Structured Graphic Motor Therapy in Pediatric CP

Upper-limb dysfunction is a major cause of activity limitation and reduced independence in children with cerebral palsy. Although conventional physiotherapy and occupational therapy improve motor performance, persistent deficits in fine motor control, visuomotor integration, and movement precision remain common. Structured Graphic Motor Therapy (SGMT) was developed as a standardized rehabilitation intervention based on principles of task-specific practice, motor learning, progressive overload, intrinsic visual feedback, and experience-dependent neuroplasticity. Rather than emphasizing artistic expression, SGMT employs individualized graphical trajectories of increasing complexity to promote coordinated upper-limb movement, continuous error correction, and sensorimotor integration.

This assessor-blinded pilot randomized controlled trial will enroll children aged 8-12 years with unilateral or predominantly unilateral cerebral palsy. Participants will be randomly assigned to receive either SGMT in addition to conventional rehabilitation or a time-matched program of conventional upper-limb rehabilitation alone. Both groups will complete four supervised 70-minute sessions per week for 16 weeks. Clinical outcomes will be assessed using the Melbourne Assessment of Unilateral Upper Limb Function (MA2) and selected Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) subtests. Exploratory quantitative image-derived measures, including the Graphic Motor Performance Index (GMPI), will also be evaluated. Assessments will be performed at baseline, Week 8, Week 16, and 12-week follow-up to determine the feasibility, safety, and preliminary effectiveness of SGMT and to generate data for a future definitive multicenter randomized clinical trial.

These sections conform well to the style typically expected by ClinicalTrials.gov: the Brief Summary is concise, while the Detailed Description explains the scientific rationale, study design, intervention, outcomes, and objectives without presenting study results.

Inclusion criteria

• Children aged 8 to 12 years. Confirmed diagnosis of cerebral palsy with unilateral or predominantly unilateral upper-limb motor impairment.

Sufficient voluntary movement of the affected upper limb to grasp and manipulate a drawing instrument on a supported horizontal surface.

Adequate visual, auditory, cognitive, and communication abilities to understand study instructions and complete standardized rehabilitation tasks.

Ability to follow standardized two-step verbal commands. Written informed consent provided by a parent or legal guardian and age-appropriate assent provided by the child.

Exclusion criteria

• Uncontrolled epilepsy. Fixed upper-limb contracture preventing completion of the intervention tasks. Orthopedic surgery involving the upper limb within the previous 6 months. Botulinum toxin injection affecting the upper limb within the previous 6 months.

Severe uncorrected visual impairment. Clinically significant upper-limb pain that interferes with task performance. Unstable medical condition that could interfere with participation. Participation in another intensive upper-limb rehabilitation program during the study period.