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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neurology & Neurodevelopmental Disorders".

Deadline for manuscript submissions: closed (1 September 2025) | Viewed by 13007

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Special Issue Editor

Dr. Kara B. Ayers

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Guest Editor

1. College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
2. Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
Interests: cerebral palsy; developmental disabilities; ableism; healthcare equity; disabled identity; developmental and behavioral pediatrics

Special Issue Information

Dear Colleagues,

This Special Issue aims to focus on the holistic health and well-being of children with cerebral palsy (CP) and other developmental disabilities. While medical advancements have improved many aspects of care for these children, we must also address the social and environmental factors that impact their lives. This Special Issue aims to explore the intersections of health, identity, and society for children with CP and related conditions.

We invite submissions that examine the effects of ableism and healthcare inequities on children with CP, as well as research that highlights strengths-based approaches to care and support. Of particular interest are studies that investigate the benefits of fostering positive disabled identities in children, promoting self-advocacy, and challenging deficit-based narratives.

This Special Issue welcomes the submission of research focused on a wide range of topics, including, but not limited to, the following: innovative therapies and interventions, mental health and well-being, family-centered care, educational inclusion, assistive technology, and transition to adulthood. We especially encourage work that amplifies the voices and experiences of children with CP and their families.

By bringing together diverse perspectives, we hope to advance our understanding of how to best support the whole child, promoting not just physical health, but also emotional, social, and personal growth.

Dr. Kara B. Ayers
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cerebral palsy
developmental disabilities
ableism
healthcare equity
disabled identity
strengths-based approaches
self-advocacy
holistic health
family-centered care
inclusion

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Published Papers (10 papers)

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Research

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23 pages, 2817 KB

Open AccessArticle

Feasibility, Safety, and Tolerability of Remote Ischemic Conditioning in Children with Unilateral Cerebral Palsy: A Randomized Controlled Trial

by Swati M. Surkar, Shailesh Gardas, John Willson, Joseph Kakyomya and Charity Moore Patterson

Children 2025, 12(10), 1372; https://doi.org/10.3390/children12101372 - 11 Oct 2025

Viewed by 199

Abstract

Background: Remote ischemic conditioning (RIC) has shown promise as a neuroprotective strategy, but its application in children with cerebral palsy (CP) remains unexplored. We conducted a randomized controlled trial to evaluate the feasibility, safety, and tolerability of repeated, 6–7 sessions of RIC in children with unilateral CP. Methods: Fifty-one children aged 6–16 years with unilateral CP were randomized (1:1) to receive RIC or sham conditioning on the more affected arm. Primary feasibility outcomes included recruitment metrics, intervention adherence, retention, and protocol fidelity. Safety endpoints included continuous monitoring of oxygen saturation, blood pressure, heart rate, and adverse event incidence. Tolerability was assessed via child-reported pain ratings, conditioning pressure tolerance, skin integrity evaluations, and session adherence. Results: Of 148 children screened, 51 were randomized to RIC (n = 25), sham (n = 26) groups; 48 (94.1%) completed the intervention as allocated. Recruitment yielded 2.04 participants/month. Intervention adherence was 100% in both groups. RIC was well tolerated, with mean pain scores 2.8 ± 3.1 during inflation in RIC and 0.3 ± 0.8 in Sham group. No serious adverse events occurred. Physiological parameters remained stable across 314 conditioning sessions; no clinically significant hypoxemia, blood pressure derangements, or arrhythmias were detected. Minor adverse events (transient erythema, mild discomfort) were rare (2.22%) and self-limiting. Skin integrity was preserved, and no participants required session termination. Conclusions: Repeated RIC is feasible, safe, and tolerable in children with unilateral CP. These findings support the design of future trials using RIC as a priming agent to enhance pediatric neurorehabilitation outcomes. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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12 pages, 229 KB

Open AccessArticle

Cross-Cultural Adaptation and Validation of the Mini-Eating and Drinking Ability Classification System for Korean Children with Cerebral Palsy Aged 18–36 Months

by You Gyoung Yi, Seoyon Yang, Jeong-Yi Kwon, Dong-wook Rha, Juntaek Hong, Ja Young Choi, Eun Jae Ko, Bo Young Hong and Dae-Hyun Jang

Children 2025, 12(10), 1348; https://doi.org/10.3390/children12101348 - 7 Oct 2025

Viewed by 293

Abstract

Background/Objectives: Feeding and swallowing difficulties are common in young children with cerebral palsy (CP), yet no validated tool has been available in Korea for those under 3 years. The Mini-Eating and Drinking Ability Classification System (Mini-EDACS) was designed for children aged 18–36 months. This study aimed to translate the Mini-EDACS into Korean and evaluate its reliability and validity. Methods: Translation followed international guidelines, including forward–backward translation and Delphi consensus with experts in pediatric dysphagia. Forty-eight children with CP (mean age 27.1 ± 5.0 months) were assessed. Caregivers and speech–language pathologists (SLPs) independently rated Mini-EDACS and assistance levels. Inter-rater reliability was examined using Cohen’s κ. Construct validity was tested by Spearman’s correlations with the Gross Motor Function Classification System (GMFCS), Mini-MACS, the Communication Function Classification System (CFCS), the Visual Function Classification System (VFCS), and the Functional Oral Intake Scale for Children (FOIS-C). Results: Agreement between caregivers and SLPs was excellent (κ = 0.90; weighted κ = 0.98). Assistance-level ratings also showed almost perfect concordance (κ = 0.97). Mini-EDACS correlated strongly with FOIS-C (ρ = −0.86, p < 0.001) and with assistance levels (ρ = 0.81, p < 0.001). Moderate-to-strong positive correlations were observed with GMFCS (ρ = 0.56), Mini-MACS (ρ = 0.64), CFCS (ρ = 0.61), and VFCS (ρ = 0.61), supporting construct validity. Conclusions: The Korean Mini-EDACS is a reliable and valid tool for classifying eating and drinking abilities in children with CP under 3 years. It enables standardized communication between caregivers and clinicians, complements existing functional classification systems, and may facilitate earlier identification and intervention for feeding difficulties. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

14 pages, 345 KB

Open AccessArticle

Construct Validity and Internal Consistency of the Italian Version of the PedsQL^TM 4.0 Generic Core Scale and PedsQL^TM 3.0 Cerebral Palsy Module

by Ilaria Pedrinelli, Sofia Biagi, Domenico Marco Romeo, Elisa Musto, Valeria Fagiani, Martina Lanza, Erika Guastafierro, Alice Colombo, Andrea Giordano, Cristina Montomoli, Cristiana Rezzani, Tiziana Casalino, Eugenio Mercuri, Daria Riva, Matilde Leonardi, Giovanni Baranello and Emanuela Pagliano

Children 2025, 12(6), 749; https://doi.org/10.3390/children12060749 - 9 Jun 2025

Viewed by 632

Abstract

Background: Health-related quality of life (HRQoL) has emerged as a meaningful outcome measure in clinical trials and healthcare interventions in children with cerebral palsy (CwCP). We assessed the construct validity and internal consistency of the Italian version of the Paediatric QoL inventory (PedsQL^TM) 4.0 Generic Core Scales (GCS) and PedsQL^TM 3.0 Cerebral Palsy Module (CPM). Methods: A total of 125 CwCP and their parents were enrolled. Participants completed both the GCS and the CPM modules, and the results were compared to those of a sample of 121 healthy peers and their parents. The dimensionality of the two modules was assessed through exploratory factor analysis. Construct validity was assessed by a known-groups method evaluating the differences between CwCP and healthy sample. Results: Only a few GCS subscales were unidimensional, while all CPM subscales proved to be unidimensional, except for the Speech and Communication subscales of child self-reports. GCS internal consistency was good for all subscales of the parent proxy-reports, as well as for the Physical Activities and Psychosocial Health subscales of child self-reports. CPM internal consistency was good for both parent proxy-reports and—with a few exceptions—child self-reports. As for the PedsQL^TM validity, the GCS proved effective in discriminating between CwCP and healthy participants; the CPM showed a significant association between lower neurofunctional abilities and lower HRQoL. Parent–child concordance shows that child self-report scores were always higher than the those of the proxy-reports for both the GCS and CPM modules. Conclusions: The present study confirms the internal consistency and construct validity of the Italian version of both PedsQL^TM modules. In CwCP, greater functional disability resulted in lower HRQoL scores, and there was significant discrepancy between the parent and child ratings. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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9 pages, 204 KB

Open AccessArticle

Evaluation of Problematic Media Use in Children with Cerebral Palsy Aged 4–11 Years: A Case–Control Study

by Orhan Coşkun, Abdurrahman Zarif Guney, Uğur Topçu and Mustafa Karaduman

Children 2025, 12(6), 675; https://doi.org/10.3390/children12060675 - 24 May 2025

Cited by 1 | Viewed by 602

Abstract

Background/Objectives: Excessive screen exposure that negatively impacts a person’s life is referred to as problematic media use (PMU). In healthy children, PMU is associated with a sedentary lifestyle and negative health outcomes. However, this issue is not well understood in children with cerebral palsy (CP). The aim of our study was to evaluate PMU and screen exposure times in children with CP. Methods: All CP patients with variable etiology who were followed up at the child neurology clinic and met the inclusion criteria were included in our study. A total of 91 patients diagnosed with CP and 92 control children, aged 4–11, participated in the study. Daily screen exposure times, sleep durations, and body mass index (BMI) were evaluated. In children with CP, additional data such as the need for special education, CP subtype, epilepsy status, and mobility status were recorded. All participants were administered the long form of the Problematic Media Use Scale, which is valid for children aged 4–11. Results: When comparing screen exposure between the patient group and the control group, the patient group had significantly higher screen exposure (p < 0.001). Spearman’s rho correlation coefficients, calculated to evaluate the relationship between age, sleep duration, screen exposure time and screen addiction questionnaire scores of the children in the patient and control groups, were statistically significant. For the patient group specifically, there was a significant positive relationship between screen exposure duration and screen addiction questionnaire scores (r = 0.380, p < 0.001). Conclusions: In our study, it was seen that problematic media use was no different in CP patients within the same age group. However, screen exposure durations were found to be higher than in the normal population. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

17 pages, 908 KB

Open AccessArticle

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

by Simon Strübbe, Susmita Roy, Irina Sidorenko and Renée Lampe

Children 2025, 12(3), 335; https://doi.org/10.3390/children12030335 - 7 Mar 2025

Cited by 1 | Viewed by 1971

Abstract

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. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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16 pages, 224 KB

Open AccessArticle

Giving Voices: Qualitative Study on Parental Experiences of Caring for Children with Cerebral Palsy or Developmental Disabilities in South Korea

by Bogcheon Choi

Children 2025, 12(3), 284; https://doi.org/10.3390/children12030284 - 26 Feb 2025

Cited by 1 | Viewed by 1992

Abstract

Background/Objectives: This study investigates the lived experiences of Korean parents caring for children with cerebral palsy or developmental disabilities, focusing on the challenges they face. It highlights systemic and societal factors, including gaps in diagnostic processes, financial support, access to information, and inclusive education. Methods: Using a qualitative approach, semi-structured interviews were conducted with 17 parents, recruited through purposive sampling. Thematic analysis was employed to identify key patterns and challenges in their experiences. Results: Parents reported significant difficulties, including delayed and insensitive diagnostic processes, financial burdens due to inadequate welfare support, and limited access to coordinated information. Educational challenges included disabling attitudes among teachers and a lack of genuine inclusion. Societal stigma further compounded their struggles. Despite these obstacles, parents demonstrated resilience and advocated for their children’s needs. Despite these obstacles, parents demonstrated resilience and advocated for their children’s needs. Conclusions: This study provides valuable insights into the challenges faced by parents of disabled children in South Korea, emphasizing the need for systemic reforms to foster a more inclusive and supportive environment for these families. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

12 pages, 1316 KB

Open AccessArticle

Constraint Therapy with and Without Virtual Reality for Children with Unilateral Cerebral Palsy: A Randomized Trial

by Heather Roberts, Nancy J. Clegg, Wayni Wang, Sydney Chapa, Briana Arellano, Madison Trahan, Fabiola Reyes, Mauricio R. Delgado, Sue Ram and Angela Shierk

Children 2025, 12(3), 283; https://doi.org/10.3390/children12030283 - 26 Feb 2025

Viewed by 2249

Abstract

Background/Objectives: Cerebral palsy (CP) is the most common childhood motor disorder, with unilateral cerebral palsy (UCP) presenting with asymmetrical motor function that can cause decreased upper limb function. Constraint-Induced Movement Therapy (CIMT) is an evidence-based intervention that addresses upper limb functional limitations, but further study on combining interventions with CIMT is warranted. Combining CIMT with virtual reality (VR) is hypothesized to enhance engagement and therapeutic outcomes. This study compared the effectiveness of CIMT alone versus CIMT combined with VR (CIMT + VR) in improving upper limb function and occupational performance in children with UCP. Methods: A blinded, randomized, controlled trial included children aged 5–13 years with Manual Ability Classification System (MACS) levels I–III. The participants were randomized into CIMT or CIMT + VR groups and completed a standardized 10-day camp protocol (60 h). Pre-intervention and post-intervention assessments included the Assisting Hand Assessment (AHA) and the Canadian Occupational Performance Measure (COPM). Secondary measures included acceptability ratings of VR devices and fidelity. Results: Thirty-two participants, with a mean age of 9 years and 3 months (3 years 1 month), MACS I = 4, II = 20, and III = 8, completed this study. CIMT and CIMT + VR led to significant improvements in upper limb function, with no statistically significant differences between the groups in bilateral hand use and occupational performance. Conclusions: These findings reinforce the efficacy of CIMT while highlighting the potential of VR to enhance engagement when the child prefers to interact with the technology, underscoring the importance of individualized approaches that consider a child’s preferences and responsiveness to different intervention modalities. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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Review

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27 pages, 983 KB

Open AccessReview

Time and Mind: A State-of-the-Art Perspective on Time Perception and Cognitive–Motor Interactions in Children and Adolescents with Cerebral Palsy

by Giuseppe Accogli, Valentina Nicolardi, Mariangela Leucci, Luigi Macchitella, Greta Pirani, Maria Carmela Oliva and Antonio Trabacca

Children 2025, 12(10), 1283; https://doi.org/10.3390/children12101283 - 23 Sep 2025

Viewed by 539

Abstract

Background: Time perception (TP) is increasingly recognized as a key cognitive domain in children and adolescents with cerebral palsy (CP), yet existing studies are scarce, heterogeneous, and methodologically limited. Objective: To synthesize empirical evidence on TP in pediatric CP, distinguishing perceptual timing deficits from motor-based impairments and outlining putative cognitive mechanisms. Methods: Following PRISMA where appropriate, we systematically searched Scopus, Embase, and PubMed Central for studies on TP in individuals with CP under 18 years. Four studies met inclusion criteria. Risk of bias was appraised with STROBE, AXIS, and RoB 2. Results: Available evidence suggests that TP difficulties in CP are not solely due to motor dysfunction but also reflect broader cognitive–perceptual challenges. Studies using low-motor-demand tasks sometimes report intact TP, whereas tasks requiring overt movement often confound perceptual timing with execution demands. Intervention findings are mixed: time-related supports show promising but inconsistent effects on everyday time processing, while motor-focused timing training demonstrates limited impact on TP itself. However, conclusions are constrained by the small number of studies and variability in samples, tasks, and outcomes. Conclusions: TP should be considered a distinct, clinically relevant construct in pediatric CP. Future work should employ motor-minimal paradigms, report standardized CP classifications, and adopt longitudinal designs to isolate TP deficits and guide targeted interventions. Clarifying TP profiles may improve cognitive characterization and rehabilitation planning in CP. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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23 pages, 2452 KB

Open AccessReview

Defining Goal-Directed Training for Children with Cerebral Palsy: A Scoping Review and Framework for Implementation

by Angela Shierk, Bridget Barry Thias, Haley Becker, Baylee Allen, Benjamin Chaiprasert, Katherine C. Lampe, Ava Wallace-McCollom, Aidan O’Brien and Heather Roberts

Children 2025, 12(8), 1039; https://doi.org/10.3390/children12081039 - 8 Aug 2025

Viewed by 2113

Abstract

Background/Objectives: This scoping review aimed to define goal-directed training (GDT) and its impact on outcomes for children with cerebral palsy (CP), and to develop a structured framework outlining its core components for effective implementation. Methods: Using the Arksey and O’Malley framework and PICO criteria, nine databases were searched and reference lists reviewed. Two reviewers independently screened and extracted data, which were analyzed using a qualitative descriptive approach. Results: From 1273 articles, 156 met inclusion criteria, including 112 efficacy studies (53 randomized trials, 53 non-randomized trials, 6 secondary analyses) involving 4708 children aged 3 months to 21 years (mean age 6.7 years). Interventions addressed all GMFCS and MACS levels. Ninety outcome measures across ICF domains were used. GDT was associated with improvements in motor function, hand use, self-care, communication, and participation. Findings were synthesized into an eight-step GDT framework highlighting collaborative goal setting, goal analysis, strategy determination, structured practice, feedback, re-evaluation, and generalization. This framework supports consistent, high-quality GDT implementation across settings and disciplines. Conclusions: In conclusion, GDT shows broad functional benefits and emphasizes individualized, client-centered care. The review offers a practical, evidence-informed framework to guide clinicians and researchers in delivering GDT with fidelity. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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Other

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29 pages, 2281 KB

Open AccessSystematic Review

The Pathway Is Clear but the Road Remains Unpaved: A Scoping Review of Implementation of Tools for Early Detection of Cerebral Palsy

by Álvaro Hidalgo-Robles, Javier Merino-Andrés, Mareme Rose Samb Cisse, Manuel Pacheco-Molero, Irene León-Estrada and Mónica Gutiérrez-Ortega

Children 2025, 12(7), 941; https://doi.org/10.3390/children12070941 - 17 Jul 2025

Cited by 1 | Viewed by 1577

Abstract

Background/Objectives: International guidelines recommend the combined use of the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI) to support early and accurate diagnosis of cerebral palsy (CP). However, their implementation remains inconsistent. This study aimed to map their reported global use and identify associated enablers and barriers. Methods: A scoping review was conducted following JBI and PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Cochrane, PEDro, ProQuest, Web of Science, and Scopus. Eligible studies were charted and thematically analyzed, focusing on tools use and implementation factors at individual, organizational, and system levels. Results: Fourteen articles (seven surveys, seven implementation studies) from seven countries met the inclusion criteria. While awareness of GMA, HINE, and MRI was generally high, routine clinical use was limited—particularly outside structured implementation initiatives. Major barriers emerged at the system level (e.g., limited training access, time constraints, lack of standardized referral pathways) and social level (e.g., unclear leadership and coordination). Conclusions: The limited integration of GMA, HINE, and MRI into routine practice reflects a persistent “know–do” gap in early CP detection. Since implementation is shaped by the dynamic interplay of capability, opportunity, and motivation, bridging this gap demands sustained and equitable action—by addressing system-wide barriers, supporting professional development, and embedding early detection within national care pathways. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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