Functional Outcomes of a Complex Rehabilitation Program in Children with Spastic Diplegic Cerebral Palsy: A Prospective Observational Study

Abstract

Background: Cerebral palsy is associated with complex motor impairments, including spasticity, reduced joint mobility, and functional limitations. Longitudinal data describing changes during sustained rehabilitation remain limited. Objective: We evaluated longitudinal changes in muscle tone, joint mobility, and gross motor function in children with spastic diplegic cerebral palsy participating in a structured 12-month rehabilitation program. Methods: This prospective, uncontrolled observational study included 94 children aged 5–10 years, selected from 116 children screened for eligibility. Assessments were performed at baseline (T0), 6 months (T1), and 12 months (T2). Outcomes included muscle tone (Modified Ashworth Scale, MAS), joint mobility (goniometry), and gross motor function (GMFM-88). Longitudinal changes were assessed using the Friedman test, followed by Bonferroni-adjusted post hoc pairwise comparisons between T0–T1, T0–T2, and T1–T2. Associations were assessed using Spearman’s rank correlation coefficient (ρ). Results: Significant longitudinal differences were observed across the evaluated outcomes (overall Friedman tests, p < 0.0001). Median MAS scores decreased from 3 at T0 to 2 at T2 across the evaluated muscle groups. Hip abduction increased, knee extension deficit decreased, and ankle dorsiflexion improved over the study period. GMFM-88 scores also increased longitudinally. Moderate-to-strong associations were observed between muscle spasticity and joint mobility parameters (ρ = −0.881 to 0.682). Conclusions: Favorable longitudinal changes in muscle tone, joint mobility, and gross motor function were observed during participation in the 12-month rehabilitation program. Given the uncontrolled observational design, these changes cannot be attributed exclusively to the rehabilitation intervention.