The influence of selective movements, strength training and emotional well-being on balance and quality of life in children with cerebral palsy: A holistic approach

Background & Aim: Cerebral palsy (CP) is a leading cause of childhood disability, with spastic subtypes often resulting in motor impairments and reduced quality of life. While strength training and selective movement interventions show therapeutic potential, their combined effects with psychosocial support remain underexplored. This study evaluated the impact of a 12-week integrative program combining strength training, selective motor control exercises, and psychosocial support on motor function, balance, and emotional well-being in children with spastic CP.
Methods: A prospective single-arm intervention was conducted in rehabilitation centres affiliated with Mazandaran University of Medical Sciences in Iran. Sixty-one children (aged 4–12 years; Gross Motor Function Classification System [GMFCS] levels I–III) completed three 60-minute sessions per week. Primary outcomes included selective motor control (Selective Motor Control Questionnaire), balance (Timed Up-and-Go test, TUG), and strength (handheld dynamometry). Secondary outcomes were gross motor function (Gross Motor Function Measure-88, GMFM-88), quality of life (Paediatric Quality of Life Inventory, PedsQL), and emotional well-being (Strengths and Difficulties Questionnaire, SDQ). Psychosocial support included mood check-ins, positive reinforcement, and emotion-regulation techniques.
Results: The study included 61 children with spastic CP [mean age 7.8 (SD=2.1) years; 31 male, 30 female], distributed across GMFCS levels I (n=22), II (n=27), and III (n=12). Subtypes included hemiplegic (n=27), diplegic (n=29), and quadriplegic (n=5). Significant improvements were observed in selective motor control (51.2% increase, p<0.001), balance (27.3% faster TUG times, p<0.001), and knee extensor strength (35.6% increase, p<0.001). Secondary outcomes showed clinically meaningful gains in gross motor function (GMFM-D section +12.8% E section +13.7%), quality of life (PedsQL physical/emotional: +18.3/+16.2 points), and reduced emotional difficulties (SDQ: −5.3 points, p<0.001).
Conclusions & Recommendations: The integrated program improved motor and psychosocial outcomes in children with spastic CP, advocating for holistic rehabilitation. Future research should explore long-term sustainability and controlled trials.