Assessment of the effects of craniosacral therapy and breathing exercises (as methods of reducing stress and its consequences) on the functional status and quality of life of women raising a child with a disability.

Arm 1 – Craniosacral Therapy (CST): Participants in this group (n=50) will receive individual craniosacral therapy sessions performed once weekly for 8 consecutive weeks by the same certified physiotherapist (Dr. Aneta Gutowska). Each session will last approximately 60 minutes. The therapy involves gentle touch (approx. 5 g pressure, “butterfly touch”) applied to specific areas of the body: feet, sacrum, lumbar spine, diaphragm, thoracic inlet, occipital base, occiput, temporal, frontal, and sphenoid bones. No mobilization or manipulation techniques will be used. Sessions will be conducted individually (1 therapist / 1 participant) in a quiet physiotherapy room equipped with a couch; participants will remain clothed and covered with a blanket. The same intervention protocol will be applied to all participants. Participants will be informed that mild sensations of warmth, cold, or emotional reactions may occur. They will be advised to increase water intake after therapy and to contact the therapist if any symptoms persist beyond 72 hours. Contraindications: active bleeding, meningitis, head trauma, fever, cerebrospinal fluid leakage, intoxication, intracranial bleeding, thrombosis, pregnancy, severe psychiatric disorders, uncontrolled hypertension, or epidural anesthesia within 6 weeks. Adherence will be monitored through an attendance/session log completed by the treating physiotherapist at each weekly visit (date, duration, participant ID). Intervention fidelity will be ensured by having one certified physiotherapist deliver all sessions and by applying a standardized CST protocol to every participant. Any protocol deviations (e.g., shortened session, missed session, adverse reactions) will be recorded in the session log. Arm 2 – Breathing Exercises (BE): Participants in this group (n=50) will complete an 8-week respiratory training program based on American Thoracic Society / European Respiratory Society (ATS/ERS) recommendations for pulmonary rehabilitation. The program includes inspiratory muscle training (PowerBreathe Plus device) following Hill et al. protocol: 2 sets of 30 breaths daily, with individually adjusted load and progressive intensity. Participants will be trained before starting and will continue the program independently at home. In addition, participants will perform controlled breathing exercises aimed at normalizing the breathing pattern: nasal inhalation, 1–2 s breath hold, and slow nasal exhalation, with inspiration:exhalation ratio 1:2. Breathing can be practiced in sitting or quadruped positions, twice daily (morning and evening), 5–10 repetitions per session. Each exercise lasts about 5–10 minutes. Possible side effects: dizziness, tingling, muscle tremor, visual disturbances, or headache (due to hyperventilation); hypotension upon standing; cardiac rhythm disturbances. Participants will be instructed to breathe slowly, avoid forceful inhalation, change posture gradually, and stop exercises if discomfort occurs. Contraindications: respiratory failure, recent pulmonary hemorrhage, active cancer. Participants will receive standardized pre-intervention training (demonstration + written instructions) before starting home practice. As no daily breathing diary will be used, adherence will be monitored by structured self-report at follow-up contacts/assessments (participants will report the number of days/sessions completed and reasons for missed sessions). Training parameters for inspiratory muscle training (e.g., initial load setting and planned progression) will be documented at instruction and reviewed at follow-up. Participants will be contacted weekly (phone/SMS) to reinforce adherence and to record any problems or adverse events. Participants will also be informed that they may contact the study lead at any time in case of questions or concerns. Allocation (non-randomised): This is a non-randomised study. Group allocation will be determined pragmatically based on participant availability/scheduling constraints and feasibility (e.g., the ability to attend sessions at the required times). Allocation will occur after baseline assessment. No random sequence generation or allocation concealment will be used.