Search Results (985)

The Gross Motor Function Measure-66 (GMFM-66, range of values: 0 to 100 points) is one of the most widely used clinical tests to quantify motor function in children with cerebral palsy (CP). A disadvantage of the GMFM-66 is that it can take up to one hour to complete. The aim of the study was to evaluate whether the GMFM-66 can be predicted with sufficient accuracy by the results of an instrumental gait analysis (IGA) in ambulant children with CP. A retrospective analysis was conducted on n = 256 ambulant children with CP enrolled in a rehabilitation program between 2018 and 2023. The sample consisted of 97 females and 159 males, with a mean age of 9.0 years (SD 3.6 years). The IGA was performed with a Zebris FDM pressure plate. For the prediction of the GMFM-66, different statistical models were used (multiple linear regression and machine learning algorithms). Among the models considered, the XGBoost model had the best predictive performance (mean absolute error 6.32 (95%CI 5.35–7.28)). Agreement between results from gait analyses by the Zebris FDM pressure plate and GMFM-66 is not yet sufficient to predict the GMFM-66 score with acceptable accuracy for clinical purposes. Full article

Background and Objectives: Dual-task training (DTT) is an innovative therapeutic approach that involves the simultaneous application of two tasks, which can be motor, cognitive, or a combination of both. Children with cerebral palsy (CP) often exhibit impairments in balance, motor skills, and gait, conditions that may be amenable to improvement through DTT. The aim of this study was to determine the effectiveness of DTT in enhancing balance, walking speed, and gross motor function-related balance in children with CP. Materials and Methods: In accordance with PRISMA guidelines, a comprehensive systematic review with meta-analysis (SRMA) was conducted. Electronic databases like PubMed Medline, Scopus, Web of Science, CINAHL, and PEDro were searched up to March 2025, with no language or publication date restrictions. Only randomized controlled trials (RCTs) examining the effectiveness of DTT on balance, gross motor function, and walking speed in children with CP were included. The methodological quality and risk of bias of the included RCTs were assessed using the PEDro scale. Pooled effects were calculated using Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI) within random-effects models. Results: Eight RCTs, providing data from 216 children, were included. Meta-analyses suggested that DTT was more effective than conventional therapies for increasing functional (SMD = 0.65; 95% CI 0.18 to 1.13), dynamic (SMD = 0.61; 95% CI 0.15 to 1.1), and static balance (SMD = 0.46; 95% CI 0.02 to 0.9), as well as standing (SMD = 0.75; 95% CI 0.31 to 1.18; p = 0.001) and locomotion dimensions (SMD = 0.65; 95% CI 0.22 to 1.08) of the Gross Motor Function Measure (GMFM) and walking speed (SMD = 0.46; 95% CI 0.06 to 0.87). Subgroup analyses revealed that a motor–cognitive dual task is better than a motor single task for functional, dynamic, and static balance and standing and locomotion dimensions for the GMFM. Conclusions: This SRMA, including the major number of RCTs to date, suggests that DTT is effective in increasing balance, walking and gross motor function-related balance in children with CP. Full article

Purpose: This study investigates the test–retest reliability of maximal voluntary contraction (MVC) and integrated object positioning during bimanual box lifting tasks in children with unilateral spastic cerebral palsy (USCP), using the Activities of Daily Living Test and Training Device (ADL-TTD). Materials and Methods: Utilizing an explorative cross-sectional design, the study recruited 47 children with USCP. The ADL-TTD, equipped with an Inertial Measurement Unit (IMU) for precise object positioning, measured MVC, and object position in 3D space in a cross-sectional measurement containing two measurements in a fixed time period. Results: The findings demonstrated good test–retest reliability for MVC, with an ICC_agreement of 0.95 for the mean MVC value. Additionally, good reliability was observed for object positioning in different directions measured with an IMU, with ICC_agreement ranging from 0.82 to 0.86 degrees. Regarding the standard error of measurement (SEM), the SEM_agreement for the mean MVC value was 5.94 kg, while the SEM_agreement for object positioning was 1.48, 5.39, and 3.43 degrees, respectively. Conclusions: These results indicate that the ADL-TTD demonstrates good test–retest reliability for both MVC and object positioning, making it a valuable tool for analyzing this population in cross-sectional research by providing reliable measures of task-oriented strength and object manipulation. However, the relatively high SEM_agreement, particularly in MVC, suggests that caution is needed when using this tool for repeated testing over time. This pioneering approach could significantly contribute to tailored assessment and training for children with USCP, highlighting the importance of integrating task-specific strength and positional accuracy into therapeutic interventions. Full article

Background: Self-report physical activity (PA) scales, accelerometry, and heart rate (HR) monitoring are reliable tools for PA measurement for children with cerebral palsy (CP); however, there are limitations for those who are primary wheelchair users. The purpose of our study was to evaluate face and construct validity of the PROMIS^® Pediatric PA parent proxy short form 8a in measuring PA amount and intensity in children with CP who are non-ambulatory. Methods: Face validity: Semi-structured interviews with parents and pediatric physical therapists (PTs) were conducted about the appropriateness of each item on the PROMIS^® Pediatric PA short form. Construct validity: Children with CP who were non-ambulatory participated in a one-week observational study. PA amount and intensity were examined using PA monitors (Actigraph GT9X) and HR monitors (Fitbit Charge 4). Activity counts and time in sedentary and non-sedentary intensity zones were derived and compared to the PROMIS^® T-scaled score. Results: Twenty-two physical therapists (PTs) and fifteen parents participated in the interviews, and ten children completed 1-week PA observation. Eight and seven participants completed sufficient time of uninterrupted PA and HR monitor wear, respectively. Parents and PTs agreed that several questions were not appropriate for children with CP who were non-ambulatory. PA intensity via activity counts derived from wrist worn monitors showed a strong positive correlation with the PROMIS^® PA measure. Conclusions: Construct validity in our small sample was established between PROMIS^® scores and accelerometry activity counts when documenting PA amount and intensity; however, there were some differences on PROMIS^® face validity per parent and PT respondents. Despite some concerns regarding face validity, the PROMIS^® Pediatric PA parent proxy short form 8a shows promise as a valid measure of physical activity amount and intensity in non-ambulatory children with CP, warranting further investigation and refinement. Full article

Background: Dystonic cerebral palsy (DCP) is a complex, disabling manifestation of secondary dystonia, which significantly impacts motor function, quality of life, and well-being. Conventional pharmacologic therapies frequently do not relieve symptoms sufficiently. Deep brain stimulation (DBS) of the globus pallidus internal segment (GPi) has gained increasing attention as a neuromodulatory therapy for refractory dystonia. Still, the experience of the effect of GPi DBS treatment in adults with DCP has, until recently, been limited. Methods: We performed a retrospective, two-center case series of 11 adult patients with medically refractory DCP who underwent bilateral GPi-DBS. The clinical outcomes were evaluated based on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), the Functional Independence Measure (FIM), the Gross Motor Function Classification System (GMFCS), and the Caregiver Burden Scale (CBS). The assessments were done preoperatively and at 1-year follow-up. Changes in continuous variables were analyzed using paired t-tests. Results: At the 1-year follow-up, the mean BFMDRS score improved from 69.6 ± 27.6 to 54.3 ± 36.5 (p = 0.001), indicating a significant reduction in overall dystonia severity. Functional independence also improved, demonstrated by the rise in FIM scores from 65.3 ± 33.9 to 79.2 ± 43.4 (p = 0.006). Although GMFCS levels did not change in most patients (p = 0.125), the burden on caregivers decreased significantly, with CBS scores falling from 35.7 ± 18.8 to 32.0 ± 17.1 (p = 0.015). There were no surgical complications. Conclusions: In adults, bilateral GPi-DBS is a safe and effective intervention for DCP, improving motor control and increasing functional independence while decreasing caregiver burden. These findings lend support to its role in the multidisciplinary management of DCP. Full article

Background/Objectives: Early experiences can significantly influence brain development, particularly when they occur during specific time windows known as sensitive or critical periods. Therefore, the early promotion of neurodevelopmental functions is crucial in children at risk for neurodevelopmental disabilities, such as those with cerebral palsy. This article introduces AMIRA (A Multidimensional and Integrated Rehabilitation Approach), a rehabilitative framework designed for infants at risk of neurodevelopmental disabilities. Methods: AMIRA is intended to guide clinical–rehabilitation reasoning rather than prescribe a rigid sequence of predetermined activities for the child. The theoretical foundation and structure of AMIRA are presented by formalizing its criteria, objectives, tools, and intervention procedures. The framework comprises four distinct sections, each supported by adaptive strategies to facilitate access to materials and to promote play-based interactions among the child, their environment, and communication partners. Particular attention is given to optimizing both micro- and macro-environments for children with, or at risk of, co-occurring visual impairment. Each rehabilitative section includes three progressive phases: an initial observation phase, a facilitation phase to support the child’s engagement, and an active experimentation phase that gradually introduces more challenging tasks. Results: The intervention pathways in AMIRA are organized according to six core developmental domains: behavioral–emotional self-regulation, visual function, postural–motor skills, praxis, interaction and communication, and cognitive function. These are outlined in structured charts that serve as flexible guidelines rather than prescriptive protocols. Each chart presents activities of increasing complexity aligned with typical developmental milestones up to 24 months of age. For each specific ability, the corresponding habilitation goals, contextual recommendations (including environmental setup, objects, and tools), and suggested activities are provided. Conclusions: This study presents a detailed intervention approach, offering both a practical framework and a structured set of activities for use in rehabilitative settings. Further studies will explore the efficacy of the proposed standardized approach. Full article

Background/Objectives: Malnutrition is a common problem in children with cerebral palsy (CP). The aim of this study was to investigate the suitability and diagnostic performance of mid-upper arm circumference (MUAC) z-score in diagnosing wasting in children with CP, and its impact on diagnostic accuracy when evaluated concomitantly with additional clinical factors (birth weight, history of phototherapy). Methods: This single-center, cross-sectional study included 83 children with CP, aged 6 months–17 years, followed-up in our clinic. Anthropometric measurements (MUAC, Body Mass Index (BMI)) and clinical data (birth weight, history of phototherapy, Gross Motor Function Classification System (GMFCS)) were prospectively collected. Wasting was defined according to the BMI z-score ≤ −2 criteria. The diagnostic performance of MUAC z-score was evaluated by Receiver Operating Characteristic (ROC) analysis. The contribution of additional covariates was examined using logistic regression analysis and the backward elimination method. Results: MUAC z-score alone demonstrated good discrimination in diagnosing wasting with an Area Under the Curve (AUC) value between 0.805 and 0.821, but its sensitivity was limited (67.0%). No statistically significant difference was found in diagnostic performance between MUAC measurements of the right arm, left arm, and the unaffected arm (p > 0.050). In logistic regression analysis, MUAC z-score (p = 0.001), birth weight (p = 0.014), and a history of phototherapy (p = 0.046) were found to be significantly associated with wasting malnutrition. The simplified model including these variables yielded an AUC value of 0.876. Conclusions: MUAC z-score is a usable tool for wasting malnutrition screening in children with CP. Although its sensitivity is limited when used alone, its diagnostic accuracy increases when evaluated concomitantly with additional clinical factors such as birth weight and a history of phototherapy. This combined approach may offer clinicians a more robust tool for the early diagnosis and management of wasting malnutrition in children with CP. Full article

Background and objectives: Neurosurgical intervention on the newborn’s developing brain is a risk factor for neurodevelopmental disorders (NDDs). These patients necessarily require regular, coordinated follow-up. The ventricular subgaleal shunt (VSGS) technique has been used since 2013 at Rouen University Hospital. Like any change in practice, this technique must be evaluated. In this paper, we describe the population of patients with hydrocephalus treated by VSGS, the complications associated with the procedure, and the outcome of these patients at two and six years old. Methods: This study was an observational, descriptive, retrospective, single-center study. Children included were those less than three months old with hydrocephalus treated by VSGS at Rouen University Hospital from January 2013 to December 2023. Data were anonymized and collected using EDSaN software. A descriptive analysis was performed. Results: Thirty-two patients were included in our study. Of these, 22 (69%) were born prematurely; 16 (50%) of these 22 had postnatal intraventricular hemorrhage (IVH) requiring treatment with VSGS. A total of three patients (13.6%) died within the first year of life; twenty-four patients (75%) required definitive shunting. Twenty-two patients were over 2 years old in our study. Only 10 of them acquired the ability to walk (45%). Cerebral palsy was present in 10 (45%) patients. Fifteen patients were over 6 years old; thirteen (87%) attended school, but six (40%) had special needs (the need of an assistant, or part-time schedule). In our study, only 24 patients (82%) were followed by a pediatrician trained in neurodevelopment at Rouen University Hospital, and 27 (93%) were followed by a neurosurgeon. Conclusions: This study describes all patients with hydrocephalus treated by VSGS at Rouen University Hospital between January 2013 and December 2023, as well as their complications and their neurological outcomes. The follow-up of these children at risk of NDDs is essential. Full article

Background: Aquatic therapy (AT), immersion in hot water, and supported standing are frequently used to manage spasticity, contractures, and joint retractions in children with cerebral palsy (CP). Recently, the use of exoskeletons has been offering a new treatment option for severe CP. This study aimed to compare the post-immediate effects of four treatments on spasticity, range of motion, and the heart rate of children with severe CP. Methods: Three children with spastic CP (levels IV and V GMFCS) received a single 30-min session in consecutive weeks of robot-assisted gait training (RAGT), AT, supported standing, and immersion in hot water. Post-immediate assessments included knee flexor spasticity (modified Ashworth scale, MAS, and modified Tardieu scale, MTS); knee range of motion (ROM, in degrees (°)); and heart rate (HR). Results: AT and supported standing induced greater reductions in spasticity based on MAS scores. RAGT demonstrated superior spasticity reduction using MTS and yielded the greatest improvement in popliteal angle (mean increase: 27°). AT and RAGT induced a 14 beats-per-minute change in HR, indicating moderate cardiovascular engagement. Conclusions: RAGT appears particularly effective in improving spasticity and ROM in children with severe CP. Nonetheless, conventional treatments still offer an effective option when addressing spasticity. Full article

Background and Objectives: Cerebral palsy (CP) is a non-progressive neurological disorder characterized by motor impairments such as spasticity and poor postural control. Among these, trunk control plays a critical role in maintaining balance and enabling functional mobility. Since spasticity is known to interfere with motor coordination and posture, evaluating its response to trunk-focused interventions may offer additional clinical insights. This systematic review and meta-analysis evaluated the effectiveness of trunk-focused interventions on trunk control, gross motor function, balance, and spasticity. Materials and Methods: A systematic search was conducted in PubMed, Embase, Web of Science, MEDLINE, and CINAHL for randomized controlled trials (RCTs) published in the last 10 years up to 11 April 2023. Studies targeting trunk-specific interventions in children with CP were included. Meta-analyses were performed using RevMan 5.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was assessed using the PEDro scale. Results: Fifteen RCTs involving 454 children were included. Trunk control improved significantly (SMD = 3.67; 95% CI: 3.10–4.25; I² = 0%). Gross motor function showed a small but significant improvement (SMD = 0.49; 95% CI: 0.06–0.92; I² = 44%). Balance exhibited a large, though not statistically significant, effect (SMD = 0.90; 95% CI: −0.00 to 1.79; I² = 81%). Subgroup analysis indicated that interventions performed more than four times per week produced a significant effect on balance (SMD = 0.54; 95% CI: 0.08–1.01). Only one study assessed spasticity and found no group difference. Conclusions: Trunk-based interventions significantly improve trunk control and gross motor function in children with CP. While improvements in balance were inconsistent, higher-frequency interventions yielded more favorable results. Further research is warranted to clarify effects on spasticity and optimize intervention protocols for clinical application. Full article

Background: Standing has medical and psychosocial benefits for people with lower limb impairments; however, systemic, logistical, and economic barriers often limit opportunities to stand in daily life. This study explored how users perceive standing and standing-assistive technologies. Methods: This study used a mixed-methods approach: in-person interviews (n = 18) and a nationwide web-based survey (n = 125; 74.4% male, mean age 52.2 ± 13.9 years, diagnoses: spinal cord injury 37.6%, cerebrovascular disease 27.2%, and cerebral palsy 16.8%). Results: Participants described the psychosocial values of standing, such as feeling more confident and being able to interact with others at eye level. The web survey revealed that most participants believed that standing was beneficial for health (76.8%) and task efficiency (76.0%), although only 49.6% showed an interest in standing wheelchairs. The multivariate analysis revealed that ongoing standing training was the strongest predictor of positive perceptions of health benefits, task efficiency, and interest in standing wheelchairs. Younger participants showed a greater interest in standing wheelchairs. The reported barriers include a lack of awareness, high costs, and difficulty in accessing training. Conclusions: These findings suggest the need for a user-centered design and improved support systems to integrate standing into the daily lives of people with mobility impairments. Full article

Weakness, spasticity, and muscle shortening are common in children with cerebral palsy (CP), leading to deficits in gross motor, gait, and selective motor functions. While traditional assessments, such as the Gross Motor Function Measure (GMFM-66), instrumented gait analysis, and the Selective Control Assessment of the Lower Extremity (SCALE), are widely used, they are often limited by the resource-intensive nature of hospital-based evaluations. We employed cyclogram-based analysis, utilizing simple hip and knee joint kinematics to assess clinical measures, including GMFM-66, normalized gait speed, the gait deviation index (GDI), and the gait profile score (GPS). Principal component analysis was used to quantify the cyclogram shape characteristics. A total of 144 children with ambulatory spastic CP were included in the study. All the cyclogram parameters were significantly correlated with GMFM-66, gait speed, the GDI, and the sagittal plane subscore of the GPS for the hip and knee, with the swing phase area showing the strongest correlation. Regression models based on the swing phase area were used to estimate the GMFM-66 (R² = 0.301) and gait speed (R² = 0.484). The PC1/PC2 ratio showed a moderate correlation with selective motor control, as measured by the SCALE (R² = 0.320). These findings highlight the potential of hip–knee cyclogram parameters to be used as accessible digital biomarkers for evaluating motor control and gait function in children with bilateral spastic CP. Further prospective studies using wearable sensors, such as inertial measurement units, are warranted to validate and build upon these results. Full article

The “Baby Ubuntu” programme is a well-established, low-cost, community-based intervention to support caregivers of children with complex neurodisability, like cerebral palsy, in low- and middle-income country (LMIC) contexts. This process-focused paper describes our utilisation of the ADAPT guidance to adapt “Baby Ubuntu” for use in ethnically and linguistically diverse, and economically deprived urban boroughs in the United Kingdom (UK). The process was guided by an adaptation team, including parents with lived experience, who explored the rationale for the intervention from local perspectives and its fit for this UK community. Through qualitative interviews and co-creation strategies, the perspectives of caregivers and healthcare professionals substantially contributed to the “Encompass” programme theory, drafting the content, and planning the delivery. Ten modules were co-produced with various topics, based on the “Baby Ubuntu” modules, to be co-facilitated by a parent with lived experience and a healthcare professional. The programme is participatory, allowing caregivers to share information, problem solve, and form supportive peer networks. The “Encompass” programme is an example of a “decolonised healthcare innovation”, as it aims to transfer knowledge and solutions developed in low- and middle-income countries to a high-income context like the UK. Piloting of the new programme is underway. Full article

Extended reality (XR)-based rehabilitation is an emerging therapeutic approach that combines real and virtual environments to enhance patient engagement and promote motor and cognitive recovery. Its clinical utility in children with cerebral palsy (CP), particularly regarding gross motor skills, balance, and psychosocial well-being, remains underexplored. This preliminary study aimed to evaluate the potential effects of XR-based rehabilitation on gross motor function, balance, parental stress, and quality of life in children with cerebral palsy. Thirty children with cerebral palsy were randomly assigned to an extended reality training group (XRT, n = 15) or a conventional physical therapy group (CPT, n = 15). Both groups received 30 min sessions, three times per week for 6 weeks. Outcome measures included the Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), Functional Independence Measure (FIM), Parenting Stress Index (PSI), and Pediatric Quality of Life Inventory (PedsQL), assessed pre- and post-intervention. A 2 (group) × 2 (time) mixed ANOVA was conducted. The XR group demonstrated improvements in GMFM-88, PBS, and FIM scores, with decreased PSI and increased PedsQL scores. Although most interaction effects were not statistically significant (GMFM-88: η² = 0.035, p = 0.329; PBS: η² = 0.043, p = 0.274), a marginal interaction effect was observed for PSI (p = 0.065, η² = 0.059), suggesting a potential benefit of XR-based rehabilitation in reducing parental stress. This preliminary study indicates that XR-based rehabilitation may provide beneficial trends in motor function and psychosocial health in children with CP, particularly in reducing parental stress. Further studies with larger sample sizes are needed to confirm these findings. Full article

Anemia due to acquired copper deficiency is most commonly the result of malabsorption or dietary deficiency. However, it can occasionally be due to excess zinc intake, which impairs the absorption of copper. Copper deficiency may result in vacuolated erythroid and myeloid precursors in the bone marrow, and sometimes features resembling myelodysplasia that, although not specific, may be an important clue to the diagnosis. Background and Clinical Significance: We report bone marrow findings in a child with anemia due to zinc-induced copper deficiency. Case Presentation: An 18-year-old female with cerebral palsy admitted for respiratory failure was found to have anemia and leukopenia with absolute neutropenia. A bone marrow smear showed occasional ring sideroblasts. Additional testing revealed reduced serum copper and elevated serum zinc. Further inquiry uncovered a several-year history of high-dose zinc supplementation. Conclusions: It is important to consider copper deficiency as a potential etiology in patients with anemia and neutropenia, as it may otherwise be mistaken for vitamin B12 deficiency or myelodysplasia. The presence of small vacuoles in hematopoietic precursors is an important clue to the diagnosis and may help avoid ineffective interventions. Full article