Effects of Play Based Neural Mobilisation Activities on Hand Grip Strength and Dexterity in Cerebral Palsy Children

The study design will be a Randomized control trial. The data will be collected from Acme Medical complex and Rehab cure clinic. The study will be completed in 10 months after the approval of synopsis. The sampling technique will be non-probability convenient sampling. Sample size is 16 calculated by epitool. Group A will receive Routine Physical therapy with play based neural mobilization activity method and Group B will receive Routine Physical therapy with baseline treatment. Diplegic cerebral palsy girls and boys included with age limit 6-12 years and without history of injury 1 year, Patients who cannot obey commands will be excluded. Hand dynamometer and pegboard test will used as outcome tool. Single blinding will be used. Data Analysis will be done on Statistical Package for the Social Sciences (SPSS) version 23.00.

Study Overview

• Status: Recruiting
• Conditions: Cerebral Palsy
• Intervention / Treatment: Other: neural mobilization which include ulnar, median and radial nerves mobilisation by a play activity called "Simon says" in addition to the routine physical therapy treatment.; Other: Regular physical therapy

Detailed Description

Examining the UL's hand grip strength is arguably the best method to determine its overall consistency. Everybody's everyday life depends on their upper limbs. For people to function at their best, a number of sensorimotor factors are required, including hand grip strength. Dexterity is a manual skill that requires quick synchronization of voluntary gross and fine movements. It is built on a number of abilities that are developed via education, practice, and experience. It is commonly known as the "ability to use the hand in daily activities based on the anatomical integrity, sensation, coordination, strength, and dexterity." Both manual dexterity and grip strength are necessary for work-related tasks as well as play, leisure, and self-care activities. Neural mobilization (NM), a treatment approach used to treat patients with musculoskeletal disorders, has demonstrated promise in lowering pain and enhancing functionality. Combinations of joint motions that facilitate the gliding or tensioning of neural tissue make up NM, which can be carried out actively by the patient or passively by the healthcare provider. It is thought to promote axoplasmic flow, neural vascularity, and nerve gliding in relation to surrounding tissues, all of which lead to better neural functioning and, ultimately, better motor and sensory performance. The aim of study is to determine the effects of play based neural mobilization activities on hand grip strength and dexterity in cerebral palsy.

The study design will be a Randomized control trial. The data will be collected from Acme Medical complex and Rehab cure clinic. The study will be completed in 10 months after the approval of synopsis. The sampling technique will be non-probability convenient sampling. Sample size is 16 calculated by epitool. Group A will receive Routine Physical therapy with play based neural mobilization activity method and Group B will receive Routine Physical therapy with baseline treatment. Diplegic cerebral palsy girls and boys included with age limit 6-12 years and without history of injury 1 year, Patients who cannot obey commands will be excluded. Hand dynamometer and pegboard test will used as outcome tool. Single blinding will be used. Data Analysis will be done on Statistical Package for the Social Sciences (SPSS) version 23.00.

• Study Type: Interventional
• Enrollment (Estimated): 34
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: IMRAN AMJAD, PhD; Phone Number: 9233224390125; Email: imran.amjad@riphah.edu.pk
• Study Contact Backup: Name: Muhammad Asif Javed, MS-PT; Phone Number: 923224209422; Email: a.javed@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • Acme Medical center, Liaqat medical center
      • Contact: IMRAN AMJAD, PhD; Phone Number: 9233224390125; Email: imran.amjad@riphah.edu.pk
      • Contact: Muhammad Asif Javed, MS-PT; Phone Number: 923224209422; Email: a.javed@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Inclusion Criteria:

  • Diplegic cerebral palsy patients
  • Both Girls and boys included
  • Age limit 6-12 years
  • CP child with Gross Motor Function Classification System (GMFCS) level III and IV(20)
  • CP child at MACS level II and III

Exclusion Criteria:

• • Patients with history of injury in 1 year.

  • Patients who cannot obey commands
  • CP children with associated scoliosis

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A: intervention group (routine physical therapy +play based neural mobilisation); movements that are advantageous for neural mobility will be used to incorporate neural mobilization. Total 20 sessions will be performed (40 min, 3 days a week)	Other: neural mobilization which include ulnar, median and radial nerves mobilisation by a play activity called "Simon says" in addition to the routine physical therapy treatment.; treatment include muscle stretching, strengthening, gait training, Range of motion exercises for both upper and lower limbs. Group A will perform neural mobilization which include ulnar, median and radial nerves mobilisation by a play activity called "Simon says" in addition to the routine physical therapy treatment. Total 20 sessions will be performed (40 min, 3 days a week)
Active Comparator: Group B:control Group( routine physical Therapy); exercises will be stretching exercises, strengthening exercises, gait training, range of motion exercises of upper and lower limbs. Total 20 sessions will be performed (40 min, 3 days a week).	Other: Regular physical therapy; Regular physical therapy was administered to the control group along with baseline care. These workouts included upper and lower limb range of motion activities, gait training, strengthening exercises, and stretching exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hand Dynamometer for hand grip strength	Handgrip dynamometers are employed for a wide range of purposes. Assessing general strength is the most widely used method for comparing muscular function across groups, evaluating the course of wasting disorders such as sarcopenia, and even identifying prospective deficits. In order to quantify the strength of various muscles that are directly linked to a pathological condition, such as rotator cuff strength, handgrip dynamometers are also utilized as functional evaluation instruments. Handgrip dynamometers are mostly used for evaluation in the rehabilitation process, such as monitoring general rehabilitation progress or assessing the impact of a particular rehabilitation regimen aimed at a grip strength issue, such as shoulder impingement syndrome. Strong handgrips are essential for independent and fulfilling daily functioning	baseline, 16th weeks
Pegboard test for Dexterity	The functional dexterity test (FDT), a timed pegboard test that involves manipulating each peg, is appropriate for young children due to its ease of use and speed. The 16-hole wooden pegboard used for the FDT is set up in four rows of four, with each peg hole that is 2.5 cm in diameter, 3 cm deep, and 2 cm away from the neighboring peg holes. Every patient will be requested to take a seat in a chair facing the FDT pegboard on a table. The patients will be instructed to practice by flipping every peg on the board once. After the test will be completed, the examiner will note how long it take to complete the test	baseline, 16th week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Uzma Irshad, MS-PT, Riphah International University

Publications and helpful links

General Publications

• Baptista FM, Cruz EB, Afreixo V, Silva AG. Effectiveness of neural mobilization on pain intensity, disability, and physical performance in adults with musculoskeletal pain-A protocol for a systematic review of randomized and quasi-randomized controlled trials and planned meta-analysis. PLoS One. 2022 Mar 10;17(3):e0264230. doi: 10.1371/journal.pone.0264230. eCollection 2022.

Study record dates

Study Major Dates

• Study Start (Actual): October 29, 2025
• Primary Completion (Estimated): February 20, 2026
• Study Completion (Estimated): February 20, 2026

Study Registration Dates

• First Submitted: November 18, 2025
• First Submitted That Met QC Criteria: February 23, 2026
• First Posted (Actual): February 24, 2026

Study Record Updates

• Last Update Posted (Actual): February 24, 2026
• Last Update Submitted That Met QC Criteria: February 23, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Cerebral palsy, Diplegic, Exercise, Hand strength, Spastic
• Additional Relevant MeSH Terms: Neurologic Manifestations; Musculoskeletal Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Muscular Diseases; Muscle Hypertonia; Neuromuscular Manifestations; Brain Damage, Chronic; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Muscle Spasticity; Cerebral Palsy; Motor Activity
• Other Study ID Numbers: REC/RCR&AHS/UZMAIRSHAD

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No