Effects of the Bad Ragaz Ring Method on Muscle Characteristics, Balance, and Functional Performance in Children with Cerebral Palsy

INTERVENTION: Procedure/Surgery : 1. Study Design and Intervention Environment This study is designed to compare and analyze the effects of two specialized aquatic interventions in children with cerebral palsy. Participants are randomly assigned to either the Experimental Group (Bad Ragaz Ring Method, BRRM; n=6) or the Control Group (Halliwick Aquatic Therapy; n=6). Both groups undergo aquatic physical therapy for 40 minutes per session, twice a week, for a total of 8 weeks (16 sessions) in the same therapeutic pool. To ensure environmental consistency, the water temperature is maintained at 32–34°C to facilitate muscle relaxation and spasticity reduction. The water depth is set at the level of the child's xiphoid process (T8–T10) to maximize the therapeutic effects of buoyancy and hydrostatic pressure. 2. Mechanisms of Aquatic Physical Therapy Aquatic physical therapy utilizes the physical properties of water—buoyancy, hydrostatic pressure, resistance, viscosity, and temperature—as therapeutic media. Buoyancy reduces the compressive load on joints caused by gravity, providing a safe environment for children with cerebral palsy to perform movements more freely. Hydrostatic pressure enhances cardiopulmonary efficiency and facilitates sensory input, while water resistance provides isokinetic exercise effects to promote muscle strengthening. These environmental characteristics regulate abnormal neuromuscular tension and positively influence postural stability and ambulatory function. 3. Control Group Intervention: Halliwick Aquatic Therapy The Halliwick aquatic therapy applied to the control group is a function‐oriented approach focusing on water adaptation and independent body control. The program is implemented according to the Ten‐Point‐Programme based on mental preparation, ba CONDITION: Diseases of the nervous system PRIMARY OUTCOME: Maximum Isometric Muscle Strength of Ankle Dorsiflexion MusclThickness of Transverse Abdominis Static Balance Duration during One‐Leg Stance Tibialis Anterior Muscle Thickness SECONDARY OUTCOME: Korean version of Modified Barthel Inde X(K‐MBI) Score Timed Up and Go Test (TUG) Completion Time INCLUSION CRITERIA: (1) Children aged 5 to 14 years diagnosed with spastic diplegic cerebral palsy (2) Children classified as Level I or II according to the Gross Motor Function Classification System (GMFCS), indicating the ability to walk independently (3) Children with a score of = 2 on the Modified Ashworth Scale (MAS) (4) Children without visual, auditory, or other sensory impairments (5) Children who do not exhibit fear of the aquatic environment and are able to understand and follow the therapist’s instructions