Effects of Proprioceptive Neuromuscular Facilitation and Task-Oriented Training on Upper Extremity Function in Children With Spastic Diplegic Cerebral Palsy
PNF-TOT-CP
Isolated Versus Combined Effects of Proprioceptive Neuromuscular Facilitation and Task-Oriented Training on Upper Extremity Function in Children With Spastic Diplegic Cerebral Palsy
1 other identifier
interventional
63
1 country
1
Brief Summary
Children with spastic diplegic cerebral palsy often experience upper extremity impairments, including reduced coordination, muscle control, and functional hand use, which limit independence in daily activities. Proprioceptive Neuromuscular Facilitation (PNF) and Task-Oriented Training (TOT) are commonly used rehabilitation approaches to improve motor function; however, evidence comparing their individual and combined effects on upper extremity function remains limited. This randomized controlled trial aims to compare the effects of PNF alone, TOT alone, and a combined PNF plus TOT intervention on upper extremity function in children with spastic diplegic cerebral palsy. Sixty-three children aged 6 to 12 years with Gross Motor Function Classification System (GMFCS) levels I to III will be randomly assigned to one of three intervention groups. Each group will receive supervised 45-minute treatment sessions, three times per week for six weeks. Upper extremity function, functional independence, and joint range of motion will be assessed at baseline, mid-intervention (3 weeks), and post-intervention (6 weeks) using the Melbourne Assessment of Unilateral Upper Limb Function (MA2), Pediatric Evaluation of Disability Inventory-Functional Skills Scale (PEDI-FSS), and goniometric measurements. The findings of this study are expected to provide evidence regarding the most effective rehabilitation approach for improving upper extremity function in children with spastic diplegic cerebral palsy.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P50-P75 for not_applicable
Started Feb 2026
Shorter than P25 for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
February 17, 2026
CompletedFirst Submitted
Initial submission to the registry
July 4, 2026
CompletedPrimary Completion
Last participant's last visit for primary outcome
July 5, 2026
CompletedStudy Completion
Last participant's last visit for all outcomes
July 8, 2026
CompletedFirst Posted
Study publicly available on registry
July 10, 2026
CompletedJuly 13, 2026
July 1, 2026
5 months
July 4, 2026
July 10, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (3)
Upper Extremity Function
Upper extremity function will be assessed using the Melbourne Assessment of Unilateral Upper Limb Function, Second Edition (MA2). The MA2 evaluates movement quality, dexterity, accuracy, fluency, and range of motion during functional upper limb tasks. Higher scores indicate better upper extremity function.
Baseline, Week 3, and Week 6
Functional Independence in Activities of Daily Living
Functional independence will be assessed using the Pediatric Evaluation of Disability Inventory-Functional Skills Scale (PEDI-FSS). The instrument measures the child's capability to perform age-appropriate self-care and functional activities. Higher scores indicate greater functional independence.
Baseline, Week 3, and Week 6
Upper Extremity Range of Motion
Active range of motion of the shoulder, elbow, and wrist joints will be measured using a standard universal goniometer. Measurements will be recorded in degrees to evaluate changes in joint mobility following the intervention.
Baseline, Week 3, and Week 6
Study Arms (3)
Proprioceptive Neuromuscular Facilitation (PNF)
EXPERIMENTALParticipants assigned to this arm will receive Proprioceptive Neuromuscular Facilitation (PNF) exercises targeting the upper extremity. Treatment will include upper limb diagonal movement patterns (D1 and D2 flexion and extension) to improve neuromuscular control, coordination, muscle activation, and functional movement. Each participant will receive supervised physiotherapy sessions lasting 45 minutes, three times per week for six weeks.
Task-Oriented Training (TOT)
EXPERIMENTALParticipants assigned to this arm will receive Task-Oriented Training focused on repetitive, goal-directed functional activities of the upper extremity. Intervention will include reaching, grasping, releasing, object manipulation, stacking, and other task-specific activities designed to improve upper limb function and functional independence. Each participant will receive supervised physiotherapy sessions lasting 45 minutes, three times per week for six weeks.
Combined PNF and Task-Oriented Training
EXPERIMENTALParticipants assigned to this arm will receive a combination of Proprioceptive Neuromuscular Facilitation (PNF) and Task-Oriented Training (TOT) during each treatment session. The intervention will incorporate upper extremity PNF diagonal movement patterns followed by task-specific functional training, including reaching, grasping, releasing, and object manipulation. Each participant will receive supervised physiotherapy sessions lasting 45 minutes, three times per week for six weeks.
Interventions
Participants will receive Proprioceptive Neuromuscular Facilitation (PNF) exercises for the upper extremity using diagonal movement patterns (D1 and D2 flexion and extension). Treatment is designed to facilitate neuromuscular activation, improve muscle strength, coordination, proprioception, and functional upper limb movement. Each participant will receive supervised 45-minute treatment sessions, three times per week for six weeks.
Participants will perform structured, goal-directed functional upper extremity activities including reaching, grasping, releasing, object manipulation, stacking, and other task-specific exercises. The intervention emphasizes repetitive practice of meaningful functional tasks to improve motor control, upper limb function, and independence in daily activities. Sessions will last 45 minutes, three times per week for six weeks.
Participants will receive a combined intervention consisting of Proprioceptive Neuromuscular Facilitation (PNF) followed by Task-Oriented Training (TOT) within the same treatment session. The intervention integrates upper extremity PNF diagonal movement patterns with repetitive task-specific functional activities to enhance neuromuscular control, motor learning, upper limb function, and functional independence. Each supervised session will last 45 minutes and will be delivered three times per week for six weeks.
Eligibility Criteria
You may qualify if:
- Children aged 6 to 12 years.
- Clinical diagnosis of spastic diplegic cerebral palsy.
- Gross Motor Function Classification System (GMFCS) Levels I-III.
- Ability to understand and follow simple verbal instructions.
- Medically stable and able to participate in physiotherapy sessions.
- Parent or legal guardian willing to provide written informed consent.
You may not qualify if:
- Orthopedic surgery involving the upper or lower extremities within the previous 6 months.
- Botulinum toxin injections administered within the previous 6 months.
- Severe visual, hearing, or cognitive impairments that would interfere with assessment or treatment.
- Uncontrolled epilepsy or other unstable neurological or medical conditions.
- Fixed upper extremity contractures or musculoskeletal deformities preventing participation in the intervention.
- Participation in another structured upper extremity rehabilitation program during the study period.
- Failure to obtain informed consent from a parent or legal guardian.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Helping Hand Institute of Rehabilitation
Mansehra, KPK, Pakistan
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Dr Zahid Mehmood
Ibadat International University
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- OUTCOMES ASSESSOR
- Masking Details
- Outcome assessments will be performed by an assessor who is blinded to participants' group allocation. Due to the nature of the physiotherapy interventions, participants and treating physiotherapists cannot be blinded.
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
July 4, 2026
First Posted
July 10, 2026
Study Start
February 17, 2026
Primary Completion
July 5, 2026
Study Completion
July 8, 2026
Last Updated
July 13, 2026
Record last verified: 2026-07
Data Sharing
- IPD Sharing
- Will not share
Individual participant data (IPD) will not be shared to protect participant confidentiality and privacy, as the informed consent process did not include permission for public data sharing. De-identified aggregate study results will be published in peer-reviewed journals and presented at scientific conferences. Requests for additional information regarding the study methodology or summary findings may be considered by the principal investigator in accordance with institutional policies and ethical guidelines.