Effects of DMI vs Bobath on Neuromuscular Development in CP

NCT07238634 | Recruiting DMC

• 1 other identifier: UBS24LMSPT027
• Study Type: interventional
• Target: 58
• Locations: 1 country
• Sites: 1

Brief Summary

Cerebral palsy (CP) is a leading cause of permanent motor disability in children, resulting from non-progressive disturbances to the developing brain. Prematurity and low birth weight are major risk factors, with infants under 1500 g having a markedly higher risk. Spastic CP is the most common subtype, and spastic diplegia accounts for 30-40% of cases, primarily affecting the lower limbs and trunk control. CP prevalence has declined in high-income countries but remains higher in low- and middle-income regions, including Pakistan. Beyond clinical challenges, CP imposes a substantial lifelong economic burden. Current management follows the ICF framework, emphasizing function, participation, and independence. Traditional approaches such as the Bobath method show limited evidence compared with task-oriented therapies. Dynamic Movement Intervention (DMI) is a neuroplasticity-based, task-oriented approach emphasizing repetitive functional activities. Trunk-focused dynamic training has shown superior improvements in balance and gross motor function. However, comparative evidence between DMI and Bobath therapy in young children is limited, necessitating further research using validated outcome measures.

Conditions

Bobath Therapy; Dynamic Movement Intervention

Keywords

Dynamic Movement Intervention; Bobath Therapy; Spastic Cerebral Palsy

Outcome Measures

Primary Outcomes (3)

• Gross Motor Function Measure-88 (GMFM-88)

  A standardized observational tool used to assess changes in gross motor function across five dimensions, including lying, sitting, crawling, standing, and walking, specifically designed for children with cerebral palsy.

  12 weeks

• Shoaib Sensorimotor Development Tool (SSDT)

  A specialized tool designed to assess sensorimotor development in children, including sensory integration, motor planning, and coordination. It provides insight into neuromotor function beyond gross motor skills.

  12 weeks

• Trunk Impairment Scale (TIS)

  Evaluates trunk control through assessments of static sitting balance, dynamic sitting balance, and trunk coordination. It is essential for measuring core stability and postural control improvements.

  12 weeks

Study Arms (2)

Group A

EXPERIMENTAL

Other: Dynamic Movement Intervention

Group B

ACTIVE COMPARATOR

Other: Bobath Therapy

Interventions

Dynamic Movement Intervention OTHER

Participants will receive Dynamic Movement Intervention (DMI) consisting of task-specific, structured, repetitive, and progressively challenging exercises designed to improve neuromuscular control. The intervention will be delivered for 12 weeks, with evaluations at baseline (week 0), mid-intervention (week 6), and post-intervention (week 12). DMI sessions will include dynamic tasks such as rolling on soft or unstable surfaces to promote trunk rotation and segmental control; sitting balance training on therapy balls or foam pads with perturbations to activate trunk and head righting responses; and trunk stability exercises in quadruped and kneeling positions to enhance coordination and proprioception. Standing activities on balance discs or BOSU balls will target weight shifting, small squats, and multidirectional reaching for balance control, while walking tasks on varied surfaces(foam mats, tactile paths and beams)will challenge gait, coordination, and postural alignment.

Group A

Bobath Therapy OTHER

Participants in this group will receive therapy based on the Bobath Concept (Neurodevelopmental Treatment), an evidence-informed, problem-solving approach designed to facilitate normal movement patterns, inhibit abnormal tone, and improve postural control and functional mobility in children with spastic cerebral palsy. The intervention will be implemented over 12 weeks, with evaluations at baseline (week 0), mid-intervention (week 6), and post-intervention (week 12). The Bobath approach emphasizes individualized handling and facilitation techniques aimed at enhancing postural alignment, balance reactions, and coordinated functional movements. The therapist uses guided facilitation at key points of control-such as the pelvis, trunk, and shoulders-to promote normal movement synergies and reduce the influence of spasticity or abnormal reflex patterns.

Group B

Eligibility Criteria

• Age: 2 Years - 4 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Diagnosed with spastic diplegic cerebral palsy.
• Gross Motor Function Measurement Scale (GMFC) level I to III.
• Children who have head control.
• Ability to understand and follow simple instructions.

You may not qualify if:

• Visual or hearing impairments (e.g., cataract, myopia, deafness).
• Cognitive problems impacting participation.
• Uncontrolled convulsions or recent seizure activity.
• Orthopedic surgeries of the lower limbs, such as dorsal rhizotomy within the last year.

Sponsors & Collaborators

• Lahore University of Biological and Applied Sciences: lead

Study Sites (1)

Ghurki Trust Teaching Hospital

Lahore, Punjab Province, Pakistan

RECRUITING

Related Publications (2)

• Park EY, Kim WH. Effect of neurodevelopmental treatment-based physical therapy on the change of muscle strength, spasticity, and gross motor function in children with spastic cerebral palsy. J Phys Ther Sci. 2017 Jun;29(6):966-969. doi: 10.1589/jpts.29.966. Epub 2017 Jun 7.

  PMID: 28626301 RESULT

• Sah AK, Balaji GK, Agrahara S. Effects of Task-oriented Activities Based on Neurodevelopmental Therapy Principles on Trunk Control, Balance, and Gross Motor Function in Children with Spastic Diplegic Cerebral Palsy: A Single-blinded Randomized Clinical Trial. J Pediatr Neurosci. 2019 Jul-Sep;14(3):120-126. doi: 10.4103/jpn.JPN_35_19. Epub 2019 Sep 27.

  PMID: 31649770 RESULT

MeSH Terms

Conditions

Cerebral Palsy

Condition Hierarchy (Ancestors)

Brain Damage, Chronic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases

Central Study Contacts

Atiqa Niamat

CONTACT

03039559523; atiqaniamat09@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: Interventional Study Model: Randomized Clinical Trial (Parallel-Group Design): This study will adopt a randomized clinical trial (RCT) model, employing a parallel-group design to evaluate and compare the effects of two physiotherapeutic interventions-Dynamic Movement Intervention (DMI) and the Bobath (Neurodevelopmental) Approach-on neuromuscular development in children with spastic cerebral palsy. Participants who meet the inclusion criteria will be randomly assigned into two groups: Group A (Experimental Group): will receive Dynamic Movement Intervention (DMI). Group B (Control Group): will receive therapy based on the Bobath Approach. Both groups will undergo intervention sessions of equal duration and frequency under standardized conditions. Pre- and post-intervention assessments will be conducted using validated neuromuscular and functional outcome measures to ensure objectivity.

Study Record Dates

• First Submitted: November 16, 2025
• First Posted: November 20, 2025
• Study Start: January 5, 2026
• Primary Completion (Estimated): June 10, 2026
• Study Completion (Estimated): June 10, 2026
• Last Updated: January 12, 2026

Record last verified: 2026-01

Locations

PA (1)