This study will be randomized controlled trial, data will be collected from BASES special education school sialkot , Allama Iqbal Memorial Hospital, sialkot and Lahore. The study will include 28 patients equally divided into two groups and randomly allocated. Inclusion criteria for the study will be age of 8-13 years old of both sexes, ability to follow simple instructions, able to sit or stand with support to participate in physical therapy sessions( MACS level Ⅰ-Ⅲ) and (GMFCS level Ⅰ-Ⅲ), ability to communicate needs and discomfort (verbally or non-verbally), No concurrent participation in other physical therapy and excluded with Severe visual and hearing impairments, severe cognitive disabilities, History of seizures, Recent (within 6 months) or planned orthopedic surgery, Concurrent use of botulinum toxin injections. Experimental group will perform both Kinesiotherapy protocol and conventional physical therapy while Control group will perform only conventional physical therapy for 8 weeks 2-3 times weekly with 45 min of each session. Outcomes to be analyzed will be upper limb function and Activities of daily living (ADLs). Tools used for data collection will be Action Research Arm (ARA) test, Pediatric Evaluation of Disability Inventory (PEDI). Data will be analyzed through SPSS version 26, 27.
Age: 8-13 years old both sexes
Ability to follow simple instructions, able to sit or stand with support to participate in physical therapy sessions( MACS level Ⅰ-Ⅲ)(9) and (GMFCS level Ⅰ-Ⅲ)(10)
Ability to communicate needs and discomfort (verbally or non-verbally)
No concurrent participation in other physical therapy or rehabilitation programs
Severe visual and hearing impairments that would hinder participation
Severe cognitive or intellectual disabilities that would impede understanding of instructions
History of seizures or other neurological conditions that may impact participation
Recent (within 6 months) or planned orthopedic surgery
Parallel
control
Other interventionFollowing baseline assessments, participants will begin their respective 8-week intervention program with 2-3 times per week. The group A will receive base line conventional exercise program with standard physical therapy interventions as follow: * Stretching of tight muscles of affected upper limb. * Weight bearing of affected upper limb. * Manual dexterity exercises like grasp release, pack board activities. * Teaching of ADLs. * Functional task practice(2)
experimental
Other interventionFollowing baseline assessments, participants will begin their respective 8-week intervention program with 2-3 times per week. The group A will receive base line conventional exercise program with standard physical therapy interventions as follow: * Stretching of tight muscles of affected upper limb. * Weight bearing of affected upper limb. * Manual dexterity exercises like grasp release, pack board activities. * Teaching of ADLs. * Functional task practice(2)
action arm research arm test
The Action Research Arm Test (ARAT) is a 19 item observational measures used by physical therapists and other health care professionals to assess upper extremity performance (coordination, dexterity and functioning) in stroke recovery, brain injury and multiple sclerosis populations. Items comprising the ARAT are categorized into four subscales (grasp, grip, pinch and gross movement) and arranged in order of decreasing difficulty, with the most difficult task examined first, followed by the least difficult task maximum score 57 means better performance
pediatric evaluation of disability inventory
The PEDI is a standardized clinical assessment tool designed to measure the functional performance of children with typical development whose chronological age is below 7.5 years old, and the functional performance of children with disabilities whose functional capabilities are below those of a 7.5-year-old child. The PEDI can be used for children with developmental disabilities aged 6 months to 21 years and for individuals without disabilities aged less than 7 years(12) The PEDI is composed of 3 domains: functional skill, caregiver assistance, and modification. Each domain includes 3 sub-domains: self-care, mobility, and social function. The functional skill domain, which was used for measuring ADL performance, consists of 197 specific questions. Each child is assigned either 1 point for being capable of performing the assigned task or 0 points for incomplete performance or being unable to perform the task. The reliability of the functional skill subscale of the PEDI is very high.
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