Effects of DMI vs Bobath on Neuromuscular Development in CP

Cerebral palsy (CP) is a leading cause of permanent motor disability in children, resulting from non-progressive disturbances to the developing brain. Prematurity and low birth weight are major risk factors, with infants under 1500 g having a markedly higher risk. Spastic CP is the most common subtype, and spastic diplegia accounts for 30-40% of cases, primarily affecting the lower limbs and trunk control. CP prevalence has declined in high-income countries but remains higher in low- and middle-income regions, including Pakistan. Beyond clinical challenges, CP imposes a substantial lifelong economic burden. Current management follows the ICF framework, emphasizing function, participation, and independence. Traditional approaches such as the Bobath method show limited evidence compared with task-oriented therapies. Dynamic Movement Intervention (DMI) is a neuroplasticity-based, task-oriented approach emphasizing repetitive functional activities. Trunk-focused dynamic training has shown superior improvements in balance and gross motor function. However, comparative evidence between DMI and Bobath therapy in young children is limited, necessitating further research using validated outcome measures.

Inclusion Criteria: * Diagnosed with spastic diplegic cerebral palsy. * Gross Motor Function Measurement Scale (GMFC) level I to III. * Children who have head control. * Ability to understand and follow simple instructions. Exclusion Criteria: * Visual or hearing impairments (e.g., cataract, myopia, deafness). * Cognitive problems impacting participation. * Uncontrolled convulsions or recent seizure activity. * Orthopedic surgeries of the lower limbs, such as dorsal rhizotomy within the last year.