Active Participation-Neuro-Developmental Therapy on Gross Motor Function in Low Functioning Children with Cerebral Palsy: A Single-Blinded Randomized Controlled Study

Objectives Evidence on the benefits of Bobath therapy or neurodevelopmental therapy (NDT) in children with cerebral palsy (CP) is available elsewhere. However, there is limited evidence for low-functioning children with cerebral palsy. The study aimed to evaluate the effectiveness of active participation in NDT (AP-NDT) compared to passive physiotherapy intervention (PPI) in promoting gross motor function in children aged 2 to 4 years with cerebral palsy at Gross Motor Function Classification System (GMFCS) levels IV and V. Material and Methods This single-blinded randomised clinical trial recruited 56 children with CP aged between 2 and 4 years with GMFCS levels IV (n=26) and V (n=30), were randomly allocated into two groups, AP-NDT group and PPI group, through block randomisation. Both the groups received intervention for 45 minutes a session, thrice a week for 12 weeks, and a carryover effect was seen after one month of cessation of training. Gross motor function measure (GMFM 66, 88) and paediatric evaluation disability inventory (PEDI) were the outcomes. Interaction effects of group versus time were computed using two-way repeated-measures analysis of variance (ANOVA). Results Among 56 children with CP recruited, 48 have completed the total 12-week intervention and four-week follow-up. A two-way repeated-measures ANOVA reveals a significant difference in GMFM [F (1,46) = 13.88 (GMFM 88), p<0.001; F (1,46) = 16.71, p<0.001]. However, PEDI did not show significant group versus time interaction effects across three-time points (p = 0.102 - 0.826). Post hoc power analysis using Cohen’s d and Cohen’s f confirmed the power >99.9%. Thus, limiting type-II error to less than 1%. Conclusion Active participation in NDT has demonstrated good clinical improvements in gross motor function when compared with passive physiotherapy intervention.