Core Strength for Head Control and Quality of Life in Cerebral Palsy

Effect of Core Strength Training on Head and Trunk Control and Quality of Life in Spastic Cerebral Palsy

The goal of this observational study is to examine the effect of an 8-week therapist-assisted core muscle strengthening program on head control, trunk stability, functional core strength, quality of life, and automatic righting reactions in non-ambulatory children with spastic cerebral palsy. The main questions it aims to answer are:

• Does head control improve over time in supine, prone, and supported sitting?
• Does segmental trunk control improve across static, active, and reactive tasks?
• Does functional cervico-trunk strength improve?
• Do automatic righting reactions change after the intervention?

Participants will:

• Take part in 24 therapy sessions over 8 weeks.
• Receive therapist-assisted core activation exercises such as bridging, modified quadruped over a bolster, supported sitting on a therapy ball with multidirectional perturbations, and assisted pull-to-sit.
• Complete assessments at baseline, week 4, and week 8 for head control, trunk control, functional strength, and righting reactions.

Researchers will compare participants' outcomes across baseline, mid-intervention, and post-intervention time points to see whether the program is associated with improvements in motor control and function.

Inclusion criteria

• Confirmed medical diagnosis of spastic cerebral palsy.
• Chronological age 4-10 years.
• GMFCS Level IV or V.
• Demonstrated impairment of head control, operationalized as a Head Control Scale score of 1 or 2 in prone, supine, or supported sitting at screening, ensuring measurable baseline deficit with biological capacity for improvement.
• Sufficient receptive cognitive and language capacity to attempt simple, modified therapeutic instructions (e.g., 'look up,' 'hold').

Exclusion criteria

• Fixed structural spinal deformity, defined as Cobb angle > 30° on most recent radiographic assessment.
• Orthopedic surgery within the preceding 12 months.
• Botulinum toxin type-A (BoNT-A) injection to trunk or cervical musculature within the preceding 6 months.
• Uncontrolled seizure disorder posing safety risk during physical exertion.
• Uncorrected severe visual or auditory impairment precluding response to therapeutic stimuli.