Development and reliability of a system to classify gross motor function in children with cerebral palsy

Effects of neonatal behavioral assessment scale on postnatal depressive symptoms in mothers of very low birth weight infants: a pilot randomized controlled trial

BACKGROUND

Mental support for mothers of low birth weight infants (LBWI) or preterm infants in neonatal intensive care unit (NICU) is a crucial issue as postpartum depressive symptoms are more prevalent among mothers of such infants in NICU compared to mothers of full-term infants.

OBJECTIVE

In this pilot randomized controlled trial, we aimed to investigate the impact of psychological intervention through the neonatal behavioral assessment scale (NBAS) administration to very low birth weight infants, with or without mothers present, on the postnatal depressive symptoms experienced by mothers.

METHODS

Mothers of LBWI were divided into two groups depending on their presence during NBAS assessment: Group M (n = 9) with mothers present and Group non-M (n = 8) without mothers present. Mothers in both groups answered the Edinburgh Postnatal Depression Scale (EPDS) before and after the NBAS assessment. The mothers in Group M received early intervention with their infants following assessment by the NBAS.

RESULTS

No significant difference was observed in the EPDS score between the two groups in this study.

CONCLUSION

Early intervention using the NBAS with mothers present may yield no positive and negative effects on the mothers' depressive symptoms. Due to the small sample size of this pilot study, the results should be interpreted with caution, and there remains a need for further research about the effectiveness of the NBAS as early intervention.

Trial registration number: jRCT1040230179 (JRCT).

Impact of social participation, motor, and cognitive functioning on quality of life in children with Cerebral Palsy

BACKGROUND

Cerebral Palsy (CP) may impact the quality of life (QOL) and social.participation in different life situations and the discussion concerning the predictive.factors related is still open. The aim of the present study is to investigate the QOL in.Italian children with CP by a parent-reported questionnaire, evaluating the predictive.role of social participation and of motor and cognitive levels on the QOL dimensions.

PARTICIPANTS AND METHODS

Seventy-one children with CP (31 males and 40 females) and with a mean age 8.9 years (SD 2.5 years) participated in this study and the Cerebral Palsy Quality of Life Questionnaire for Children (CP-QOL-Child) questionnaire was fulfilled by their parents. Type of CP, The Participation and Environment Measure for Children and Youth questionnaire (PEM-CY), functional motor level (described with GMFCS and MACS) and cognitive profile (Wechsler scales assessment) were collected.

RESULTS

Significant differences within CP-QOL domains were found (X2(6) = 176.38,p < .001). The age and the level of environmental helpfulness in social participation impacted significantly the majority of CP-QOL domains (p < .001). The MACS and Verbal cognitive levels significantly influence CP-QOL domains, in terms of Feeling about functioning and Family health as Social wellbeing respectively(p < .001). The GMFCS level does not directly predict QOL but significantly impacts the environmental helpfulness in social participation (p < .001).

DISCUSSION

Beside the known role of motor impairment in determining QOL, the verbal cognitive level and the parent-perception of environmental supports in social context,also represent significant co-predictive factors of QOL. Important implications in terms of multidimensional social and health care of children with CP may be proposed.

Transcranial direct current stimulation combined with an intensive training program for upper limb rehabilitation in children with unilateral cerebral palsy. A randomized controlled pilot study

BACKGROUND

Unilateral cerebral palsy (UCP) presents a greater functional alteration of the upper limb. Among the recommended interventions are certain therapeutic tools, such as transcranial direct current stimulation (tDCS) that could increase the therapeutic window and enhance the effect of interventions.

AIMS

To determine the effectiveness of a 3-weeks intervention of cathodal tDCS applied over the motor cortex of the less affected hemisphere combined with a manual function intensive training program in the upper limbs on quality of movement and the spontaneous use of upper limb in children with UCP. Secondarily, quality of life and user´s experience was also assessed.

METHODS AND PROCEDURES

A pilot randomized triple-blind clinical trial was conducted. 18 children with UCP between 4 and 8 years were recruited and randomly allocated to one of the two experimental groups: 1) Active group: cathodal tDCS + intensive motor training; 2) Control group: Sham tDCS + intensive motor training. Assessments were performed before and after the intervention, and at three months follow-up.

OUTCOMES AND RESULTS

Outcome measures: Shriners Hospital Upper Extremity Evaluation children's manual experience questionnaire, Paediatric Quality of Life Questionnaire and the Children's Manual Experience Questionnaire (miniCHEQ). Both groups improved in all variables but in the inter-group analysis only quality of life obtained significant results (p = 0.043).

CONCLUSIONS AND IMPLICATIONS

Adding cathodal tDCS to a program of intensive manual function therapy training did not produce a greater improvement on the spontaneous use, nor improving the experience of use in children with UCP. However, this technique has a short-term beneficial effect on quality of life.

Prediction of Neurodevelopmental Outcomes at 18 to 22 Months Using the Numerical Sarnat Score Compared with Modified Sarnat Staging in Infants with Moderate to Severe Hypoxic-Ischemic Encephalopathy

OBJECTIVE

To examine the association of a numerical Sarnat score (NSS) and modified Sarnat staging among newborn infants with moderate/severe hypoxic-ischemic encephalopathy and their neurodevelopmental outcomes at 18-22 months.

STUDY DESIGN

This secondary analysis included participants with gestational age ≥36 weeks and moderate/severe hypoxic-ischemic encephalopathy (HIE) from the Induced Hypothermia and Optimizing Cooling trials. Early (<6 hours age) neurologic examinations were performed by trained examiners to categorize HIE severity by modified Sarnat staging. The NSS was calculated by summing abnormal scores (2 for moderate, 3 for severe) in the 6 examination categories. The primary outcome was death or moderate/severe disability. Statistical analysis included logistic regression, adjusting for center, trial, and cooling group, and linear regression for continuous scales.

RESULTS

The cohort (n = 528) included infants with 71% moderate and 29% severe HIE (37% Induced Hypothermia and 63% Optimizing Cooling participants). Median (IQR) NSS of infants with moderate and severe HIE were 11 (9-13) and 16 (16-17), respectively. There were significant associations among NSS, NSS tertiles, and modified Sarnat staging and death or disability, but there were no differences found in their area-under-the-curve estimates. Similar to modified Sarnat staging, NSS showed significant associations with Bayley-III cognitive, language, and motor scores and Bayley-II mental and psychomotor developmental indices.

CONCLUSION

Among infants with moderate or severe HIE, the NSS did not improve the predictive accuracy for death or disability at 18-22 months of age, compared with modified Sarnat staging performed in the initial 6 hours after birth by trained examiners.

Exploring experiences of parents of young children with cerebral palsy with a standing frame program promoting hip development

PURPOSE

Children with Cerebral Palsy (CP) are at risk for hip problems, and early monitoring and intervention are recommended. This study explores the experiences of parents of young children with CP with a standing frame program (SFP) promoting hip development and identifies factors promoting or hindering the program's feasibility.

METHODS

Qualitative data were collected through 11 interviews, which were transcribed, and analyzed thematically. Quantitative data were collected through ratings of the level of agreement with statements related to the SFP.

RESULTS

For parents, balancing between their roles as parent and co-therapist, implementing the SFP involved physical and mental load. Involving the social environment, sharing care responsibilities, and integrating the SFP in different settings facilitated implementation of the program. Parents were motivated by potential benefits for their child and the opportunity for quality time.

CONCLUSIONS

Implementing the SFP is challenging for parents. For better integration of the SFP program into daily life, it is important to consider parents' needs and to collaborate with all caregivers. Future research should strengthen evidence on the SFP's impact on hip development and parental burden. Additionally, it is essential to ensure that the perspectives of burdened parents are incorporated in the program's development and evaluation.

Structural brain correlates of balance control in children with cerebral palsy: baseline correlations and effects of training

Structural brain abnormalities likely underlie impaired balance control in cerebral palsy (CP). This study investigated whether balance measures were associated with measures derived from conventional MRI and diffusion tensor imaging (DTI), and whether an X-Box One Kinect balance training (6 weeks, 5 days/week, 30 min/session) could induce neuroplastic changes in CP. Twelve children with spastic CP (age:11.3 ± 2.3y) underwent balance evaluation and MRI examination, at baseline and after training. Nine age-matched typically developing (TD) children underwent baseline measurements. Balance control was evaluated testing advanced motor skills (Challenge score) and during gait (medio-lateral Margin of Stability, MoS). With conventional MRI, but especially with DTBM (DTI-based VBM), we found smaller volumes of several deep grey matter structures and within the right inferior parietal cortex, right supramarginal cortex, and left postcentral cortex, and lower fractional anisotropy (FA) and smaller volumes of various white matter regions in CP compared to TD. Within the CP group alone, no correlations within brain tissue were found. After training, Challenge scores of children with CP improved. In an exploratory analysis DTBM showed a trend for volume increase within the right inferior parietal cortex, volume decrease within the right retrolenticular limb of the internal capsule, and an increase of FA within the right corticospinal tract. This indicates that a 6-week balance intervention may induce neuroplastic changes in children with CP. CP-RehOP (trial registration number: NTR6034/NL5854, date of registration: August 26th 2016).

The nutritional status according to anthropometric indexes and growth patterns in children and adolescents with cerebral palsy: A scoping review of the literature

BACKGROUND

Determining the nutritional status of children with cerebral palsy (CP) presents numerous challenges. Accurate nutritional assessment is crucial in this population to ensure the provision of appropriate and effective nutritional interventions.

AIM

This scoping review aimed to analyze the most frequently used anthropometric indexes and growth patterns to determine the nutritional status of children and adolescents with CP.

METHODS

The literature search was performed in six databases Scopus, Cochrane Library, Web of Science, SciELO, Medline and PubMed. It was conducted on studies that included children aged 0 to 18 years. Sixty-three publications met the inclusion criteria.

RESULTS

The prevalence of undernutrition was higher when WHO growth standards and CDC growth charts were used (93.3% and 56.8%, respectively), whereas the prevalence of normal nutritional status was higher when US CP growth charts were used (92.5%). The prevalence of stunting was higher with the WHO growth standards (97.7%) and lowest with the US CP growth charts (4.3%). The WHO growth standards were the most frequently used (50.8%), followed by the CDC growth charts (22.2%) and the US CP growth charts (12.7%).

CONCLUSION

The index with more relevance in this scoping review was BMI since it was addressed in 77.8% of the studies. When assessing the nutritional status with typically developed children's patterns, there was a higher prevalence of undernutrition and stunting. When using US CP growth charts, more children were included in the normal range. More studies are needed to determine which growth pattern is a better indicator of health.

Development and Validation of a Prognostic Model for Independent Walking in Children with Cerebral Palsy Based on Machine Learning

OBJECTIVE

To develop and validate machine learning-based models for predicting independent walking ability in children with cerebral palsy (CP) DESIGN: Retrospective cohort study.

SETTING

Data were collected from a national cerebral palsy registry platform and follow-up assessments were conducted telephone interviews.

PARTICIPANTS

Children with cerebral palsy (n=807) registered between January 2016 and December 2020, with follow-up data collected from October 2022 to March 2023.

INTERVENTIONS

Not applicable.

MAIN OUTCOME

Measures The primary outcome was independent walking before the age of 6 years old.

RESULTS

Among the 807 participants, 561 (69.5%) achieved independent walking. Univariate Cox regression identified several predictive factors, including neonatal asphyxia, bilirubin encephalopathy, Gross Motor Function Classification System (GMFCS) level before age 2, age of independent sitting, type of CP, MRI classification, GMFM-88 scores, epilepsy, intellectual disability, early preterm birth, and very low birth weight (P<0.05). Machine learning models demonstrated excellent predictive performance, with logistic regression achieving the highest area under the curve (AUC=0.947), followed by XGBoost (AUC=0.946) and multilayer perceptron (AUC=0.945). Cox proportional hazard models identified key predictors for the timing of independent walking, with a nomogram constructed for clinical application. Internal validation confirmed model reliability, though calibration curves indicated potential overestimation for ages 5∼6 years.

CONCLUSION

Machine learning models accurately predict independent walking ability in children with CP, though calibration analyzes indicated potential overestimation for children aged 5∼6 years. The proposed nomogram provides clinicians with an interpretable tool for personalized prognosis. While internal validation demonstrated excellent performance, future external validation in multi-center cohorts will be critical to confirm generalizability.

CLINICAL TRIAL REGISTRATION NUMBER

Not applicable.

Risk Factor Effects on Neurodevelopment at 2 Years in Very Preterm Children: A Systematic Review

CONTEXT

Various medical and social factors are associated with adverse neurodevelopment in children born very preterm. Analyses accounting for confounders involving representative samples are essential to quantify the effects of different factors.

OBJECTIVE

We aimed to systematically review the effects of various risk factors on neurodevelopmental impairment (NDI) at 18 to 36 months of age in children born before 32 weeks' gestation.

DATA SOURCES

Ovid MEDLINE, Embase, and PubMed were searched for articles up through April 29, 2024.

STUDY SELECTION

We used geographic or network population cohort studies of children born after January 1, 1990 at less than 32 completed weeks' gestation reporting risk factors and NDI measures at 18 to 36 months old. Studies including less than 50 children, not addressing confounders in the analysis, or comprising nonrepresentative samples were excluded.

DATA EXTRACTION

Study characteristics, population characteristics, exposure and outcome definitions, effect sizes, and covariates were extracted.

RESULTS

Of 18 012 studies screened, 51 were eligible. Brain injury (intraventricular hemorrhage grade III or IV and/or periventricular leukomalacia) had the highest adjusted odds of moderate-to-severe NDI and its main contributors (moderate-to-severe cognitive or language delay and moderate-to-severe cerebral palsy), followed by neonatal seizures and retinopathy of prematurity (≥stage 3, "threshold disease" or "treated"). Small for gestational age exhibited inconsistent effects, whereas lower maternal age exhibited no effect on the outcomes included.

LIMITATIONS

This included an inability to meta-analyze due to factor and outcome definition heterogeneity.

CONCLUSIONS

This review illustrates the extent to which risk factors influence the odds of NDI in children born very preterm, finding neurologic morbidities confer the highest risk. We highlight the need for consistent factor and outcome definitions.

The transfusion of prematures early school age follow-up (TOP 5): protocol for a longitudinal cohort study

BACKGROUND

Anemia of prematurity is a common concern for extremely low birth weight (ELBW) patients in the neonatal intensive care unit. The hemoglobin threshold at which the benefits of red blood cell transfusion outweigh the risks is unknown. The NICHD Neonatal Research Network Transfusion of Prematures (TOP) Trial evaluated whether higher (more liberal) hemoglobin transfusion thresholds resulted in improved survival without neurodevelopmental impairment at 22-26 months' corrected age. A total of 1824 ELBW infants born at 22-28 weeks' gestation were enrolled in the trial and randomized to either a restrictive or liberal set of red blood cell transfusion thresholds. Longer-term impacts of different transfusion thresholds in treatment for anemia of prematurity remain unknown. The Transfusion of Prematures Early School Age Follow-up (TOP 5) Study extends follow-up of all surviving children enrolled in the TOP Trial until early school age. It aims to assess longer-term cognitive and functional effects of differing transfusion thresholds in the newborn period for anemia in this large, multicenter cohort.

METHODS

Parents of surviving trial participants complete telephone questionnaires when their children are 3 and 4 years' corrected age. A single in-person study visit takes place at early school age (5 years, 0 months to 7 years, 11 months' corrected age). Children undergo a multidimensional assessment of functional outcomes, and parents complete a battery of questionnaires.

DISCUSSION

The TOP 5 Study will be the largest and most comprehensive evaluation to date of the functional early school age outcomes of children managed with different red blood cell transfusion thresholds during infancy for treatment of anemia of prematurity. This will substantially improve understanding of the longer-term neurological and functional outcomes of different transfusion thresholds; provide more refined evaluation of cognition, executive function, school readiness, motor skills, adaptive functioning, and behavior in former extremely preterm infants; and inform future clinical decision-making for treating anemia of prematurity.

TRIAL REGISTRATION

Clinicaltrials.gov ID: NCT01702805. Primary trial registration 10/05/2012; modified to include follow-up through school age 12/20/2018. This manuscript reflects version 3 of the trial protocol, dated 12/07/2020.

Caregiver-reported meaningful change in functional domains for individuals with developmental and epileptic encephalopathy: A convergent mixed-methods design

AIM

To investigate how caregivers of children with developmental and epileptic encephalopathy and severe developmental impairments describe meaningful change for functional domains and why it is important.

METHOD

This was a convergent mixed-methods design study. A survey was completed by 267 parents of children aged 12 months or older. For prioritized functional domains (communication, gross motor, fine motor, eating), parents reported the smallest improvement that would be important and explained why. Data were analyzed using directed content analysis and meaningful change codes were mapped to impairment levels.

RESULTS

The median age of the children was 8 years 8 months (interquartile range 4 years 2 months-14 years 6 months) and 149 (55.8%) were female. Content analysis yielded 86 meaningful change codes. Common codes described capacity to communicate preferences and emotions, gain sitting and walking skills, grasp objects for play, eat foods without choking, or using utensils. Some codes were reported for each impairment level (e.g. communicating needs/wants/likes for expressive communication); others were specific to an impairment level (e.g. gaining head control if unable to walk). Meaningful change was anticipated to affect health, independence and safety, care regimens, and quality of life of affected individual and families.

INTERPRETATION

The meaningful change codes indicate critical components within domains for evaluations in clinical trials.

Development and Preliminary Validation of a Parkinsonism-Dystonia Scale for Infants and Young Children

BACKGROUND

Parkinsonism in infancy is rare and is highly correlated with the presence of dystonia. Advances in treating and characterizing developmental and infantile degenerative parkinsonism have highlighted the need for a specialized assessment scale.

OBJECTIVE

The aim of this study was to design and validate a scale that effectively assesses parkinsonism-dystonia in early life.

METHODS

The Infantile Parkinsonism-Dystonia Rating Scale (IPDRS) was designed to capture the key clinical features of parkinsonism-dystonia in early life. It consists of 28 items across three subscales: Non-motor symptoms, Motor symptoms, and Dyskinesias. Thirty-two patients with hypokinetic movement disorder were scored following a standardized protocol. Filmed motor examinations were analyzed independently by three pediatric movement disorders specialists to evaluate interrater reliability. Twenty additional patients with primary neurotransmitter disorders were scored, and nine of them were evaluated at baseline and after treatment. Psychometric validation was conducted.

RESULTS

A total of 52 patients were scored using the IPDRS. Mean age was 3.1 years (standard deviation [SD]: 2.0), and the mean IPDRS score was 40.8 (SD: 13.17). Internal consistency analysis demonstrated a Cronbach's α of 0.21 for Non-motor symptoms subscale, 0.84 for Motor symptoms subscale, and 0.95 for Dyskinesia subscale. Kappa indexes exceeded 0.70 in seven items. Correlation coefficients for dystonia items with the Barry-Albright-Dystonia Scale ranged from 0.46 to 0.64. After treatment, all IPDRS scores changed significantly, with an effect size of 2.42.

CONCLUSIONS

The IPDRS appears to be a reliable and valid tool for assessing parkinsonism in early life. Further validation studies with a larger sample size are needed to confirm these findings and complete the validation process. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Analysis of multichannel intraluminal impedance and pH monitoring values in children with cerebral palsy: A comparative multicenter study

OBJECTIVES

To compare the features of multichannel intraluminal impedance and pH monitoring (MII-pH) tracings in children with cerebral palsy (CP) and children without CP.

METHODS

Multicenter, retrospective, analytical study. We examined tracings of children aged 1 to 15 years old, evaluated from May 2017 to January 2024. Population included two groups: Group 1 consisted of children with CP, while control group comprised children without CP who had extra-digestive symptoms suggestive of gastroesophageal reflux disease (GERD) but normal MII-pH results. Quantitative data were analyzed using analysis of variance and t tests. Qualitative data were analyzed using contingency tables and chi-square tests.

RESULTS

We studied 245 children. CP group included 110 children with a mean age of 5.71 years (standard deviation [SD] ± 4.24), while control group included 135 children with a mean age of 5.73 years (SD ± 3.39). The CP group had fewer reflux episodes (p = 0.0015), slower mean acid clearance time (p = 0.04), lower mean baseline impedance and mean nocturnal baseline impedance (p = 1.82e-07 and p = 7.50e-07).

CONCLUSION

Children with CP have fewer reflux episodes and longer acid clearance times compared with children without CP. Prospective studies including esophagogastroduodenoscopy findings are needed to establish MII-pH reference values in children with CP.

How to identify children with cerebral palsy at risk of low bone mineral density

AIM

Cerebral palsy is a common chronic motorically disabling condition in children. The aim of this study was to determine prevalence of low bone mineral density (BMD) in children with cerebral palsy and to examine the association between BMD with risk factors.

METHODS

Cross sectional study of children with cerebral palsy analyzing Dual X-ray Absorptiometry, blood tests, full clinical medical examination including Tanner stage and nutritional status, measurement of anthropometrics and assessment of physical activity.

RESULTS

The 81 participants were aged 2.1-17.4 years (median 9 years) and 64 out of 81 had a mild cerebral palsy (Gross Motor Function Classification System score of I-II). Mean BMD z-score was -0.2 (SD = 1.05, range -4.6 to 2.0). GMFCS score was negatively associated with BMD (p < 0.01) as higher score led to 1.43 SD lower BMD [-1.97 to -0.89]. Weight bearing activity was negatively associated with lower BMD z-score (p = 0.01), as having <30 min of weight bearing activity per day lead to 0.98 SD lower BMD [-1.75; -0.22]. Use of anti-seizure medication was negatively associated with BMD (BMD z-score 0.7 SD lower; p = 0.02, [-1.28; -0.12]). Serum vitamin D levels or fracture rates were not statistically significantly associated with BMD changes.

CONCLUSION

We found 17 % of children have low BMD regardless of motoric impairment level. GMFCS score, Sparse weight bearing activity and use of anti-seizure medicine were negatively associated to BMD. No significant associations were found with vitamin D, sex, BMI, puberty.

Validation of the French version of the Caregivers' Priorities and Child Health Index of Life with Disabilities questionnaire

INTRODUCTION

The Caregivers' Priorities and Child Health Index of Life with Disabilities (CPCHILD) is a questionnaire that measures the health-related quality of life (HRQL) of children with cerebral palsy (CP). Though measuring HRQL is challenging in these children, it is a valuable help for medical decision-making. There is no questionnaire to assess HRQL in French-speaking children with severe CP.

OBJECTIVE

To translate and adapt transculturally the CPCHILD questionnaire into French (CPCHILD-FV).

MATERIAL AND METHODS

The CPCHILD was translated from English into French by forward and backward translation by independents translators. The questionnaire was then tested on 32 caregivers of patients with CP classified as GMFCS IV or V, remarks of caregivers were analyzed by an expert committee and, if necessary, modifications were performed. Internal consistency of the CPCHILD-FV was assessed using a sample of 32 parents or caregivers and test-retest reliability was assessed on a random sample of 10 patients.

RESULTS

The translation and transcultural process resulted in a French version of the CPCHILD. Some items of the CPCHILD required careful discussion to ensure that items had the same meaning as in the original. Internal consistencies were over 0.70 for each domain except for health, and 0.97 for the total scores. The ICC for the test-retest reliability of the CHILD-FV total score was 0.98 (95% CI: 0.93-0.99) and ranged from 0.59 to 0.99 for the domains.

CONCLUSION

The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a French version than can measure the HRQL of children with severe CP.

LEVEL OF EVIDENCE

IV; prospective study without control group.

Experiences of Parents of Children With Cerebral Palsy Participating in an Online Parenting Course Grounded in Acceptance and Commitment Therapy

BACKGROUND

To understand the experiences of parents of children with cerebral palsy (CP) participating in an online parenting course grounded in acceptance and commitment therapy (PACT) from an implementation perspective.

METHOD

Fifty-five parents from 50 families of children with CP (GMFCS I = 21, II = 15, III = 8, IV = 8, V = 3) participated in this mixed methods study. Families were drawn from 67 families participating in an RCT of PACT. Parents participated in a qualitative interview and gave additional feedback on 10-point Likert scales and open-ended questions via the course platform. The implementation analysis consisted of a thematic analysis as well as descriptive statistics, t-tests and ANOVAs to examine the impact of child age and motor functioning as potential barriers.

RESULTS

Parents reported that they liked both the ACT content and the online format, and the modules were rated highly in the course feedback (7-9 on 10-point Likert scales). Parents reported positive changes for both them and their child. Parents of younger (2-5 years) children rated the videos from Module One Living a Meaningful Life more highly than parents of older (6-10 years) children. There were no other effects of child age or motor functioning.

CONCLUSION

Overall, parental response to PACT was positive, and child age and motor functioning level were not barriers. The online format of the programme and ACT content were well suited to the needs of this population. In particular, the ACT components of values and mindfulness were found to be particularly relevant. Implementation should focus on understanding that ACT can be psychologically challenging, ensuring that parents who need individualised support for intervention adaptation receive it, providing good support to address technological difficulties and building effective reminders into the intervention protocol.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616000351415.

Physical activity and exercise interventions in adults with cerebral palsy: a systematic review of quantitative and qualitative studies

PURPOSE

Participating in physical activity may benefit health-related outcomes for adults with cerebral palsy (CP). The aim of this review is to provide a synthesis of the evidence from both qualitative and quantitative studies on the impact of physical activity and exercise interventions in adults with CP.

METHODS

Literature searches were conducted from inception to November 2023 in nine electronic databases. A meta-analysis was carried out to evaluate the efficacy of the interventions on walking speed related outcomes and muscle strength.

RESULTS

Twenty-two studies met the inclusion criteria. The interventions of the nine studies included in the meta-analysis did not improve walking speed over a distance of 10 m (SMD = -0.03, 95% CI: -0.34-0.40, p = 0.88, I2 = 0%) or endurance (distance covered in 2 or 6 min) (SMD = 0.25, 95% CI: -0.10-0.59, p = 0.16, I2 = 0%), but there was an improvement in lower limb muscle strength in favour of the experimental groups (SMD = 0.59, 95% CI: 0.19-0.99, p = 0.004, I2 = 20%). Only a few studies reported on psychosocial outcomes, quality of life, or intervention sustainability.

DISCUSSION AND CONCLUSIONS

Further research is needed to explore the impact on psychosocial outcomes and quality of life in adults with CP and the sustainability of physical activity participation.

The 24-Hour Physical Activities in Adults With Cerebral Palsy and Their Adherence to the 24-Hour Movement Guideline

OBJECTIVE

To describe 24-hour physical activities (sleep and physical activity) in adults with cerebral palsy (CP), explore potential influencing factors, and compare 24-hour physical activities with controls.

DESIGN

Cross-sectional, observational internet study involving adults with CP and a convenience sample of adults without CP.

SETTING

Individuals residing in the Netherlands.

PARTICIPANTS

A total of 110 adults with CP (median age: 42, range: 28-77 years; 64 [58%] ambulant; 40% men) and 89 adult controls (median age; 43, range: 18-78 years; 29% men).

MAIN OUTCOME MEASURES

Sleep quantity and quality measured by the Pittsburgh Sleep Quality Index, physical activity measured using the International Physical Activity Questionnaire- Short Form, and health status using the 5-level EuroQol-5D.

RESULTS

Most recurrent sleep problems for adults with CP included falling asleep, waking up, needing the toilet, having nightmares, and experiencing pain during the night. Sleep quality was significantly worse for adults with CP than controls. A total of 64% of adults with CP met the physical activity guidelines. Total physical activity was similar between adults with CP who are ambulatory and controls. A total of 44% of adults with CP, compared with 51% controls, met both sleep and physical activity guidelines. No factors influencing the 24-hour activities were found for level of severity, age, sex, pain/discomfort, and anxiety/depression.

CONCLUSIONS

Given the prevalence of worse sleep quality and modest adherence to the 24-hour movement guideline, this study emphasizes the importance for clinicians to assess problems in physical activities during clinical encounters with adults with CP.

Quantification of gait impairment using the gait profile and variable score in children with cerebral palsy

BACKGROUND

gait kinematic parameters of children with unilateral and bilateral cerebral palsy must be characterized separately by a statistical index with promising psychometric properties. The objective of this study was to compare both forms of cerebral palsy using the gait profile score and gait variable score.

METHODS

Gait profile score of 47 children with cerebral palsy classified with a Gross Motor Function Classification System level I-III were retrospectively calculated from gait analysis. Statistical analysis were used to compare (1) gait profile score between level I and II, (2) gait profile and variable score between children with unilateral (n = 28) and bilateral (n = 16) forms as well as their difference between both limbs for each subgroup (significance level of 0.05).

FINDINGS

The gait profile score was significantly different between level I and II (p ≤ 0.021). No significant difference was found for gait profile score between both subgroups (p = 0.72) or between both limbs of children with bilateral form (p = 0.85). The gait profile score was significantly higher for the paretic compared to the non-paretic limb of children with unilateral form (p < 0.005). Significant differences were found for some gait variable score between subgroups (p < 0.05).

INTERPRETATION

The gait profile score can distinguish altered kinematic gait parameters in paretic from non-paretic limb in children with unilateral form. The gait variable score helps to localize the largest kinematic impairment.

The effect of Snoezelen intervention on problem behaviors in children with cerebral palsy: A randomized controlled trial

AIM

To evaluate the effect of Snoezelen intervention on problem behaviors in children with cerebral palsy (CP) and to analyze its correlation with motor function, as measured by the Gross Motor Function Classification System (GMFCS).

METHOD

This study is registered under the Clinical Research Information Service (CRIS) with the registration number KCT0002794. The unique protocol ID for this trial is SRH2018R-01. A randomized controlled trial with 28 children (aged 2-5 years) with CP was conducted. The experimental group received Snoezelen intervention three times a week for four weeks. Problem behaviors were assessed using the CBCL 1.5-5 and K-PSI, and motor function was assessed using the GMFCS.

RESULTS

The experimental group showed a significant reduction in emotionally reactive behavior (p = 0.044). A strong negative correlation (Spearman's ρ = -0.744, p = 0.002) was found between GMFCS scores and changes in emotionally reactive behavior.

INTERPRETATION

The Snoezelen intervention may reduce emotional reactivity and enhance emotional stability in children with CP, although its effectiveness may vary depending on the level of motor impairment. Further research is needed to confirm these findings.

Automated extraction of functional biomarkers of verbal and ambulatory ability from multi-institutional clinical notes using large language models

BACKGROUND

Functional biomarkers in neurodevelopmental disorders, such as verbal and ambulatory abilities, are essential for clinical care and research activities. Treatment planning, intervention monitoring, and identifying comorbid conditions in individuals with intellectual and developmental disabilities (IDDs) rely on standardized assessments of these abilities. However, traditional assessments impose a burden on patients and providers, often leading to longitudinal inconsistencies and inequities due to evolving guidelines and associated time-cost. Therefore, this study aimed to develop an automated approach to classify verbal and ambulatory abilities from EHR data of IDD and cerebral palsy (CP) patients. Application of large language models (LLMs) to clinical notes, which are rich in longitudinal data, may provide a low-burden pipeline for extracting functional biomarkers efficiently and accurately.

METHODS

Data from the multi-institutional National Brain Gene Registry (BGR) and a CP clinic cohort were utilized, comprising 3,245 notes from 125 individuals and 5,462 clinical notes from 260 individuals, respectively. Employing three LLMs-GPT-3.5 Turbo, GPT-4 Turbo, and GPT-4 Omni-we provided the models with a clinical note and utilized a detailed conversational format to prompt the models to answer: "Does the individual use any words?" and "Can the individual walk without aid?" These responses were evaluated against ground-truth abilities, which were established using neurobehavioral assessments collected for each dataset.

RESULTS

LLM pipelines demonstrated high accuracy (weighted-F1 scores > .90) in predicting ambulatory ability for both cohorts, likely due to the consistent use of Gross Motor Functional Classification System (GMFCS) as a consistent ground-truth standard. However, verbal ability predictions were more accurate in the BGR cohort, likely due to higher adherence between the prompt and ground-truth assessment questions. While LLMs can be computationally expensive, analysis of our protocol affirmed the cost effectiveness when applied to select notes from the EHR.

CONCLUSIONS

LLMs are effective at extracting functional biomarkers from EHR data and broadly generalizable across variable note-taking practices and institutions. Individual verbal and ambulatory ability were accurately extracted, supporting the method's ability to streamline workflows by offering automated, efficient data extraction for patient care and research. Future studies are needed to extend this methodology to additional populations and to demonstrate more granular functional data classification.

Depressive Symptoms and Behavioral Manifestations in Children and Adolescents with Cerebral Palsy: A Parent-Child Perspective Study

Individuals with cerebral palsy (CP) often exhibit mental health problems, including depressive symptoms. This study investigated self-reported depressive symptoms in children and adolescents with and without CP and associated factors. Herein, 52 and 38 children and adolescents with and without CP were enrolled in the CP and typically developing (TD) groups. Depressive symptoms were assessed using the Birleson Depression Self-Rating Scale for Children. Parents of the participants completed the Strengths and Difficulties Questionnaire. Self-reported depressive symptoms were more severe in the CP group than in the TD group, which was primarily attributed to declining activities and enjoyment in daily life. Depressive symptoms in the CP group were not correlated with age, the severity of CP, or parent-reported behavioral features. However, in the overall cohort, the cluster with high levels of depressive symptoms had significantly higher proportions of individuals with CP and participants with conduct, emotional, and peer problems. Multivariate analyses revealed that only peer problems were associated with increased depressive symptoms. Furthermore, peer problems fully mediated the relationship between the presence of CP and depressive symptoms. Our study suggests that providing opportunities for activities involving social interactions with peers and offering support to enable the enjoyment of such activities from an early age are imperative to prevent an increase in depressive symptoms in children with CP.

Predictors of community participation from preschool to school age in children with cerebral palsy

AIM

To investigate participation frequency patterns and child and family predictors of community participation in young children with cerebral palsy (CP).

METHOD

We prospectively assessed participation frequency at preschool (Young Children's Participation and Environment Measure) and again at school age (Participation and Environment Measure-Children and Youth). Linear regressions examined preschool predictors of community school-age participation: preschool child age; sex; gross motor function (Gross Motor Function Classification System [GMFCS]); manual function (Manual Ability Classification System); pain; prosocial behaviour; conduct; family ethnicity; income; and residence type.

RESULTS

Children with CP (n = 155, 44% females, 64% classified in GMFCS level I or II), mean baseline age = 4 years 4 months (SD = 1 year 1 month) and at school age = 6 years 7 months (SD = 7 months) had a median community participation frequency at preschool age of 2.8 (interquartile range [IQR] = 1.3) and 2.8 (IQR = 1.6) at school age. Preschool community participation was 2.02 (confidence interval [CI] = -2.20 to -1.83) units lower than at home; at school age, it was 2.40 (CI = -2.59 to -2.22) units lower. Greater prosocial behaviour (child model: R2 = 0.26, p = 0.001) predicted higher school age community participation.

INTERPRETATION

In young children with CP, community participation was infrequent at preschool age (a few times in the last 4 months) and this persisted into school age. Higher preschool prosocial behaviour predicted community participation at school age. Enhanced awareness of infrequent community participation of preschool children with CP and supporting a child's social behaviours may help facilitate community participation.

Ambulatory children with spastic cerebral palsy have smaller bone area and deficits in trabecular microarchitecture

Cerebral palsy (CP) is a non-progressive neurological syndrome resulting in abnormal muscle tone, movement, and posture. It is unclear whether ambulatory children with CP have deficits in bone quantity or quality. Furthermore, the relationship between abnormal muscle tone, altered function, and bone health remains largely unexplored. This observational study investigated bone mineral density (BMD) and microarchitecture in ambulatory children with spastic CP and associations of BMD with function, muscle spasticity, and gait. Children with spasticity in both lower limbs (n = 12) aged 3-8 years were recruited. Areal BMD was measured with dual energy x-ray absorptiometry (DXA) at the proximal femur and lateral distal femur and compared to normative data. High resolution peripheral quantitative computed tomography (HR-pQCT) was performed at the metaphyseal tibia and radius in a subset of participants (n = 5) and compared to healthy children (n = 7). Gait pathology and cardiopulmonary function were investigated with the Gait Deviation Index, Edinburgh Visual Gait Score, and energy expenditure index. DXA areal BMD (aBMD) Z-scores at the lateral distal femur were within a normal range. However, the CP group's median aBMD Z-score at the proximal femur was -1.8 (IQR: -2.2, -1.2, p = .03) indicating potential skeletal fragility. Strong correlations were found between gait pathology and DXA-based bone outcomes (correlation coefficient 0.62 [p = .04] to 0.73 [p = .01]) as well as energy expenditure index and DXA-based bone outcomes (correlation coefficient -0.63 [p = .03] to -0.98 [p ≤ .001]). At the metaphyseal tibia, children with spastic CP had significant deficits in HR-pQCT-measured bone geometry and trabecular microarchitecture: 35% lower total area, 42% lower trabecular area, and 48% lower trabecular number than controls. HR-pQCT parameters were similar between groups at the metaphyseal radius. These differences in tibial metaphysis size and trabecular microarchitecture are similar to those observed in disuse and thus could be a result of abnormal biomechanics or low levels of physical activity.

Lower limb orthopedic surgery in children and adolescents with cerebral palsy is well captured using individualized Goal Attainment Scale (GAS) and Canadian Occupational Performance Measure (COPM) goals

PURPOSE

To investigate individualized goals set and goal attainment following lower limb orthopedic surgery for children and adolescents with cerebral palsy (CP).

MATERIALS AND METHOD

Retrospective chart review. Individualized goals set prior to orthopedic surgery using the Canadian Occupational Performance Measure (COPM) and/or Goal Attainment Scaling (GAS) with follow-up within 18 months post-surgery were analyzed. Goals were categorized into functional mobility, leisure, self-care and productivity.

RESULTS

44 children met the inclusion criteria, mean age 12.5 years (range 4.8-18.2yrs, SD 3.9), GMFCS I = 6, II = 19, III = 6, IV = 9, V = 4. In total 111 goals were analyzed, n = 79 COPM goals and n = 32 GAS goals. Clinically and statistically positive change was demonstrated in the COPM post-surgery, with mean changes of 3.74 (<0.0001) for performance and 4.26 (p < 0.0001) for satisfaction with performance. Of the 32 GAS goals set, 22 had an expected to much greater than expected outcome.

CONCLUSIONS

COPM goals demonstrated clinically and statistically significant improvement in performance and satisfaction with performance for children of all GMFCS levels post-surgery. GAS goals were not universally met. This study highlights the importance of individualized goal setting and recommends further evaluation into non-achievement of goals and the relationship between goal outcomes and surgery type.

Long-term musculoskeletal outcomes in pediatric hemispherotomy

OBJECTIVE

The purpose of this study is to describe long-term functional mobility and musculoskeletal interventions in a group of pediatric patients who underwent hemispherotomy and hemispherectomy (HS) for drug-resistant epilepsy.

METHODS

We conducted a retrospective review of patients who underwent HS at UPMC Children's Hospital of Pittsburgh from 1997 to 2023 with at least 1 year of follow-up. Gross Motor Function Classification System (GMFCS) levels and data on upper extremity function were collected pre-operatively and at 1-, 2-, 5-, 10-, and 15-years post-HS for each patient. Musculoskeletal interventions including use of orthotic devices, chemodenervation, and orthopedic surgery were also documented for each patient at follow-up timepoints.

RESULTS

A total of 35 patients (51.4 % female) underwent HS at 4.26 ± 4.26 years old for drug-resistant epilepsy and presented for follow-up at 1 (n = 35), 2 (n = 29), 5 (n = 19), 10 (n = 15), and 15 (n = 13) years post-HS. All patients had post-operative hemiparesis with upper extremity functioning exhibiting the expected proximal-to-distal gradient in impairment. 20 patients (57 %) experienced no change in GMFCS levels throughout follow-up while 14 (40 %) showed improvement in GMFCS level. Use of orthotics at each timepoint ranged from 78 % to 100 % of the cohort. In total, 11 (34 %) patients underwent at least one round of chemodenervation and 11 (34 %) underwent at least one orthopedic surgical procedure.

CONCLUSIONS

Our study demonstrates that children who undergo HS experience minimal long-term impact on broad measures of functional mobility but may still require intervention for management of spasticity, muscle contractures, and bony deformities.

Knee surveillance for ambulant children with cerebral palsy

Purpose

A majority of ambulant children with cerebral palsy (CP) develop progressive musculoskeletal pathology (MSP) during growth. Fixed flexion deformity at the knee joint (FFDKn) contributes to flexed knee gait and is prone to relapse after index multi-level surgery. This perspective introduces the concept of "knee surveillance" (KS), defined as a repeated systematic assessment of gait and knee range of motion until skeletal maturity. KS aims to detect early FFDKn, allowing for early intervention with minimally invasive techniques such as anterior distal femur hemiepiphysiodesis (ADFH), and reduce the need for higher-risk surgery such as distal femoral extension osteotomy (DFEO) and patellar tendon shortening (PTS).

Methods

Recent literature on the assessment of ambulant children with CP, consensus statements on indications for dose-based knee surgery, and the indications for ADFH have been reviewed and synthesized. These provide a preliminary evidence base for the concept of KS in ambulant children with CP.

Conclusion

We propose the concept of KS for ambulant children with CP. The goals of KS are early detection of knee flexion deformity, early intervention, less invasive surgery, and better long-term outcomes. There is preliminary evidence to suggest that soft-tissue surgery, in combination with ADFH, can reduce, or perhaps replace, the need for more invasive surgery such as DFEO and PTS.

Level of evidence

IV.

BCI move: exploring pediatric BCI-controlled power mobility

Introduction

Children and young people (CYP) with severe physical disabilities often experience barriers to independent mobility, placing them at risk for developmental impairments and restricting their independence and participation. Pilot work suggests that brain-computer interface (BCIs) could enable powered mobility control for children with motor disabilities. We explored how severely disabled CYP could use BCI to achieve individualized, functional power mobility goals and acquire power mobility skills. We also explored the practicality of pediatric BCI-enabled power mobility.

Methods

Nine CYP aged 7-17 years with severe physical disabilities and their caregivers participated in up to 12 BCI-enabled power mobility training sessions focused on a personalized power mobility goal. Goal achievement was assessed using the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS). The Assessment for Learning Powered Mobility (ALP) was used to measure session-by-session power mobility skill acquisition. BCI set-up and calibration metrics, perceived workload, and participant engagement were also reported.

Results

Significant improvements in COPM performance (Z = -2.869, adjusted p = 0.012) and satisfaction scores (Z = -2.809, adjusted p = 0.015) and GAS T scores (Z = -2.805, p = 0.005) were observed following the intervention. ALP scores displayed a small but significant increase over time (R 2 = 0.07-0.19; adjusted p = <0.001-0.039), with 7/9 participants achieving increased overall ALP scores following the intervention. Setup and calibration times were practical although calibration consistency was highly variable. Participants reported moderate workload with no significant change over time (R 2 = 0.00-0.13; adjusted p = 0.006-1.000), although there was a trend towards increased frustration over time(R 2 = 0.13; adjusted p = 0.006).

Discussion

Participants were highly engaged throughout the intervention. BCI-enabled power mobility appears to help CYP with severe physical disabilities achieve personalized power mobility goals and acquire power mobility skills. BCI-enabled power mobility training also appears to be practical, but BCI performance optimization and skill acquisition may be needed to translate this technology into clinical use.

Psychological aspects of hippotherapy for children with severe neurological impairment: An exploratory study

BACKGROUND AND OBJECTIVES

Neuropediatric hospitalization presents significant psychological challenges that affect quality of life, learning, and treatment adherence. Hippotherapy might address these factors, but its psychological effects are underexplored. This paper explores the psychological and neuropsychological potential of hippotherapy in pediatric neurorehabilitation. Objectives include analyzing (1) patient characteristics, (2) session characteristics, (3) patients' psychological and neuropsychological reactions, and (4) therapists' perceptions of the extent to which the therapeutic goals were realized in the sessions.

METHODS

This retrospective explorative study examines data from 581 children and adolescents (M =  9.01 years, SD =  3.88) with severe neurological disorders who underwent hippotherapy. We used the registration form for each patient and session-documentation forms for each hippotherapy session. We extracted information regarding patient and session characteristics, performed a content analysis on the documented reactions of the patients and the predefined neuropsychosocial goals set by the rehabilitation team, and examined to what extent the goals were met during hippotherapy. The data were analyzed using descriptive statistics.

RESULTS

Patients received an average of 3.47 hippotherapy sessions. During hippotherapy, 66.4% of the predefined goals were reached; cognitive functions and social behavior were the most successfully achieved goals. The most frequently documented patient reaction was had fun (81% of all sessions).

CONCLUSION

Our study shows that hippotherapy is a feasible and beneficial treatment for neuropediatric patients with severe neurological impairments. The goals of hippotherapy can be much broader than the usually targeted physical functioning and mobility. Hippotherapy might be especially effective in promoting fun and motivation and in addressing patients' socioemotional needs.

Childhood muscle growth: Reference curves for lower leg muscle volumes and their clinical application in cerebral palsy

Skeletal muscles grow substantially during childhood. However, quantitative information about the size of typically developing children's muscles is sparse. Here, the objective was to construct muscle-specific reference curves for lower leg muscle volumes in children aged 5 to 15 y. Volumes of 10 lower leg muscles were measured from magnetic resonance images of 208 typically developing children and 78 ambulant children with cerebral palsy. Deep learning was used to automatically segment the images. Reference curves for typical childhood muscle volumes were constructed with quantile regression. The median total leg muscle volume of a 15-y-old child is nearly five times that of a 5-y-old child. Between the ages of 5 and 15, boys typically have larger muscles than girls, both in absolute terms (medians are greater by 5 to 20%) and per unit of body weight (1 to 13%). Muscle volumes vary widely between children of a particular age: the range of volumes for the central 80% of the distribution (i.e., between the 10th and 90th centiles) is more than 40% of the median volume. Reference curves for individual muscle volumes have a similar shape to reference curves for total lower leg muscle volume. Confidence bands about the centile curves were wide, especially at the youngest and oldest ages. Nonetheless, the reference curves can be used with confidence to identify small-for-age muscles (centile < 10). We show that 56% of children with cerebral palsy in our cohort had total lower leg muscle volumes that were small-for-age and that 80% had at least one lower leg muscle that was small-for-age.

Sustainable Model of Early Intervention and Telerehabilitation for Children With Cerebral Palsy in Rural Bangladesh: The SMART-CP Randomized Clinical Trial

Importance

Access to early intervention and rehabilitation services among children with cerebral palsy (CP) remains limited in Bangladesh, which demands an innovative and sustainable service delivery model.

Objective

To evaluate the effectiveness of the Sustainable Model of Early Intervention and Telerehabilitation for Children With CP (SMART-CP) model compared with usual care in improving access to and utilization of early diagnosis, early intervention, and rehabilitation services in rural Bangladesh.

Design, Setting, and Participants

This was a 2-arm cluster randomized clinical trial, with 8 clusters (ie, subdistricts) randomly allocated to the intervention (SMART-CP model) or control arm. The setting was in Sirajganj, Bangladesh, and included children with CP 18 years or younger. Outcomes were measured at 0 and 12 months, and an intention-to-treat analysis was conducted. Data were analyzed from December 2023 to May 2024.

Interventions

The SMART-CP model comprised (1) a rural referral network involving key informants and caregiver peer groups (called mPower or mothers' power), (2) subdistrict level SMART-CP centers, and (3) telerehabilitation services. Children in the intervention arm received weekly goal-directed therapy, mPower group meetings every 2 weeks, and monthly telerehabilitation sessions.

Main Outcomes and Measures

The primary outcome was whether a child with CP accessed any form of rehabilitation services, with secondary outcomes analyzed as hypothesis generating.

Results

Overall, 968 children with CP (mean [SD] age, 7.9 [4.9] years; 581 male [60.0%]) were enrolled, with 500 in the intervention arm and 468 in the control arm. Between baseline and endline, rehabilitation services uptake significantly increased in the intervention arm (70.2% [351 of 500] vs 99.4% [497 of 500]), compared with the control arm (63.9% [299 of 468] vs 68.2% [319 of 468]; P <.001). Children in the intervention arm were 1.5 times more likely to access rehabilitation than the control arm. Secondary analyses suggested that the intervention arm also facilitated early CP diagnosis (mean [SD] diagnosis time, 2.0 [2.0] years vs 3.8 [3.3] years; Cohen d = -0.7) and initiation of rehabilitation (mean [SD] rehabilitation time, 1.8 [1.8] years vs 3.6 [2.4] years; Cohen d = -0.9). Additionally, higher therapy session counts (mean [SD] session counts, 23.4 [31.7] vs 4.3 [20.8]; Cohen d = 0.7), increased assistive device utilization (20.8% [104 of 500] vs 3.0% [14 of 468]; risk ratio, 0.82; 95% CI, 0.78-0.86; P < .001), and lower out-of-pocket expenditure per month (mean [SD] expenditure, $1.5 [$1.6] vs $2.9 [$5.1]; Cohen d = -0.4) were found in the intervention arm. No significant difference in clinical outcomes and mortality rates was observed between the intervention and control groups.

Conclusions and Relevance

Results of this cluster randomized clinical trial reveal that the SMART-CP model improved access to and utilization of early diagnosis and intervention services for children with CP in rural Bangladesh. This model holds promise for global scalability.

Trial Registration

ANZCTR Trial Identifier: ACTRN12622000396729.

A 6-Week Modified Physical Therapy Intensive Program for a Child With Cerebral Palsy

PURPOSE

This case report assesses the outcomes of a 6-week modified intensive program for a 4-year-old boy with cerebral palsy (CP), Gross Motor Function Classification System Level IV.

SUMMARY OF KEY POINTS

The modified intensive program included the practice of developmental gross motor skills, standing/gait training in adaptive equipment, constraint-induced movement therapy, and whole body vibration.

CONCLUSIONS

The child improved in 4 of the 5 outcomes, including timed sitting balance and modified versions of the 5 Times Sit-to-Stand Test and 9-Hole Peg Test. His ability to assist with transfers, sit independently, and use both hands for play and self-help skills also improved.

RECOMMENDATIONS FOR CLINICAL PRACTICE

This case report adds to the body of evidence supporting the use of intensive program models of physical therapy for children with CP and highlights the need for additional research in this emerging area of clinical practice.

Long-term impact of early identification of cerebral palsy

PURPOSE OF REVIEW

Early identification of cerebral palsy (CP), as in all neurologic conditions, has a profound impact on the ability to initiate interventions, support the education and empowerment of parents, ameliorate the effect of the conditions, and importantly identifies cohorts for neuroprotection or repair to address the primary injury. CP is a life span condition. Rapid initiation of services, support and anticipatory guidance is essential to maximize functional outcomes, prevent or manage complications and improve quality of life.

RECENT FINDINGS

CP diagnosis should not be delayed. Early imaging as well as motor and neurologic evaluation can aid in early detection of CP before age 5 months. Early therapeutic intervention can influence function and assist in prevention of complications that can impact abilities. There is important ongoing research with efforts to prevent CP or alter the phenotype of the condition.

SUMMARY

Literature review provides evidence to change in standard of care in diagnosing CP. There are published guidelines on how to pursue the diagnosis during early infancy. Early identification results in early intervention with the purpose of enhancing functional skill development, prevention of complications, and establishing parental support. Early identification provides an optimistic view and opportunity to intervene immediately in hopes to have an impact in the functional outcome and improving quality of life.

Reliability and validity of the Mini-Eating and Drinking Ability Classification System (Mini-EDACS) among Dutch preschoolers with cerebral palsy

PurposeThis study aimed to translate the English version of the Mini-Eating and Drinking Ability Classification System (Mini-EDACS) into Dutch and assess its psychometric properties and applicability among preschool-aged children with cerebral palsy (CP) in the Netherlands.MethodsForty-eight children with CP (18-36 months) were included. Inter-rater reliability of the Dutch version of the Mini-EDACS was assessed between two speech and language therapists (SLTs) and between two SLTs and parents. Construct validity was established by hypothesis testing regarding the expected strength of the correlation between Mini-EDACS level and sum score of (a) the Pediatric Eating Assessment Tool (PEDI-EAT-10) and (b) the Montreal Children's Hospital Feeding Scale (MCH-FS).ResultsThe level of agreement for Mini-EDACS level was almost perfect between SLTs (weighted kappa (kw) = 0.83) and substantial between parents and SLTs (parents vs SLT-1: kw = 0.77; parents vs SLT-2: kw = 0.70).Kendall's tau-b correlation between Mini-EDACS and PEDI-EAT-10 was 0.66 (p < 0.001), slightly lower than hypothesized, and 0.52 (p < 0.001) between Mini-EDACS and MCH-FS, aligning with the hypothesis. Applicability was found to be good.ConclusionThe Dutch version of the Mini-EDACS showed sufficient inter-rater reliability, construct validity and applicability and can be used in clinical care in the Netherlands to promote unambiguous communication between healthcare professionals and parents.

How does the environmental inadequacy mediate the effect of functional limitations on participation restrictions in young adults with cerebral palsy?

BACKGROUND

Adults with cerebral palsy (CP) face various functional limitations and comorbidities, that prevent them from participating fully in social life. Disability models suggest that an environment not tailored to their needs could partly explain the link between functional limitations and participation restrictions. However, there is still insufficient knowledge about how the environment hinders participation.

OBJECTIVE

To investigate the mediating role of environmental inadequacy in the relationship between functional limitations and participation restrictions in young adults with CP.

METHODS

Cross-sectional study, which included 310 young adults with CP, aged 22-27 years at interview (2018-2020) and recruited in well-defined geographical areas in France, Germany, Italy, Portugal and Sweden. Environmental inadequacy was assessed using the EAEQ and participation restrictions using the QYPP-YA. A theorical model was tested with a partial least squares structural equation model.

RESULTS

Functional limitations had a significant direct effect on participation restrictions (β = 0.62, p < 0.001). A small part of the total effect was mediated by the "inadequacy of services, systems and policies" environmental latent variable (β = 0.10, p < 0.001). "Inadequacy of support and relationships" and "inadequacy of attitudes" environments demonstrated no mediating effect. Unexpectedly, a higher "inadequacy of products and technology" environmental score appeared to reduce participation restrictions (β = -0.10, p = 0.025).

CONCLUSIONS

The environment considered as suggested by the ICF had only a minimal mediating effect in our study. However, public health policies must give priority to improvements at the macro-environmental level, particularly in terms of availability and access to the "services, systems and policies".

Nutritional aspects in patients with cerebral palsy: A multicenter observational study in Spain

INTRODUCTION

Cerebral palsy (CP) encompasses a group of motor disorders that can result in swallowing difficulties, affecting food intake and contributing to poor nutritional status. The goal of the study was to describe the clinical and nutritional characteristics of Spanish children with CP.

METHODS

Multicenter observational study conducted in children aged 4-14 years with a diagnosis of CP. For every patient, we collected data on sociodemographic and clinical characteristics as well as anthropometric measurements, schooling modality, nutrition received at school, nutritional support and gastrointestinal comorbidities.

RESULTS

The sample included a total of 112 patients with a mean age of 9.2 years old. The majority (70.5%) had been classified as Gross Motor Function Classification System (GMFCS) level IV or V. Compared to children classified as GMFCS level I, II or III, the group of children with GMFCS level IV/V had significantly lower mean z scores in body weight, height, weight-to-height ratio, body mass index and upper arm circumference and a significant lower mean arm area. A higher proportion of patients with GMFCS level IV/V attended special education schools compared to patients classified as level I to III (68.4% vs. 12.1%; P < .0001). A higher proportion of children classified as level IV/V compared to children classified as levels I to III presented dysphagia (62.0% vs. 15.2%; P < .0001), constipation (51.9% vs. 27.3%, P = .0218) and gastroesophageal reflux (31.6% vs. 3.0%; P = .0005).

CONCLUSIONS

Our study shows that Spanish children with CP, especially those with severe motor impairment, are at risk of malnutrition, present gastrointestinal comorbidities and require nutritional support.

Speech and communication classification of children with cerebral palsy: Novice rater agreement and clinical utility

PURPOSE

To examine novice inter-rater agreement and clinical utility perspectives for speech and communication classification of children with cerebral palsy (CP).

METHOD

Twenty-one clinicians (speech-language pathologists [SLPs] n = 11; physiotherapists [PTs] n = 5; occupational therapists [OTs] n = 5) novice to the Viking Speech Scale (VSS), Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS) rated eight unfamiliar children with CP (8-16 years) following classification orientation. Inter-rater agreement was examined between (a) novices, (b) novice SLPs vs. PTs and OTs, and (c) novice vs. expert (kappa statistics). Utility perceptions were scored regarding classification terminology, ease of use, assistive decision-making resources, and construct validity and were analysed using Kruskal-Wallis H-tests.

RESULT

Rating agreement between novices was substantial (VSS, k = 0.72, 95% CI [0.53-0.92]) to moderate (FCCS, k = 0.44, 95% CI [0.23-0.65]; CFCS, k = 0.45, 95% CI [0.18-0.71]), and almost perfect between novice and expert ratings (VSS, kw = 0.89, 95% CI [0.86-0.92]; FCCS, kw = 0.89, 95% CI [0.86-0.92]; CFCS, kw = 0.86, 95% CI [0.82-0.91]). Statistically significant differences, presented highest to lowest, were found for clinical utility: terminology (VSS, FCCS, CFCS; p = 0.02), assistive decision-making resources (FCCS, VSS, CFCS; p = 0.009), and construct validity (FCCS, CFCS, VSS; p < 0.001).

CONCLUSION

Novice raters achieved substantial agreement for speech classification, supporting utilisation in clinical, research, and CP register activities. Orientation to communication classification constructs, content, and instructions is recommended for novice raters.

The Relationship Between Hispanic Ethnicity and Outcomes for Infants Born Extremely Preterm

OBJECTIVE

To characterize the association between maternal ethnicity and infant survival to discharge without major morbidity.

STUDY DESIGN

This is secondary analysis of a prospective cohort of infants born <27 weeks of gestation at National Institute of Child Health and Human Development Neonatal Research Network centers from 2006 through 2020. The primary outcome was survival to discharge without major morbidity (sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia grade 3, intracranial hemorrhage grade ≥3, periventricular leukomalacia, and advanced retinopathy of prematurity). Outcomes were compared by ethnicity and adjusted for center, perinatal characteristics, and sociodemographic characteristics.

RESULTS

Of 14 029 subjects, 2155 (15%) were Hispanic, 6116 (44%) non-Hispanic Black, and 5758 (41%) non-Hispanic White. Infants of Hispanic mothers had the lowest survival to discharge without major morbidity (Hispanic 523/2099 [25%], non-Hispanic Black 1701/5940 [29%], non-Hispanic White 1494/5597 [27%], P = .002). Adjusted odds of survival without major morbidity differed between Hispanic and non-Hispanic Black (adjusted odds ratio [aOR] 0.80, 95% CI 0.69-0.93), but not between Hispanic and non-Hispanic White infants (aOR 1.07, 95% CI 0.92-1.25). At 2 years, children of non-Hispanic White mothers had the lowest incidence of neurodevelopmental impairment (Hispanic 544/1235 [44%], non-Hispanic Black 1574/3482 [45%], and non-Hispanic White 1004/3182 [32%], P < .001). Odds of impairment were greater for Hispanic than non-Hispanic White children (aOR 1.25, 95% CI 1.05-1.48) but did not differ between Hispanic and non-Hispanic Black children (aOR 0.88, 95% CI 0.74-1.04).

CONCLUSIONS

In a multicenter cohort, infants of Hispanic mothers had lower odds of survival to discharge without major morbidity than infants of non-Hispanic Black mothers and similar odds of survival without major morbidity as infants of non-Hispanic White mothers.

CLINICALTRIALS

GOV ID

Generic Database: NCT00063063.

Longitudinal relationship between hip displacement and hip function in children and adolescents with cerebral palsy: A scoping review

AIM

To identify, describe, and synthesize available evidence on the longitudinal relationship between hip displacement and hip function, using the International Classification of Functioning, Disability and Health (ICF) framework, in children and adolescents with cerebral palsy (CP) aged up to 18 years.

METHOD

Five databases were searched systematically from inception to May 2022. Study and sample characteristics, and hip displacement and hip function measures, mapped to the ICF domains, were extracted for narrative synthesis.

RESULTS

Twenty-nine studies were included: four longitudinal registry-based studies; 12 prospective studies; 12 retrospective studies; and one randomized controlled trial. Sample size ranged from 11 to 267. Twenty-seven (93%) studies entailed an intervention: surgery (n = 16); rehabilitation (n = 2); nerve block or botulinum neurotoxin A injection (n = 4); and combined surgery and injection (n = 2). Twenty-six studies (90%) reported outcomes at the body structure and function and impairment domain of the ICF; 17 (59%) reported outcomes in the activity domain; and three (10%) included participation measures. The most common hip displacement measure was Reimers' migration percentage (79%).

INTERPRETATION

Because of the inclusion of interventions in most studies, and the preponderance of retrospective studies, the relationship between hip displacement and hip function in CP is unclear. More high-quality prospective evidence on the natural history of hip displacement, and its effect on function, is needed to improve population-wide screening of children with CP.

Natural history of cerebral visual impairment in children with cerebral palsy

AIM

To longitudinally evaluate the natural history of cerebral visual impairment (CVI) in children with cerebral palsy (CP) and identify which early visual signs or symptoms are associated with cognitive visual disorders (CVDs) at school age.

METHOD

Fifty-one individuals with CP and CVI underwent an ophthalmological, oculomotor, and basic visual function evaluation at three time points: T0 (6-35 months old); T1 (3-5 years old); and T2 (≥6 years old). We also performed a cognitive visual evaluation at T2. Logistic regression fitted using a generalized estimation equation (binary) and cumulative link models (ordinal) were used to model the outcomes of interest.

RESULTS

Ophthalmological deficits were stable over time, except for ocular fundus abnormalities (T1-T0, p = 0.01; T2-T1, p = 0.02; T2-T0, p < 0.01) and strabismus, whose frequency increased with age (T2-T0, p= 0.02 with T2-T0, p = 0.05). Conversely, fixation (T1-T0, T2-T0, p < 0.01), smooth pursuit (T2-T1, T2-T0, p < 0.01), saccades (T1-T0, T2-T1, T2-T0, p < 0.01), as well as visual acuity, contrast sensitivity, and visual field (T1-T0, T2-T0, p < 0.01) all improved over time. Early oculomotor dysfunction was associated with CVD at T2.

INTERPRETATION

Although a diagnosis of CVI was confirmed in all children at each time point, several visual signs and symptoms improved over time; in some cases, they reached complete recovery at T1 and T2. These results emphasize the 'permanent' but 'not unchanging' nature of the CVI associated with CP during development.

Anesthesia, extremely premature infants and full-scale intelligence quotient at 5 years of age

BACKGROUND

To determine the association between exposure to Food and Drug Administration (FDA) warned anesthetics in premature infants and their full-scale intelligence quotient (FSIQ) score at 5 years of age.

METHODS

Premature infants born <27 weeks gestational age (GA) between January 2006 and December 2012 with FDA anesthetic exposure status were included. Exposures included volatile anesthetics, propofol, benzodiazepines, ketamine, chloral hydrate, and barbiturates/phenobarbital. Exposure was treated as a binary variable with infants stratified into those who were or were not exposed to any FDA warned drug. Associations were explored using univariable and multivariable regressions.

RESULTS

238 (61.5%) of 387 eligible infants had available FSIQ scores. Of these, 110 (46.2%) were exposed to warned anesthetics. Unadjusted and adjusted imputed case associations (95% CI) between FDA warned anesthetics and FSIQ were -5 (-10 to -2, p = 0.014) and -2 (-7 to 3, p = 0.528) points. An unobserved confounder(s) the strength of severe IVH [-9 points (-15 to -3)] would be required to overturn the directional association between FDA exposure and FSIQ in our complete case model.

CONCLUSION

Premature infants exposed to anesthetics flagged by the FDA showed no significant reduction in FSIQ at 5 years of age.

IMPACT

It is unclear whether early exposure to anesthetics in premature infants born <27 weeks gestation is associated with full-scale intelligence quotient (FSIQ) at 5 years of age. Our retrospective cohort study included 387 premature infants born <27 weeks gestational age. FSIQ scores were available for 238/387 at 5 years of age of which 110 were exposed to Food and Drug Administration (FDA) warned anesthetic drugs. After missing data imputation and adjustment for maternal and neonatal characteristics, no significant associations were found between FDA warned anesthetic exposure and FSIQ. No adjusted volatile anesthetic or opioid dosage effect was associated with FSIQ.

Season of conception and neurodevelopmental outcomes in singleton preterm infants less than 29 weeks gestation

Background

Environmental factors vary with the seasons and affect fetal development. Our objective was to assess the impact of the season of conception on neurodevelopmental outcomes at 18-21 months corrected age in singleton infants <29 weeks' gestation.

Methods

A retrospective cohort study of infants born between 2006 and 2015 at a tertiary-level neonatal intensive care unit was conducted. The conception date was calculated as the date of birth minus gestational age plus 14 days, and the conception dates were then divided into winter and non-winter months. The primary outcomes were a composite score of <85 in any of the cognitive, language, or motor components of the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), at 18-21 months corrected gestational age, and scores of <85 in the individual components. Multivariate logistic regression was used to assess confounders.

Results

Of the 493 eligible infants, 162 (32.8%) were conceived in winter. There was no difference in the adjusted odds ratios (aORs) of any Bayley-III cognitive, language, or motor composite scores of <85 between the two groups. The aORs of cognitive and language scores <85 in the winter group were significantly higher [2.78, 95% confidence interval (CI) 1.37-5.65 and 1.97, 95% CI 1.07-3.62, respectively].

Conclusion

Singleton infants <29 weeks' gestation conceived in winter months have worse cognitive and language outcomes. Our results need validation in other and larger cohorts.

Neurodevelopmental outcomes at age 3 years of preterm infants born at 22-31 weeks' gestation

OBJECTIVE

To evaluate neurodevelopmental outcomes of very preterm infants by gestational age (GA) using high follow-up rate data.

STUDY DESIGN

This secondary analysis included infants born before 32 weeks' gestation in 2012-2014 from the Improvement of NICU practices and Team Approach Cluster randomized controlled Trial (INTACT). The primary outcome was survival without moderate or severe neurodevelopmental impairment (NDI).

RESULTS

Among 2722 infants, NICU survival rate was 96.5%, ranging 72.1-99.6% at 22-31 weeks. At age three years, 2336 (89.5% of 2610 survivors) were completely assessed; 303 had moderate NDI and 183 had severe NDI. Of these, the proportions of infants surviving without NDI increased with GA; 45.2% at 22 weeks, 57.5% at 23 weeks, 88.1% at 31 weeks.

CONCLUSION

Although survival without NDI varied by GA, more than half (55.0%, 83/151) of infants born at 22-23 weeks who survived to age three years were without neurodevelopmental sequelae.

Attention Deficit Hyperactivity Disorder in Children With Cerebral Palsy: A Case-Control Study

BACKGROUND AND OBJECTIVES

Cerebral palsy (CP) is the most prevalent physical disability in children and is often accompanied by other neurodevelopmental disorders (NDDs) such as attention deficit hyperactivity disorder (ADHD). Both conditions are influenced by genetic and environmental factors and significantly affect daily functioning. This study aims to estimate the prevalence of ADHD in school-aged children with CP from a large, population-based registry and explore associated factors including sex, material and social deprivation, epilepsy, prematurity, CP subtype, and motor functioning.

METHODS

This cross-sectional study linked a population-based registry (the Registre de la paralysie cérébrale du Québec [CP Registry]) and 2 administrative health claims databases (the Régie de l'assurance maladie du Québec [RAMQ] and Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière). The study included children diagnosed with CP born between 1999 and 2002, tracked through these databases. ADHD diagnosis was identified using International Classification of Diseases codes and specific ADHD medication prescriptions. Odds ratios and 95% confidence intervals were used to explore factors associated with an ADHD diagnosis.

RESULTS

The study comprised 302 children with CP and 6,040 controls matched by age, sex, and region. The prevalence of ADHD in the CP cohort was significantly higher (38%) compared with the control group (12%). Univariate analysis showed that odds of ADHD in the CP cohort were higher in male children (OR 1.63, 95% CI 1.02-2.62) and individuals with no epilepsy diagnosis (OR 1.70, 95% CI 1.02-2.87), a spastic hemiplegic CP subtype (OR 1.87, 95% CI 1.10-3.20), and less severe motor impairment (OR 2.48, 95% CI 1.37-4.65). In the multivariate analysis, odds of ADHD were only higher in those with less severe motor impairment (OR 2.02, 95% CI 1.07-3.94).

DISCUSSION

ADHD is significantly more prevalent among children with CP compared with their peers, aligning with previous literature that suggests a neurodevelopmental overlap. The study highlights the importance of considering NDDs in CP management, particularly ADHD, which may contribute to the challenges faced by these children. Future research is needed to explore the neurobiological links between CP and ADHD and the impact of NDDs on health outcomes in this population.

Stakeholder's perspective on brain-computer interfaces for children and young adults with cerebral palsy

Communication Brain-Computer Interfaces (cBCIs) are a promising tool for people with motor and speech impairment, in particular for children and young adults with communication impairments, for example due to cerebral palsy (CP). Here we aimed to create a solid basis for the user-centered design of cBCIs for children and young adults with severe CP by investigating the perspectives of their parents/caregivers and health care professionals on communication and cBCIs. We conducted an online survey on 1) current communication problems and usability of used aids, 2) interest in cBCIs, and 3) preference for specific types of cBCIs. A total of 19 parents/caregivers and 36 health care professionals who interacted directly with children and young adults (8-25 years old) with severe CP, corresponding to Gross Motor Function Classification System level IV or V, participated. Both groups of respondents indicated that motor impairment occurred the most frequently and had the greatest impact on communication. The currently used communication aids included mainly no/low-tech aids and high-tech aids. The majority of health care professionals and parents/caregivers reported an interest in cBCIs, with a slight preference for implanted electrodes over non-implanted ones, and no preference for either of the two proposed mental BCI control strategies. Results indicate that cBCIs should be considered for a subpopulation of children and young adults with severe CP, and that in the development of cBCIs for this group both visual stimuli and sensorimotor rhythms, as well as the use of implanted electrodes, should be considered.

Bone health and bisphosphonate treatment in females with Rett syndrome in a national center

BACKGROUND

Impaired bone health is a common morbidity in Rett syndrome (RTT). We aimed to assess lumbar bone mineral density (BMD) and trabecular bone score (TBS) in females with RTT, and to evaluate the effectiveness of bisphosphonate treatment.

METHODS

This retrospective study included 40 females with RTT, aged 5-22 years, who underwent dual-energy X-ray absorptiometry (DXA) scans during 2019-2024 at a national center for RTT. Data collected included medical treatment, anthropometric measurements, and functional scores.

RESULTS

The median age at the first DXA scan was 10.8 years. The mean L1-4 BMD Z-score was -2.1 ± 1.4, and the mean TBS Z-score was -0.4 ± 1.3. The L1-4 BMD Z-score correlated with height (r = 0.407, p = 0.009), weight (r = 0.551, p < 0.001), BMI (r = 0.644, p < 0.001), and TBS Z-scores (r = 0.594, p = 0.009). Poor L1-4 BMD Z-scores were associated with poor mobility scores (p = 0.05) and valproate treatment (p = 0.016). Nine patients (23%) received zoledronate, for a mean 2 years. The mean age at zoledronate initiation was 9.7 ± 2.3 years. Four completed two DXA scans (pre- and post-treatment); the mean BMD Z-score improved from -2.2 ± 0.9 to -1.4 ± 0.9 after treatment.

CONCLUSIONS

Females with RTT have reduced lumbar BMD, which was associated with anthropometric factors, TBS, mobility, and valproate use. Zoledronate may be effective for some patients.

IMPACT

In a retrospective study of 40 females with Rett syndrome (RTT), low bone mineral density (BMD) correlated with lower anthropometric measurements, impaired mobility, and valproic acid use. The association between BMD and trabecular bone score (TBS) in the context of RTT is a novel finding. Our preliminary data support the effectiveness and safety of zoledronate for treating osteoporosis in patients with RTT. Our findings are important in light of the increasing life expectancy of individuals with RTT, and the consequent need to prioritize bone health in this population.

The Effectiveness of Leg- and Arm-Powered Trike Training Among Children with Impaired Walking Ability-A Pilot Study

Background/Objectives: The GO-TRYKE® Kid (GTK®) is an arm- and leg-powered tricycle which, in addition to promoting strength, endurance, and coordination, aims to reactivate the central pattern generators of the spine for locomotion through cyclical movements. The present study investigated the effects of GTK® training on walking ability, GTK® riding performance, and health-related quality of life in children with walking disabilities. Methods: Nine children trained with the device twice a week for nine weeks. Short- and long-term effects on walking ability were measured using the timed up and go test (TUG) and the two-minute walk test (2MWT). GTK® riding performance and health-related quality of life were compared before and after the intervention period. Results: While no long-term effect on walking was found, a significant short-term effect on functional walking ability was observed (p = 0.009). GTK® riding performance improved significantly over the training period (p = 0.004). There were no significant changes in health-related quality of life. Conclusions: GTK® enables children with walking disabilities to participate in cycling as part of play and sport. Further research is required to investigate its functional and participatory effects, as there is significant potential to improve physical activity and overall well-being in this population.

Health-Related Quality of Life of Individuals with Physical Disabilities in Childhood

Background: The use of patient-reported outcomes is essential to understand and manage health-related quality of life (HRQOL) in youth with lifelong disabilities. This study evaluated HRQOL in youth with physical disorders and examined its relationship with mobility. Methods: We conducted an IRB-approved retrospective study in which we administered the parent-reported Pediatric Outcomes Data Collection Instrument (PODCI) and Gross Motor Function Measure section D (GMFM-D) to ambulatory youth aged 2-18 years with cerebral palsy (CP; Gross Motor Function Classification System II; n = 258), arthrogryposis (n = 138), achondroplasia (n = 102), and Morquio syndrome (n = 52) during clinical visits to a gait lab. The PODCI has two validated versions, child and adolescent, that assess perceptions about mobility, happiness, and pain. Differences in HRQOL between diagnostic groups, between age groups, and compared with non-disabled youth were examined using non-parametric tests. The relationship between GMFM-D and PODCI scores was analyzed with Pearson's correlations. Results: Both age cohorts within all diagnosis groups demonstrated higher pain and lower mobility compared with non-disabled youth (p < 0.015). Happiness was lower for both age groups with CP and arthrogryposis, and for the child group with Morquio syndrome compared with non-disabled youth (p < 0.002). In diagnostic groups in both age spans, Global Function was higher (p < 0.0001) for those with achondroplasia compared with other groups. Despite functional differences, there were no significant differences between diagnostic groups in pain scores (p > 0.10). Happiness was lower in the group with CP compared with that with achondroplasia (p = 0.01). GMFM-D was related to PODCI mobility scores for all diagnoses (r = 0.31 to 0.79, p < 0.03) but was not correlated with happiness (r = -0.16 to 0.092; p > 0.14); GMFM-D and PODCI pain scores were associated only for the child group with achondroplasia (r = 0.355; p < 0.001). Conclusions: Significant limitations in HRQOL are present in youth with physical disabilities. Pain levels were higher than those of non-disabled youth, but pain was not related to lower motor function. Happiness was not related to gross motor function, suggesting the need to examine other factors when mental health concerns are present in youth with disabilities.

Developing a Profile of Canadian Children With Cerebral Palsy Who Require Augmentative and Alternative Communication

PURPOSE

Cerebral palsy (CP) is the most prevalent motor disability affecting children. Many children with CP have significant speech difficulties and require augmentative and alternative communication (AAC) to participate in communication. Despite demonstrable benefits, the use of AAC systems among children with CP remains constrained, although research in Canada is lacking.

METHOD

Data were collected as part of an exploratory survey of Canadian caregivers and clinicians (N = 60) who shared their perspectives on children's need for, access to, and use of AAC systems. Quantitative data were summarized using descriptive statistics. Qualitative data were analyzed using inductive content analysis.

RESULTS

Caregivers and clinicians reported high rates of need for AAC systems (> 75%) among children with CP. Both groups reported that access was roughly equivalent to need, although caregiver reports were lower. Despite high rates of need and access, only 38% of children used AAC systems. Children who used AAC primarily used high-tech systems, mostly to make choices, rather than engaging in meaningful reciprocal interactions and conversations.

CONCLUSIONS

Canadian children with CP who required AAC systems generally received them. However, AAC systems were not used to their full potential, suggesting limited participation in social and learning situations. Like reports on other pediatric populations, barriers to obtaining AAC systems related to service, family, and child-specific factors. Although our sample captured the complexity present in the CP population, sample sizes were small and unlikely to be representative of the population of Canada, indicating the need for further research on a national scale.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28229720.

Motor-Sensory Learning in Children with Disabilities: Does Piano Practice Help?

Background/Objectives: Patients with physical disabilities, like cerebral palsy, the most common movement disorder in childhood, can benefit from instrumental therapy using piano. Playing the piano promotes the interaction between different brain regions and integrates motor skills, sensory skills, musical hearing, and emotions. A pilot music study examined the effects of six months of piano lessons on hand motor skills and musical hearing in groups of children with motor disabilities. Methods: The allocation to the group was not randomized. Various tests, including the standardized Box and Block Test (BBT) and piano tests, assessed hand motor skills. Musical hearing was evaluated, and a questionnaire was used to determine the participants' enjoyment and experience with the piano lessons. The regularity, tempo of keystrokes, and synchronization between the two hands were assessed and compared to evaluate the effects of six months of piano training. Results: After six months of piano training, statistically significant improvements were observed in the BBT, as well as in the regularity and tempo of the non-dominant hand. The children showed significant improvement in hand-motor control, moving 27.3% more cubes in the BBT. Regularity and tempo in piano playing, especially in the non-dominant hand, also improved. Moreover, 55% of the children better recognized the correct pitches of notes. Conclusions: Thus, this study supports the concept that piano lessons are an effective form of physical therapy for the development of hand motor skills and musical hearing.