Discussion
The aim of this quasi-randomized controlled study was to assess the effects of the Intensive Neurophysiological Rehabilitation System on the population of children with bilateral CP.We found an increase in gross motor function (GMFM), manual dexterity (BBT), and hand function (JTHFT) after the course of INRS in children with bilateral CP. At the same time, we did not find any significant changes in the scores of the PEDI self-care and mobility domains and the ABILHAND-Kids questionnaire.The obtained results are consistent with previous experimental research on the effects of INRS on the gross motor function and hand function of children with CP. In the single-blind study of INRS, an increase in the GMFM-66 score was detected after one rehabilitation course [We suggest that our findings in motor function may appear due to the intensity, repetition, and functional components of the INRS intervention. Participants received intensive treatment for up to 4 h, five days a week, over a period of 2 weeks. And the current literature has reported positive mobility outcomes with treatment dosages ranging from 2 to 5 days a week for two weeks and more [Other authors achieved similar results. An experimental study of intensive rehabilitation described concomitant changes in both upper and lower extremities in the population of children with bilateral CP [We observed positive but not statistically significant improvements in the outcome measures aimed at evaluating the changes in activities of daily living, such as the score of ABILHAND-Kids and PEDI assessment. The possible reason for this finding is that participants stayed in the rehabilitation center during their experimental treatment, and children did not have the pre-conditions to undertake their typical activities. Another rationale for no detectable changes in activities of daily living is the short follow-up; the average duration of follow-up in other studies was at least three months [This study has several limitations. The main limitation is the absence of classic randomization because we could not implement it methodologically. Instead, we applied quazi-randomization. Another limitation is the follow-up at one month. In other studies, excellent progression appeared at the follow-up at three months [This quazi-randomized controlled trial also has noticeable strengths. This study is the first assessor-blinded trial with two groups that evaluates the effects of INRS on different functions in children with CP. The findings of this research allow for planning further studies with a longer follow-up that potentially may facilitate exploring changes in the Activities and Participation domains of ICF. Moreover, it added evidence to understanding how gross and fine motor skills improve after short-term intensive rehabilitation in children with bilateral CP in their middle childhood.