A total number of 47 participants will be included in the study. A written informed assent will be taken from the parent or guardian of the child prior to intervention which includes a detailed description of the method, procedure, benefits and risks of the training. Children will perform GMFM-88 based individualized goal-oriented training selected with the concern of family and caregivers. All children will be assessed initially based on GMFCS level and categorized into levels I, II & III. Baseline assessment will be carried out before the first session of all the recruited children using GMFM-88 to assess gross motor function, Kids-Balance Evaluation-System (Kids-BESTest) for balance & Quality of Life assessed through CPQOL questionnaire respectively. Children will be reassessed after the 16 weeks of training and re-evaluated on the 18th for residual effects after completion of 16 weeks of training. The intervention will be given 3 times per week for a duration of 40-45 minutes for each session for 16 weeks (In addition, a written home program will be given to the parents/guardians of the participants to carry out the program at home). To ensure that the parents are regularly performing exercises a WhatsApp group will be created for sending reminders. Parents will be appreciated and motivated through messages. After completing the home program parents will send a message.
Goal Oriented Exercise Protocol:
After screening the children will perform GMFM-88 based goal-oriented training assigned by trained therapists such as items of dimension D are related to standing and dimension E items are related to walking and running. 5-10 minutes of warm-up provided preliminary. Including stretching, bridging, upper and lower limb range of motions. Children will be assessed initially by using GMFM-88 and selecting specific items for individuals according to his/her needs with the help of experts and family. At least 3 items will be selected for each subject in which they score less such that 0, 1 or 2. Training based on those specific items will be given to the children. This is goal-oriented training in which, according to the needs of children training will be provided. There are 13 items in dimension D and 24 items in dimension E. At the end of the study, we analyze the children's number on each item and their improvement after the training.
Dimension D: Standing Items of dimension included such as maintaining standing with and without arms, lifting a single leg from the floor, sitting to stand, attaining standing from high kneeling, squats and picking objects from the floor.
Dimension E: Walking, Running & Jumping
Dimension E included items such as cruising, forward and backward walking, turning 180 degrees, walking on parallel and straight lines, crossing hurdles, running, kicking ball, jumping, hopping, ascending and descending stairs.MATCHING ACTIVITIES:
- The child stands with the wall support at the back and engages in catch and throw activities with his peers/therapist.
- The child stands against the wall with a table in front to be engaged in the activity.
- The child is asked to kick the ball with/without holding a parallel bar.
- For one leg standing balance, the child's one leg will be placed on the football while the other on the floor.
- Placing alternate feet on the bench of 0.5 feet in height.
- Sit to stand from the 1-foot high bench, a key point of control /assistance as needed.
- DIMENSION E (WALKING & RUNNING):
- Walking holding onto the parallel bar.
- Walking while holding a book/toy in hand.
- Motivate the child to climb up and down stairs starting with rail support and progressing to without rail support. Initially with both feet and then progress to a single foot.
- Cruising on the left and right side using furniture for support.
- Crossing over the small obstacles of varying height (child's ankle, mid calf & knee level).
- Making figures of 8 while walking.
- Jumping on the same mark.
- Hold the parallel bar with hand and kick the ball.
