The Effects of Connective Tissue Manipulation versus Proprioceptive Neuromuscular Facilitation on Gait, Postural Control, and Hip Alignment in Children with Cerebral Palsy and Hip Displacement
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Abstract
Background: Cerebral palsy is commonly associated with impaired gait, reduced postural control, abnormal pelvic mechanics, and secondary hip displacement, all of which may limit functional mobility in children. Rehabilitation strategies that address neuromotor control and soft-tissue restrictions may improve walking performance and balance; however, comparative evidence between connective tissue manipulation and proprioceptive neuromuscular facilitation remains limited. Objective: To compare the effects of connective tissue manipulation and proprioceptive neuromuscular facilitation on gait parameters, postural control, and hip alignment in children with spastic cerebral palsy and hip displacement. Methods: A quasi-experimental comparative study was conducted among 30 children aged 6–14 years with spastic cerebral palsy, GMFCS levels I–III, and imaging-confirmed hip displacement. Participants were allocated into a connective tissue manipulation group and a proprioceptive neuromuscular facilitation group, with 15 participants in each group. Both groups received 45-minute sessions three times weekly for 8 weeks. Gait speed, stride length, gait symmetry, Pediatric Balance Scale score, and Reimers Migration Percentage were assessed before and after intervention. Results: The proprioceptive neuromuscular facilitation group showed greater improvements in gait speed (+0.15 m/s), stride length (+7.4 cm), symmetry index (+0.08), and Pediatric Balance Scale score (+6.7) than the connective tissue manipulation group, which improved by +0.06 m/s, +1.6 cm, +0.02, and +1.9, respectively. Reimers Migration Percentage decreased modestly in both groups, with greater numerical reduction after proprioceptive neuromuscular facilitation (-2.5%) than connective tissue manipulation (-1.3%). Conclusion: Proprioceptive neuromuscular facilitation produced larger short-term improvements in gait and postural control than connective tissue manipulation, while hip alignment changes remained limited over 8 weeks
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