Comparative effects of high- vs. low-intensity Bobath therapy on spasticity in young children with spastic cerebral palsy

BACKGROUND: Spastic cerebral palsy, the most common cerebral palsy subtype, is characterised by increased muscle tone that restricts movement and daily functioning. The Bobath approach is widely applied in paediatric neurorehabilitation; however, the effects of therapy intensity and sequencing remain insufficiently understood. OBJECTIVE: To compare the effects of high versus low-intensity Bobath therapy on spasticity in young children with spastic cerebral palsy. METHODS: A double-blinded, randomised, crossover trial was conducted at Livingstone University Teaching Hospital, Zambia, involving 30 children aged 3 months to 4 years. Participants were randomly allocated to one of two sequences: Standard Bobath followed by Modified Bobath (AB) or Modified Bobath followed by Standard Bobath (BA). Each phase lasted 12 weeks. The Modified protocol comprised three 60-minute sessions weekly; the Standard protocol comprised two 40-minute sessions weekly. Spasticity was measured at baseline and after each phase using the Modified Ashworth Scale. Data were analysed using paired tests and Wilcoxon rank-sum tests in SPSS v25 (p < 0.05). RESULTS: Both sequences produced significant improvements in spasticity. The BA sequence yielded greater gains, including a 28–35% reduction in Modified Ashworth Scale scores (p = 0.008), compared with the AB sequence, which showed a 12–18% reduction (p = 0.032). No carryover effect was observed (p = 0.67). Endline comparisons showed significantly lower right-sided upper limb spasticity in the BA group, particularly in shoulder flexion (p = 0.0213), shoulder extension (p = 0.0187), elbow flexion (p = 0.0213), elbow extension (p = 0.0213), wrist flexion (p = 0.0213), and wrist extension (p = 0.0213). Lower limb improvements included significant reductions in hip extension, knee extension, ankle flexion, and ankle extension (all p = 0.0479). CONCLUSION: Bobath therapy effectively improves motor outcomes in children with spastic cerebral palsy. Initiating treatment with a higher-intensity Modified Bobath protocol leads to superior reductions in spasticity, underscoring the importance of therapy intensity and sequencing in paediatric neurorehabilitation. TRIAL REGISTRATION: Pan African Clinical Trial Registry (PACTR) PACTR202512685522786. Registered in December 2024.