This study aims to investigate the effects of rhythmic auditory stimulation on pain levels and range of motion in children undergoing post-fracture rehabilitation of the lower limb. It seeks to determine whether incorporating rhythmic auditory cues can help reduce pain and improve joint mobility during the recovery process.

Despite notable advancements in pediatric orthopedic rehabilitation, effective pain management and the restoration of functional range of motion continue to present significant challenges for children recovering from lower limb fractures. Traditional physiotherapy interventions largely emphasize manual therapy and structured exercise programs, often supplemented with pharmacological pain management. However, reliance on medications may lead to potential side effects and can negatively impact treatment adherence, particularly in pediatric populations. As a result, there is increasing interest in non-pharmacological approaches that can enhance rehabilitation outcomes while minimizing risks.

One such approach, Rhythmic Auditory Stimulation (RAS), has demonstrated considerable effectiveness in neurorehabilitation settings, including in conditions such as stroke, Parkinson's disease, and cerebral palsy. In these populations, RAS has been shown to improve motor coordination, regulate gait patterns, and positively influence pain perception through the use of rhythmic cues. Despite these promising outcomes, there remains a clear gap in the literature regarding the application of RAS within pediatric orthopedic rehabilitation, especially for children recovering from fractures.

Exploring the role of RAS in this specific context could provide valuable insights into its potential as an adjunct to conventional therapy. Integrating rhythmic auditory cues into rehabilitation programs may not only support improved physical outcomes, such as enhanced joint mobility and reduced pain, but also contribute to better emotional engagement and overall patient experience. Addressing this gap is essential for advancing evidence-based practice, expanding the use of innovative therapeutic techniques, and ultimately improving the quality of care and satisfaction for pediatric patients and their families.

Inclusion Criteria:

• Age range typically 5 to18 years
• Closed lower limb fracture (tibia, fibula, femur, ankle) treated non-surgically with immobilization (e.g., cast, splint, brace)
• Patients in rehabilitation stage (not immediate post-op trauma care)
• Sub-acute or post-casting phase where active ROM and gait training are clinically indicated
• Post-Fracture Stage: Within 4-6 weeks post-fracture
• Ability to Participate
• Able to follow instructions and participate in RAS sessions
• Medically stable and cleared for physical therapy.

Exclusion Criteria:

• Acute emergency management studies
• Presence of multiple fractures or other significant injuries.
• Known hearing impairments that may affect response to auditory stimulation.
• Presence of cognitive or neurological impairments that may affect participation.
• Pre-existing chronic pain conditions that may confound pain assessments.
• Recent surgeries or medical conditions that may contraindicate physical therapy or RAS.

In a quasi-experimental pre-test/post-test single-group design, full blinding is generally not feasible. Since all participants receive the same intervention and there is no comparison or control group, both the participants and the therapist are usually aware of the treatment being given, making participant and therapist blinding impractical.

However, partial blinding can still be applied. For example, the outcome assessor (the person measuring pain or range of motion) can be blinded to the study objectives or the timing of assessment (pre vs. post) to reduce measurement bias. Similarly, data analysts can be blinded to the intervention phase when analyzing results. While full blinding is limited in this design, implementing assessor or analyst blinding can still improve the validity and reliability of the study findings.