Investigating the effect of adding cognitive training to balance exercises on gait, motor performance, balance, brain activation pattern, quality of life, and fall risk in children with cerebral palsy.

The aim of this study is to evaluate the effects of cognitive–balance and specific balance training on motor performance, balance, gait, brain activation patterns, quality of life, and fall risk in children with cerebral palsy.

Sample size and study groups: The sample includes 42 children with cerebral palsy, who will be divided into three groups of 14 participants each: Control group Balance training group Cognitive–balance training group Allocation will be performed randomly using the Randomizer software.

Assessments will be conducted at Kharazmi University Laboratory, and interventions in the school. Motor function, balance, and walking will be measured using standardized tools, under researcher supervision. The study is single-blind, with participants unaware of their group allocation.

inclusion criteria: Diagnosis of spastic cerebral palsy by a physician Age 7 to 18 years Gross Motor Function Classification System (GMFCS) level I or II General good health Written informed consent from parents No participation in similar training programs during the past 6 months exclusion criteria: Surgery or medical conditions that prevent participation in exercises Lack of cooperation or inability to follow instructions

Participants were divided into three groups. The cognitive–balance group performed balance exercises with cognitive tasks (counting, problem-solving, color/shape recognition) three times a week for eight weeks (45–60 min/session). The specific balance group performed similar balance exercises without cognitive tasks. The control group received no intervention and only took part in assessments.

motor function, balance, gait, brain activation patterns, quality of life, and fall risk.

Participants will be allocated to three study groups using block randomization with fixed block size of 6 and an allocation ratio of 1:1:1. Considering the total sample size of 42 participants, randomization will be performed in 7 consecutive blocks (7×6=42). In each block: Two participants will be assigned to the cognitive–balance training group Two participants will be assigned to the specific balance training group Two participants will be assigned to the control group The random sequence will be generated using the website Randomizer (https://www.randomizer.org/). To ensure allocation concealment, each group assignment will be placed in opaque, sealed, and sequentially numbered envelopes. After confirming eligibility and obtaining written informed consent from the parents or legal guardians, each participant will be given an envelope by an independent person who is not involved in data collection or intervention implementation. The participant will then be assigned to the group indicated inside the envelope. This procedure ensures that participants enter the random sequence in a sequential and concealed manner, preventing any investigator or staff involved in the intervention or data collection from knowing the group assignment in advance.

In this study, the outcome assessor will be blinded, so that they will not be aware of the participants’ group allocation. Participants, their parents, and the intervention administrators (therapists) will not be blinded, as it is necessary for them to perform and supervise the exercises.