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Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy

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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: 30 June 2025 | Viewed by 10010

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Special Issue Editors

Dr. Ann Kristin G. Elvrum

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Guest Editor

1. Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7130 Trondheim, Norway
2. Clinic of Rehabilitation, St. Olavs Hospital, 7130 Trondheim, Norway
Interests: cerebral palsy; hand function; longitudinal outcomes; intervention research; measurement

Prof. Dr. Ann-Christin Eliasson

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Guest Editor

Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, 17176 Stockholm, Sweden
Interests: neurodevelopmental disorder; early development and intervention in children with cerebral palsy; early brain lesion

Special Issue Information

Dear Colleagues,

Cerebral palsy (CP), resulting from brain damage during fetal or infant development, is the most common childhood motor disorder and associated impairments have consequences for development and participation. Cerebral palsy is a clinical description rather than a distinct diagnosis and, historically, the clinical diagnosis is made around two years of age. Recent advances in early diagnositcs suggest, however, that diagnosing infants at risk of cerebral palsy should be followed by early and specific intervention. The challenges concern whether the children’s abilities can be improved by intervention and whether we can understand more about the factors influencing development after an early brain lesion. Coherent and flexible services are required to meet the needs of the families, necessitating the inclusion of the parent/carer voice and expectations. The aim of this Special Issue is to provide an overview of recent advances in the early diagnosis and treatment of pediatric cerebral palsy, as well as early detection and treatment of associated comorbidities and complications. Researchers in the field of cerebral palsy are encouraged to submit original articles or reviews to this Special Issue, so that we can build an evidence base to guide decision making.

Dr. Ann Kristin G. Elvrum
Prof. Dr. Ann-Christin Eliasson
Guest Editors

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Keywords

cerebral palsy
early diagnosis
family factors
associated impairments
outcome measures
intervention
mental health

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Published Papers (8 papers)

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Research

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18 pages, 247 KiB

Open AccessArticle

Doing Everything We Can to Help Our High-Risk Newborns: A Qualitative, Lifeworld-Led Study of What Early Risk Assessment for Cerebral Palsy Means to Parents

by Kristin Bjørnstad Åberg, Karin Dahlberg, Gunfrid Vinje Størvold, Ragnhild Støen and Lars Adde

J. Clin. Med. 2025, 14(8), 2740; https://doi.org/10.3390/jcm14082740 - 16 Apr 2025

Viewed by 292

Abstract

Background/Objectives: Early predictive assessments for CP are recommended for infants with medical risk factors after birth. For parents of children with CP, receiving an early diagnosis is important. But most children with risk factors who have not yet developed CP are labeled “high-risk infants” and repeatedly assessed for abnormal signs. We aim to investigate the experience of parents of high-risk infants and describe the meaning that “early predictive assessments for CP” has for them before they know whether their children have CP. Methods: This was a qualitative study conducted using a phenomenological, reflective lifeworld approach. Fourteen individual in-depth interviews were conducted with parents who received different GMA results to learn about their experiences involving early predictive assessments. The interviews were analyzed for meaning. Results: Early predictive assessments take place over time while parents process the traumatic experience of becoming parents to an infant at risk. “Early predictive assessment” is perceived as any examination or assessment intended to unveil signs of illness or disability. The child’s future well-being and fulfillment, and the demands of parenthood, are at stake. Essential meaning structures are (1) on a spectrum from death to insignificancies, (2) living with uncertainty of what the parental role will entail, and (3) seeing one’s own child through the eyes of strangers, just in case. Conclusions: For months following the birth of a high-risk child, parents experience uncertainty and worrying, affecting the parent–infant relationship. Predictive assessments reduce their sense of alarm when the GMA result indicates a low risk of CP. But when the GMA result is uncertain, the burden of uncertainty is amplified and prolonged. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

16 pages, 2144 KiB

Open AccessArticle

Barriers, Facilitators, and a Proposed Model of Care for Implementation of Upper Limb Distributed Practice Approaches for Children with Unilateral Cerebral Palsy

by Emma Taylor, Susan Greaves and Brian Hoare

J. Clin. Med. 2025, 14(3), 924; https://doi.org/10.3390/jcm14030924 - 30 Jan 2025

Viewed by 1272

Abstract

Background/Objectives: There is high-level research evidence supporting task-focused upper limb therapy models for children with unilateral cerebral palsy (CP). However, a knowledge gap exists in understanding how to effectively implement distributed practice approaches in clinical practice and the effect on the development of bimanual performance. This study aims to evaluate clinical outcomes, examine key considerations for implementation outcomes, and propose a Model of Care for children with unilateral CP. Methods: A mixed-methods approach was applied, including a retrospective case series with an observational descriptive design. A convenience sample of nine children (<5 years of age) with unilateral CP who received multiple blocks of distributed, evidence-based upper limb therapy approaches between 2014 and 2020 were included. Outcomes were evaluated using the Assisting Hand Assessment family of assessments. A Model of Care framework was informed by the Updated Consolidated Framework for Implementation Research and the Conceptual Model for Implementation Research. Results: A total of 59 blocks of upper limb therapy (10 mCIMT and 49 bimanual therapy) were delivered, ranging from two to nine blocks (mean = 6.6) for each child. All children demonstrated improved outcomes in bimanual performance with an average change of 14 AHA units (range 1–22). Barriers to implementation included complexity and cost. Facilitators included the evidence base and adaptability of the approaches that allowed clinicians to respond to an individual child and family’s needs. Informed by evidence-based protocols and visual analysis of data, and in consideration of the barriers and/or facilitators to implementation from this study, a Model of Care for implementation of upper limb distributed practice approaches for children with unilateral CP in clinical practice is proposed. Conclusions: Implementing repeated, distributed blocks of evidence-based upper limb therapy in a clinical setting for children with unilateral CP led to incremental improvements in bimanual performance. There are a range of barriers and facilitators to the implementation of distributed practice approaches in clinical practice. The Model of Care outlines best practice care and service delivery for children with unilateral CP and their families and aims to support clinical practice and the future examination of implementation-effectiveness in practice. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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13 pages, 485 KiB

Open AccessArticle

Early Independent Wheeled Mobility in Children with Cerebral Palsy: A Norwegian Population-Based Registry Study

by Anne Kilde, Kari Anne I. Evensen, Nina Kløve, Elisabet Rodby-Bousquet, Stian Lydersen and Gunvor Lilleholt Klevberg

J. Clin. Med. 2025, 14(3), 923; https://doi.org/10.3390/jcm14030923 - 30 Jan 2025

Viewed by 821

Abstract

Background: The aim was to explore independent wheeled mobility in children with CP, and identify predictors of early independent wheeled mobility and changes over time across birth cohorts. Methods: We included data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) comprising 11,565 assessments of 1780 children born in 2002–2019. Variables included demographic data, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, wheelchair use, and independent wheeled mobility. Cox proportional hazard regression was used to identify predictors for early independent wheeled mobility. Kaplan–Meier survival curves were used to compare birth cohorts. Results: Of 769 (43%) children who used a wheelchair, 511 (67%) had independent wheeled mobility. Two thirds of the children (n = 337) achieved independent wheeled mobility before age 7. Most children with independent wheeled mobility used powered wheelchairs. Children at GMFCS levels III and IV were more likely to reach independent wheeled mobility at an early age. Children at MACS levels III–V had a lower probability of early independent wheeled mobility. The average age of achieving independent mobility decreased from 9.5 to 4.0 years between birth years 2002 and 2019. Conclusions: Two in three children were independent wheelchair users before 7 years of age, and the age of obtaining independent wheeled mobility has decreased over the last 20 years. Children with better hand function were more likely to obtain early independent wheeled mobility. Early intervention programs to promote mobility, development and participation should include powered mobility, adapted steering options, and interventions for hand function. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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13 pages, 1214 KiB

Open AccessArticle

Is It Feasible to Apply a Virtual Box and Block Test in Children with Unilateral Cerebral Palsy?: A Pilot Study

by Soraya Pérez-Nombela, Javier Merino-Andrés, Julio Gómez-Soriano, María Álvarez-Rodríguez, Silvia Ceruelo-Abajo, Purificación López-Muñoz, Rocío Palomo-Carrión and Ana de los Reyes-Guzmán

J. Clin. Med. 2025, 14(2), 391; https://doi.org/10.3390/jcm14020391 - 9 Jan 2025

Viewed by 809

Abstract

Background: With technological advancements, virtual versions of the Box and Block Test (BBT) employing the Leap Motion Controller have been developed for evaluating hand dexterity. Currently, there are no studies about the usefulness of this system in children with unilateral cerebral palsy (UCP). Thus, our main objective is to apply a virtual BBT based on the Leap Motion Controller in children with UCP compared with the real BTT for assessing upper limb function within a pilot study. Methods: Seven children between the ages of 4 and 8 years who were diagnosed with UCP were assessed three times using the real and virtual BBT. Results: For all the participants, performance was greater in the real BBT than in the virtual BBT. During the last assessment, the participants reached 28.17 (SD:6.31) blocks in the real test and 9.00 (SD:5.90) in the virtual test. The correlation index between the two modalities of the BBT was moderate (r = 0.708). Conclusions: The results obtained in this study suggest that the application of the virtual BBT in children with UCP is feasible. Future studies are needed to validate the application of the virtual BBT in children with UCP. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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10 pages, 2019 KiB

Open AccessArticle

Gross Motor Development by Age and Functional Level in Children with Cerebral Palsy from 6 Months to 17 Years—A Norwegian Population-Based Registry Study

by Reidun Birgitta Jahnsen, Harald Weedon-Fekjar, Gerd Myklebust and Gunfrid Vinje Storvold

J. Clin. Med. 2025, 14(1), 178; https://doi.org/10.3390/jcm14010178 - 31 Dec 2024

Viewed by 1071

Abstract

Background: Cerebral palsy is a complex lifespan disability caused by a lesion to the immature brain. Evaluation of interventions for children with cerebral palsy requires valid and reliable outcome measures. Motor development curves and reference percentiles for The Gross Motor Function Measure (GMFM-66) are valuable tools for following, predicting, comparing, and evaluating changes in gross motor skills. The aims of this study were to create motor development curves with reference percentiles based on Norwegian data and compare them with published counterparts for Canadian children aged 2–21 years. Method: Prospective population-based cohort data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) for 1206 children with 3612 GMFM-66 tests between 0.5 and 17.3 years of age. Median development by Gross Motor Function Classification System (GMFCS) levels was estimated using a generalized additive regression model with smoothed parameters for location, scale, and shape (based on the R GAMLSS library). To adjust for repeated individual measurements, we report the median curve of 100 random samples with only one observation per observed child. Results: The Norwegian motor development curves for GMFCS levels I–IV increase up to 7 years of age before flattening off, while GMFCS level V curves are relatively flat. Overall, both motor development curves and GMFM-66 percentiles are very similar to Canadian counterparts. Conclusions: The existing Canadian reference curves are valid also for Norway, working well for both clinical and research applications. However, Norwegian percentiles can be used from an earlier age. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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13 pages, 707 KiB

Open AccessArticle

Parents in the Driver’s Seat—Experiences of Parent-Delivered Baby-mCIMT Coached Remotely

by Katarina Svensson, Ann-Christin Eliasson, Heléne Sundelin and Kajsa Lidström Holmqvist

J. Clin. Med. 2024, 13(16), 4864; https://doi.org/10.3390/jcm13164864 - 18 Aug 2024

Cited by 1 | Viewed by 1040

Abstract

Background/Objectives: Recent guidelines on early intervention in children at high risk of cerebral palsy (CP) recommend parental involvement and family-centered home-based interventions with parents as primary trainers. Therapist coaching by home visitation is resource demanding, and telerehabilitation is a viable option for remote intervention and coaching. This study aims to describe parents’ experiences of engaging in Baby-mCIMT coached remotely. Their infants are at high risk of unilateral cerebral palsy and the parents have been the primary trainers in regard to home-based intervention, optimizing the use of the affected hand. Methods: A qualitative approach involving semi-structured interviews with eight parents was employed. Data were analyzed using qualitative content analysis. Results: The overarching theme “Parents in the driver’s seat—learning through remote coaching to create conditions to enhance the child’s motor skills” describes parents’ experiences as primary training providers. The following three underlying categories with subcategories were identified: (1) Baby-mCIMT coached remotely in an everyday context—practical and technical prerequisites; (2) the child’s response and the therapists’ coaching supports active parental learning; (3) capability and sense of control—strengthening and demanding aspects. Conclusions: Our findings revealed that Baby-mCIMT coached remotely empowered the parents as primary trainers, which provided them with opportunities for understanding and learning about their child and their development. The findings underscore the importance of responsive professional guidance and a strong therapist–parent relationship to succeed with the Baby-mCIMT program coached remotely and to manage the digital coaching format. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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Review

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20 pages, 935 KiB

Open AccessReview

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

by Susan Greaves and Brian Hoare

J. Clin. Med. 2024, 13(22), 6873; https://doi.org/10.3390/jcm13226873 - 15 Nov 2024

Cited by 2 | Viewed by 3007

Abstract

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. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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Other

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21 pages, 933 KiB

Open AccessSystematic Review

Early Intervention Including an Active Motor Component in Preterms with Varying Risks for Neuromotor Delay: A Systematic Review and Narrative Synthesis

by Nele De Bruyn, Britta Hanssen, Lisa Mailleux, Christine Van den Broeck and Bieke Samijn

J. Clin. Med. 2025, 14(4), 1364; https://doi.org/10.3390/jcm14041364 - 18 Feb 2025

Viewed by 797

Abstract

Background/Objectives: Previous reviews demonstrated stronger benefits of early interventions on cognition compared to motor outcome in preterm-born infants. Potentially, motor development needs more targeted interventions, including at least an active motor component. However, there is no overview focusing on such interventions in preterm-born infants, despite the increased risk for neuromotor delays. Methods: PubMed, Embase and Web of Science were systematically searched for (quasi-)randomized controlled trials regarding early interventions in preterm-born infants, with varying risks for neuromotor delay, and trials comprising an active motor component started within the first year were included. Study data and participant characteristics were extracted. The risk of bias was assessed with the Risk of Bias 2 tool. Results: Twenty-five reports, including twenty-one unique (quasi-)RCTs, were included and categorized as either pure motor-based interventions (n = 6) or family-centered interventions (n = 19). Of the motor-based interventions, four improved motor outcomes immediately after the intervention, and one of these also did so at follow-up, compared to five and one for family-centered approaches, respectively. Only five family-centered studies assessed long-term effects beyond age five, finding no greater efficacy than standard care. Overall, large variations were present for intervention intensity, type and outcomes between the included studies. Conclusions: Although methodological heterogeneity compromised conclusions, limited effects on motor outcome, in particular long-term outcome, were identified. Including a stronger motor-focused component embedded within a family-centered approach could potentially increase the impact on motor outcome, which would be of particular interest for infants showing early signs of neuromotor delay. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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