This study aims to compare the clinical effects of a sensory-motor integration-based exercise program and a virtual reality-based exercise program on gross motor function, balance, and functional mobility in children with cerebral palsy. Participants will be randomly assigned to one of two groups. Both groups will continue to receive standard conventional physiotherapy. In addition, one group will receive a structured sensory-motor integration-based exercise program, while the other group will receive a Nintendo Wii Sports-based virtual reality exercise program. The intervention period will last 16 weeks, with two sessions per week. Outcomes will be assessed before and after the intervention using standardized clinical measures.
Diagnosed with cerebral palsy, including diplegic, hemiplegic, or dyskinetic types
Gross Motor Function Classification System level I, II, or III
Aged between 6 and 12 years
Having sufficient cognitive ability to understand and follow simple verbal instructions
Gross Motor Function Classification System level IV or V
Spasticity level of 2 or higher in target muscle groups according to the Modified Ashworth Scale
Botulinum toxin injection within the last 6 months
Orthopedic or neurological surgery affecting motor function within the last 6 months
Parallel
Sensory-Motor Integration-Based Exercise Program
BehavioralA structured sensory-motor integration-based exercise program targeting postural control, balance, motor planning, sensory processing, body awareness, and functional movement organization through tactile, vestibular, and proprioceptive sensory inputs. The program will be administered in addition to standard conventional physiotherapy.
Virtual Reality-Based Exercise Program
BehavioralA Nintendo Wii Sports-based virtual reality exercise program using visual and auditory feedback in a game-based environment to support motivation, task-oriented movement repetition, balance, and functional motor performance. The program will be administered in addition to standard conventional physiotherapy.
Change in Gross Motor Function Measure Dimensions D and E Score
Gross motor function will be assessed using the Gross Motor Function Measure, dimensions D and E. The assessment will evaluate standing, walking, running, and jumping-related gross motor abilities in children with cerebral palsy.
Change in Pediatric Balance Scale Score
Functional balance will be assessed using the Pediatric Balance Scale. Higher scores indicate better functional balance performance.
Change in Timed Up and Go Test Performance
Functional mobility and dynamic balance will be assessed using the Timed Up and Go Test. The time required to stand up from a chair, walk 3 meters, turn, return, and sit down will be recorded in seconds. Shorter completion time indicates better functional mobility.
Change in ABILHAND-Kids Score
Upper extremity and hand function in daily activities will be assessed using the ABILHAND-Kids questionnaire completed with parent or caregiver report.
Change in Hand Grip Strength
Hand grip strength will be measured using a calibrated hand dynamometer according to a standardized testing position. Measurements will be performed for each hand, and the highest value will be used for analysis.
Change in Physical Activity Self-Efficacy Scale for Children Score
Physical activity self-efficacy will be assessed using the Physical Activity Self-Efficacy Scale for Children to evaluate children's perceived confidence and ability to participate in physical activity.
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