State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Enhancing motor function in children with cerebral palsy: A Comparative study of pediatric tuina and conventional rehabilitation

OBJECTIVE

This study explores the impact of combining Pediatric Tuina (PT) with conventional rehabilitation on motor function in children diagnosed with cerebral palsy (CP).

METHODS

This controlled trial involved 115 CP-affected children aged 1 month to 13 years. They were allocated into an experimental group (n = 57) receiving PT and conventional rehabilitation, and a control group (n = 58) receiving only conventional rehabilitation for three months. The GMFM-88 scale was employed for evaluating motor function at the start and end of the treatment period.

RESULTS

Compared to the conventional rehabilitation group, the combination of PT and standard rehabilitation therapy showed significant improvement in motor function among children with CP after 3 months. There were no significant differences in baseline characteristics between the two groups. Children in the PT combined with the standard rehabilitation therapy group exhibited more prominent improvements in motor function (supine and rolling: experimental group 47.88 ± 5.02 vs control group 42.86 ± 10.30; sitting: experimental group 45.16 ± 18.52 vs control group 35.59 ± 18.97; total score: experimental group 147.88 ± 75.59 vs control group 118.90 ± 77.87; P = 0.045). Furthermore, there was a significant increase in scores for children after the combination therapy (pre-treatment 105.39 ± 85.76 vs post-treatment 147.88 ± 75.59; P = 0.045).

CONCLUSION

PT, when used in conjunction with conventional rehabilitation methods, significantly enhances motor function in children with CP. The study advocates for further extensive research to validate and understand the broader implications of PT in CP treatment.

Does botulinum neurotoxin A make walking easier in children with cerebral palsy? A randomized clinical trial

AIM

To assess the effect of single botulinum neurotoxin A (BoNT-A) injections into the calf muscles on the gross energy cost of walking in children with cerebral palsy (CP) and to evaluate the effect of BoNT-A on walking capacity, physical activity, perceived changes in mobility, and pain.

METHOD

This was an industry-independent, randomized, quadruple-blind, placebo-controlled, multicentre trial (ClinicalTrials.gov registration: NCT02546999). Sixty-one children (33 male, median age [range] = 8 years [4-16 years]) with spastic CP and classified in Gross Motor Function Classification System (GMFCS) levels I and II allocated to single injections of either BoNT-A or 0.9% saline into the calf muscles. The main outcome was gross energy cost (J/kg/m); secondary outcomes were walking capacity, habitual physical activity, perceived change in mobility tasks, and calf pain at baseline, 4 weeks (P1), 12 weeks (P2), and 24 weeks (P3) after the injection.

RESULTS

The mean change in energy cost did not differ significantly between groups at the primary time point P2 (-0.27 J/kg/m, 95% confidence interval - 0.91 to 0.36, p = 0.404), nor at P1 or P3. Regarding the secondary outcomes, there was some evidence of a larger reduction in pain intensity in the group given BoNT-A (p = 0.043).

INTERPRETATION

One treatment with BoNT-A was not superior to placebo in making walking easier in children with CP classified in GMFCS levels I and II, at least in the short term. BoNT-A may have a pain-reducing effect.

Limited Evidence of Functional Benefit After Upper Limb Botulinum Toxin Treatment in Children With Cerebral Palsy: Systematic Review and Meta-analysis

OBJECTIVES

This systematic review and meta-analysis of randomized controlled trials aimed to summarize the reported functional effects of upper limb botulinum toxin treatment in children with spastic cerebral palsy.

DESIGN

Six databases were searched in October 2022. Two independent authors screened and extracted data on upper limb function, body function, life quality, muscle tone, spasticity, goals, pain, adverse events, and client satisfaction. A random effect model meta-analysis was performed, and RoB 2 and GRADE pro tools were used.

RESULTS

A total of 4862 publications were screened, 14 trials (621 patients) included. Pooled analyses confirm a decrease in muscle tone: mean difference Ashworth scale wrist -0.85 (95% confidence interval = -1.42 to -0.27). No significant functional gain was established: Melbourne Assessment mean difference 3.13 (95% confidence interval = -3.13 to 9.3), and Assisting Hand Assessment mean difference 3.84 (95% confidence interval = -1.86 to 9.54). Botulinum toxin groups had better goal achievement: Goal Attainment Scaling T scores mean difference 9.55 (95% confidence interval = 6.05 to 13.04) and better client satisfaction: improvement had an odds ratio of 8.44 (95% confidence interval = 1.34 to 53.08).

CONCLUSIONS

Results suggest that upper limb botulinum toxin treatment is effective to decrease muscle tone, but functional benefits are not clearly established. The discrepancy between subjective and objective results requires further investigation.

Updates on neonatal cell and novel therapeutics: Proceedings of the Second Neonatal Cell Therapies Symposium (2024)

Cell therapies as treatments for neonatal conditions have attracted significant research and parent interest over the last two decades. Mesenchymal stromal cells, umbilical cord blood cells and neural stem cells translate from lab, to preclinical and into clinical trials, with contributions being made from all over the world. Effective and timely translation involves frequent reflection and consultation from research-adjacent fields (i.e. cell therapies for cerebral palsy, adult neurology, companies, and regulatory bodies) as well as meaningful involvement of people with lived experience. Progress to date suggests that aligning outcome and data reporting in later phase clinical trials will support our sector, as well as involving industry partners for streamlined solutions in cell manufacturing, commercialisation and regulatory processes. Importantly, our field can also benefit from resource sharing and research collaboration in novel drug therapies, small molecules and extracellular vesicles as we attempt to bridge preclinical and clinical research. In this review, we present highlights and learnings from the second Neonatal Cell Therapies Symposium (2024), held in Sydney, Australia. IMPACT: Multiple cell therapy candidates have advanced through preclinical and clinical trials in neonatology, showing promising feasibility, safety and efficacy. Effective and timely translation is enabled by collaboration across research-adjacent fields, commercial partnerships, harmonising research outcomes and meaningful involvement of people with lived experience. Progress on the potential utility of cell therapies for neonatal conditions and further translational considerations are discussed in this paper.

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.

Effect of individual variations in genes related to dopamine brain transmission on performance with and without rewards during motor sequence and probabilistic learning tasks in children and young adults with and without cerebral palsy

Children with cerebral palsy (CP) often participate in training to improve mobility, hand function and other motor abilities. However, responses to these interventions vary considerably across individuals even those with similar brain injuries, ages and functional levels. Dopamine is a neurotrasmitter known to affect motor skill acquistion in animals and humans and may be influenced by individual variations in genes related to brain transmission of dopamine. To evaluate potential genetic influences on learning in young people with and without CP, we calculated individual dopamine-related gene scores and compared these to the ability to learn two different tasks, an implicit sequence learning task and a probablistic classification task. Each task was also administered in an unrewarded condition and a rewarded one known to increase circulating levels of dopamine. The main finding was an interaction between gene score and condition for the sequence task such that those with low gene scores were poorer learners without rewards but responded positively to rewards whereas the converse was true for those with high gene scores. This is the first prospective study in CP suggesting that genetic variability may influence neurorehabilitation outcomes and could potentially be modulated using rewards or medications for those with poorer learning at baseline, thus promoting more personalized approaches to enhancing motor training in CP and other neurological conditions.

Effects of Hippotherapy and Horse-Riding Simulators on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review

Background/Objectives: Cerebral palsy (CP) can have a negative impact on gross motor function. Conventional hippotherapy and horse-riding simulators (HRS) have shown promising results on gross motor function in populations with neurological disorders. This review aims to update the knowledge on the effectiveness of hippotherapy on gross motor function in children with CP. Methods: A search was conducted in Academic Search Ultimate, CINAHL, Medline complete, and PEDro covering publications between 2012 and 2022. Two authors identified studies that met the inclusion criteria; a third author resolved discrepancies. Studies were included if they analyzed the effects of hippotherapy on the gross motor function of children with CP. The quality of the methodology was assessed according to the PEDro scale. Results: Of the 150 studies initially identified, 9 were included in this review. The studies showed fair (N = 3) and good (N = 6) methodological quality on the PEDro scale. The majority used conventional hippotherapy (N = 7), while a minority used HRS (N = 2). The most commonly used protocol for conventional hippotherapy was 1-2 sessions of 30-45 min per week for 8 weeks (N = 4), whereas for HRS, these protocols were varied. Seven studies on conventional hippotherapy and one study on HRS showed improvements in gross motor function. However, the hippotherapy protocols were not very standardized and the samples were neither homogeneous nor representative. Conclusions: Conventional hippotherapy and HRS appear to have evidence to support their benefits on gross motor function in children with CP. However, more clinical trials with standardized protocols and more representative samples are needed to confirm these effects.

Direct healthcare costs for people with cerebral palsy in the Brazilian unified health system between 2015 and 2019

BACKGROUND

Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil.

RESEARCH DESIGN AND METHODS

Health records of people with CP in the Hospital and Outpatient Information Systems of Brazil between 2015 and 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs.

RESULTS

A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD 'spastic quadriplegic CP' received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU, and the types of CP are related to increased cost.

CONCLUSIONS

Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assist in better resource allocation for more effective healthcare provision.

Aquatic Compared With Land-Based Exercises on Gross Motor Function of Children/Adolescents With Cerebral Palsy: A Systematic Review With Meta-Analysis

AIM

This study aimed to compare gross motor function between aquatic- and land-based exercises in children and adolescents with cerebral palsy (CP).

METHODS

The authors conducted an electronic search of nine databases from their inception to 21 November 2024 (PROSPERO registration: CRD42020194121). Inclusion criteria were randomized controlled trials involving aquatic-based exercises for children and adolescents with CP, assessing gross motor function using standardized scales or tests. Three authors independently extracted data using a predetermined Excel form. The risk of bias was assessed with the PEDro scale. The body of evidence was synthesized using the GRADE approach. Meta-analysis was conducted using the Revman 5.3 program.

RESULTS

A total of 369 children aged 2-18 years from 15 studies were included. Most participants were ambulatory and classified as having spastic hemiparetic or diparetic CP. The majority of studies had a high risk of bias and small sample sizes. Aquatic-based exercises were categorized as aquatic physical therapy, Halliwick, swimming exercises, gait training and exercises. Low-quality evidence indicated that aquatic physical therapy resulted in higher gross motor function than land-based exercises (SMD = 0.47, n = 93, 4 trials, I2 = 5%, p = 0.03), with a small effect size. No significant differences were found for Halliwick or swimming exercises.

INTERPRETATION

There is low-quality evidence, because of high risk of bias, imprecision and inconsistency, suggesting that aquatic-based exercises are comparable with land-based exercises. Future research should focus on well-designed interventions with adequate sample sizes to compare the combination of aquatic- and land-based therapies with land-based therapy alone.

Barriers and facilitators to parent-delivered interventions for children with or infants at risk of cerebral palsy. An integrative review informed by behaviour change theory

PURPOSE

Empowering parents to deliver evidenced-based interventions improves outcomes for children with or infants at risk of cerebral palsy (CP), by integrating repetition and contextual learning into daily routines. We aimed to identify the barriers and facilitators to parent-delivered interventions and suggest practice improvements guided by behaviour change models.

METHODS

Eight electronic databases were searched to identify studies presenting parent and therapist perspectives on parent-delivered interventions in CP. Included studies were critically appraised using validated checklists. Barriers and facilitators to parent-delivered interventions were identified and categorised into subcomponents of The Capability Opportunity and Motivation Model of Behaviour (COM-B), the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel to formulate appropriate practice recommendations.

RESULTS

Thirty-four studies were identified which mainly used qualitative or randomised control trial designs. Barriers to parent-delivery included insufficient parental knowledge, lack of confidence and time. Facilitators included staff continuity, empowering parents, efficient resource utilisation and flexible delivery. Practice recommendations emphasise realistic goal setting, tailored parental education and enhancing the coaching skills of therapists.

CONCLUSIONS

Fostering parent-delivered interventions requires addressing knowledge gaps, skill and capacity of parents and therapists. Therapists forming strong alliances with parents and setting collaborative realistic goals are key to successful parent-delivered interventions.

Functioning and activity outcomes of the Akwenda Intervention Program for children and young adults with cerebral palsy in Uganda: A cluster-randomized trial

AIM

To evaluate the efficacy of the Akwenda Intervention Program on motor, self-care, and social function of children and young people with cerebral palsy (CP).

METHOD

This was a cluster-randomized, controlled, single-blinded, intervention study of 100 participants with CP (2-23 years; 52 males) in rural eastern Uganda. Half were allocated to the intervention program, the remainder served as waitlist controls. Gross Motor Function Measure-66 (GMFM-66) and the Ugandan version of Pediatric Evaluation of Disability Inventory (PEDI-UG) were collected before group allocation and after intervention. General linear models and t-tests were used to compare changes within and between groups. Cohen's d estimated the effect size of group differences. Change scores were evaluated by age and mobility subgroups.

RESULTS

Significant group by time interactions were found for GMFM-66 (p =0.003) and PEDI-UG outcomes (p <0.001), except mobility, with the intervention group demonstrating greater changes. Both groups increased their scores on the GMFM-66 and child PEDI-UG, while only the intervention group had significant increases in caregiver assistance scores and across all age and mobility subgroups. Cohen's d showed large effect sizes (d >0.8) of differences for PEDI-UG outcomes except mobility.

INTERPRETATION

The Akwenda Intervention Program had a large positive impact on functioning and activity across age and mobility levels.

e-EARLY TOGETHER Intervention for Infants at High Risk of Cerebral Palsy: Randomized Controlled Trial Protocol

PURPOSE

The purpose of this study is to evaluate the effectiveness of an early intervention program, e-EARLY TOGETHER, that combines goal-oriented training, parental coaching, environmental enrichment in a telehealth approach in a low- and middle-income country.

METHODS

Protocol for a randomized controlled clinical trial to evaluate the effectiveness of e-EARLY TOGETHER intervention compared to standard guidelines on outcomes related to development and performance in infants at high risk of cerebral palsy.

DISCUSSION

This protocol will inform and enrich clinical practice related to early intervention in low- and middle-income countries. It is expected that the data obtained will contribute to the implementation of effective early intervention programs with positive and lasting results for the child, their family, and the community.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials: RBR-7WWJRQ3, registered May 10, 2023; WHO Trial Registration UTN Code U-1111-1286-4639.

Implementing Clinical Practice Guidelines for Improving Function in Cerebral Palsy: Development of a Fidelity Tool

PURPOSE

To develop a fidelity tool to support the implementation of clinical practice guidelines to improve physical function for children and young people with cerebral palsy.

METHODS

Fidelity tool development followed a 5-step process: the pilot study, using a mixed-methods action research approach, and including focus groups, questionnaires, and field notes.

RESULTS

A 21-item fidelity tool representing the core components of the clinical practice guidelines was developed, including subsections of goal setting, intervention, and elements seen throughout therapeutic intervention. Clinicians and supervisors reported this tool as acceptable and feasible, especially when used as a self-reflection tool.

CONCLUSIONS

A fidelity tool has been developed that clinicians, supervisors and organizations can use to reflect on current practice and plan for changes to align practice with guidelines to improve function in children with cerebral palsy.

Using 3D immersive virtual reality interactive tasks for upper limb rehabilitation in children with cerebral palsy: A randomized controlled trial

The aim of this study was to investigate the effects of the virtual reality device on the evolution of motivation, and motor, functional and kinematic parameters of the upper limb in children with cerebral palsy. Twenty children were randomly assigned in VR and control groups. VR group scored higher than the control group in the Movement Assessment Battery for Children - Second Edition (MABC-2; standardized motor skills test), exhibited an increased range of motion, and showed improved results in various movement parameters in the interaction with the 3D virtual space. All participants presented high motivation scores in the iVR sessions. This new Immertrack tool may improve the motor, kinematic parameters, and motivation in children with CP.

Enabling participation in community-dwelling children and young people with acquired brain injuries and their families: a theory-based, evidence-based and person-based approach to intervention development

OBJECTIVE

To codesign and develop an intervention to promote participation and well-being in children and young people (CYP) with acquired brain injury (ABI) and family caregivers.

DESIGN

A complex intervention development study including a scoping review, mixed-methods study, co-design workshop and theoretical modelling.

SETTING

Community-dwelling participants in one geographical region of the UK.

PARTICIPANTS

CYP with ABI (5-18 years) and their parents, health, education, social care and voluntary/third-sector practitioners.

RESULTS

The intervention development process using a theory-driven and evidence-informed approach, combining the Behaviour Change Wheel and the person-based approach is described. Findings from the scoping review and mixed-methods study were analysed and synthesised using the framework method and the International Classification of Functioning, Health and Disability and the Behaviour Change Wheel. Evidence of identified participation needs, barriers and facilitators was presented at the codesign workshop. The findings demonstrate the significant long-term impact of an ABI on CYP participation and both CYP and parent well-being with significant unmet family needs. Barriers and facilitators were identified, with key barriers being lack of knowledge and understanding, lack of parental and family support and a need for cross-sector collaboration and communication. Stakeholders identified potential solutions and intervention ingredients, such as the need for education for families and schools regarding long-term impact of ABI, and longer-term practical and emotional support for families. Findings from the workshop were analysed using the framework method and synthesised with previous findings using the Behaviour Change Wheel. Theoretical modelling enabled guiding principles to be identified and an intervention logic model to be produced. 'ABI-Participate' is a novel, multifaceted intervention, developed with CYP with ABI, their parents and professionals from across health, education, social care and charity sectors. Using a case coordination model, ABI-Participate aims to address the unmet needs and barriers of this population and includes needs assessment, goal setting, action planning, health coaching, practical and emotional support for families and multiagency liaison and collaboration, adopting an individualised needs-based approach.

CONCLUSION

A systematic process using a theory-based, evidence-based and person-based approach resulted in a novel, codesigned, multifaceted intervention, grounded in an in-depth understanding of CYP with ABI participation needs, barriers and facilitators. Further development and refinement of the individual elements of ABI-Participate and the care pathway to support its implementation are now required prior to feasibility testing.

The Case for Parent-Implemented Programs to Mitigate Musculoskeletal Complications in Children With Severe Cerebral Palsy in Resource-Limited Settings

Children with severe cerebral palsy are vulnerable to orthopedic complications, particularly in resource-limited settings, which can compound disability. A focus on home-based programs may help to improve their quality of life and participation.

Inclusivity is child's play: pilot study on usability, acceptability and user experience of a sensory-motor PC game for children with cerebral palsy (GiocAbile)

BACKGROUND

The use of video games in rehabilitation settings is gaining increasing popularity. However, the lack of commercial video games suitable for children with disabilities and the disappointing user experience of serious games limit their applicability. The aim of this study was to assess the usability, acceptability and user experience of GiocAbile, an active video game for children with cerebral palsy (CP).

METHODS

This multicenter pilot observational study was conducted from May to September 2022 at the participating institutions, and enrolled school-aged children affected by CP. Enrolled children played GiocAbile in single-player mode for one hour. The gaming experience was evaluated through self-assessment questionnaires. Non-parametric correlation analysis was conducted to examine the influence of motor and cognitive abilities (GMFCS, MACS, ICF) on declared usability and acceptability.

RESULTS

Nineteen children (9.01 ± 1.95 years, 63.1% male) with mild to severe CP were enrolled. The 100% of respondents expressed satisfaction and fulfillment associated with gameplay, with no reports of frustration or disappointment. The 83% would recommend the game to a friend. The controllers were generally deemed easy to use and maneuver, with very few reports of discomfort associated with their use. No correlations were found between usability/acceptability levels and measures of impairment (i.e., GMFCS, MACS, and ICF scales), while cognitive impairment positively correlated with satisfaction during gameplay.

CONCLUSIONS

GiocAbile is an accessible, user-friendly and enjoyable tool for children with CP, regardless of level of impairment. Based on existing literature, we hypothesize that GiocAbile may improve motivation, participation, and rehabilitation outcomes in children with CP, although further studies are needed to confirm our hypothesis.

Hospitalizations Following Complex Hip Surgery in Children with Intellectual Disability: A Self-Controlled Case Series Analysis

OBJECTIVE

To evaluate the associations between complex hip surgery and subsequent hospitalizations in children with intellectual disability, including a subset of children with cerebral palsy.

STUDY DESIGN

We conducted a retrospective cohort study using linked administrative, health, and disability data from Western Australia. Children born between 1983 and 2009 who underwent complex hip surgery by end 2014 were included (intellectual disability, n = 154; subset with cerebral palsy, n = 91). A self-controlled case series analysis using Poisson regression was used to estimate the age-adjusted associations of complex hip surgery on all-cause hospitalizations and when the principal diagnosis was lower respiratory tract infection or epilepsy, for periods following the individual's first major hip surgery, compared with the year before surgery.

RESULTS

Age adjusted incidence of all-cause hospitalizations decreased after surgery (year 1: incidence rate ratio [IRR] 0.87 [95% CI, 0.74-1.02]; year 6: IRR 0.57 [95% CI, 0.46-0.72]). The incidence of hospitalizations for lower respiratory tract infection increased (year 1: IRR, 1.03 [95% CI, 0.72-1.51]; year 6: IRR 2.08 [95% CI, 1.18-3.68]). The incidence of hospitalizations for epilepsy decreased (year 1: IRR 0.93 [95% CI, 0.57, 1.54]; year>6: IRR 0.72 [95% CI, 0.34-1.55]) after surgery. A similar pattern was observed for the subset of children with or without cerebral palsy.

CONCLUSION

Complex hip surgeries are associated with fewer hospitalizations overall but not respiratory hospitalizations for children with intellectual disability. Fewer hospitalizations suggest benefits for better musculoskeletal alignment.

Research methodology: A bibliometric review using the spastic hand as an example

Bibliometric review involves systematically analysing the academic literature on a particular topic, enabling researchers to better understand the trajectory and future trends of a specific research field. This study uses various bibliometric tools to analyse relevant research on the spastic hand over the past two decades, aiming to identify key contributors, hotspots and emerging trends. The results show that early studies focused on cerebral palsy, stroke and botulinum toxin treatment, while recent advancements highlight surgical procedures such as neurectomy and soft tissue transfer. Future research should enhance international collaboration and the use of neuroimaging and electrophysiological techniques to gain a deeper understanding of the neural mechanisms underlying spasticity, optimize surgical procedures and explore novel treatments for spastic hand.

Pediatric Constraint-Induced Movement Therapy: Current Practices and Implementation Barriers

Hemiplegic Cerebral Palsy (CP) is the most common pediatric motor disability, characterized by unilateral motor weakness. Pediatric Constraint-Induced Movement Therapy (pCIMT) improves affected extremity function but faces variable clinical integration. This study assessed U.S. providers' awareness and use of pCIMT, educational practices, and barriers to broader implementation for more eligible children. Overall, 148 providers specializing in pediatric stroke or hemiplegic CP completed surveys on pCIMT familiarity, implementation challenges, and support for evidence-based practices (EBP). Participants indicated high pCIMT competency. Although 75% reported regional pCIMT availability, only 14% indicated that pCIMT is accessible to all children who could benefit. Reported barriers included therapist and family availability, cost, and institutional limitations. Despite valuing EBP, participants reported minimal workplace support for its use. The study revealed significant barriers to pCIMT accessibility and implementation. Further research is needed to address these challenges and improve clinical adoption of EBP, such as pCIMT.

Usability and Safety of the ATLAS 2030 Robotic Gait Device in Children with Cerebral Palsy and Spinal Muscular Atrophy

PURPOSE

the purpose of this study was to evaluate the safety and usability of the ATLAS 2030 in children with Cerebral Palsy (CP) and Spinal Muscular Atrophy (SMA).

MATERIALS AND METHODS

the sample consisted of six children, three with CP and three with SMA, who received eight sessions of robot-assisted gait therapy. Safety was measured by the presence of adverse events. Usability was measured by spatiotemporal parameters, the Six-Minute Walking Test (6MWT), and the time needed for donning and doffing, as well as satisfaction questionnaires administered to therapists and patients.

RESULTS

no serious adverse events were reported. The average cadence and number of steps per session increased throughout sessions, as well as the distance covered in the 6MWT, both in participants with CP and SMA. The mean donning time at the end of the study was 4.6 ± 1.3 min, and only one therapist was necessary to carry out all of the sessions. Satisfaction was considered high by both children and therapists.

CONCLUSIONS

the ATLAS 2030 was shown to be safe for children with CP and SMA. The usability of the device was good, since a progression in the spatiotemporal parameters was observed throughout the sessions, and patient and therapist satisfaction were high.

Type and Distribution of Gross Motor Activity During Physical Therapy in Young Children With Cerebral Palsy

OBJECTIVE

Physical therapists routinely deliver and prescribe motor practice to improve function. The ability to select optimal practice regimens is limited by a current lack of detail in the measurement of motor practice. The objective of this study was to quantify the type, amount, and timing of gross motor practice during physical therapist sessions.

METHODS

A secondary video coding analysis of physical therapist sessions from the iMOVE clinical trial (NCT02340026) in young children with cerebral palsy (CP) was conducted. The 37 children who completed the treatment phase were included (mean age = 22.1 months). Children could initiate pulling to stand but were unable to walk. Videos of randomly selected therapy sessions were coded for gross motor activity (422 videos total). The 10 gross motor activity codes included lying, sitting, four point, crawling, kneeling, knee walking, standing, walking, transitions between floor postures, and transitions to/from an upright posture. Twenty percent of each video was double coded for reliability. Time per session, number of bouts, and median time per bout were calculated for each gross motor activity and for 2 aggregate measures: movement time and upright time.

RESULTS

Participants spent more than half of therapy time in sitting and standing combined (60.3%). Transitions occurred more frequently than any other motor activity (49.3 total transitions per session). Movement time accounted for 16.3% of therapy time. Upright time accounted for 53.3% of therapy time.

CONCLUSIONS

Critical practice time to gain motor skill is not equivalent to chronological time or time spent in therapy. Toddlers with CP spent a small amount of therapy time moving. Future work should explore the relations between motor practice and rehabilitation outcomes.

IMPACT

Physical therapists are ideally suited to detail the content of motor practice and ultimately to prescribe optimal patterns of motor practice. We report the characteristics of gross motor practice during therapy in children with CP.

Integrating Stakeholder Priorities for the Optimization of Care of the Preterm Infant in a Safety-Net NICU

OBJECTIVE

 This study aimed to engage clinical and community stakeholders to create a prioritization matrix of interventions to reduce neonatal brain injury and improve neurodevelopmental outcomes.

STUDY DESIGN

 We collaborated with our community partner to establish a Lived Experience Advisory Group (LEAG). Faculty performed a literature review to identify neonatal neuroprotective interventions; additional priorities from the LEAG were also included. Project leaders scored and presented intervention bundles for impact. Stakeholder priorities for value/feasibility were obtained via questionnaire. Mean values were incorporated into a prioritization matrix.

RESULTS

 Themes from discussions with LEAG members included the role of the neonatal intensive care unit (NICU) parent, the experience of trauma, shared decision-making, communication and trust with the health care team, and bias in medical care. Five interventions were placed in the highest priority quadrant of the prioritization matrix: thermoregulation, maternal antepartum steroids, delayed cord clamping, optimized oxygen delivery, and optimized glucose regulation.

CONCLUSION

 It is feasible to incorporate community and parent values into clinically oriented neuroprotective intervention bundles for preterm infants. This clinical-community collaboration is vital to ensure that our project objectives meet the needs and priorities of the population it is intended to serve.

KEY POINTS

· Including input from parent advisory groups supports interventions that meet the needs of families.. · Collaboration between clinical and community stakeholders can improve neuroprotective and neurodevelopmental strategies.. · Incorporation of clinical interventions into a prioritization matrix improves resource utilization.. · Five perinatal interventions were ranked highly for impact and feasibility in the prioritization matrix..

Clinical Actionability of Genetic Findings in Cerebral Palsy: A Systematic Review and Meta-Analysis

Importance

Single gene variants can cause cerebral palsy (CP) phenotypes, yet the impact of genetic diagnosis on CP clinical management has not been systematically evaluated.

Objective

To evaluate how frequently genetic testing results would prompt changes in care for individuals with CP and the clinical utility of precision medicine therapies.

Data Sources

Published pathogenic or likely pathogenic variants in OMIM genes identified with exome sequencing in clinical (n = 1345) or research (n = 496) cohorts of CP were analyzed. A systematic literature review for evidence of effective therapies for specific genetic etiologies was performed.

Study Selection

Nonstandard interventions that led to a detectable improvement in a defined outcome in individuals with variants in the gene of interest were included.

Data Extraction and Synthesis

Literature was evaluated using PRISMA guidelines. A diverse, expert working group was established, scoring rubrics adapted, and scoring consensus built with a modified Delphi approach.

Main Outcomes and Measures

Overall clinical utility was calculated from metrics assessing outcome severity if left untreated, safety and practicality of the intervention, and anticipated intervention efficacy on a scale from 0 to 3.

Results

Of 1841 patients with CP who underwent exome sequencing, 502 (27%) had pathogenic or likely pathogenic variants related to their phenotype. A total of 243 different genes were identified. In 1841 patients with identified genetic etiologies of CP, 140 (8%) had a genetic etiology classified as actionable, defined as prompting a change in clinical management. Also identified were 58 of 243 genes with pathogenic or likely pathogenic variants with actionable treatment options: 16 targeting the primary disease mechanism, 16 with specific prevention strategies, and 26 with specific symptom management. The level of evidence was also graded according to ClinGen criteria; 45 of 101 interventions (44.6%) had evidence class D or below. The potential interventions have clinical utility with 98 of 101 outcomes (97%) being moderate-high severity if left untreated and 63 of 101 interventions (62%) predicted to be of moderate-high efficacy. Most interventions (72 of 101 [71%]) were considered moderate-high safety and practicality.

Conclusions and Relevance

The findings indicate that actionable genetic findings occurred in 8% of individuals referred for genetic testing with CP. Evaluation of potential efficacy, outcome severity, and intervention safety and practicality indicates moderate-high clinical utility of these genetic findings. Genetic sequencing can identify precision medicine interventions that provide clinical benefit to individuals with CP. The relatively limited evidence base underscores the need for additional research.

Predictors of Death or Severe Impairment in Neonates With Hypoxic-Ischemic Encephalopathy

Importance

Outcomes after hypoxic-ischemic encephalopathy (HIE) are variable. Predicting death or severe neurodevelopmental impairment (NDI) in affected neonates is crucial for guiding management and parent communication.

Objective

To predict death or severe NDI in neonates who receive hypothermia for HIE.

Design, Setting, and Participants

This prognostic study included participants enrolled in a large US clinical trial conducted in US neonatal intensive care units who were born between January 2017 and October 2019 and followed up to age 2 years. Eligible participants were neonates with moderate-severe HIE born at 36 weeks or more gestation and with 2-year outcome data. Data were analyzed June 2023. External validation was performed with a UK cohort.

Exposure

Clinical, electroencephalography (EEG), and magnetic resonance imaging (MRI) variables were curated and examined at 24 hours and following cooling.

Main Outcome and Measures

Death or severe NDI at age 2 years. Severe NDI was defined as Bayley Scales of Infant Toddler Development cognitive score below 70, Gross Motor Function Classification System score of 3 or higher, or quadriparesis. Model performance metrics were derived from training, internal, and external validation datasets.

Results

Among 424 neonates (mean [SD] gestational age, 39.1 [1.4] weeks; 192 female [45.3%]; 28 Asian [6.6%], 50 Black [11.8%], 311 White [73.3%]), 105 (24.7%) had severe encephalopathy at enrollment. Overall, 59 (13.9%) died and 46 (10.8%) had severe NDI. In the 24-hour model, the combined presence of 3 clinical characteristics-(1) severely abnormal EEG, (2) pH level of 7.11 or below, and (3) 5-minute Apgar score of 0-had a specificity of 99.6% (95% CI, 97.5%-100%) and a positive predictive value (PPV) of 95.2% (95% CI, 73.2%-99.3%). Validation model metrics were 97.9% (95% CI, 92.7%-99.8%) for internal specificity, with a PPV of 77.8% (95% CI, 43.4%-94.1%), and 97.6% (95% CI, 95.1%-99.0%) for external specificity, with a PPV of 46.2% (95% CI, 23.3%-70.8%). In the postcooling model, specificity for T1, T2, or diffusion-weighted imaging (DWI) abnormality in at least 2 of 3 deep gray regions (ie, thalamus, caudate, putamen and/or globus pallidus) plus a severely abnormal EEG within the first 24 hours was 99.1% (95% CI, 96.8%-99.9%), with a PPV of 91.7% (95% CI, 72.8%-97.8%). Internal specificity in this model was 98.9% (95% CI, 94.1%-100%), with a PPV of 92.9% (95% CI, 64.2%-99.0%); external specificity was 98.6% (95% CI, 96.5%-99.6%), with a PPV of 83.3% (95% CI, 64.1%-93.4%).

Conclusions and Relevance

In this prognostic study of neonates with moderate or severe HIE who were treated with therapeutic hypothermia, simple models using readily available clinical, EEG, and MRI results during the hospital admission had high specificity and PPV for death or severe NDI at age 2 years.

Effects of various exercise interventions on motor function in cerebral palsy patients: a systematic review and network meta-analysis

PURPOSE

A network meta-analysis was utilized to compare the rehabilitative effectiveness of different exercise interventions on motor function in cerebral palsy(CP) patients.

METHODS

Computer searches were conducted across 9 databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase, and others, to identify randomized controlled trials focusing on different exercise interventions aimed at enhancing motor function in CP patients. The search spanned from the inception of the databases to January 31, 2024.

RESULTS

20 articles, encompassing 570 patients and evaluating three types of exercise interventions, were included in the analysis. Results showed that aerobic training, resistance training, and mixed training exhibited superior outcomes compared to the control group, as evidenced by improvements in Gross Motor Function Measure scores, muscle strength, gait speed, and 10-Meter Walk Test scores (P < 0.05). Furthermore, the network meta-analysis revealed that resistance training ranked highest in enhancing gross motor function and gait speed among CP patients, while mixed training was deemed most effective in improving muscle strength and 10-Meter Walk Test scores.

CONCLUSION

Exercise interventions have been shown to significantly improve motor function in CP patients. Among these, resistance training and mixed training stand out for their effectiveness in enhancing walking capabilities. Resistance training is specifically aimed at improving gross motor function, while mixed training focuses on increasing muscle strength.

Efficacy and threshold dose of intensive training targeting mobility for children with cerebral palsy: A systematic review and meta-analysis

AIM

To systematically review the evidence for intensive mobility training in cerebral palsy (CP) and to determine the minimum effective dose to improve mobility.

METHOD

Randomized controlled trials (RCTs) or quasi-RCTs that included participants with CP, and which used intensive task-oriented training (TOT) mobility interventions and reported mobility outcomes, were included. Five databases were searched; two independent reviewers selected studies and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane Risk of Bias 2 tool were used to rate the certainty of evidence at the outcomes level and to determine the risk of bias respectively. Meta-analyses were conducted with clinically homogeneous studies. Threshold dose was analysed through meta-regression.

RESULTS

Forty-six RCTs with 1449 participants (mean age range 1 year 2 months to 16 years 4 months) were included. TOT had statistically and clinically significant effects on walking speed (p = 0.001), cadence (p = 0.02), gross motor function (p = 0.03), and functional mobility (p = 0.009) compared with control interventions. The threshold dose was undeterminable owing to the high heterogeneity of studies.

INTERPRETATION

TOT may improve walking speed, walking endurance, and balance. Studies with homogeneous samples and outcomes are needed to support clinical recommendations for intensive mobility interventions.

Digital technologies for pediatric rehabilitation: current access and use in the European Rehatech4child survey

BACKGROUND

Digital technologies such as robotics and treadmill-systems (RobTS), virtual-reality and active video-gaming (VR-AVG), and telehealth and apps (T&Apps) used within pediatric motor rehabilitation may promote recovery and improve function. However, digital technology uptake may be limited in clinical practice.

AIM

To explore access to and use of digital technologies for pediatric motor rehabilitation (DT4R) in Europe as a function of individual and environmental factors, as well as potential barriers to their use.

DESIGN

This observational study was based on RehaTech4child, a cross-sectional survey (2022), supported by the European Academy of Childhood Disability.

SETTING

Online survey available in 20 European languages.

POPULATION

The survey was disseminated through convenience and snowball sampling to pediatric motor rehabilitation professionals in Europe.

METHODS

The survey included items on outcomes (access, use, purposes of use and intention to use for the three categories of DT4R, i.e. RobTS, VR-AVG and T&Apps), determinants (socio-demographics, rehabilitation practice) and barriers. The association between access and use, and individual and environmental determinants was assessed using logistic regression adjusted for age, gender and profession.

RESULTS

Of the 1397 responses received, 635 were included. Respectively 67.7% and 74.3% of respondents reported using and having access to at least one of the three categories of DT4R. T&Apps and VR-AVG were used by 50.8% and 45.5% of respondents, respectively, and RobTS by 36.6% (P<0.001). Ease of access was the main determinant of use and frequency of use. Individual (e.g. age) and environmental (e.g. healthcare facility, patients' age) factors were access determinants. At least 70% of professionals intended to use a DT4R if available. Lack of financial resources and training were the most frequently reported severe barriers.

CONCLUSIONS

This study found that DT4R were already used in clinical practice by around two-thirds of respondents and that they generally wished to use them even more. Access was the main determinant of use and frequency of use.

CLINICAL REHABILITATION IMPACT

To facilitate access and use of DT4R, infrastructure and financial resources should be outlined, and training opportunities provided for professionals. Practice guidance should be developed and adapted for specific age groups and rehabilitation goals.

Short-term selective dorsal rhizotomy responders among children with bilateral cerebral palsy

AIM

To identify the short-term effects of selective dorsal rhizotomy (SDR) on gait and clinical impairments in children with bilateral spastic cerebral palsy (CP) and subgroups based on baseline gait patterns.

METHOD

Eighty-nine children with bilateral spastic CP (55 males, mean age [SD] before SDR: 9 years 5 months [2 years 3 months]; Gross Motor Function Classification System level I: 18; II: 54; III: 17) received three-dimensional gait analyses at two time points (baseline and 1 year after SDR); their baseline gait patterns were classified. The analysis included the comparisons of (1) sagittal plane kinematic waveforms, the Gait Profile Score, and non-dimensional spatiotemporal parameters between the two time points, (2) the kinematic waveforms of both time points to those of typically developing children, and (3) composite impairment scores of spasticity, weakness, and selectivity between the two time points.

RESULTS

Overall, kinematics improved distally but deteriorated proximally in the entire sample, especially in genu recurvatum and crouch gait patterns. Jump gait showed the most improvements after SDR, followed by apparent equinus and crouch gait. Spasticity was reduced after SDR, but not at the expense of strength or selectivity.

INTERPRETATION

The potential merit of investigating short-term SDR effects on gait according to baseline gait patterns was shown, with an overview of changes after SDR that may facilitate patient-tailored treatment.

A Rare Case of Posterior Fossa Syndrome Associated with Neuropathic Pain Successfully Treated with a Combination of Gabapentin, Diazepam and Baclofen-A Case Report and Literature Review

BACKGROUND

Posterior fossa syndrome (PFS), also known as cerebellar mutism syndrome, occurs in about 25% of pediatric patients undergoing resection of a posterior cranial fossa medulloblastoma. It is characterized primarily by mutism or reduced/impaired speech and may include variable symptoms such as motor dysfunction (apraxia, ataxia, hypotonia), supranuclear cranial nerve palsies, neurocognitive changes, and emotional lability. Long-term multidisciplinary rehabilitation is typically required, with recovery taking approximately six months, though many children experience long-term residual deficits. Neuropathic pain associated with PFS is rarely reported in pediatric patients, and evidence for its management is limited.

METHODS

This case report describes a 10-year-old boy who developed PFS following incomplete resection of a medulloblastoma. Clinical presentation included mutism, irritability, emotional lability, sleep disturbances, and neuropathic pain localized at the C5 level. The patient was treated with a combination of gabapentin, diazepam, and baclofen.

RESULTS

The combined pharmacological approach resulted in successful management of the patient's neuropathic pain and other symptoms associated with PFS, improving his overall condition.

CONCLUSIONS

This case highlights the potential effectiveness of a multimodal pharmacological regimen for treating neuropathic pain and associated symptoms in pediatric patients with PFS. Further research is needed to explore optimal treatment strategies for this rare but challenging complication.

Development of clinical practice guidelines for rehabilitation after diagnosis for primary bone and soft tissue tumours

BACKGROUND AND AIMS

Clinical practice guidelines for rehabilitation in musculoskeletal oncology are lacking. Guidelines should include recommendation statements aimed at optimising care to enhance recovery and quality of life. The project aim was to provide a foundation of best practice based upon expert consensus and evidence.

DESIGN

Consensus-based guidelines supported by systematic literature search.

METHODS

This was a consensus-based guideline developed with the support of the British Sarcoma Group (BSG). A group of national rehabilitation experts working within bone or soft tissue sarcoma centres across the UK met from December 2019. Evidence was gathered from a narrative literature review. Recommendations were developed with a variety of stakeholders to achieve consensus.

RESULTS

During the face to face consultation event and literature review seven themes were identified which should guide rehabilitation: (1) access to specialist Allied Health Professionals (AHPs) for treatment; (2) documented referral pathway for specialist AHP care; (3) assessment of individual issues, personal and multi-dimensional (holistic) needs; (4) patient centred care; (5) evidence-based rehabilitation treatment; (6) effective communication and provision of information; (7) patient support through access to other services.

CONCLUSIONS

Development of consensus-based, evidence-informed rehabilitation guidelines for those treated for primary malignant musculoskeletal tumours, provides rationale and evidence-based recommendations.

Multi-session adaptation to audiovisual and sensorimotor biofeedback is heterogeneous among adolescents with cerebral palsy

BACKGROUND

There is growing interest in the use of biofeedback-augmented gait training in cerebral palsy (CP). Audiovisual, sensorimotor, and immersive biofeedback paradigms are commonly used to elicit short-term gait improvements; however, outcomes remain variable. Because biofeedback training requires that individuals have the capacity to both adapt their gait in response to feedback and retain improvements across sessions, changes in either capacity may affect outcomes. Yet, neither has been explored extensively in CP.

METHODS

In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 years (12.5,15.26)) could adapt gait and retain improvements across four, 20-minute sessions using combined audiovisual and sensorimotor biofeedback. Both systems were designed to target plantarflexor activity. Audiovisual biofeedback displayed real-time soleus activity and sensorimotor biofeedback was provided using a bilateral resistive ankle exoskeleton. We quantified the time-course of change in muscle activity within and across sessions and overground walking function before and after the four sessions.

RESULTS

All individuals were able to significantly increase soleus activity from baseline using multimodal biofeedback (p < 0.031) but demonstrated heterogeneous adaptation strategies. In-session soleus adaptation had a moderate positive correlation with short-term retention of the adapted gait patterns (0.40 ≤ ρ ≤ 0.81), but generally weak correlations with baseline walking function (GMFCS Level) and motor control complexity (ρ ≤ 0.43). The latter indicates that adaptation capacity may be a critical and unique metric underlying response to biofeedback. Notably, in-session gains did not correspond to significant improvements in overground walking function (p > 0.11).

CONCLUSIONS

This work suggests that individuals with CP have the capacity to adapt their gait using biofeedback, but responses are highly variable. Characterizing the factors driving adaptation to biofeedback may be a promising avenue to understand the heterogeneity of existing biofeedback training outcomes and inform future system optimization for integration into clinical care.

Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development. We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given.

The goal-oriented collaborative approach with postural management strategies intervention via telehealth for children with non-ambulant cerebral palsy: Feasibility randomized clinical trial protocol

INTRODUCTION

Children with non-ambulant Cerebral Palsy (CP), have limitations in terms of self-mobility and require the use of assistive technology with extensive adaptations. However, purchasing assistive technology equipment is expensive and difficult to access in low- and middle-income countries, like Brazil. Guidelines recommend a postural management program to children with CP and emphasize the need for high doses of practice to achieve functional goals. Furthermore, collaborative practices are recommended, with active parental participation in the intervention.

AIMS

This study describes a protocol for assessing the feasibility of a future randomized clinical trial using a goal-oriented collaborative approach with postural management strategies via telehealth for non-ambulant children with CP.

METHODS

Eighteen children (1-5 years) with CP and their families will be randomized into two groups for 12 weeks: (A) goal-oriented collaborative approach with postural management strategies intervention via telehealth associated with conventional physical therapy or (B) conventional physical therapy. Feasibility measures will be verified, and outcomes will include parents' perceptions of performance and satisfaction, gross motor function, postural control, goal achievement and participation at home, preschool, and community.

IMPLICATIONS

The findings will inform the planning and preparation of a future randomized clinical trial of interventions for non-ambulant CP children via telehealth.

Modified sports interventions for children and adolescents with disabilities: A scoping review

AIM

To establish the scope of the literature on modified sports interventions for children and adolescents with disabilities.

METHOD

For this scoping review, articles were screened and the characteristics of studies were extracted. The modified sports interventions were described in terms of their structure, using the items of the Template for Intervention Description and Replication. Components of intervention treatment were described by using the language of the Rehabilitation Treatment Specification System. Results were analysed and validated by a group of professionals, using the Public and Patient Involvement strategy.

RESULTS

Twelve studies were eligible for inclusion, investigating interventions for children with autism spectrum disorder, cerebral palsy, and other conditions. Most studies presented a moderate level of evidence. Active ingredients were repeated sports-related motor training and introduction to the sport through a 'learning by action' mechanism. The intervention target was gross motor skills performance, and intervention aims (indirect outcomes) were physical activity participation and different body functions.

INTERPRETATION

The inclusion of stakeholders in this review helped to validate our findings about the characteristics and structure of modified sports interventions, to identify research gaps, and to provide a step process for clinical implementation. Future investigations are warranted of the effectiveness of modified sports investigations with better quality studies, including participation outcomes and studies with non-ambulant children.

WHAT THIS PAPER ADDS

Modified sports interventions target sport-related skills performance and aim to achieve physical activity participation and body functions. These interventions included group-based, sports-related motor skills training and introduction to sports in real-world environments. They are offered mostly for ambulant children with autism spectrum disorder and cerebral palsy. Most studies of modified sports interventions presented moderate level of evidence.

Research on the Cognitive Orientation to daily Occupational Performance Approach: A Bibliometric Review

IMPORTANCE

The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. However, how the research literature on this topic is patterned is still unknown, so it is difficult to identify potential areas for research and clinical interest.

AIMS

To analyze the literature published on the CO-OP approach to provide a detailed and structured analysis of the publication patterns.

DATA SOURCES

All literature related to CO-OP included in the Web of Science database through June 15, 2024.

STUDY SELECTION AND DATA COLLECTION

All published studies related to CO-OP were included in the bibliometric analysis, which was conducted on the raw data retrieved from the Web of Science database using the Bibliometrix R package.

FINDINGS

The annual growth rate in CO-OP research has been 0.8%, significantly increasing from 2015 onward. Most of the research has been published in occupational therapy and rehabilitation journals by English-speaking research teams, and its scope has expanded from developmental coordination disorder to a wide range of health conditions. In addition, two main lines of research have emerged: one focusing on understanding the underlying cognitive processes involved in CO-OP and the other focusing on its clinical effectiveness.

CONCLUSIONS AND RELEVANCE

Research on CO-OP has significantly increased over the past decade, and it currently encompasses a wide range of areas. This analysis may facilitate the advancement of research on and the clinical practical application of CO-OP. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. Occupational therapists use it to improve the occupational performance of both children and adults with movement difficulties. However, it is unknown how the research literature on this topic is patterned, so it is difficult to identify potential areas for research and clinical interest. This study found that scientific literature on CO-OP has significantly increased in the past decade and that its scope has expanded from developmental coordination disorder to a wider range of health conditions, such as cerebral palsy. Moreover, research is now focused on two main questions: What are the underlying cognitive processes involved during intervention, and how effective is the CO-OP approach? These findings can be used to further improve occupational performance and participation among occupational therapy clients who struggle with motor performance and planning.

Development and content validation of the Upper Limb-Motor Learning Strategy Tool for cerebral palsy

PURPOSE

To describe the development and content validation of the Upper Limb-Motor Learning Strategy Tool (UL-MLST) that aims to guide clinicians on how to implement and document the motor learning strategies used in the upper limb therapy approaches for children with cerebral palsy.

METHODS

The study consists of two main stages (1) item generation and development and (2) content validation and refinement. The UL-MLST Online Training Program, Manual and Checklist were developed by the authorship group in stage one. In stage 2, two experts evaluated the UL-MLST regarding the Relevance, Coherence, and Significance of the individual strategies and whether the tool is Relevant, Comprehensive, and Clinically useful.

RESULTS

Of sixty-two strategies included in the UL-MLST, 52 strategies were rated as being either "Moderately" or "Highly" Relevant, Coherent, and Significant. Ten strategies did not achieve mutual agreement; however, they did not meet the criteria for deletion and were revised according to expert feedback. Overall, the UL-MST was judged to be Relevant, Comprehensive, and Clinically useful.

CONCLUSIONS

The UL-MLST provides a valid tool to support clinicians in the implementation of the motor learning strategies for children with cerebral palsy.IMPLICATIONS FOR REHABILITATIONThe Upper Limb- Motor Learning Strategy Tool (UL-MLST) Online Training Program, Manual, and Checklist provide a comprehensive package of resources to support the application of motor learning strategies in upper limb therapy for children with cerebral palsy.The UL-MLST provides clinicians with a valid tool for self-appraising the implementation of motor learning-based therapies.The tool has the potential to improve fidelity, enhance the quality, and ensure consistency of evidence-based, task-focused approaches of therapy.

Comprehensive assessment of periodontal health in cerebral palsy: A systematic review and meta-analysis

AIMS

Cerebral palsy (CP) is the term for a set of neurological disorders resulting from brain damage that impairs motor function. The aim of the present study was to perform a systematic review of the literature to determine whether individuals with CP are at a greater risk of negative periodontal health outcomes compared to those without CP.

METHODS

This study followed the recommendations of the MOOSE guidelines. Electronic searches were conducted in the PubMed, Web of Science, Scopus, Ovid, Embase, and PsycInfo databases. Observational studies assessing periodontal outcomes in individuals with CP were included. Risk of bias was appraised using the Newcastle-Ottawa scale. Meta-analyses were conducted and the results were presented using standardized mean differences (SMD), odds ratios (OR), and 95% confidence intervals (CI). The strength of the evidence was also assessed.

RESULTS

A total of 316 records were retrieved from the electronic databases, 17 of which were included in the qualitative synthesis. Meta-analyses revealed significantly higher scores in individuals with CP compared to those without CP for the oral hygiene index (SMD = 0.47 [95% CI: 0.17-0.78, I2 = 80%), gingival index (SMD = 0.75 [95% CI: 0.39-1.11], I2 = 79%), plaque index (SMD = 0.70 [95% CI: 0.07-1.33], I2 = 93%), and calculus index (SMD = 0.98 [95% CI: 0.76-1.20], I2 = 0%). However, no significant difference was found between groups for the prevalence of gingivitis (OR = 1.27 [95% CI: 0.28-5.66], I2 = 93%). The risk of bias for the outcome assessment and statistical tests was low. The strength of the evidence was deemed very low.

CONCLUSION

Individuals with CP may experience more significant negative periodontal health outcomes compared to those without CP.

Impact of World Cerebral Palsy Day on Public Interest in Brazil: Evidence from Internet Search Data

AIM

This study investigated the impact of the World Cerebral Palsy Day (WCPD) campaign on the public interest using Google Trends Analysis data in Brazil.

METHODS

Google Trends was used to collect Relative Search Volume (RSV) data for "cerebral palsy" from 2004 to 2011 (control years) and 2012 to 2022 (WCPD years). RSV during the 4 weeks around WCPD (period of interest) was compared with the rest of the year (control period) in each timeframe. Regional RSV, search queries, and main topics were also investigated.

RESULTS

RSV increased by 62.22% from pre-campaign to campaign period. During the WCPD years, a 21.36% RSV increase occurred in campaign weeks, with an average difference of 12.16 (95% CI: 1.74, 22.58); notably in in the last five years in the southeast 9.47 (95% CI: 2.93, 16.01) and south 8.66 (95% CI: 1.66, 15.66) macro-regions.

CONCLUSION

The campaign has fulfilled its role, but targeting more vulnerable areas could further amplify its impact.

Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo

As intervenções de esportes modificados visam o desempenho de habilidades relacionadas ao esporte e visam alcançar a participação em atividades físicas e funções corporais Essas intervenções incluíram treinamento de habilidades motoras relacionadas ao esporte em grupo e introdução ao esporte em ambientes do mundo real Eles são oferecidos principalmente para crianças ambulantes com transtorno do espectro do autismo e paralisia cerebral A maioria dos estudos de intervenção de esportes modificados apresentou nível de evidência moderado Resumo gráfico: Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo. https://onlinelibrary.wiley.com/doi/10.1111/dmcn.15952.

Feasibility of the Challenge Assessment, the Gait Outcomes Assessment List and 'Moving Together' ('Sammen I Bevægelse'), a Group-Based Motor Skills Intervention for Independent School-Aged Children with Cerebral Palsy

This single group pre and posttest study evaluated the feasibility of a new 10-week group-based motor skills enhancement intervention: "Moving Together," and associated use of the Challenge assessment and Gait Outcomes Assessment List (GOAL). Participant attendance/completion and satisfaction with the assessments and intervention were evaluated, and a first estimate of associated motor skill-related changes obtained. Ten ambulatory children with cerebral palsy (7-14 years) and their parents participated. Ninety percent of Challenge sessions were attended and 82.5% of GOAL questionnaires completed. Program attendance was 83% overall. Satisfaction with assessments was high for the Challenge and moderate for the GOAL, and intervention satisfaction was high. Mean change scores (95% CI) post-intervention for the Challenge and GOAL were 4.2 (-11.4 to 3.1) and 3.6 (-14.4 to 4.0) points (/100) respectively. Challenge and GOAL use was feasible and appropriate for "MovingTogether" and associated with gains in motor skill performance and functional abilities.

EFFECTIVENESS OF RADIAL EXTRACORPOREAL SHOCKWAVE THERAPY IN THE LOCAL MANAGEMENT OF HYPERTONIA (SPASTICITY AND DYSTONIA) IN PATIENTS WITH CEREBRAL PALSY

Objective

To assess the effect of radial extracorporeal shockwave therapy on the reduction of local hypertonia in patients with cerebral palsy.

Design

Explorative pre-post intervention study.

Subjects/Patients

Forty-five patients with cerebral palsy.

Methods

All patients received 3 sessions of radial extracorporeal shockwave therapy with a time interval of 1 week for each session. The outcomes were V1 and V3 of the Tardieu scale, the Timed Up and Go test, and the 10-metre walk test. The measurements were collected at baseline, immediately after the last session of shockwaves, at 12 and 24 weeks after baseline.

Results

The statistical analysis used was a mixed linear model of repeated measures. The degrees on the Tardieu scale increased significantly in all the treated muscles. The results of the Timed Up and Go test and the 10 m walk test confirmed a significant functional effect after the shockwave therapy (p < 0.001).

Conclusion

Functional improvement in patients treated with extracorporeal shockwave therapy has been observed to last up to 24 weeks.

Preventing deformities in paediatric cerebral palsy in poorly-resourced areas: A scoping review

Background

Managing children with cerebral palsy (CP) in poorly-resourced contexts, especially those with greater functional limitations, is challenging. Unmitigated orthopaedic complications can further restrict already compromised functional capacity. Where rehabilitation skills and knowledge are scarce, primary healthcare worker- and caregiver-implemented routines are warranted. The essential elements of a home-based routine to mitigate musculoskeletal (MSK) complications in children with severe CP in resource-limited settings (RLSs) have not been determined.

Objectives

To summarise the evidence for programmes and interventions that mitigate MSK complications in children with severe CP and make recommendations for a programme suited to RLSs.

Method

Scientific databases and professional websites were searched for studies and reports describing guidelines, interventions or programmes for children aged 0-18 years with severe, partially- or non-ambulant CP, that included aims for the prevention of MSK complications. Articles reporting on surgical, pharmacological and advanced or expensive technological interventions were excluded.

Results

A total of 57 studies or reports were included in the review. Low-grade evidence exists for 24-hour postural management (24-h PM), supported standing, sustained stretching and splinting to mitigate MSK complications in children with CP. Caregiver training and support, and integration of the programme into daily routines were identified as important components for successful implementation.

Conclusion

Clinical guidelines and evidence that support caregiver-delivered interventions to reduce MSK complications in children with severe CP are limited, and only weak recommendations can be made.

Clinical implications

There is a need for context-specific, home-based intervention programmes to prevent MSK complications in children with CP in RLSs.

Effect of sling exercise training on motor function in children with cerebral palsy: A systematic review and meta-analysis

BACKGROUND

To systematically evaluate the efficacy of sling exercise training on balance and gross motor movement in children with cerebral palsy, and to investigate the effects of different intervention times and ages on treatment outcomes.

METHODS

Randomized controlled trials on sling exercise training for children with cerebral palsy published in full text from CNKI, Wanfang datebase, PubMed, Cochrane Library, Web of Science, and Scopus were searched from the time of build to November 2023. Literature screening, data extraction, and quality assessment were performed independently by 2 researchers, and Meta-analysis was performed using RevMan5.4 and Stata17.0 software.

RESULTS

A total of 12 studies with 725 patients were included sling exercise training significantly improved balance (I2 = 0%, mean difference [MD] = 3.42, 95% CI: 2.93-3.92, P < .00001), gross motor function (I2 = 0%, MD = 5.90, 95% CI: 1.50-10.29, P < .00001), standing function (I2 = 14%, MD = 2.73, 95% CI: 2.17-3.29, P < .00001) walking and running and jumping function(I2 = 79%, MD = 5.93, 95% CI: 3.82-8.04, P < .00001) and 10-meter maximum walking speed(I2 = 58%, MD = 1.47, 95% CI: 0.52-2.42, P = .003) in children with cerebral palsy. Subgroup analyses of balance showed that children in the 5 + age group (I2 = 0%, MD = 3.73, 95% CI: 2.55-4.91, P < .00001) had better outcomes relative to the 4-5 year old group (I2 = 23%, MD = 3.49, 95% CI: 2.88-4.09, P<0.00001) and the under 4 year old group (I2 = 0%, MD = 282.73, 95% CI: 1.57-4.06, P < .00001). Subgroup analyses of walking and running and jumping function showed that a 6-month treatment course(I2 = 0%, MD = 5.93, 95% CI: 3.82-8.04, P < .00001) had better efficacy relative to a 3-month treatment course(I2 = 0%, MD = 4.11, 95% CI: 2.84-5.39, P < .00001).

CONCLUSION

Sling exercise training significantly improves balance and gross motor function in children with cerebral palsy, and The average age of 5+ years is a critical period for the development of balance in children with cerebral palsy, and the treatment course is an important factor affecting walking and running and jumping function.

A systematic review on machine learning approaches in cerebral palsy research

Background

This review aims to explore advances in the field of cerebral palsy (CP) focusing on machine learning (ML) models. The objectives of this study is to analyze the advances in the application of ML models in the field of CP and to compare the performance of different ML algorithms in terms of their effectiveness in CP identification, classifying CP into its subtypes, prediction of abnormalities in CP, and its management. These objectives guide the review in examining how ML techniques are applied to CP and their potential impact on improving outcomes in CP research and treatment.

Methodology

A total of 20 studies were identified on ML for CP from 2013 to 2023. Search Engines used during the review included electronic databases like PubMed for accessing biomedical and life sciences, IEEE Xplore for technical literature in computer, Google Scholar for a broad range of academic publications, Scopus and Web of Science for multidisciplinary high impact journals. Inclusion criteria included articles containing keywords such as cerebral palsy, machine learning approaches, outcome response, identification, classification, diagnosis, and treatment prediction. Studies were included if they reported the application of ML techniques for CP patients. Peer reviewed articles from 2013 to 2023 were only included for the review. We selected full-text articles, clinical trials, randomized control trial, systematic reviews, narrative reviews, and meta-analyses published in English. Exclusion criteria for the review included studies not directly related to CP. Editorials, opinion pieces, and non-peer-reviewed articles were also excluded. To ensure the validity and reliability of the findings in this review, we thoroughly examined the study designs, focusing on the appropriateness of their methodologies and sample sizes. To synthesize and present the results, data were extracted and organized into tables for easy comparison. The results were presented through a combination of text, tables, and figures, with key findings emphasized in summary tables and relevant graphs.

Results

Random forest (RF) is mainly used for classifying movements and deformities due to CP. Support vector machine (SVM), decision tree (DT), RF, and K-nearest neighbors (KNN) show 100% accuracy in exercise evaluation. RF and DT show 94% accuracy in the classification of gait patterns, multilayer perceptron (MLP) shows 84% accuracy in the classification of CP children, Bayesian causal forests (BCF) have 74% accuracy in predicting the average treatment effect on various orthopedic and neurological conditions. Neural networks are 94.17% accurate in diagnosing CP using eye images. However, the studies varied significantly in their design, sample size, and quality of data, which limits the generalizability of the findings.

Conclusion

Clinical data are primarily used in ML models in the CP field, accounting for almost 47%. With the rise in popularity of machine learning techniques, there has been a rise in interest in developing automated and data-driven approaches to explore the use of ML in CP.

Practices of Physical Therapists Who Assist People With Cerebral Palsy in Brazil: A National Survey

PURPOSE

To describe the practices of pediatric physical therapists (PTs) working with children and adolescents with cerebral palsy (CP) in Brazil.

METHODS

PTs working with children and adolescents with CP were invited to participate via social media and email campaigns to complete an online survey containing 46 questions.

RESULTS

In total, 373 PTs participated. Most PTs reported searching in scientific databases (96.8%) and on social media (71%). The main barrier to information reported was limited access to full-text articles (44%). Among the PTs, 58.4% and 84% reported using the International Classification of Functioning, Disability and Health (ICF) and family centered practice models, respectively. Regarding tools and interventions, there was little focus on the domains of contextual factors and participation.

CONCLUSIONS

This survey points to some important advances. However, strategies are still needed to promote knowledge translation and evidence-based practices among pediatric PTs in Brazil.

Effectiveness of upper extremity BoNT-A Treatment followed by rehabilitation approaches on activity and participation in children with cerebral palsy: A systematic review

PURPOSE

This study aimed to investigate the effect of interventions applied in addition to Botulinum Toxin Type A (BoNT-A) application to the upper extremities on activity and participation in children with Cerebral Palsy (CP).

MATERIALS AND METHODS

A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine Methodology. The PubMed, PEDro, ScienceDirect, Web of Science, and Cochrane Library databases were searched. All the included articles were evaluated based on their level of evidence and conduct.

RESULTS

Six articles met the inclusion criteria and included children and adolescents with CP. Studies have examined the effectiveness of different approaches, and some studies have found that the intervention applied is effective for activities or participation.

CONCLUSIONS

It was concluded that BoNT-A followed by upper limb rehabilitation approaches is effective in improving activity and participation levels of the International Classification of Functioning, Disability, and Health (ICF). However, the superiority of combining BoNT-A with rehabilitation programs over rehabilitation programs alone remains inconclusive. Therefore, further clinical trials are needed to determine the efficacy of combining BoNT-A with a rehabilitation program to improve ICF parameters.

Development of GO Move: A Website for Children With Unilateral Cerebral Palsy

It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.