Comparative Effectiveness of Grade IV Joint Mobilization vs. Soft Tissue Mobilization for Post-Operative Rehabilitation in Children with Spinal Muscular Atrophy (SMA)

Abstract

Background: Spinal Muscular Atrophy (SMA) is a progressive neuromuscular disorder often necessitating spinal surgery to manage deformities and improve posture. Post-operative rehabilitation plays a vital role in restoring mobility and functional independence. Manual therapy interventions such as Grade IV Joint Mobilization (GVJM) and Soft Tissue Mobilization (STM) are frequently used in rehabilitation, but their comparative efficacy in pediatric SMA patients remains underexplored. Objective: To evaluate and compare the effectiveness of Grade IV Joint Mobilization and Soft Tissue Mobilization in improving post-operative outcomes—specifically range of motion, pain reduction, and functional mobility—in children with SMA. Methods: A randomized controlled trial was conducted on 30 children aged 5–12 years diagnosed with Type II or III SMA following spinal surgery. Participants were randomly assigned to the GVJM group (n=15) or STM group (n=15). Both groups received 20-minute therapy sessions, three times weekly for six weeks. Range of Motion (ROM), pain intensity (VAS), and functional mobility (TUG and PEDI) were assessed at baseline, six weeks, and 12 weeks. Data were analyzed using paired and independent t-tests with p<0.05 as the significance threshold. Results: Both groups showed significant improvements in all outcome measures (p<0.05). The GVJM group demonstrated superior gains in ROM (Δ15.1°, p=0.003, d=0.92), greater pain reduction (Δ3.3 vs. 2.3 VAS points, p=0.006), and faster functional mobility (Δ7.3s vs. 5.9s, p=0.011). These improvements persisted at 12 weeks, indicating sustained benefits of GVJM over STM. Conclusion: Grade IV Joint Mobilization is more effective than Soft Tissue Mobilization for enhancing joint mobility, reducing pain, and improving functional recovery in children with Spinal Muscular Atrophy after spinal surgery. Integration of both techniques may further optimize rehabilitation outcomes in pediatric neuromuscular care.