This quantitative study utilised a pre-experimental, pre-test-post-test design conducted without a control group (Adiputra et al. 2021). It took place from February 2025 to March 2025 at a private, specialised paediatric rehabilitation centre located in a major urban area in Indonesia. A total of 20 participants were recruited via purposive sampling based on detailed eligibility criteria. Inclusion criteria for participants were as follows: (1) A spastic diplegia diagnosis verified by a paediatric neurologist at least 1 year prior to the study; (2) an age range of 5–12 years. This range was selected as children in this developmental stage are typically able to participate actively in therapy and assessments, while their motor patterns are still adaptable to intervention; and (3) children with CP who are actively undergoing therapy at Ramah Cerebral Palsy (RCP) Bogor. All participants were actively undergoing regular therapy at the centre. Children were excluded if they had undergone orthopaedic surgery during the previous 12 months or had received injections of botulinum toxin, which could confound the results. Prior to participation, the parents or legal guardians of every child provided written, informed consent.

Two standardised instruments were employed to evaluate therapy outcomes: ‘GMFM-88’ and ‘WeeFIM’.

The GMFM-88 is a criterion-referenced test designed to measure motor function in children with CP. Walking, sprinting, leaping, crawling, kneeling, sitting, rolling over and standing are the five domains into which its 88 tasks are divided. The GMFM-88 is acknowledged for its good construct validity for this demographic and its strong test-retest and inter-rater reliability (Intra-class Correlation Coefficient [ICC] > 0.98), providing statistical justification for its use (Alotaibi et al. 2013; Anggoro et al. 2012).

To evaluate functional independence in daily activities, this study utilised a 25-item Modified WeeFIM. This specific version was previously adapted and validated for use in children with developmental disorders in Indonesia (Kim et al. 2022). The instrument assesses two domains: self-care and mobility, with item scores ranging from 1 (completely dependent) to 5 (fully independent). In its validation study, this modified instrument demonstrated high test-retest reliability (ICC = 0.89), as well as internal consistency (Cronbach’s alpha = 0.92) (Kim et al. 2022). This established psychometric evidence ensures its appropriateness and justifies its application in this study.

The intervention was delivered by two certified Neurodevelopmental Treatment (NDT) physiotherapists, each possessing more than 5 years of clinical experience in paediatric rehabilitation. All participants attended 60-min individual therapy sessions twice weekly over an 8-week period, for a total of 16 sessions. The physiotherapy programme was based on NDT principles and individually designed to meet the unique requirements of children suffering from spastic diplegia, focusing on improving trunk control, modulating muscle tone and facilitating more typical movement patterns. Key treatment strategies involved the facilitation of postural control by utilising therapeutic balls and bolsters to activate core musculature; the inhibition of atypical tone through specific handling techniques like slow, rhythmic rotation of the trunk over the pelvis; and the guidance of functional movements such as sit-to-stand using key points of control to ensure proper alignment and weight-bearing. These techniques were integrated into task-oriented practice, such as reaching for objects or practising stepping patterns, to enhance motor learning and functional carryover into daily life.

At the start of the study, parents or guardians provided written consent and participated in interviews to gather basic demographic information, including the child’s identity, age range and sex classification. During the week prior to the intervention, pre-assessments were conducted by the two certified NDT physiotherapists involved in the study. The Modified WeeFIM was administered via structured interviews with parents or guardians, and the GMFM-88 was assessed by seeing the child’s performance up close. After the 8-week intervention, post-intervention assessments using the same instruments and procedures were administered to evaluate changes in motor and functional performance.

SPSS (Version 26.0) software was used for statistical analysis. To ascertain if the data distribution was normal, the Shapiro-Wilk test was employed. Respondent characteristics were described using descriptive statistics; measures of central tendency were presented as the median for data that are not normally distributed and the mean and standard deviation for data that are normally distributed. The selection of inferential statistical tests was based on the outcome of the normality test. The data for the Modified WeeFIM scores were found to be normally distributed; therefore, the pre- and post-intervention scores were suitably compared using the paired t-test. Conversely, the GMFM-88 scores were not normally distributed, which necessitated using the Wilcoxon signed-rank test, which is non-parametric. To look at the relationship between gross motor skills (GMFM-88 scores) and daily activities (Modified WeeFIM scores), the correlation between Spearman’s rank and order was employed. This test is non-parametric and was chosen because the GMFM-88 data did not meet the assumption of normality required for a Pearson correlation test.

This study involving human subjects was carried out in compliance with national regulations and institutional policies, following the Declaration of Helsinki’s ethical guidelines (World Medical Association 2013). This study was approved ethically by the Ethics Committee of the Vocational Education Programme, Universitas Indonesia, on 14 February 2025 (Approval No.: KES-53/01/2025).

Table 1 presents a summary of participants’ characteristics, including age, sex and their scores on the GMFM-88 and Modified WeeFIM assessments, both before and after the intervention.

The age distribution revealed that most participants (40%) were 5 years old. Other age groups, such as 6 years, 7 years and 12 years old, represented between 10% and 20% of the total sample. Although the age range varied, children aged 5 made up the largest group. The composition of participants showed a difference in the proportion of responders who were male and female.

Among the 20 participants, 11 were male (55%) and 9 were female (45%). The results of the pre-test and post-test for (GMFM-88) and (Modified WeeFIM) showed an increase across all dimensions, demonstrating an overall improvement. In GMFM-88, the average scores across all dimensions increased from pre-test to post-test. Similarly, the average Modified WeeFIM score rose from 67.1 during the pre-test to 80.7 in the post-test. Tables 2 and 3 summarise the pre- and post-intervention scores for GMFM-88 and WeeFIM.

In order to determine how the independent variable affects the dependent one, the Shapiro–Wilk test was utilised to first ascertain if the data distribution was normal. In light of the test’s outcome, the authors employed the Wilcoxon signed-rank test for data that were not normally distributed and the paired samples t-test for data that were normally distributed. The relationships between the variables were also investigated using the Pearson correlation test. For all inferential tests, the threshold for statistical significance was set at p < 0.05. The Wilcoxon signed-rank test, which was used to evaluate the GMFM-88 scores, revealed an increase in scores following the intervention, and are summarised in Table 4. Results demonstrated an increase in the mean scores across all five dimensions (A–E) following the intervention, suggesting improvement.

Additionally, a paired t-test was performed to compare the Modified WeeFIM scores both before and following the intervention. Table 5 displays the paired t-test outcomes for the Modified WeeFIM.

The analysis of the Modified WeeFIM scores revealed a significant improvement in the participants’ daily living abilities following the intervention (p < 0.001). The mean increase of 13.600 points indicates a substantial and clinically meaningful gain in functional independence. These findings strongly suggest that the NDT protocol was effective in enhancing the participants’ ability to carry out daily activities.

To assess the connection between NDT intervention and progress in motor abilities and daily functioning, a Pearson correlation analysis was conducted between total GMFM-88 and Modified WeeFIM scores. These findings are summarised in Table 6, which presents the detailed results of the Pearson correlation analysis.

Table 6 presents the results of paired t-tests comparing pre- and post-intervention scores. Significant improvements were observed in GMFM-88 and WeeFIM scores (p < 0.05), indicating that NDT positively impacted both gross motor function and daily living activities. The analysis showed a noteworthy positive correlation (p < 0.001, r = 0.702), suggesting that improvements in motor function are closely associated with increased independence in daily tasks.

It is crucial to consider this study’s several limitations. Firstly, the pre-post experimental design lacked a control group, making it difficult to attribute the observed improvements solely to the NDT intervention. Secondly, generalisability is constrained by the tiny sample size as well as the fact that it was drawn from one private paediatric rehabilitation centre in an urban context in Indonesia; these results may not be applicable to children in public or rural healthcare settings. Thirdly, the study focused exclusively on children with spastic diplegia, which restricts the applicability of the findings to other forms of CP. The brief 8-week duration of the intervention made it difficult to observe any long-term clinical changes. The pre- and post-intervention tests were not done by independent researchers but by the same therapists who undertook the intervention.