Parental Experiences of Home-Based Intensive Segmental Trunk Training in Children With Cerebral Palsy

The goal of this feasibility study is to evaluate the adherence, parental experiences, and perceptions of a home-based Intensive Segmental Trunk Training (ISTT) program for children aged 4-12 with spastic diplegic cerebral palsy (CP) in Pakistan. The main questions it aims to answer are: What is the rate of caregiver adherence to a home-based ISTT program over 12 weeks? What are the primary barriers, experiences, and perceptions of caregivers implementing the program? What are the preliminary signals of clinical effectiveness on trunk control and gross motor function? Researchers will compare pre- and post-intervention outcomes (baseline vs. week 12) to see if there are statistically significant improvements in trunk control (measured by SATCo) and gross motor function (measured by GMFM-88). Participants (20 primary caregivers and their children) will: Attend an initial in-person orientation session to learn trunk stabilization exercises from a senior pediatric physical therapist Complete a 12-week home-based ISTT program with weekly tele-supervision video calls to monitor progress and address challenges Attend monthly face-to-face monitoring visits at the hospital for clinical assessment and technique reinforcement Complete a KABA (Knowledge, Attitudes, Barriers, and Adherence) survey at baseline and week 12 Participate in a semi-structured interview at the end of the 12-week program to share their experiences.

Inclusion Criteria: * Children aged 4-12 years with a confirmed diagnosis of spastic diplegic cerebral palsy * Gross Motor Function Classification System (GMFCS) levels II-IV * Primary caregiver (mother or father) willing to commit to the 12-week program * Caregiver had access to a smartphone with video-calling capability * Caregiver able to understand and follow instructions in Urdu or English Exclusion Criteria: * Children with uncontrolled seizures * Children who had undergone orthopedic surgery or botulinum toxin injections in the lower extremities within the previous 6 months * Children with severe visual or hearing impairments that would interfere with participation * Caregivers with a diagnosed physical or mental health condition that would prevent them from safely delivering the home-based program