Immediate Effects of Exercise and Manual Therapy on Cervico-Mandibular Mobility and Postural Alignment in Children with Spastic Cerebral Palsy: A Randomized Crossover Trial

BackgroundSpastic cerebral palsy (CP) commonly impairs cervico-mandibular mobility and motor coordination due to increased muscle tone and altered postural control, potentially affecting head stability and orofacial function.ObjectiveTo compare the immediate effects of exercise- and manual therapy-based interventions on temporomandibular and cervical mobility in children with spastic CP, contrasting active versus passive rehabilitation strategies.MethodsThis single-blind, randomized crossover trial included 52 children with spastic CP (mean age 10.8 ± 2.4 years; GMFCS levels I-IV). Each received one exercise and one manual therapy session in randomized order with a one-week interval. Owing to missed second-week appointments, 44 children completed the exercise session and 48 completed the manual therapy session, resulting in partial crossover completion. Mandibular range of motion (maximal opening, lateral deviation, protrusion), cervical range of motion (flexion, extension, rotation), and craniovertebral angle were assessed immediately before and after each intervention.ResultsBoth interventions produced significant immediate improvements in mandibular and cervical mobility (p < 0.001). Exercise resulted in greater gains in selected active mandibular movements, whereas manual therapy elicited larger improvements in cervical mobility. Craniovertebral angle increased following both interventions, with no significant between-intervention difference, indicating comparable effects on head posture. Effect sizes were moderate to large, and no carryover effects were detected.ConclusionExercise and manual therapy induce modality-specific immediate neuromechanical responses in the cervico-mandibular system in children with spastic CP. These findings reflect short-term rather than long-term effects and suggest both approaches may be considered in individualized pediatric neurorehabilitation planning.