Effect of Parent-Mediated Home-Based Rehabilitation Program for Enhancing Functional Outcomes and Participation in Children With Diplegic Cerebral Palsy: A Case Series

Children with cerebral palsy (CP) often experience limitations in mobility, participation, and engagement in home, school, and play-related activities. Many children with CP are unable to access the required therapeutic services due to a variety of reasons, including financial constraints and caregiver availability. As CP is a lifelong condition, the required activities and exercises have to be repeated many times a day; a once-daily session with a therapist might be insufficient. Considering the comprehensive outcomes of therapy in lifelong conditions is significant to analyze the impact of an intervention program. Parent-mediated home-based rehabilitation programs may serve as a practical and possible approach to improve functional outcomes and participation of individuals with CP in daily life. This prospective, non-consecutive case series aims to analyze the effect of a 10-week parent-mediated home-based rehabilitation program on participation, gross motor function, balance, functional independence, engagement, and functional outcomes in 10 children aged between 5 years and 12 years with diplegic CP. These children were classified at Gross Motor Function Classification System (GMFCS) levels II and III. The children presented with difficulties in independent mobility within their environment and reduced participation in day-to-day activities at home and in the community. The home intervention program was designed according to the needs and routines of each child. Parents were briefed at the onset of the program and provided hands-on training on how to conduct various tasks and exercises at home. Parents were supervised through two scheduled sessions during the intervention period of 10 weeks to ensure appropriate implementation of the program. To measure functional outcomes and participation, measures used included the Canadian Occupational Performance Measure (COPM), Functional Independence Scale for Children (WeeFIM), Goal Attainment Scale (GAS), Pediatric Balance Scale (PBS), Gross Motor Function Measure-66 (GMFM-66), and the Child Engagement in Daily Life Measure Version 2 (CEDL V2). Mean scores demonstrated improvement in all outcome areas following the 10-week intervention. COPM performance improved from 3.1 to 4.2, while COPM satisfaction improved from 3 to 4.6. CEDL V2 frequency scores increased from 24.89 to 29.37, and CEDL V2 enjoyment scores increased from 23.3 to 25.8. WeeFIM scores improved from 72.5 to 78.5. The mean GMFM-66 scores improved from 63.12 to 64.84. GAS score improved from 40 to 44. Improvements were also seen in PBS scores, increasing from 33.3 to 35.3. The findings suggest that the parent-mediated home-based rehabilitation may be an effective and practical intervention approach for enhancing functional outcomes and participation among children with diplegic CP wherever direct therapeutic services are not available. Further studies with larger sample sizes are recommended to establish long-term effectiveness and broader applicability.