Research report: Functional independence in pediatric hemiplegia, spastic diplegia, and spastic tetraplegia: two-year outcomes following comprehensive rehabilitation – a prospective observational study

Children with spastic cerebral palsy who completed a two-year multidisciplinary rehabilitation programme had higher average functional-independence scores at follow-up, according to a prospective observational study of 100 programme completers. Mean scores on the Functional Independence Measure for Children (WeeFIM) increased in all 12 groups defined by motor subtype and age, but the study cannot attribute those changes to rehabilitation alone. The participants were 5 to 12 years old at enrollment and were receiving care at a single rehabilitation center.

The cohort included 36 children with spastic hemiplegia, 31 with spastic diplegia and 33 with spastic tetraplegia. Researchers assessed WeeFIM scores before the programme and again after 24 months, while describing subgroup means and standard deviations. Rehabilitation comprised 40 courses over the two-year period, with 384 reported therapy procedures and sessions lasting 45 to 60 minutes.

This means the analysis addresses changes during the overall programme rather than isolating the effect of any one type of care. For children with hemiplegia, the weighted mean WeeFIM total score rose from 79.2 at baseline to 108.5 at 24 months, corresponding to an increase of 29.3 points. The largest average change among the three motor subtypes occurred in the diplegia group: the weighted mean increased from 68.2 to 100.5, a change of 32.3 points.

Children with tetraplegia had lower scores both before and after the programme. Their weighted mean increased from 18.1 to 29.3, representing an average change of 11.2 points. Thus, although follow-up scores were higher in all three groups, the magnitude of the descriptive increase differed by motor subtype.

Age-specific results also varied within those categories. Mean score changes ranged from 25.2 to 31.9 points among children with hemiplegia and from 29.0 to 35.3 points among those with diplegia. For children with tetraplegia, changes ranged from 6.9 to 16.0 points and were larger at ages 5 to 8 than at ages 9 to 12.

Younger children had higher follow-up means in the hemiplegia and diplegia groups, but the study did not find a consistent pattern in which younger participants achieved larger changes from baseline. A higher final score and a larger improvement are therefore distinct findings in this cohort, particularly where initial functional levels differed. The study has important limitations.

It included no control group, selected children who completed the programme and may have been influenced by unmeasured confounding. Individual clinical meaningfulness could not be determined, and the results did not establish domain-specific outcomes. Authors concluded that mean functional independence increased during two years of multidisciplinary rehabilitation among programme completers, with descriptive differences by motor subtype and baseline age.

They call for controlled studies that incorporate severity and domain-level outcomes to clarify the relationship between rehabilitation and functional change without treating these observational results as proof of a treatment effect.

Subject of Research: Two-year functional-independence outcomes after multidisciplinary rehabilitation in children with spastic cerebral palsy

Article Title: Functional independence in pediatric hemiplegia, spastic diplegia, and spastic tetraplegia: two-year outcomes following comprehensive rehabilitation – a prospective observational study

Article References: Sopromadze, M., Natroshvili, I., & Gvajaia, N. (2026). Functional independence in pediatric hemiplegia, spastic diplegia, and spastic tetraplegia: two-year outcomes following comprehensive rehabilitation – a prospective observational study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07895-z

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07895-z

Keywords: cerebral palsy, pediatric rehabilitation, functional independence, WeeFIM, spastic hemiplegia, spastic diplegia, spastic tetraplegia, children, observational study, longitudinal outcomes, Functional, independence