Spinal Mobility in Children With Cerebral Palsy: NDT-Bobath and Exergaming

This study aims to evaluate the effects of NDT-Bobath therapy supplemented with exergaming on spinal mobility in children with cerebral palsy (CP) aged 10-15 years. Based on these calculations, a representative study sample includes 42 participants.

Eligible participants are children diagnosed by a physician with spastic diplegia (G80.1) or spastic hemiplegia (G80.2), the two most common clinical phenotypes of CP, representing approximately 35% and 25% of cases, respectively. Participants will be randomly assigned to two intervention groups:

Group I: NDT-Bobath therapy supplemented with exergaming performed in a sitting position.

Group II: NDT-Bobath therapy supplemented with exergaming performed in a standing position.

Participants' data will only be included in the final analysis if their attendance at therapy sessions is at least 85%.

The study will be conducted in four stages:

Stage I - Pilot Study:

A pilot study with 15 participants (who will not participate in the main study) will determine the optimal duration for measuring center-of-pressure sway in children aged 10-15 with CP. Postural stability will be assessed using posturography, Podoscan, and the Zebris platform. Zebris measurements will be dynamic and last 30, 60, and 90 seconds. Baseline assessments will include:

Socio-medical questionnaire covering personal, medical, physiotherapy, educational data, orthopedic equipment usage, physical and therapeutic activities, and nutrition.

Lumbar and thoracic spinal mobility in sagittal and transverse planes and kinematic chain mobility (lumbar spine, pelvic girdle, and lower limbs) using the MyoMotion system.

Cervical spine active range of motion using the CROM device in sagittal, frontal, and horizontal planes.

Body height via SECA 213 stadiometer and body composition (general and segmental fat mass, lean mass, estimated muscle mass) via Tanita bioimpedance analyzer.

Stage II - Intervention:

The intervention program will last 3 months, with 60-minute sessions twice weekly at a collaborating rehabilitation center.

Group I (sitting exergaming): NDT-Bobath therapy with exercises for muscle tone normalization in the pelvic girdle, central stability enhancement including trunk rotation, and exercises for shoulder girdle tone normalization. Therapy sessions follow three core NDT principles: facilitation, stimulation, and communication. Exergaming will be performed in a seated position with hips, knees, and ankles at 90°, allowing gradual position changes between exercises to manage child concentration.

Group II (standing exergaming): NDT-Bobath therapy with similar exercises as Group I, but exergaming performed in a standing position with appropriate posture. Session structure includes adjustments for position changes and attention management.

Participants will be classified according to compensatory patterns:

Type A/A: symmetrical antigravity pattern

Type P/P: symmetrical progravity pattern

Type A/P: mixed antigravity/progravity pattern

Exergaming will use Kinect Therapy-Based Exergames with Microsoft Kinect.

Stage III - Post-intervention Assessment:

Spinal mobility (lumbar, thoracic, cervical) will be reassessed using the same instruments as in Stage I.

Stage IV - Follow-up:

A repeat assessment identical to Stage III will be conducted 3 months after the intervention to evaluate the persistence of therapeutic effects.

Inclusion criteria

• Written informed consent from parents/guardians and the child (if capable)
• GMFCS levels I-III (mild to moderate motor limitations)
• Ability to maintain standing position
• Ability to follow instructions and perform exercises
• No prior exergaming therapy
• No implanted electronic devices
• No acute infections or inflammatory conditions
• No metabolic disorders affecting bioimpedance measurements

Exclusion criteria

• GMFCS levels IV-V
• Orthopedic surgery within the past 12 months
• Seizure episodes within the past 6 months
• Cognitive or behavioral impairments preventing cooperation
• Severe spinal deformities (scoliosis >40° or other significant changes)
• Attendance at therapy sessions <85%