Effect of Virtual Reality-Based Therapy Versus Plyometric Exercise Training on Lower Limb Selective Motor Control , Balance and Quality of Life in Spastic Hemiplegic Children : a Randomized Controlled Trial

Virtual reality (VR) will be used as an interactive, task-oriented intervention to improve lower-limb motor function and functional mobility. Participants will perform virtual activities involving weight shifting, stepping, squatting, reaching with the lower limbs, balance control, and multidirectional movements. The tasks will require repetitive and goal-directed lower-limb movements within an immersive or interactive virtual environment. Task difficulty will be progressively adjusted according to each participant's functional ability by modifying movement speed, range, task complexity, or level of challenge. Visual and auditory feedback provided by the VR system will be used to facilitate movement accuracy, postural control, and active participation. All VR training will be performed under the supervision of a physiotherapist to ensure appropriate and safe execution of the activities.

Plyometric exercises will be incorporated to improve lower-limb explosive strength, power, and neuromuscular performance. Participants will perform progressive, rapid stretch-shortening cycle exercises involving jumping, hopping, and landing activities. Exercises will include bilateral and unilateral jumps, forward and lateral hops, and repeated squat jumps, according to the participant's functional ability. Exercise intensity and complexity will be progressively increased by modifying the jumping distance, height, speed, or number of repetitions. Proper landing technique and controlled lower-limb alignment will be emphasized throughout the training to ensure safe and effective performance.