Comparative Effects of Vojta, Bobath, and Combined Therapy on Gait and Balance in Children with Spastic Diplegic Cerebral Palsy: A Randomized Controlled Trial

Abstract

Spastic Diplegic Cerebral Palsy (SDCP), a subtype of Cerebral Palsy (CP) characterized by increased muscle tone predominantly affecting the lower limbs, leads to impairments in balance, gait, and functional mobility in children. This Randomized Controlled Trial was conducted at Al-Farabi Institute, Islamabad, Pakistan, to compare the effects of Vojta therapy (a reflex locomotion approach that stimulates automatic motor patterns), Bobath therapy (a Neuro-Developmental Treatment (NDT) focusing on postural control and functional movement), and their combined application on muscle tone, balance, and gait parameters. A total of 68 children (mean age 4.79 ± 1.74 years) with SDCP were randomly allocated into three groups: Vojta group (received reflex locomotion therapy), Bobath group (received NDT), and combined group (received both therapies in an integrated manner). Interventions were conducted for eight weeks (two sessions per week) along with daily parent-guided exercises. Outcome measures included the Modified Ashworth Scale (a clinical measure of spasticity), Gross Motor Function Classification System (a five-level scale classifying motor abilities), Pediatric Berg Balance Scale (a functional balance assessment tool), and spatiotemporal gait parameters measured using an electronic walkway  system. All groups demonstrated significant improvements over time (p < 0.05); however, the combined group showed the greatest gains, with marked reductions in spasticity and improvements in balance and gait characteristics such as step length and stride length. These findings suggest that integrating Vojta and Bobath therapies may provide superior functional outcomes compared to either approach alone. Early implementation of combined therapy may enhance rehabilitation effectiveness in children with SDCP.