The Effects of Intensive Physiotherapy in Children With Spastic Cerebral Palsy

January 13, 2026 updated by: Fatma Hazal Ağbaba, Medipol University

The Effects of Intensive Physiotherapy on Postural Control and Selective Motor Control of the Upper and Lower Extremities in Children With Spastic Cerebral Palsy

The aim of this study is to investigate the effects of a 2-week Neurodevelopmental Treatment (NDT)-based intensive physiotherapy program with active participation on postural control and selective motor control of the lower and upper extremities in children diagnosed with spastic cerebral palsy.

Thirty children with spastic type cerebral palsy, aged between 4 and 8 years, and classified as level II, III, or IV according to the Gross Motor Function Classification System (GMFCS), will be included in the study. Participants will be randomized into two groups.

The experimental group will receive an NDT-based intensive physiotherapy program with active participation for 2 weeks, 6 days per week, 2 sessions per day, with each session lasting 50 minutes. The control group will receive a conventional physiotherapy program for 2 weeks, 3 days per week, once per day, with each session lasting 45 minutes.

Outcome measures will be assessed before and after the intervention period and will include the Seated Postural Control Measure-Function (SPCM-Function), Selective Control Assessment of the Lower Extremity (SCALE), Selective Control of the Upper Extremity Scale (SCUES), Modified Ashworth Scale (MAS), Gross Motor Function Measure-88 (GMFM-88) and the Pediatric Quality of Life Inventory (PedsQL).

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study was not prospectively registered in a public trials registry. Registration was completed retrospectively after data collection had been completed.

Study Type

Interventional

Enrollment (Actual)

30

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
      • Istanbul, Turkey (Türkiye)
        • Istanbul Medipol University Department of Physiotherapy and Rehabilitation

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Children aged 4-8 years,
  • No Botulinum Toxin type A injections within the last 6 months,
  • No orthopedic surgical intervention within the last 12 months,
  • Able to understand simple verbal commands and cooperate,
  • Diagnosed with cerebral palsy,
  • Spastic clinical type,
  • Classified as Gross Motor Function Classification System (GMFCS) levels II, III, and IV.

Exclusion Criteria:

  • Failure to participate regularly in the treatment program,
  • Failure to participate in pre- and post-treatment assessments,
  • Children who were severely distressed, crying excessively, or uncooperative.
  • Children who have cognitive problems,
  • Children who have active seizures.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intensive Physiotherapy Program

Participants in the experimental group received a 2-week intensive physiotherapy program based on Neurodevelopmental Treatment (NDT) principles with active participation.

Frequency: 6 days per week Sessions: 2 sessions per day Session duration: 50 minutes Total sessions: 24

Intervention components included:

  • Weight-shifting and reaching activities in crawling, sitting, kneeling, and standing positions
  • Functional and symmetrical reaching tasks in different postures
  • Actively assisted transitions between postures
  • Balance training and facilitation of protective reactions in various positions
  • Core stabilization exercises
  • Isolated strengthening exercises for upper and lower extremities
  • Proprioceptive training exercises
Behavioral: Neurodevelopmental Therapy

Intervention components included:

  • Weight-shifting and reaching activities in crawling, sitting, kneeling, and standing positions
  • Functional and symmetrical reaching tasks in different postures
  • Actively assisted transitions between postures
  • Balance training and facilitation of protective reactions in various positions
  • Core stabilization exercises
  • Isolated strengthening exercises for upper and lower extremities
  • Proprioceptive training exercises

Frequency: 6 days per week Sessions: 2 sessions per day Session duration: 50 minutes Total sessions: 24
Experimental: Conventional Physiotherapy Program

Participants in the control group received a 2-week conventional physiotherapy program.

Frequency: 3 days per week Sessions: 1 session per day Session duration: 45 minutes Total sessions: 6

Intervention components included:

  • Stretching and strengthening exercises
  • Passive and active range of motion exercises
  • Balance and coordination exercises in different positions
  • Electrotherapy applications
Behavioral: Conventional Therapy

Intervention components included:

  • Stretching and strengthening exercises
  • Passive and active range of motion exercises
  • Balance and coordination exercises in different positions
  • Electrotherapy applications

Frequency: 3 days per week Sessions: 1 session per day Session duration: 45 minutes Total sessions: 6

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Seated Postural Control Measure
Time Frame: Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
Seated Postural Control Measure (SPCM) evaluates static, active, and reactive trunk control at different trunk segments in a supported sitting position. It identifies the highest trunk level at which independent postural control is achieved in children with cerebral palsy. SPCM consists of three sub scales. In this study only function subscale will be used. The Function subscale of the Seated Postural Control Measure consists of 12 items evaluating head and trunk control during sitting, reaching, grasping and releasing, bimanual use, and wheelchair mobility. Each item is scored on a 4-point ordinal scale ranging from 1 to 4 points, with higher scores indicating better task performance. The total score of the Function subscale ranges from a minimum of 12 points to a maximum of 48 points.
Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
The Selective Motor Control of the Upper Extremity
Time Frame: Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
The Selective Control of the Upper Extremity Scale (SCUES) selective voluntary motor control of the shoulder, elbow, forearm, wrist, and fingers during functional tasks in children with cerebral palsy. Higher scores indicate better selective motor control of the upper extremities.Selective motor control (SMC) is graded for each joint using a four-point ordinal scale: 3 points indicate normal selective motor control, 2 points- mildly impaired SMC, 1 point-moderately impaired SMC, 0 points- absence of SMC. For each upper extremity maximum point is 15.
Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
The Selective Motor Control of the Lower Extremity
Time Frame: Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
The Selective Control Assessment of the Lower Extremity (SCALE) evaluates the ability to perform isolated voluntary movements at the hip, knee, ankle, subtalar joint, and toes independently of mass synergistic patterns in children with cerebral palsy.Higher scores indicate better SMC of the lower extremities.2 points- normal SMC, 1point impaired SMC, and 0 points unable to perform. For each lower extremity maximum point is 10.
Baseline (pre-intervention) and immediately after completion of the 2-week intervention.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Gross Motor Function Measure-88 (GMFM-88)
Time Frame: Baseline (pre-intervention) and immediately after completion of the 2-week intervention.

The Gross Motor Function Measure-88 (GMFM-88) evaluates changes in gross motor function, including lying and rolling, sitting, crawling and kneeling, standing, and walking, running, and jumping in children with cerebral palsy. The Gross Motor Function Measure-88 consists of 88 items and is administered through observation of motor performance by a physiotherapist in children with cerebral palsy.

Each item is scored on a 4-point ordinal scale as follows:

0 - Does not initiate the movement,

  1. - Initiates the movement (<10% of the task),
  2. - Partially completes the movement (10-90% of the task),
  3. - Completes the movement independently. Scores for each dimension are calculated as percentages. The total GMFM-88 score is obtained by averaging the five dimension percentage scores (0-100). Higher percentage scores indicate better gross motor function.
Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
Modified Ashworth Scale (MAS)
Time Frame: Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
The Modified Ashworth Scale (MAS) assesses muscle spasticity of the upper and lower extremities by measuring resistance during passive movement. Muscle tone is assessed using the Modified Ashworth Scale, which grades resistance to passive movement on an ordinal scale ranging from 0 to 4, where 0 indicates no increase in muscle tone and 4 indicates rigidity in flexion and extension of the affected part. Higher scores indicating greater spasticity.
Baseline (pre-intervention) and immediately after completion of the 2-week intervention.
Pediatric Quality of Life Inventory (PedsQL)
Time Frame: Baseline (pre-intervention) and immediately after completion of the 2-week intervention.

The Pediatric Quality of Life Inventory assesses health-related quality of life in children with cerebral palsy through age-appropriate parent-report and child self-report forms.Items on the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales are reverse scored and linearly transformed to a 0-100 scale, where higher scores indicate better health-related quality of life. Item scoring is performed as follows:

0 ("Never") = 100

  1. ("Almost Never") = 75
  2. ("Sometimes") = 50
  3. ("Often") = 25
  4. ("Almost Always") = 0 Scale scores are calculated as the mean of the completed item scores. To account for missing data, a scale score is computed only if at least 50% of the items are completed. If more than 50% of items are missing, the scale score is not calculated.
Baseline (pre-intervention) and immediately after completion of the 2-week intervention.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Medipol University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 15, 2020

Primary Completion (Actual)

March 1, 2021

Study Completion (Actual)

March 1, 2021

Study Registration Dates

First Submitted

December 28, 2025

First Submitted That Met QC Criteria

January 13, 2026

First Posted (Actual)

January 20, 2026

Study Record Updates

Last Update Posted (Actual)

January 20, 2026

Last Update Submitted That Met QC Criteria

January 13, 2026

Last Verified

December 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 10840098-604.01.01-E.5016

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Cerebral Palsy (CP)

Clinical Trials on Neurodevelopmental Therapy

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Mali

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe