The goal of this randomized controlled trial is to evaluate whether intensive segmental trunk training (ISTT) can improve upper extremity function and seated postural stability in children aged 4-12 years with spastic diplegic cerebral palsy and moderate trunk control impairments. The main questions it aims to answer are:

Does intensive segmental trunk training lead to greater improvements in seated postural stability compared to standard physical therapy? Does intensive segmental trunk training lead to greater improvements in upper extremity function compared to standard physical therapy? Researchers compared the ISTT group to the control group (standard physical therapy) to see if the targeted trunk training produces significantly better outcomes in trunk control, upper extremity skills, and gross motor function.

Participants underwent their assigned training regimen five times per week for eight weeks and complete pre- and post-intervention assessments measuring trunk control (SATCo, TCT), upper extremity function (QUEST, Box and Block Test), and gross motor function (GMFM).

This single-blind randomized controlled trial investigated the efficacy of intensive segmental trunk training (ISTT) as a targeted intervention for improving seated postural control and upper limb function in children with spastic diplegic cerebral palsy (CP). Trunk control deficits are a hallmark impairment in this population, contributing to compromised upper extremity function, reduced seated stability, and limitations in activities of daily living. While conventional physical therapy often addresses trunk control indirectly, this study evaluated whether a structured, segment-specific approach yields superior outcomes.

Thirty children aged 4-12 years with spastic diplegic CP and Gross Motor Function Classification System (GMFCS) levels I-III were recruited from outpatient neurorehabilitation center. Inclusion required moderate trunk control impairment, defined as a score of ≤ 3 on the Trunk Control Test (TCT) item assessing sitting without arm support. Children with uncontrolled seizures, Botulinum toxin injections within the preceding six months, orthopedic surgery within the past year, or cognitive impairment that would preclude task comprehension were excluded.

Participants were randomly assigned to either the ISTT group (n = 15) or the control group (n = 15) using a sealed envelope method with concealed allocation. The ISTT group received specialized training targeting segmental trunk control at the thoracic, lumbar, and pelvic levels. Training sessions, conducted five times weekly for eight weeks (40 sessions total, 45 minutes each), incorporated graded exercises progressing from static to dynamic sitting balance. Key ISTT components included pelvic tilt facilitation, isolated thoracic and lumbar segmental mobilization during weight shifting, trunk rotation with reaching tasks, and perturbation-based reactive balance training using a tilt board. Exercises were progressively advanced based on individual tolerance and performance.

The control group received standard physical therapy of equal duration and frequency, emphasizing neurodevelopmental treatment (NDT) principles, passive stretching of lower extremity muscles, strengthening of the lower limbs, and gait training.

Outcome measures were assessed at baseline, immediately post-intervention (week 8), and at a four-week follow-up. The primary outcomes were seated postural stability, measured by the Segmental Assessment of Trunk Control (SATCo) and the Trunk Control Test (TCT). Secondary outcomes included upper extremity function, assessed via the Quality of Upper Extremity Skills Test (QUEST) and the Box and Block Test (BBT), and gross motor function, measured by the Gross Motor Function Measure (GMFM-88). All assessments were performed by a blinded pediatric physical therapist.

A priori sample size calculation was performed based on pilot data with an effect size of 0.6, alpha of 0.05, and power of 0.80, yielding a minimum of 13 participants per group. Between-group differences were analyzed using repeated measures ANOVA, with post-hoc Bonferroni corrections. Within-group pre-post comparisons used paired t-tests. Effect sizes were calculated using Cohen's d.

The study was approved by the institutional ethics committee. Written informed consent was obtained from parents or legal guardians.

Inclusion Criteria:

Participants included were aged 4-12 years, classified under Gross Motor Function Classification System (GMFCS) Levels II-IV, with ability to sit independently for at least 10 seconds and follow simple verbal instructions. Children with trunk control scores within a moderate impairment range on the Trunk Control Test (TCT) and Segmental Assessment of Trunk Control (SATCo) were included. Parental consent was obtained prior to participation.

Exclusion Criteria:

Children with cognitive impairments severe enough to limit task comprehension, uncontrolled seizures, history of surgical interventions or Botulinum toxin injections in the preceding 6 months, and those receiving other therapeutic interventions targeting trunk control or upper limb function concurrently were excluded.

Data related to underlying results, without personal identification, of the individual will be shared on demand. The datasets generated during and/or analysed during the current study will be available upon request from Dr. Iqra Khan, PT, with email address: iqrakhan485@gmail.com Researchers who will provide a reason with proposal of their study can get access

Immediately following publication and with no end date.

The datasets generated during and/or analysed during the current study will be available upon request from Dr. Iqra Khan, PT, with email address: iqrakhan485@gmail.com