This study will be conducted to investigate the combining effect of weight-bearing exercises program with neuromuscular electrical stimulation on balance and functional abilities in children with hemiplegic cerebral palsy.

Hemiplegic cerebral palsy (HCP) is characterized by unilateral motor impairment, with the upper extremities typically exhibiting greater functional limitations compared to the lower limbs. This subtype constitutes approximately 20-30% of cerebral palsy cases and arises from unilateral injury to the developing brain, resulting in asymmetrical muscle tone abnormalities, joint deformities, and restricted range of motion. Individuals with HCP often display irregular, uncoordinated movements on the affected side, significantly impacting motor performance. Children with spastic hemiplegia experience decreased balance ability and abnormal gait because of decreased weight-bearing in the paretic leg. Diminished motor ability in the paretic leg causes weakening of the quadriceps, ankle plantar flexors, and ankle dorsiflexors.

The rehabilitation of balance and walking ability is crucial for children diagnosed with cerebral palsy. Weight-bearing exercises are defined as physical activities in which the feet and legs support the body's weight while moving against gravity. These exercises are essential for stimulating bone growth, improving bone density, and enhancing musculoskeletal health. Examples of weight-bearing exercises include walking, running, jumping, dancing, climbing stairs, playing sports such as soccer or basketball, and engaging in recreational activities like hiking or skating. Regular participation in weight-bearing exercises is particularly important for children and adolescents, as it helps maximize peak bone mass during growth and reduces the risk of osteoporosis later in life.

Exercise programs for cerebral palsy exhibit significant variation in terms of their types, such as gait training, body-weight-supported treadmill training, balance training, or multi-component approaches, and the efficacy of different exercises has not been established in improving the functional abilities of children with cerebral palsy. Studies suggest that integrating neuromuscular electrical stimulation (NMES) with conventional rehabilitation approaches enhances therapeutic outcomes compared to using NMES in isolation .

Inclusion Criteria:

• Children diagnosed with hemiplegic cerebral palsy.
• Their age will range from 6-10 years.
• Both sexes will be included.
• All participants will be able to follow simple commands.
• They will be graded as mild spasticity of the lower limbs according to MAS grade 1 to 1+ .
• They will be at levels I and II based on the GMFCS

Exclusion Criteria:

• Children with any neurological conditions other than hemiplegic cerebral palsy will be excluded from the study.
• Musculoskeletal problems or congenital deformity.
• Children with fixed contracture.
• Lower limb surgery in the last one year.
• Rhizotomy, or injection of botulinum toxin into the lower limb muscles during the previous 6 months.
• Receive any medications that affect the arousal and alertness status.
• Children having epilepsy.
• Visual or auditory defects.
• Skin sensitivity.

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