Combined core stability and nutritional therapy are associated with greater functional and nutritional gains in children with spastic cerebral palsy.

Abstract

Objective: To compare 12-month functional and nutritional outcomes among children with spastic cerebral palsy receiving conventional rehabilitation, rehabilitation plus individualized nutrition, or rehabilitation plus nutrition and core stability training.

Methods: This single-center retrospective cohort included 60 children aged 3-12 years with Gross Motor Function Classification System levels I-IV (20 per group). Core training was delivered three times weekly for 30 minutes during a 3-month supervised phase, and nutrition followed an individualized five-step protocol. Outcomes were assessed at baseline and 3, 6, and 12 months. Continuous outcomes were analyzed by repeated-measures and time-specific analysis of variance with Holm-adjusted comparisons. Ordinal outcomes were analyzed non-parametrically.

Results: Age and sex were comparable at baseline. Group-by-time interactions were observed for Gross Motor Function Measure-88 Dimension D (P=0.026), Dimension E (P=0.048), Berg Balance Scale (P<0.01), weight-for-age z-score (P<0.001), and body mass index-for-age z-score (P<0.01). At 12 months, the combined group exceeded the conventional group in Dimension D by 14.11 points (95% CI 6.50-21.72; Holm P=0.002), Dimension E by 13.54 points (95% CI 6.39-20.69; Holm P<0.001), and balance by 11.29 points (95% CI 5.02-17.56; Holm P=0.002). Weight-for-age and body mass index-for-age z-scores were higher by 2.35 and 1.99 units (both Holm P<0.001). Spasticity was lower and strength was higher in the combined group. No serious intervention-related adverse events were documented.

Conclusions: Comprehensive rehabilitation was associated with larger functional and nutritional gains, but causality could not be established. A stratified randomized trial with blinded assessment and quantified adherence is warranted.