Effect of Coordinative Locomotor Training in Children With Cerebral Palsy

Effect of Coordinative Locomotor Training as Compared to Conventional Physio Therapy in Improving Interlimb Coordination and Dynamic Balance Among Children With Spastic Hemiplegic Cerebral Palsy

Cerebral palsy is a brain disorder that affects how children move their bodies. Children with spastic hemiplegic CP have stiffness on one side of the body, making it hard to walk and balance. This study will test a special exercise program called Coordinative Locomotor Training (CLT). CLT uses running and skating movements to train both arms and legs to work together. The investigator want to see if CLT works better than regular physiotherapy for improving coordination and balance in participants. Half of the children will do CLT, and the other half will do regular exercises. The investogar will measure their balance and walking ability before and after 4 weeks of training.

This is a double-blinded, parallel-group, randomized controlled trial conducted at the Department of Rehabilitation Sciences, The University of Faisalabad. A total of 38 children diagnosed with spastic hemiplegic cerebral palsy (GMFCS Level I-II), aged 8 to 12 years, will be recruited from pediatric physiotherapy centers. Participants will be randomly assigned (1:1 ratio) using a computer-generated randomization list to either the Experimental Group (CLT) or the Control Group (CPT). The Experimental Group (n=19) will receive Coordinative Locomotor Training based on Proprioceptive Neuromuscular Facilitation (PNF) sprinter and skater patterns. The intervention will be delivered in three postures (supine, sitting, and single-leg stand) for 3 sets of 5 repetitions with a 10-second hold and 10-second rest, lasting 30 minutes per session, 3 times per week for 4 weeks (total 12 sessions). The Control Group (n=19) will receive conventional physiotherapy consisting of hot pack application for 10 minutes, rotational exercises for 5 minutes, followed by stretching and resistance training for 15 minutes, lasting 30 minutes per session, 3 times per week for 4 weeks (total 12 sessions). The primary outcome measures are interlimb coordination (assessed via 1-step time asymmetry and stride time variability) and dynamic balance (Pediatric Balance Scale). Secondary outcomes include functional gait (TUG and 10MWT) and static balance (one-leg stand test).Participants will not know whether they are in experiment or control group. A blinded assessor will evaluate all participants at baseline (Week 0) and post-intervention (Week 8). Data will be analyzed using SPSS version 23.

Inclusion Criteria:

• Children aged 8 to 12 years.
• Diagnosed with spastic hemiplegic cerebral palsy.
• GMFCS Level I or II.
• Ability to follow simple verbal instructions.
• Medically stable with no changes in anti-spastic medication in the last 3 months.

Exclusion Criteria:

• Orthopedic surgery or Botulinum toxin injection in the last 6 months.
• Severe cognitive impairment preventing cooperation.
• Visual or vestibular deficits affecting balance.
• Uncontrolled seizures.
• Other neurological or musculoskeletal disorders unrelated to CP.