Parental Experiences of Home-Based Intensive Segmental Trunk Training in Children With Cerebral Palsy

This single-arm feasibility study was conducted at a hospital in Lahore, Pakistan, to investigate parental experiences and adherence to a home-based Intensive Segmental Trunk Training (ISTT) program for children with spastic diplegic cerebral palsy (CP).

Background: Trunk control is a fundamental prerequisite for gross motor function, postural stability, and functional mobility in children with CP. Conventional clinic-based rehabilitation in Pakistan faces significant challenges including transportation barriers, high costs, and limited access to specialized pediatric physical therapy services, resulting in poor adherence and suboptimal outcomes. Home-based, caregiver-delivered programs offer a promising alternative, but evidence is limited on their feasibility and acceptability in low-resource settings.

Intervention: The ISTT program is a structured, progressive trunk stabilization protocol targeting segmental control of the cervical, upper thoracic, lower thoracic, and lumbar regions of the spine. The 12-week intervention was delivered through a hybrid model:

Week 1: In-person orientation and training session at the hospital, where a senior pediatric physical therapist taught caregivers the exercise protocol, including proper positioning, facilitation techniques, and progression criteria using both verbal instruction and practical demonstration.

Weeks 1-12: Daily home-based sessions (approximately 30 minutes), guided by a library of pre-recorded instructional videos and a picture-based manual developed specifically for this program. Exercises progressed from supported to unsupported positions and from static to dynamic tasks.

Weekly tele-supervision: Synchronous video calls between the therapist and caregiver to monitor progress, correct technique, address barriers, and adjust exercise difficulty as needed.

Monthly in-person visits: Face-to-face monitoring at the hospital for clinical reassessment, technique refinement, and reinforcement of training principles.

Participants: Twenty primary caregivers (mothers or fathers) of children aged 4-12 years with a confirmed diagnosis of spastic diplegic CP, classified at Gross Motor Function Classification System (GMFCS) levels II-IV, who were willing to commit to the 12-week program and had access to a smartphone with video-calling capability.

Outcome Measures:

Primary outcomes:

Adherence rate (percentage of prescribed sessions completed over 12 weeks) Caregiver experiences and perceptions (assessed via the KABA [Knowledge, Attitudes, Barriers, and Adherence] survey administered at baseline and week 12, and a semi-structured qualitative interview at study completion)

Secondary outcomes (pre-post comparison):

Trunk control measured by the Segmental Assessment of Trunk Control (SATCo) Gross motor function measured by the Gross Motor Function Measure-88 (GMFM-88)

Inclusion criteria

• Children aged 4-12 years with a confirmed diagnosis of spastic diplegic cerebral palsy
• Gross Motor Function Classification System (GMFCS) levels II-IV
• Primary caregiver (mother or father) willing to commit to the 12-week program
• Caregiver had access to a smartphone with video-calling capability
• Caregiver able to understand and follow instructions in Urdu or English

Exclusion criteria

• Children with uncontrolled seizures
• Children who had undergone orthopedic surgery or botulinum toxin injections in the lower extremities within the previous 6 months
• Children with severe visual or hearing impairments that would interfere with participation
• Caregivers with a diagnosed physical or mental health condition that would prevent them from safely delivering the home-based program