Introduction: Spasticity has been implicated as a major hindrance to development of motor skills and functional performance in children with cerebral palsy (CP). Exercises, either on land or in water have been reported to be efficacious in ameliorating spasticity and improving functional performance in children with CP but none of these previous reports utilized any comparative means. This study therefore compared the efficacy of water-based and land-based exercises on spasticity and gross motor function in children with CP so as to enable right choice of modality in the process of clinical decision making.

Materials and Methods: This single-blinded study involved thirty (30) participants (9 males and 21 females) aged 1-12 years. They were recruited from Children’s Developmental Centre, Lagos State, Nigeria and randomised into either water-based exercise (WBE) or land-based exercise (LBE) group. Both groups received manual passive stretching and functional training exercises, which included kneeling, sitting, standing and walking, depending on their level of motor impairment; either in water (temperature 28-32ºC) or on land. Each exercise training session lasted for about 1 hour 40 minutes, twice per week for 10 weeks in both groups. Measurements of spasticity and gross motor function were done using Modified Ashworth Scale (MAS) and Gross Motor Function Measure (GMFM-88) respectively at baseline, after 4weeks, 8weeks and 10 weeks of intervention. Both groups were compared for differences in change in spasticity and gross motor function using Mann-Whitney-U test. The level of significance was set at p<0.05.

Results: The WBE group had significant reduction in spasticity of all the tested muscle groups (shoulder adductors, elbow flexors, wrist flexors, hip adductors, knee flexors and ankle plantar-flexors) during the 10 weeks of intervention while the LBE group showed no significant improvement in spasticity of wrist flexors and knee flexors. No statistically significant difference was however observed for reduction in spasticity between both groups. Only the WBE group had significant improvement in all dimensions of gross motor function except for walking, running and jumping. Statistically significant difference was found between both groups for all dimensions of gross motor function after 10 weeks of intervention.

Conclusion: Both water-based and land-based exercises are efficacious in reducing spasticity of shoulder adductors, elbow flexors, hip adductors and ankle plantar-flexors. However, water-based exercises are more efficacious in reducing spasticity of wrist flexors and knee flexors and resulted in better improvement in gross motor function which makes water-based exercises the better option compared to land-based exercises in the functional rehabilitation of children with spastic cerebral palsy.

Keywords: Water-based exercises, land-based exercises, spasticity, gross motor function, cerebral palsy.