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Cerebral Palsy: Recent Advances in Clinical Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: 26 April 2026 | Viewed by 4494

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Special Issue Editors

Dr. Laurie J. Glader

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Guest Editor

Division of Complex Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA
Interests: cerebral palsy; pediatrics; child neurology; complex care

Dr. M. Wade Shrader

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Guest Editor

Department of Orthopedic Surgery, Alfred I. Dupont Institute, Wilmington, DE 19803, USA
Interests: cerebral palsy; neuromuscular; scoliosis; hip osteotomy; single event multi-level surgery; posterior spine fusion
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Special Issue Information

Dear Colleagues,

The care of individuals with cerebral palsy (CP) continues to advance rapidly, from making the diagnosis and identifying etiology to the implementation of innovative assessment tools and interventions. In this Special Issue, titled “Cerebral Palsy: Recent Advances in Clinical Management”, we invite authors to submit papers on topics related to original works in the clinical care of individuals with CP, including care of their comorbid conditions. Focus may be on novel processes or the evaluation of established practices that strengthen the evidence for their use. Systematic reviews are welcome. Often, even when guidance is available to drive best practices, implementation can lag. Thus, this Special Issue also considers submissions incorporating implementation science. We look forward to receiving your work and disseminating it as we collectively advance the clinical management of individuals with CP.

Dr. Laurie J. Glader
Dr. M. Wade Shrader
Guest Editors

Manuscript Submission Information

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Keywords

cerebral palsy
pediatric
neurology
complex care
clinical management

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Published Papers (5 papers)

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Research

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12 pages, 1736 KB

Open AccessArticle

Hip Reconstruction in Children with Cerebral Palsy: Comparing Treatment Plans Derived from Pelvic Radiographs Versus Those from Hip CTs

by Andy Tsai, Patrick Johnston and Benjamin J. Shore

J. Clin. Med. 2026, 15(6), 2259; https://doi.org/10.3390/jcm15062259 - 16 Mar 2026

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Abstract

Background/Objectives: Hip displacement is a common problem in children with cerebral palsy (CP). Typically, the recommended hip surveillance imaging for these children consists of an anteroposterior pelvic radiograph, from which we calculate the migration percentage (MP) to determine treatment plans (conservative/preventive therapy, femoral osteotomy, femoral and pelvic osteotomies, and salvage surgery). However, little is known about the accuracy of MP for treatment planning. We aim to compare treatment plans based on MP thresholds with plans determined by an orthopedic surgeon following review of the hip CTs. Methods: We retrospectively identified hip CTs performed in children who were ≤18 years old with CP (11/2018—07/2024). The inclusion criteria were: (1) a pelvic radiograph performed 6 months prior to the hip CT; and (2) no surgeries between the pelvic radiograph and the hip CT. These hip CTs were randomized and blindly reviewed by an orthopedic surgeon to determine each child’s treatment plan (CT-treatment). Separately, a pediatric radiologist blindly reviewed the randomized pelvic radiographs and measured each hip’s MP to determine each child’s treatment plan (XR-treatment). We used kappa-agreement and Bland–Altman analyses to compare XR- and CT-treatments. Results: Our study cohort consisted of 139 children (mean age = 9.3 ± 3.8 years; male = 90) with 278 hips. The proportion of agreement and unweighted kappa between XR- and CT-treatment were both low: 0.532 (148/278) and 0.339, respectively. Bland–Altman analyses showed that XR-treatment and CT-treatment were exchangeable when MP ≤ 10% but were not exchangeable otherwise. Conclusions: We should be cautious about relying exclusively on pelvic radiographs and subsequent MP calculation in making treatment decisions for hip displacement in children with CP since many anatomic details become evident on 3D imaging. Full article

(This article belongs to the Special Issue Cerebral Palsy: Recent Advances in Clinical Management)

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14 pages, 294 KB

Open AccessArticle

Multi-Collaborator Engagement to Identify Research Priorities for Early Intervention in Cerebral Palsy

by Angela Shierk, Nancy J. Clegg, Daralyn Fulton, Mauricio R. Delgado, Vanessa Hunt, Janet Bettger, Sydney Chapa, Sadie Oakley and Heather Roberts

J. Clin. Med. 2025, 14(21), 7592; https://doi.org/10.3390/jcm14217592 - 26 Oct 2025

Cited by 1 | Viewed by 1027

Abstract

Background/Objectives: Although clinical practice guidelines and evidence-based practices for early cerebral palsy (CP) diagnosis and treatment are well established, their implementation remains inconsistent across care settings. This study sought to identify key research priorities related to early CP diagnosis and treatment and to develop an actionable framework through multi-collaborator consensus building. Methods: The 97 adult participants included 42 who have lived experience with CP. Before the conference, participants completed a survey rating the importance of research topics. During the conference, aggregated results were presented, followed by 16 focus group discussions to refine research priorities. A follow-up survey was conducted to validate the final priorities. Results: Six actionable items were identified: improving diagnosis communication, ensuring early referrals and interdisciplinary collaboration, creating inclusive education and training, scaling evidence-based therapies and researching new interventions, developing social support systems, and advocating for policy and cultural change. A research framework was developed that outlines how these priorities can be addressed through three main strategies: education and training, research expansion, and policy advocacy. Conclusions: This study highlights the critical need for comprehensive and compassionate care for families receiving a CP diagnosis. Key priorities include early detection, coordinated multidisciplinary teams, and well-trained professionals delivering evidence-based interventions. The comprehensive framework addressing these priorities lays the foundation for future patient-centered comparative clinical effectiveness research. Full article

(This article belongs to the Special Issue Cerebral Palsy: Recent Advances in Clinical Management)

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Review

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18 pages, 445 KB

Open AccessReview

Video and Wearable Sensor Technologies for Early Detection of Cerebral Palsy in Infants: A Scoping Review

by Charlotte F. Wahle, Aura M. Elias, Nora A. Galoustian, Teana M. Tee, Michaela L. Juels, Christine Amacker, Heather Waters and Rachel M. Thompson

J. Clin. Med. 2026, 15(4), 1510; https://doi.org/10.3390/jcm15041510 - 14 Feb 2026

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Abstract

It is well established that early diagnosis and subsequent intervention can result in significant benefits in infants with neurodevelopmental disorders such as cerebral palsy (CP). This scoping review aimed to assess the current state of the literature regarding the use of innovative and emerging technologies for early CP screening, diagnosis and phenotyping in pre-ambulatory children. Searches were performed across PubMed, Embase and Cochrane databases; articles were screened by four independent reviewers at the title/abstract and full-text levels. Forty-eight studies met the inclusion criteria. The most frequently used modalities included wearable sensors (e.g., accelerometers, inertial measurement units) and video-based motion analysis. These movement-tracking systems were used to screen for a variety of pediatric-onset neurodevelopmental disorders and have been useful in quantifying spontaneous infant movements, detecting the absence or abnormality of fidgety movement, or identifying atypical motor patterns. Although CP was our primary focus, several studies applied a similar pipeline to autism spectrum disorder (ASD) and spinal muscular atrophy (SMA), underscoring broader relevance for early neurodevelopmental screening, diagnosing and phenotyping. Overall, technology-assisted motor assessment demonstrated promising feasibility and diagnostic potential; however, most studies are limited by small sample sizes, short follow-up durations, and heterogeneous validation methods. Given the benefits of early intervention and the emerging capabilities of wearable and video-based analytics, larger multi-site and longitudinal datasets are needed to support early diagnosis, risk stratification, and functional phenotyping in CP. Full article

(This article belongs to the Special Issue Cerebral Palsy: Recent Advances in Clinical Management)

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14 pages, 3367 KB

Open AccessReview

Assessment and Treatment of Varus Foot Deformity in Children with Cerebral Palsy: A Review

by Robert M. Kay and Susan A. Rethlefsen

J. Clin. Med. 2026, 15(3), 1147; https://doi.org/10.3390/jcm15031147 - 2 Feb 2026

Viewed by 973

Abstract

Cerebral palsy (CP) is a developmental disability caused by injury to the fetal or infant brain, affecting between 1.6 to 3.7 per 1000 live births worldwide. Ambulatory patients with cerebral palsy experience various gait problems, for which they seek treatment from medical professionals. Varus foot deformities are among the most problematic for patients. Varus foot deformity is characterized by the inner border of the foot being tilted upward and the hindfoot inward, increasing weightbearing on the lateral aspect of the foot. This positioning increases weight-bearing pressure under the lateral (outside) of the foot and often under the fifth metatarsal head when walking. As such, varus foot deformity can contribute to in-toeing, make shoe and brace-wearing difficult and painful, compromise gait stability, and sometimes lead to metatarsal fractures. Current knowledge of CP etiology and classifications, as well as principles and advances in assessment and treatment decision making for varus foot deformities, are outlined in this narrative review. In younger children with flexible deformities, non-operative interventions such as bracing, botulinum toxin injection, and serial casting are effective. The literature and expert consensus suggest that, if possible, surgery should be delayed until after the age of 8 years. When surgery is indicated, soft tissue procedures are used for flexible deformities. In addition to the soft tissue procedures, bone surgery is needed for rigid deformities. Careful pre-operative foot assessment is needed, including assessment of deformity flexibility and range of motion, X-rays, and computerized gait analysis if possible. Strategies are presented for thorough assessment when gait analysis is not available or feasible. Research reports of surgical outcomes for soft tissue and bony correction are positive, but should be interpreted with caution. The quality of evidence on surgical outcomes is compromised by use of varying research design methods and selection of outcome measures, with few including measures of function or patient-reported outcomes. It is recommended that surgical outcome be assessed using standardized assessment tools, such as the Foot Posture Index, which have had their validity and reliability established. Recent advances in 3D kinematic foot model development and musculoskeletal modeling have the potential to greatly improve surgical outcomes for patients with CP. Full article

(This article belongs to the Special Issue Cerebral Palsy: Recent Advances in Clinical Management)

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14 pages, 1351 KB

Open AccessStudy Protocol

Individualized 3D Planning for Hip Reconstruction in Cerebral Palsy: Study Protocol

by Britta K. Krautwurst, Thomas Dreher, Franziska L. Hatt, Bastian Sigrist, Tobias Götschi and Domenic Grisch

J. Clin. Med. 2026, 15(7), 2636; https://doi.org/10.3390/jcm15072636 - 30 Mar 2026

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Abstract

Background: In children with cerebral palsy, bony acetabular deficiencies are common and may be associated with progressive hip subluxation, abnormal joint loading, and ultimately hip dislocation. Hip reconstruction surgery is typically performed to prevent dislocation, and this includes acetabular reshaping using acetabuloplasty. The location of acetabular deficiency may vary among individuals; however, only radiographs are used for planning and intraoperative correction in many centers. Precise reconstruction and preop planning are necessary for the accurate correction of acetabular coverage. This study compares conventional hip reconstruction with a 3D-guided technique using individual preop 3D planning and 3D-printed guides during surgery to determine which method allows for a more accurate correction. We hypothesize that the patient-specific 3D planning leads to more precise anatomical correction of acetabular coverage compared to conventional freehand osteotomy. Methods: This study was registered in the German Clinical Trial Register (DRKS-ID: DRKS00031356) on 14 July 2023. In a randomized controlled trial, various imaging-based parameters were used to assess the bony anatomy preoperatively and postoperatively. Preoperative and 6-week postoperative computed tomography (CT) scans are part of routine clinical care. Additionally, an immediate postoperative CT scan was performed. One hip was operated on using individualized 3D preoperative planning, while the other hip was corrected using a conventional surgical approach. A standardized subtrochanteric osteotomy was performed for the varisation, derotation, and shortening of the proximal femur. This osteotomy was followed by acetabuloplasty under fluoroscopic control. For the 3D-planned operation, patient-specific cutting and repositioning guides were produced based on preoperative CT imaging. Patients with bilateral cerebral palsy (GMFCS levels I–V), aged 4–18 years, with an open triradiate growth plate and a migration index ≥ 40% in at least one hip were included. In a preliminary retrospective part, this project reproduces the existing three-dimensional acetabular index (3-DAI) and compares it with established radiographic methods to determine the utility and reliability of a reconstructed 3D CT measurement technique. A further component of the retrospective part is the creation of an age-adjusted database of typically developed hips and the development of a 3D head coverage index (3D-HCI) as a new 3D parameter to express acetabular coverage; therefore, it will be used as a secondary parameter and correlated to the 3DAI in the prospective part. Conclusions: Improved precision may have meaningful clinical implications for long-term joint congruency, load distribution, pain, and mobility outcomes. Full article

(This article belongs to the Special Issue Cerebral Palsy: Recent Advances in Clinical Management)

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