Comparison between effects of stretching exercises and task-oriented training on wrist flexors spasticity and upper limb function in children with spastic cerebral palsy
DOI:
https://doi.org/10.61581/mjsp.v7i03.404Keywords:
Cerebral palsy, Modified Ashworth Scale, Spasticity, Stretching exercises, Task-oriented trainingAbstract
Objective: To compare the effects of stretching exercises and task-oriented training on wrist flexor spasticity and upper-limb function in children with spastic cerebral palsy.
Methodology: This randomized controlled trial was conducted at Bakhtawar Amin Hospital from 2nd May, 2026 to 31st August, 2026. There were 60 children aged 4-8 years with spastic cerebral palsy and they were split into two groups. The stretching group (group A) and the task oriented group (group B). Both groups received four 30 minute sessions/week over a 6 week period. Upper-limb function and wrist flexor spasticity were evaluated by the Modified Ashworth Scale (MAS) and the Quality of Upper Extremity Skills Test (QUEST), respectively. Analysis of data was carried out using the IBM SPSS Statistics version 27.0. Wilcoxon signed ranked test and Mann-Whitney U-test were used.
Results: Both groups demonstrated statistically significant pre- and post-intervention changes in several outcome measures. Changes were seen in protective extension (p=.004), weight bearing (p<.001), dissociated movement (p<.001), overall QUEST score (p=.001) and MAS (p=.001) with no change seen in grasp (p=.570) in Group A. In all assessed outcomes group B results was a significant difference (p=.001). The post intervention differences between groups with respect to QUEST (p=.001) and MAS score (p=.031) were statistically significant. Group B's median after the intervention was lower than that of Goup A (1.00 compared to 2.00).
Conclusion: Task-oriented training showed a more positive post-intervention muscle tone of wrist flexors than the stretching intervention, and there was a between-group difference that was clinically significant in upper-limb functions.
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References
1. Blair E, Cans C. The definition of cerebral palsy. Cerebral palsy: From childhood to adulthood: Springer; 2025. p. 19-25.
2. Panda S, Singh A, Kato H, Kokhanov A. Cerebral palsy: a current perspective. NeoReviews. 2024;25(6):e350-e60.
3. Kamate M, Detroja M. Which is the most common physiologic type of cerebral palsy? Neurology India. 2022;70(3):1048-51.
4. Potcovaru CG, Salmen T, Chitu MC, Dima V, Mihai MB, Bohiltea RE, et al. Cerebral palsy: review of epidemiology, etiology, clinical features, classification and prevention. Romanian Journal of Pediatrics. 2022;71(S2):18-22.
5. Dan B, Rosenbaum P, Carr L, Gough M, Coughlan J, Nweke N. Updated description of cerebral palsy. Developmental Medicine & Child Neurology. 2026;68(4):465-76.
6. Dar H, Stewart K, McIntyre S, Paget S. Multiple motor disorders in cerebral palsy. Developmental Medicine & Child Neurology. 2024;66(3):317-25.
7. Handsfield GG, Williams S, Khuu S, Lichtwark G, Stott NS. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC musculoskeletal disorders. 2022;23(1):233.
8. Clewes K, Hammond C, Dong Y, Meyer M, Lowe E, Rose J. Neuromuscular impairments of cerebral palsy: contributions to gait abnormalities and implications for treatment. Frontiers in human neuroscience. 2024;18:1445793.
9. Malick WH, Butt R, Awan WA, Ashfaq M, Mahmood Q. Effects of augmented reality intervention on the range of motion and muscle strength of upper extremity in children with spastic hemiplegic cerebral palsy: A randomized clinical trial. Games for health journal. 2022;11(3):168-76.
10. Nourizadeh M, Shadgan B, Abbasidezfouli S, Juricic M, Mulpuri K. Methods of muscle spasticity assessment in children with cerebral palsy: a scoping review. Journal of orthopaedic surgery and research. 2024;19(1):401.
11. Mohamed SS, Ghany WAA, Abdelazeim FH. Upper limb physical therapy interventions to improve functions in cerebral palsy children: A review article. International Journal of Health Sciences. 2022;6(S5):6545-60.
12. Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, et al. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Frontiers in neurology. 2023;14:1171224.
13. Wagdy E, Mohamed MT, Mohamed MAR, Eid MA, Fayez MM. Functional outcome of mirror therapy versus task oriented training on hand function in children with unilateral cerebral palsy. Fizjoterapia Polska. 2024(4):343.
14. Xiao Y, Zhang J, Liu Y, Chen X, Wu R, Le S, et al. The impact of task-oriented training on hand functionality in children with cerebral palsy under 18 years: a systematic review and meta-analysis. Frontiers in Neurology. 2026;17:1775810.
15. Gómez-Diaz IC, Cabralez-Guzmán MP, Sánchez-Delgado JC, Prada-Sanabria LN, Reyes-Moreno LF, Angarita-Fonseca A. Reliability of the Modified Ashworth Scale in post-stroke spasticity assessment: cross-sectional study. Physiotherapy Quarterly. 2025;33(4):96-103.
16. Pontillo M, Bellm E, Barber P, Gauthier M, Unverzagt C, Davies G. Upper Extremity Return to Sport Functional Testing: A Systematic Review. Sports medicine-open. 2026;12(1):13.
17. Daliri M, Nasab FS, Fatorehchy S, Farzad M, Moradi A. Impact of virtual reality task-oriented training on upper extremity motor function in children with cerebral palsy: a randomised controlled trial. Pediatric Neurology. 2025;163:85-92.
18. Adiguzel H, Kirmaci ZIK, Gogremis M, Kirmaci YS, Dilber C, Berktas DT. The effect of proprioceptive neuromuscular facilitation on functional skills, muscle strength, and trunk control in children with cerebral palsy: A randomized controlled trial. Early human development. 2024;192:106010.
19. Srilakshmi M, Selvi A, Kumar M. Comparison between Task-Oriented Training and Proprioceptive Neuromuscular Facilitation Exercise on Upper Extremity Function in Spastic Cerebral Palsy. Int J Exp Res Rev. 2024;39:109-17.
20. Burgess A, Chatfield MD, Hermith‐Ramirez D, Jackman M, Thorley M, Reedman S, et al. Active upper‐limb therapies for hand function, individual goal achievement, and self‐care in children with cerebral palsy: A network meta‐analysis. Developmental Medicine & Child Neurology. 2025;67(12):1543-53.
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Copyright (c) 2026 Arosha Farooqi, Rehan Ramzan Khan
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