Review Article

Effects of Physical Therapy Management on Gross Motor Function and Spasticity among Diplegic Cerebral Palsy

Abstract

Introduction: Cerebral palsy (CP) is a leading cause of disability among the pediatric population, especially in Asia. Permanent disability is mostly due to spasticity and poor gross motor function, which adds a significant socioeconomic burden to the healthcare system. This study aims to evaluate the effectiveness of physical therapy-based interventions in improving gross motor function and reducing spasticity.
Materials and Methods: From February to July 2024, a thorough search was conducted on CINAHL, PubMed, PEDro, Web of Science and Scopus for studies assessing spasticity using the modified Ashworth scale (MAS) and gross motor function using the gross motor function measure (GMFM)-88 standing/walking dimensions in children with diplegic CP. Seventeen eligible trials were analyzed using fixed/random-effects models in MedCalc.
Results: The analysis showed significant improvements in walking ability P<0.0001 (confidence interval [CI] 95%, 0.20%, 0.50%], standardized mean differences [SMD]=0.563, Q=43.9325) and standing ability P=0.0004 (CI 95%, 0.20%, 0.50%, SMD=0.187, Q=22.5239) in the experimental group (EG), as measured using the GMFM-88. However, no significant impact was observed on any dimension of the GMFM-88 P=0.5821 (CI 95%, -0.0508%, 0.301%, SMD=0.125, Q=6.5843). According to the MAS, interventions targeting spasticity reduction showed no significant effects P=0.1018 (CI 95%, 0.20%, 0.50%, SMD=0.306, Q=10.5922).
Conclusion: This meta-analysis reveals that modified suit therapy, vibration therapy, and hippotherapy enhance standing and walking in GMFM-88 but did not reveal significant effects of physical therapy interventions in improving overall gross motor function or reducing spasticity in children with diplegic CP.

Olusanya BO, Smythe T, Ogbo FA, Nair MKC, Scher M, Davis AC. Global prevalence of developmental disabilities in children and adolescents: A systematic umbrella review. Frontiers in Public Health. 2023; 11:1122009. [DOI:10.3389/fpubh.2023.1122009] [PMID]

Lucena-Antón D, Rosety-Rodríguez I, Moral-Munoz JA. Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial. Complementary Therapies in Clinical Practice. 2018; 31:188-92. [DOI:10.1016/j.ctcp.2018.02.013] [PMID]

Maenner MJ, Blumberg SJ, Kogan MD, Christensen D, Yeargin-Allsopp M, Schieve LA. Prevalence of cerebral palsy and intellectual disability among children identified in two US National Surveys, 2011-2013. Annals of Epidemiology. 2016; 26(3):222-6. [DOI:10.1016/j.annepidem.2016.01.001] [PMID]

Arnaud C, Ehlinger V, Perraud A, Kinsner-Ovaskainen A, Klapouszczak D, Himmelmann K, et al. Public health indicators for cerebral palsy: A European collaborative study of the surveillance of cerebral palsy in Europe network. Paediatric and Perinatal Epidemiology. 2023; 37(5):404-12. [DOI:10.1111/ppe.12950] [PMID]

Chand P, Sultan T, Kulsoom S, Jan F, Ibrahim S, Mukhtiar K, et al. Spectrum of common pediatric neurological disorders: A cross-sectional study from three tertiary care centres across Pakistan. Pediatric Neurology. 2023; 138:33-7. [DOI:10.1016/j.pediatrneurol.2022.09.005] [PMID]

Ahmad A, Akhtar N, Ali H. Prevalence of cerebral palsy in children of district Swabi, Khyber Pakhtunkhwa-Pakistan. Khyber Medical University Journal. 2017; 9(2):88-91. [Link]

Rafique A, Naz H. A survey-based report on the occurrence of cerebral palsy in Urban areas of Karachi. The Journal of the Pakistan Medical Association. 2020; 70(8):1442-4. [DOI:10.5455/JPMA.28135] [PMID]

Manikowska F, Brazevič S, Jóźwiak M, Lebiedowska MK. The role of knee flexors hypertonia in the decision-making of hamstring lengthening surgery for individuals with cerebral palsy. Applied Sciences. 2022; 12(18):9210 [DOI:10.3390/app12189210]

Ayala L, Winter S, Byrne R, Fehlings D, Gehred A, Letzkus L, et al. Assessments and interventions for spasticity in infants with or at high risk for cerebral palsy: A systematic review. Pediatric Neurology. 2021; 118:72-90. [DOI:10.1016/j.pediatrneurol.2020.10.014] [PMID]

Park EY. Path analysis of strength, spasticity, gross motor function, and health-related quality of life in children with spastic cerebral palsy. Health and Quality of Life Outcomes. 2018; 16(1):70. [DOI:10.1186/s12955-018-0891-1] [PMID]

Ko J, Kim M. Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy. Physical Therapy. 2013; 93(3):393-400. [DOI:10.2522/ptj.20110374] [PMID]

Parveen S. Management and treatment for cerebral palsy in children’s. Indian Journal of Pharmacy Practice. 2018; 11(2):104-9. [DOI:10.5530/ijopp.11.2.23]

Nahm NJ, Graham HK, Gormley ME Jr, Georgiadis AG. Management of hypertonia in cerebral palsy. Current Opinion in Pediatrics. 2018; 30(1):57-64. [DOI:10.1097/MOP.0000000000000567] [PMID]

Bohn E, Goren K, Switzer L, Falck-Ytter Y, Fehlings D. Pharmacological and neurosurgical interventions for individuals with cerebral palsy and dystonia: A systematic review update and meta-analysis. Developmental Medicine and Child Neurology. 2021; 63(9):1038-50. [DOI:10.1111/dmcn.14874] [PMID]

Tekin F, Kavlak E, Cavlak U, Altug F. Effectiveness of neuro-developmental treatment (bobath concept) on postural control and balance in cerebral palsied children. Journal of Back and Musculoskeletal Rehabilitation. 2018; 31(2):397-403. [DOI:10.3233/BMR-170813] [PMID]

Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Current Neurology and Neuroscience Reports. 2020; 20(2):3. [DOI:10.1007/s11910-020-1022-z] [PMID]

Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, et al. Muscle and tendon lengthening behaviour of the medial gastrocnemius during ankle joint rotation in children with cerebral palsy. Experimental Physiology. 2018; 103(10):1367-76. [DOI:10.1113/EP087053] [PMID]

Crăciun M, Midrigan N. Effectiveness of physical therapy interventions for children with cerebral palsy. Annals of “Dunarea de Jos” University of Galati Fascicle XV, Physical Education and Sport Management. 2020; 1:21-6. [DOI:10.35219/efms.2020.1.04]

Merino-Andrés J, García de Mateos-López A, Damiano DL, Sánchez-Sierra A. Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis. Clinical Rehabilitation. 2022; 36(1):4-14. [DOI:10.1177/02692155211040199] [PMID]

Chang MC, Choo YJ, Kwak SG, Nam K, Kim SY, Lee HJ, et al. Effectiveness of extracorporeal shockwave therapy on controlling spasticity in cerebral palsy patients: A meta-analysis of timing of outcome measurement. Children. 2023; 10(2):332. [DOI:10.3390/children10020332] [PMID]

Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and extensions: A scoping review. Systematic Reviews. 2017; 6(1):263. [DOI:10.1186/s13643-017-0663-8] [PMID]

Addison AB, Wong B, Ahmed T, Macchi A, Konstantinidis I, Huart C, et al. Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction. The Journal of Allergy and Clinical Immunology. 2021; 147(5):1704-19. [DOI:10.1016/j.jaci.2020.12.641] [PMID]

Alagesan J, Shetty A. Effect of modified suit therapy in spastic diplegic cerebral palsy-a single blinded randomized controlled trial. Online Journal of Health and Allied Sciences. 2011; 9(4):1-3. [Link]

Taylor NF, Dodd KJ, Baker RJ, Willoughby K, Thomason P, Graham HK. Progressive resistance training and mobility-related function in young people with cerebral palsy: A randomized controlled trial. Developmental Medicine and Child Neurology. 2013; 55(9):806-12. [DOI:10.1111/dmcn.12190] [PMID]

Bhalara A, Talsaniya D. Short term effect of myofascial release on calf muscle spasticity in spastic cerebral palsy patients. International Journal of Health Sciences and Research. 2014; 4(9):188-94. [Link]

Ibrahim MM, Eid MA, Moawd SA. Effect of whole-body vibration on muscle strength, spasticity, and motor performance in spastic diplegic cerebral palsy children. Egyptian Journal of Medical Human Genetics. 2014; 15(2):173-9. [DOI:10.1016/j.ejmhg.2014.02.007]

Emara HA, El-Gohary TM, Al-Johany AA. Effect of body-weight suspension training versus treadmill training on gross motor abilities of children with spastic diplegic cerebral palsy. European Journal of Physical and Rehabilitation Medicine. 2016; 52(3):356-63. [PMID]

Hyun C, Kim K, Lee S, Ko N, Lee IS, Koh SE. The short-term effects of hippotherapy and therapeutic horseback riding on spasticity in children with cerebral palsy: A meta-analysis. Pediatric Physical Therapy. 2022; 34(2):172-8. [DOI:10.1097/PEP.0000000000000880] [PMID]

Lai CJ, Liu WY, Yang TF, Chen CL, Wu CY, Chan RC. Pediatric aquatic therapy on motor function and enjoyment in children diagnosed with cerebral palsy of various motor severities.Journal of Child Neurology. 2015; 30(2):200-8. [DOI:10.1177/0883073814535491] [PMID]

Jeong YA, Lee BH. Effect of action observation training on spasticity, gross motor function, and balance in children with diplegia cerebral palsy. Children. 2020; 7(6):64. [DOI:10.3390/children7060064] [PMID]

Mattern-Baxter K, Looper J, Zhou C, Bjornson K. Low-intensity vs high-intensity home-based treadmill training and walking attainment in young children with spastic diplegic cerebral palsy. Archives of Physical Medicine and Rehabilitation. 2020; 101(2):204-12. [DOI:10.1016/j.apmr.2019.09.015] [PMID]

Jha KK, Karunanithi GB, Sahana A, Karthikbabu S. Randomised trial of virtual reality gaming and physiotherapy on balance, gross motor performance and daily functions among children with bilateral spastic cerebral palsy. Somatosensory & Motor Research. 2021; 38(2):117-26. [DOI:10.1080/08990220.2021.1876016] [PMID]

Babar SS, Zafar M, Ayub G, Ahmad I, Jabbar W. The effect of rood’s ontogenic motor patterns on trunk control and balance in spastic diplegic cerebral palsy children: Effects of ROMP on trunk control and balance in CP. Journal of Health and Rehabilitation Research. 2024; 4(3):1-5. [DOI:10.61919/jhrr.v4i3.1562]

Abushameh RSR, Topcu ZG, Tunal AN, Amro A, Al Arab A. The effects of ankle mulligan mobilisation in children with cerebral palsy: A randomized single blind control study. JPMA The Journal of the Pakistan Medical Association. 2024; 74(7):1-5. [Link]

Chandler J, Churchill R, Higgins J, Lasserson T, Tovey D. Methodological standards for the conduct of new cochrane intervention reviews. Methodological Expectations of Cochrane Intervention Reviews. 2013; 3(2):1-14. [Link]

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. [DOI:10.1136/bmj.d5928] [PMID]

Makaracı Y, Soslu R, Özer Ö, Uysal A. Center of pressure-based postural sway differences on parallel and single leg stance in Olympic deaf basketball and volleyball players. Journal of Exercise Rehabilitation. 2021; 17(6):418-27. [DOI:10.12965/jer.2142558.279] [PMID]

Bingöl H, Yılmaz Ö. Effects of functional massage on spasticity and motor functions in children with cerebral palsy: A randomized controlled study. Journal of Exercise Therapy and Rehabilitation. 2018; 5(3):135-42. [Link]

Mahmood Q, Habibullah S, Babur MN. Potential effects of traditional massage on spasticity and gross motor function in children with spastic cerebral palsy: A randomized controlled trial. Pakistan journal of medical sciences. 2019; 35(5):1210. [DOI:10.12669/pjms.35.5.478]

Kwon JY, Chang HJ, Yi SH, Lee JY, Shin HY, Kim YH. Effect of hippotherapy on gross motor function in children with cerebral palsy: A randomized controlled trial. Journal of Alternative and Complementary Medicine. 2015; 21(1):15-21. [DOI:10.1089/acm.2014.0021] [PMID]

Goswami JN, Sankhyan N, Singhi P. Add-on home-centered activity-based therapy vs conventional physiotherapy in improving walking ability at 6-months in children with diplegic cerebral palsy: A randomized controlled trial. Indian Pediatrics. 2021; 58(9):826-32. [DOI:10.1007/s13312-021-2301-8] [PMID]

Katusic A, Alimovic S, Mejaski-Bosnjak V. The effect of vibration therapy on spasticity and motor function in children with cerebral palsy: A randomized controlled trial. NeuroRehabilitation. 2013; 32(1):1-8. [DOI:10.3233/NRE-130817] [PMID]

Deutz U, Heussen N, Weigt-Usinger K, Leiz S, Raabe C, Polster T, et al. Impact of hippotherapy on gross motor function and quality of life in children with bilateral cerebral palsy: A randomized open-label crossover study. Neuropediatrics. 2018; 49(3):185-92. [DOI:10.1055/s-0038-1635121] [PMID]

Gurusamy L, Balaji G, Agrahara S. A multicenter, double blind, randomized controlled trial of functional strength training on gross motor function among children with spastic diplegic cerebral palsy. Physiotherapy Quarterly. 2022; 30(4):52-8. DOI: [DOI:10.5114/pq.2022.121156]

Rasool F, Memon AR, Kiyani MM, Sajjad AG. The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial. Journal of the Pakistan Medical Association. 2017; 67(1):87-91. [Link]

Liang X, Tan Z, Yun G, Cao J, Wang J, Liu Q, et al. Effectiveness of exercise interventions for children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine. 2021; 53(4):jrm00176. [DOI:10.2340/16501977-2772] [PMID]

McIntyre S, Goldsmith S, Webb A, Ehlinger V, Hollung SJ, McConnell K, et al. Global prevalence of cerebral palsy: A systematic analysis. Developmental Medicine and Child Neurology. 2022; 64(12):1494-506. [DOI:10.1111/dmcn.15346] [PMID]

Yang G, Su H, Yang M, Chang J. The effect of physical exercise on gross motor function in children with cerebral palsy: a Meta-analysis. International Journal of Human Movement and Sports Sciences. 2022; 10:581-91. [DOI:10.13189/saj.2022.100327]

Salazar AP, Pagnussat AS, Pereira GA, Scopel G, Lukrafka JL. Neuromuscular electrical stimulation to improve gross motor function in children with cerebral palsy: A meta-analysis. Brazilian Journal of Physical Therapy. 2019; 23(5):378-86. [DOI:10.1016/j.bjpt.2019.01.006] [PMID]

Muazarroh S, Kristiyanto A, Prasetya H. Meta-analysis effectiveness of massage on spasticity in children with cerebral palsy. Indonesian Journal of Medicine. 2022; 7(2):209-18. [DOI:10.26911/theijmed.2022.07.02.09]

IssueVol 19 No 3 (2025) QRcode
SectionReview Article(s)
DOI https://doi.org/10.18502/jmr.v19i3.19083
Keywords
Diplegic cerebral palsy Spasticity Hippotherapy Myofascial release Gross motor function

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Ahmed H, Khan M, Hasnain S, Kumar R, Hussain F. Effects of Physical Therapy Management on Gross Motor Function and Spasticity among Diplegic Cerebral Palsy. jmr. 2025;19(3):211-226.