This study aims to evaluate the effects of Cuevas Medek Exercises on postural control and balance in children with spastic cerebral palsy. Children meeting the eligibility criteria will be randomly allocated into two groups receiving Cuevas Medek Exercises or conventional therapy. The outcomes will be assessed before and after the intervention period to determine the effectiveness of the intervention.
Diagnosed with spastic diplegic cerebral palsy
GMFCS Level III to V
Modified Ashworth Scale ≤ 2
Able to follow simple commands
Severe cognitive impairment
Uncontrolled epilepsy or frequent seizures
Visual or hearing impairment limiting treatment
History of recent orthopedic or neurosurgical procedures
Parallel
Cuevas medek exercises
Other interventionChildren will receive Cuevas Medek Exercises 3 sessions per week, at an appropriate effort level guided by the therapist, each session lasting 30 minutes, focusing on dynamic postural activation, balance reactions, and functional movement tasks
Conventional Therapy
Other interventionChildren will receive conventional physiotherapy 3 sessions per week, at moderate effort suitable for age and condition, each session 30 minutes long, including stretching, strengthening, and task-oriented activities to improve postural control and balance
Postural Control
Changes from baseline in postural control will be assessed using the Posture and Postural Ability Scale (PPAS). The scale evaluates the child's ability to maintain posture during functional tasks and measures automatic postural responses. The PPAS consists of several domains including trunk control, limb alignment, and dynamic balance. The scoring ranges from 0 to 30, where 0 indicates no disability and 30 indicates maximum postural impairment.
Balance
Changes from baseline in balance will be assessed using the Pediatric Balance Scale (PBS). The PBS evaluates balance in sitting, standing, and during functional tasks such as reaching and turning. The scale consists of 14 items, each scored from 0 to 4, giving a total score ranging from 0 (poor balance) to 56 (excellent balance).
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