam, which aimed to investigate the
possible factors that can affect the forced vital capacity of children with Cerebral
Palsy. A total of thirty six (36) children with Cerebral Palsy were gathered for the
study. They had evaluated the MIP, MEP, maximal phonation time and other
variables of these children. The multiple regressions with stepwise method were
used to predict respiratory function with forced vital capacity (FVC) as the
dependent variables. MIP, MEP, together with maximal phonation time were the
independent variables. The results concluded that MIP and MEP have a close
the need for children with Cerebral Palsy to undergo respiratory muscle training,
Children with Spastic Diplegic and Hemiplegic Cerebral Palsy in Comparison with
Normal Controls. The inclusion criteria were children with Spastic Diplegic or
function test (PFT), gross motor functional status classified as I, II, III of the
GMFCS and no other neurologic disorder other than cerebral palsy. Fourteen
(14) children with Spastic Diplegic Cerebral Palsy, eleven (11) children with
Hemiplegic Cerebral Palsy and fourteen (14) children with normal developments
were gathered for this research. All children were measured for their pulmonary
function tests as well as their respiratory pressure with proper rest periods within
maneuvers. MIP, MEP, FVC, FEV1, FEV1/FVC, and PEF were measured.
Results showed that children with Hemiplegic or Diplegic Cerebral Palsy had
significantly lesser MIP and MEP compared with normal children. There were no
Palsy. In their PFT, there was a significant gap between their FVC and FEV1,
being lesser in patients with Diplegic and Hemiplegic Cerebral Palsy. These
results indicate the need for children with Spastic Diplegic or Hemiplegic
(2015).
8
done by Rothman (1978). The researchers tested ten (10) children with Cerebral
Palsy and divided them into two groups. Five (5) children were designated as the
experimental group and the other five (5) children in the control group. The
children in the experimental group would undergo respiratory exercises for seven
minutes a day, every day for eight (8) weeks while the children in the control
group would not undergo exercise training. The childrens vital capacity (VC) and
forced expiratory volume (FEV) were measured before and after the children had
conditioning the muscle used for inspiration and expiration. In addition, the
children were also taught the proper ways of breathing control. The VC and FEV
of the children of in the control group had no change before and after, whereas
the children in the experimental group had an increase of their vital capacity by
46% after the program. This indicates the benefits of respiratory muscle training
Similarly, Choi, Rha & Park (2016), conducted a study titled Change in
Cerebral Palsy. A randomized controlled study. This study aimed to explore the
benefits of the pulmonary function and maximal phonation time (MPT) after using
the incentive spirometer exercise in children with Spastic Cerebral Palsy. The
research team had recruited fifty (50) children with Cerebral Palsy who met the
9
inclusion and exclusion criteria, the subjects were randomly divided into two
groups. The researchers had all the children undergo rehabilitation therapy;
intervention. The children were to use the incentive spirometer for ten to fifteen
(10 15) breaths per session with ten (10) sessions a day for four (4) weeks.
The pulmonary function testing of the children was performed before the training
and at the end of the four (4) week using a portable spirometer. The spirometer
one second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF) and were to be
phonation time. The study concluded that there were significant improvements in
the childrens pulmonary function and maximal phonation time with the use of
incentive spirometer.
To sum it all up, the article "Effects of Exercise in People with Cerebral
(PubMed), CINAHL, Sport Discus, Science Direct, PEDro, and Google Scholar.
They had come up with fifty six (56) research articles and eight (8) review
papers. They discovered that children with Cerebral Palsy have lower levels of
reduction of their health and well-being. Furthermore, these children have greater
minute per week aerobic exercise yielded improvements in their oxygen uptake.
These findings concluded that there are improvements in these patients' Quality
deficits (2014).
Conceptual Framework
Identification of Respondents
(Children with Spastic
Cerebral Palsy in S.T.A.C.)
11
Pre-assessment:
Quality of Life using the Cerebral Palsy Quality
of Life Questionnaire and maximum inspiratory
pressure for respiratory muscle strength
Post-assessment:
Quality of Life using the Cerebral Palsy Quality
of Life Questionnaire and maximum inspiratory
pressure for respiratory muscle strength
Fig. 1.0 shows the identification of respondents, the preliminary assessment, the
quality of life using the Cerebral Palsy Quality of Life Questionnaire and their
assessment will be done after the 4-week therapy to assess their quality of life
respiratory functions and quality of life in selected children with spastic cerebral
palsy.
life among children with cerebral palsy after the 4-week respiratory
muscle training.
Children with Cerebral Palsy and their parents, that the result of this study
will provide them with the necessary information related to this condition as to
enhance their knowledge about the benefits of respiratory muscle training and its
To the community, that this study may gain awareness, not only to those
families having relatives diagnosed with Cerebral Palsy but also to the other
rehabilitation programs.
13
To the Department of Health, that this study will show the implementation
muscle training and the corresponding benefits that it may bring. In addition,
To the Rehabilitation Centers, that this study may improve the current
Therapists, Speech Pathologists, and other medical practitioners, that this study
may inform them that respiratory muscle training is also beneficial to patients with
Cerebral Palsy.
muscle training on the respiratory function and the quality of life in children with
spastic cerebral palsy, which are within the age of six (6) to twelve (12) years old.
This study will be conducted at the Stimulation and Therapeutic Activity Center in
conduct of the study. These limitations will include the possible withdrawal of
prospect respondents, the sudden conflict of schedules, the attention span of the
children, the current rehabilitation programs and the condition of the rehabilitation
the researchers will render the data of the said respondent invalid. In an event of
respondents. If conflict of schedules arises, the researchers will ensure that the
intervention will take place at the time of convenience of the respondents. The
researchers are aware that children have short attention span. As such, the
researchers shall perform activities which are both entertaining and reproducible
of relevant data. In addition, the researchers recognize that there are current
therapists, and speech pathologists. The study will be structured in a way that
does not intervene with such program. The distance from the respondent's house
to the rehabilitation center, and other factors might affect the respondent's
RESEARCH METHODOLOGY
Research Design
experimental design.
Research Environment
Center (S.T.A.C) Opon, Lapu-Lapu City, Philippines. S.T.A.C. has been taking
care of children with Cerebral Palsy and is fully capable of catering to their
needs. In addition, S.T.A.C. has the highest amount of children with cerebral
Research Respondents
Activity Center in Lapu-Lapu City, who are diagnosed with Spastic Cerebral Palsy
with ages ranging from 6 to 12 years old, and can be either male or female. The
Inclusion Criteria:
The subjects that will be included in this study are children with the age of
6-12 years that are enrolled at the Stimulation and Therapeutic Activity Center.
Also, these children are those diagnosed with Spastic Cerebral Palsy that are
Exclusion Criteria:
Children that are not within the specific age range, have undergone
such as scoliosis or kyphoscoliosis, and have other type of cerebral palsy will not
be included in the study. Other factors for exclusion are language barriers,
Research Instruments
The researchers, with the approval of the author, will use the Cerebral
Palsy Quality of Life Questionnaire for Children (CP QOL-Child) by Davis, et. al.
life for children with Cerebral Palsy. It has been developed specifically for
children with Cerebral Palsy. The CP QOL Child was developed in consultation
Disability, Access to Services and Family Health using a nine (9) - point scale
algebraic mean will determine the overall CP QOL- Child score: nine (9) as the
best score (very happy), one (1) is at the other end of the range; five (5), the
score right in the middle of the range. This test can be administered using two
17
methods, either a face to face interview or a mail out questionnaire. The scores
interpretation will be based on the questionnaire that the children will use. The
interpretation of these results involves two steps. First, the items are transformed
Table 1.0 The table shows the score with the corresponding scale in the
Score Scale
1 0
2 12.5
3 25
4 37.5
5 50
6 62.5
7 75
8 87.5
9 100
Table 1.1 The table shows a 5-point score with a corresponding scale
Score Scale
1 0
2 25
3 50
4 75
5 100
Research Procedure
18
Gathering of Data
Mayor, Marcial Ycong, to ask permission for the conduct of a study in the S.T.A.C
rehabilitation center to enlist children with spastic cerebral palsy, ages 6-12 years
Researchers will explain to the social workers the intervention and how this
study can be of help not only for patients with cerebral palsy but also for parents
who have less knowledge on their childs condition. The parents of these
interventions that researchers will be giving and the length of time needed for the
conduct of such. After obtaining the informed consent, the subjects will be asked
The intervention will make use of incentive spirometry, which can help
improve respiratory muscle strength. The instrument that the researchers will use
pressure procedure. The researchers will only instruct the subjects to inhale deep
and rapid but not forceful while occluding the hole in the mouthpiece. Thereafter,
given. The researchers will have to instruct the subjects to inhale deep and
sustain that inhalation as long as they can and repeat this procedure 10 times
19
with 5-10 mins interval or rest. Maximum Inspiratory Pressure (MIP) procedure
will be performed again to obtain post exercise result after each week. This
After 4 weeks of intervention, the researchers will gather all pre and post
Treatment of Data
DEFINITION OF TERMS
subjects before and after they will be given the interventions. It will be measured
through the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL -
with disability.
performance of the muscles involved in ventilation. This will help evaluate the
respondent will reflect their respiratory muscle strength. The pre- and post-
Incentive spirometry (IS). The type of respiratory muscle training that will
be used in the study among children with cerebral palsy in S.T.A.C. to help
improve their lung function and quality of life. The slow, deep breaths in incentive
spirometry will exercise and improve the respiratory muscle strength. Also, the
alveoli and will also facilitate airway clearance which is a great benefit to the
REFERENCES
Facts about Cerebral Palsy. (2015, July 13). Retrieved February 22,2017, from
https://www.cdc.gov/ncbddd/cp/facts.html
Kyoung, K., Young, L., & Jun, C. (2014). The effect of feedback respiratory
training on pulmonary function of children with cerebral palsy: a
randomized controlled preliminary report [Abstract].Retrieved February 9,
2017, from https://www.ncbi.nlm.nih.gov/pubmed/23897949.
Lee, H., & Kim, K. (2014).Can Walking Ability Enhance the Effectiveness of
Breathing Exercise in
Children with Spastic Cerebral Palsy? Journal Of Physical Therapy
Science,39-542. Retrieved February 21, 2017, from
http://pubmedcentralcanada.ca/pmcc/articles/PMC3996417/
McLaughlin, J., MD & Walker, W., MD. (2011,June). Cerebral Palsy (Critical
Elements of Care). Retrieved February 22,2017, from http://cshcn.org/wp-
content/uploads/files/CriticalElementsofCare-CerebralPalsy.pdf
22
Nam, K., & Lee, H. (2013).Predictive Factors Affected to Forced Vital Capacity in
http://www.kptjournal.org/journal/view.html?
uid=1062&page&pn=mostread&sort=publish_Date
%20DESC&spage&vmd=Full
Philippine Cerebral Palsy Incorporated. (n.d.). Retrieved February 17, 2017, from
http://philippinecerebralpalsy.org/about_cerebral
Priego, C., Lucas, C., Llana, B., & Perez, S. (2014). Effects of exercise in people
with cerebral palsy.A review. . Journal of Physical Education and Sport,
36-41. Retrieved February 9, 2017, from
http://roderic.uv.es/bitstream/handle/10550/36114/094249.pdf?sequence=1
Stern, K. A., Att. (2017). Types of Cerebral Palsy. Retrieved February 22, 2017,
from http://www.cerebralpalsy.org/about-cerebral-palsy/types-and-forms
Stern, K. A., Att (2017). Types of Cerebral Palsy. Retrieved February 22, 2017,
from http://www.cerebralpalsy.org/about-cerebral-
palsy/treatment/therapy/respiratory-therapy
Stern, K. A., Att. (2017). Definition of Cerebral Palsy. Retrieved February 10,
2017, from http://www.cerebralpalsy.org/about-cerebral-palsy/definition
Tilton, A., MD. (2009). Management of Spasticity in children with Cerebral Palsy.
Retrieved February 22,2017, from
http://www.americanchildneurologyuae.com/ar/files/neurological-
disease/cp/SPASTICITYCHILDREN.pdf
23
Appendix A-1
A-2
APPENDIX B
Function and Quality of Life of Children with Spastic Cerebral Palsy in Cebu City.
Investigators. Arquillano, Aleck L., Enopia, Kathlene Mae N., Lee, Aecarah S.,
Remilla, Christelle Faye T., Villamor, Bryan Jomer G., Bachelor of Science in
phone 09089874182.
Purpose and Background. The purpose of this study is to improve the lung
function and quality of life of children with cerebral palsy, and educate not only
the people with a direct relationship with children diagnosed with cerebral palsy
but also the rehabilitation centers that respiratory muscle training will improve the
lung function of the children affected. This is a study that assesses the maximum
inspiratory pressure among children with cerebral palsy before and after the 4-
condition.
2. My child will perform the Maximum Inspiratory Pressure maneuver for the
3. My child will perform the incentive spirometry and will be guided by the
Benefits. My child's participation in this study will assess his/her lung function
and quality of life and then will be given an intervention which will then improve
Risks. While performing the procedure, my child may experience discomfort and
hyperventilation but this does not affect his/her present health status.
shouldered by the researchers for any injuries acquired during the intervention,
given that my child has followed the safety procedures and pre-intervention
instructions.
Confidentiality. The data and results that will be obtained in this study will be
Except for this disclosure, all data gathered in this study will be considered
confidential and will used for research purposes only. My childs identity and I will
to me -- including the procedure, risks, benefits, and results from data gathered,
and offered to answer my questions. if I have any further questions, I can contact
her at 09089874182.
entirely voluntary, and he/she can refuse or freely withdraw at any time without
Consent. I have been given a copy of this form and had a chance to read it and I
Name of Child:
Date:
Signature of Investigator:
Appendix C
Appendix D-1
RESEARCH INSTRUMENT
Appendix D-2
RESEARCH INSTRUMENT
Date:
Spastic:_______ Nonspastic:______
If Spastic,
Hemiplegia:_______ Diplegia:_______
Name of Guardian:
Signature:
Contact Number:
39
Appendix E
RESEARCH FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT
ACTIVITIES
Assignment of
Research Mentor
Screening and
Approval of Title
Approval of
Proposal Paper
Ethical Review
Submission of
Thesis Proposal
Paper
Presentation and
Approval of the
Proposal Paper
Implementation
of the Study
Data Processing
and Analysis
Submission of
the Thesis Paper
Final Report
Oral Defense of
the Thesis Paper
Final Report
Approval of the
Revised Thesis
Paper
Approval for
Final Printing of
the Paper
Submission of
Research
Requirements
Appendix F
40
RESEARCH BUDGET
Expense/s Cost
Transportation 500.00
Appendix G
RESEARCH DOCUMENTATION
41
Appendix H
42
RESEARCH LOCALE
CURRICULUM VITAE
43
Personal Background
Address : Block 11, Lot 19 & 20, Rosal St. V&G Subdivision,
Consolacion, Cebu
Educational Background
2002-2008
Elementary level
Sotero B. Cabahug Forum for Literacy
Cebu City
2008-2012
Secondary Level
Sacred Heart School - Ateneo de Cebu
H. Abellana St., Canduman, Mandaue City
2012-Present
Tertiary Level
Bachelor of Science in Respiratory Therapy
Cebu Doctors University
Mandaue City
CURRICULUM VITAE
44
Personal Background
Educational Background
2003-2009
Elementary level
2009-2013
Secondary Level
2013-Present
Tertiary Level
Bachelor of Science in Respiratory Therapy
Cebu Doctors University
Mandaue City
45
CURRICULUM VITAE
Personal Background
Educational Background
2001-2003
Elementary Level
Marie Ernestine School
2003-2007
Elementary Level
2007-2010
Secondary Level
Maria Montessori International School
2013-Present
Tertiary Level
Bachelor of Science in Respiratory Therapy
Cebu Doctors University
Mandaue City
CURRICULUM VITAE
Personal Background
Educational Background
2002-2008
Elementary Level
St. Benedict Childhood Education Centre
Redemptorist Plaza, Cebu City
2008-2012
Secondary Level
Sacred Heart School - Ateneo de Cebu
H. Abellana St., Canduman, Mandaue City
47
2012-2013
Tertiary Level
Bachelor of Science in Pharmacy
University of San Carlos Talamban Campus
Cebu City
2013-Present
Tertiary Level
Bachelor of Science in Respiratory Therapy
Cebu Doctors University
Mandaue City
CURRICULUM VITAE
Personal Background
Educational Background
2002-2008
Elementary Level
Maria Montessori International School
San Jose Talamban, Cebu City
2008-2012
Secondary Level
Sacred Heart School - Ateneo de Cebu
H. Abellana St., Canduman, Mandaue City
48
2013-Present
Tertiary Level
Bachelor of Science in Respiratory Therapy
Cebu Doctors University
Mandaue City