The goal of this clinical trial is to determine whether virtual reality (VR) training using the Nintendo Wii Fit can improve balance, gross motor function, and agility in children aged 7-14 years with spastic cerebral palsy (GMFCS Levels I-II). The main questions it aims to answer are:

Does Wii Fit-based VR training improve balance more than conventional physiotherapy?

Does VR training enhance gross motor skills such as standing, walking, running, and jumping?

Does VR training improve agility in children with cerebral palsy?

Does VR training increase enjoyment and engagement during therapy?

Researchers will compare Wii Fit-based VR training with conventional physiotherapy to determine which approach leads to greater improvements in motor function.

Participants will:

Attend 18 sessions over 6 weeks (3 sessions per week).

Perform either VR-based exercises using the Wii Fit Balance Board or traditional physiotherapy exercises.

Complete pre- and post-intervention assessments using the Pediatric Balance Scale, GMFM-88 (domains D and E), BOT-2 agility subtest, and the PACES enjoyment scale.

This study aims to explore a fun, cost-effective, and engaging rehabilitation strategy that may improve functional independence and overall quality of life for children with cerebral palsy.

This clinical trial aims to evaluate the effects of virtual reality training using the Nintendo Wii Fit on balance, gross motor function, agility, and enjoyment in children with spastic cerebral palsy. Cerebral palsy commonly affects motor control, posture, coordination, and mobility, and children often require long-term physiotherapy to improve their functional independence. While traditional physiotherapy is effective, many children struggle with motivation, participation, and engagement during repetitive therapeutic exercises. Virtual reality-based interventions are emerging as a fun, interactive, and affordable way to increase motivation and enhance motor learning in pediatric rehabilitation.

In this study, children aged 7 to 14 years with spastic cerebral palsy (GMFCS Levels I-II) will be randomly assigned to either Wii Fit-based virtual reality training or conventional physiotherapy. The intervention will last 6 weeks, with sessions held three times per week. The virtual reality group will perform selected Wii Fit games that specifically target balance, coordination, strength, motor planning, and agility. These include Table Tilt, Balance Bubble, Perfect 10, Super Hula Hoop, Obstacle Course, Ultimate Obstacle Course, Ski Jump, and Basic Step. Each session consists of a warm-up phase, 20 minutes of Wii Fit gameplay, and a cool-down period. Game difficulty will progressively increase as the child's performance improves, while therapists will ensure safety and provide encouragement.

The control group will receive conventional physiotherapy, which includes strengthening exercises, gait training, dynamic and static balance tasks, and functional task-oriented activities. Both groups will receive an equal number of sessions with similar session duration to ensure fairness in comparison.

Outcome measures include the Pediatric Balance Scale (balance), GMFM-88 domains D and E (standing, walking, running, jumping), BOT-2 Running Speed and Agility Subtest (agility), and the Physical Activity Enjoyment Scale. Assessments will be conducted before and after the 6-week intervention by trained assessors who are blinded to group allocation.

This study aims to address the lack of comprehensive research evaluating the combined effects of virtual reality on multiple motor skills in children with cerebral palsy, particularly in Pakistan. By comparing Wii Fit training with conventional physiotherapy, the study seeks to determine whether VR offers a more engaging, motivating, and effective rehabilitation option. If successful, the findings may support the use of low-cost, accessible virtual reality tools in pediatric therapy settings to improve functional outcomes, engagement, and quality of life for children with cerebral palsy.

Inclusion Criteria:

• ● Children aged 7 to 14 years

  • Diagnosed cases of spastic diplegic CP, characterized by bilateral lower limb involvement
  • Classified under GMFCS levels I to II.
  • Having mild to moderate spasticity on Modified Ashworth Scale (MAS) scores ranging from 1, +1 or 2
  • Mild level intellectual disability according to their health records
  • Medically stable with no acute illness or uncontrolled comorbidities
  • No major changes in medication or therapy planned during the study period.

Exclusion Criteria:

• ● Orthopedic surgery or botulinum toxin injections in the past 16 months

  • Hearing or visual impaired .
  • Uncontrolled epilepsy or seizures
  • Severe attention deficits or psychological issues interfering with task engagement such as attention deficit hyperactivity disorder (ADHD), Autism Spectrum Disorder (ASD) will be excluded from the study .