Universal exercise unit versus rebounding on genu recurvatum in children with cerebral palsy: a comparative randomised controlled trial

Merhan M. Hamouda; Nanees E. Mohamed; Walaa A. Abd El-Nabie

doi:10.2478/advrehab-2026-0018

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Universal exercise unit versus rebounding on genu recurvatum in children with cerebral palsy: a comparative randomised controlled trial

Advances in Rehabilitation

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By: Merhan M. Hamouda , Nanees E. Mohamed and Walaa A. Abd El-Nabie

Open Access

|Sep 2026

Abstract

Introduction

This study aimed to compare the effects of universal exercise unit (UEU) versus rebounding on genu recurvatum (GR) in children with spastic cerebral palsy (CP).

Material and methods

A total of 51 children aged 5–7 years with spastic hemiplegic CP were randomly allocated into three groups: control group (n = 17), and study groups A (n = 17) and group B (n = 17). While all groups received a designed physical therapy programme, the control group additionally received traditional progressive strengthening exercises; group A received the UEU programme, and group B underwent rebound therapy. The primary outcome was GR, while secondary outcomes comprised muscle strength, including the quadriceps and gluteus maximus muscles, balance skills, functional mobility and quality of life, which were evaluated pre- and post-treatment using X-ray, Lafayette manual muscle tester, Pediatric Balance Scale (PBS), Mobility Questionnaire and Pediatric Quality of Life Inventory, respectively.

Results

All groups showed significant post-treatment improvements in all measured outcomes (p < 0.001). Post-treatment comparisons of the outcome measures among the three groups demonstrated a significant enhancement in favour of groups A and B compared with the control group. Post-treatment comparison between groups A and B revealed no significant difference across most measured variables, except for PBS scores, which was significantly improved in favour of group B (p = 0.01).

Conclusions

Both UEU and rebound therapy may be incorporated into the rehabilitation protocol of children with spastic hemiplegic CP to manage GR, while rebound therapy demonstrated an additional statistically significant advantage over UEU, specifically for balance.

References

Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatr Dis Treat. 2020;16:1505–18. doi: 10.2147/NDT.S235165.
Open DOI Search in Google Scholar Back to article
Graham HK, Rosenbaum P, Paneth N, Dan B, Lin J-P, Damiano DL, et al. Cerebral palsy. Nat Rev Dis Primers. 2016;2:15082. doi: 10.1038/nrdp.2015.82.
Open DOI Search in Google Scholar Back to article
Westbom L, Rimstedt A, Nordmark E. Assessment of pain in children and adolescents with cerebral palsy: a retrospective population-based registry study. Dev Med Child Neurol. 2017;59:858–63. doi: 10.1111/dmcn.13459.
Open DOI Search in Google Scholar Back to article
Steele KM, Schwartz MH. Causal effects of motor control on gait kinematics after orthopedic surgery in cerebral palsy: a machine-learning approach. Front Hum Neurosci. 2022;16:846205. doi: 10.3389/fnhum.2022.846205.
Open DOI Search in Google Scholar Back to article
Agostini V, Nascimbeni A, Gaffuri A, Knaflitz M. Multiple gait patterns within the same winter’s class in children with hemiplegic cerebral palsy. Clin Biomech (Bristol). 2015;30:908–14. doi: 10.1016/j.clinbiomech.2015.07.010.
Open DOI Search in Google Scholar Back to article
Yngve DA. Recurvatum of the knee in cerebral palsy: a review. Cureus. 2021;13(4):e14394. doi: 10.7759/cureus.14408.
Open DOI Search in Google Scholar Back to article
Sutherland DH, Davis JR. Common gait abnormalities of the knee in cerebral palsy. Clin Orthop Relat Res. 1993;288:139–47. doi: 10.1097/00003086-199303000-00018.
Open DOI Search in Google Scholar Back to article
Ahn S-H, Kwon O-Y, Hwang U-J, Jung S-H, Kim H-A, Kim J-H. The association between genu recurvatum angle and the strength of the hip and knee muscles in standing workers. Work. 2020;66(1):173–81. doi: 10.3233/WOR-203161.
Open DOI Search in Google Scholar Back to article
Chandran A, Mandhuripu, Premkumar M, Menezes CR. Association between genu recurvatum and gluteus maximus muscle strength in college students-case control study. J Orthop Rep. 2024;3(2):100229. doi: 10.1016/j.jorep.2023.100229.
Open DOI Search in Google Scholar Back to article
Liaqat S, Butt MS, Javaid HMW. Effects of universal exercise unit therapy on sitting balance in children with spastic and athetoid cerebral palsy: A quasi-exprerimental study. Khyper Med Univ J 2016;8(4):177–180. https://doi.org
Search in Google Scholar Back to article
Afzal F, Ahmed HI, Asim H, Rasul A, Islam A. Effects of universal exercise unit combined with conventional combination therapy on gross motor and functional skills in spastic and athetoid cerebral palsy children. Int J Med Appl Health 2015;3(1):28–34. https://doi.org
Search in Google Scholar Back to article
Kora AN, Abdelaziem FH. The effect of rebound therapy on gross motor function in a child with spastic cerebral palsy: a case study. BioSci Rev. 2020;2:1–7. doi: 10.21608/bsr.2020.126487.
Open DOI Search in Google Scholar Back to article
Germain AM, Blackmore AM, Gibson N, Newell B, Williams SA. Effects of adaptive bumgee trampoline for children with cerebral palsy: a single-subject study. Pediatr Phys Ther. 2019;31(2):165–74. doi: 10.1097/PEP.0000000000000577.
Open DOI Search in Google Scholar Back to article
Ansari NN, Naghdi S, Younesian P, Shayeghan M. Inter- and intra-rater reliability of the Modified Ashworth scale in patients with knee extensor post-stroke spasticity. Physiother Theory Pract. 2008;24(3):205–13. doi: 10.1080/09593980701523802.
Open DOI Search in Google Scholar Back to article
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and validation of a gross motor function classification system for children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214–23. doi: 10.1111/j.1469-8749.
Open DOI Search in Google Scholar Back to article
Mohamed RA, Sherief AA, Aboelazm SN. Effects of rebounding versus whole body vibration on functional capacity, genu recurvatum angle and bone mineral density in children with Down syndrome. J Adv Med Med Res. 2015;7(10):847–60. doi: 10.9734/BJMMR/2015/15720.
Open DOI Search in Google Scholar Back to article
Abd-elmonem AM, Abd El-nabie WA. Therapeutic outcomes of functional strength training versus conventional physical therapy in children with cerebral palsy. Phys Ther Rehabil. 2019;6(1):7. doi: 10.7243/2055-2386-6-7.
Open DOI Search in Google Scholar Back to article
Mentiplay BF, Perraton LG, Bower KJ, Adair B, Pua YH, Williams GP, et al. Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: A reliability and validity study. PLoS One. 2015;10(10):e0140822. doi: 10.1371/journal.pone.0140822.
Open DOI Search in Google Scholar Back to article
Azab AR, Mahmoud WS, Basha MA, Hassan SM, Morgan EN, Elsayed AE, et al. Distinct effects of trampoline-based stretch-shortening cycle exercises on muscle strength and postural control in children with Down syndrome: a randomized controlled study. Eur Rev Med Pharmacol Sci. 2022;26(6):1952–62. doi: 10.26355/eurrev_2022203_28346.
Open DOI Search in Google Scholar Back to article
Newton RA. Joint receptor contributions to reflexive and kinesthetic responses. Phys Ther. 1982;62(1):22–9. doi: 10.1093/ptj/62.1.22.
Open DOI Search in Google Scholar Back to article
Darr N, Franjoine M, Young B. Minimal detectable difference and meaningful change for children with cerebral palsy on the pediatric balance scale. IV STEP Conference; 2016 July 14–19; Columbus, OH.
Search in Google Scholar Back to article
Cesar GM, Giebler M, Buster TW, Burnfield JM. Balance assessment with decreased base of support for children with disabilities. Clin Exp Pediatr. 2024;67(12):718–24. doi: 10.3345/cep.2024.00780.
Open DOI Search in Google Scholar Back to article
Van Ravesteyn NT, Scholtes VA, Becher JG, Roorda LD, Geweniger JE, Post MW. Measuring mobility in children with cerebral palsy: content and construct validity of a mobility questionnaire (MobQues). Dev Med Child Neurol. 2010;52(3):229–35. doi: 10.1111/j.1469-8749.2009.03362.x.
Open DOI Search in Google Scholar Back to article
Seid M, Limbers CA, Driscoll KA, Opipari-Arrigan LA, Gelhard LR, Varni JW. Reliability, validity and responsiveness of the Pediatric Quality of Life Inventory (PedsQL) generic core scales and asthma symptoms scale in vulnerable children with asthma. J Asthma. 2010;47(2):170–7. doi: 10.3109/02770900903533966.
Open DOI Search in Google Scholar Back to article
Varni JW, Burwinkle TM, Seid M. The PedsQl as a pediatric patient-reported outcome: reliability and validity of the PedsQl measurement model in 25,000 children. Expert Rev Pharmacoecon Outcomes Res. 2005;5(6):705–19. doi: 10.1586/14737167.5.6.705.
Open DOI Search in Google Scholar Back to article
Madbouly MM, Olama KA, Ayoub HS, Hachem RH. Knee cage versus long ankle foot orthosis for genu_recurvatum in children with spastic diaplegia. Paper presented at: The 19th International Scientific Conference of the Faculty of Physical Therapy; 2018 March 22–23; Cairo, Egypt.
Search in Google Scholar Back to article
Verschuren O, Smorenburg ARP, Luiking Y, Bell K, Barber L, Peterson MD. Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature. J Cachexia Sarcopenia Muscle. 2018;9(3):453–64. doi: 10.1002/jcsm.12287.
Open DOI Search in Google Scholar Back to article
Faigenbaum AD, Milliken LA, Westcott WL. Maximal strength testing in healthy children. J Strength Cond Res. 2003;17(1):162–6. doi: 10.1519/00124278-200302000-00025.
Open DOI Search in Google Scholar Back to article
David G, Avery DF, Falk B, Klentrou P. Canadian society for exercise physiology position paper: resistance training in children and adolescent. Appl Physiol Nutr Metab. 2008;33(3):547–61. doi: 10.1139/H08-020.
Open DOI Search in Google Scholar Back to article
Kushwaha P, Suresh PR. Effectiveness of progressive resistance training for children with spastic diplegic cerebral palsy. Int J Adv Res. 2025;13(12):1313–22. doi: 10.21474/IJAR01/18025.
Open DOI Search in Google Scholar Back to article
Merino-Andres J, Garcia de Mateos-Lopez A, Damiano DL, Sanchez-Sierra A. Effect of muscle strength training in children and adolescents with spastic cerebral palsy: a systematic review and meta-analysis. Clin Rehabil. 2022;36(1):4–14. doi: 10.1177/02692155211040199.
Open DOI Search in Google Scholar Back to article
Hamouda MM, Mohamed NE, Abd El-Nabie WA. Effect of pulley therapy on genurcurvatum in children with unilateral cerebral palsy: randomized controlled trial. Pakistan J Med Health Sci. 2021;15(7):1994–8. doi: 10.53350/pjmhs211571994.
Open DOI Search in Google Scholar Back to article
Elsharkawy MR, Sherif AEA, Sarhan EE, El-Agamy OA, Elsebahy SY. Effect of universal exercise unit versus functional electrical stimulation on genu recurvatum in diplegic cerebral palsy. J Musculoskelet Neuronal Interact. 2025;25(1):109–18. doi: 10.22540/JMNI-25-109.
Open DOI Search in Google Scholar Back to article
El nahas AM, Olama KA, Rajab SH, Nour El din SM. Effect of universal exercise unit on balance in children with spastic diplegia. Int J Multidiscip Res Dev. 2017;4(10):115–9.
Search in Google Scholar Back to article
Mohamed AS, Kamal HM, Elsied AO, Abd El-Gafar EM. Universal exercise unit versus functional resisted training effect on muscle strength in spastic diaplegia. Executive Editor. 2020;11(4):1139–44.
Search in Google Scholar Back to article
Elshahat IM, El Hadidy EI, Ahmed NSE, Abdou RGED. Universal exercise unit versus functional resisted training on balance in children with diplegia. Egypt J Phys Ther. 2024;20:57–64. doi: 10.21608/ejpt.2024.234567.
Open DOI Search in Google Scholar Back to article
Elhady RA, Eldeen SN, Eldeen MS, Abd El-Nabie WA. Thera suit versus universal exercise unit on muscle strength and functional mobility in children with spastic cerebral palsy. The 21st International Scientific Conference of the Faculty of Physical Therapy; 2022 July 28–29; Cairo, Egypt.
Search in Google Scholar Back to article
El-Nemr A, Kora AN. Effect of core stabilization versus rebound therapy on balance in children with cerebral palsy. BioSci Rev. 2021;3(2):15–22. doi: 10.21608/bsr.20210234568.
Open DOI Search in Google Scholar Back to article
Abd Elmonem AM, Abd Elhady HS. Effect of rebound exercises on balance in children with spastic diplegia. Int J Phys Ther Rehabil. 2018;25(9):467–74. doi: 10.12968/ijtr.2018.25.9.467.
Open DOI Search in Google Scholar Back to article
Kora AN, Abdelaziem F, Kilany A. Role of rebound therapy in the rehabilitation of children with spastic cerebral palsy. Pan African Clinical Trials Registry. 2019. Trial ID: PACTR201908766157563. Available from: https://samrc.ac.za.
Search in Google Scholar Back to article
Romero-Franco N, Martinez-Lopez EJ, Lomas-Vega R, Hita—Contreras F, Martinez-Amat A. Short-term effects of proprioceptive training with unstable platform on athlete’s stabilometry. J Strength Cond Res. 2013;27(8):2189–97. doi: 10.1519/JSC.0b013e31827de323.
Open DOI Search in Google Scholar Back to article
Al-Abdulwahab SS, Kachanathu SJ. Reliability of goniometric measurements of knee hyperextension in children with cerebral palsy. J Phys Ther Sci. 2021;33(11):801–4. doi: 10.1589/jpts.33.801.
Open DOI Search in Google Scholar Back to article
Chen C, Shen I, Chen C, Wu C, Liu W, Chung C. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. Res Dev Disabil. 2013;34(3):916–22. doi: 10.1016/j.ridd.2012.11.020.
Open DOI Search in Google Scholar Back to article
Wright FV, Majnemer A, Maltais DB, et al. Development and validation of the MobQuest: a mobility questionnaire for children and adolescent with cerebral palsy. Dev Med Child Neurol. 2015;57(12):1158–65. doi: 10.1111/dmcn.12815.
Open DOI Search in Google Scholar Back to article
Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003;3(6):329–41. doi: 10.1367/1539-4409(2003)003<;0329:TPAAPP>2.0.CO;2.
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/advrehab-2026-0018 | Journal eISSN: 1734-4948

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Language: English

Submitted on: May 24, 2026

Accepted on: Sep 1, 2026

Published on: Sep 29, 2026

Published by: Józef Piłsudski University of Physical Education in Warsaw

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

cerebral palsy,

genu recurvatum,

progressive resistance training,

rebound therapy,

universal exercise unit

Related subjects:

Physical and rehabilitation medicine,

Sports and recreation,

Sports and recreation, other

© 2026 Józef Piłsudski University of Physical Education in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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