Search Results (1,069)

Background/Objectives: Inclusive nutrition services and data on children with disabilities living in low- and middle-income countries remain limited. We estimated the prevalence of undernutrition and described feeding practices and difficulties among children with disabilities ages birth to 10 years at a rehabilitation hospital in Uganda and identified barriers and opportunities for inclusive nutrition. Methods: This cross-sectional study enrolled 428 children. Data included demographics, weight, height, mid–upper arm circumference (MUAC), hemoglobin levels, risk for feeding difficulties, caregiver-reported feeding practices, and functional difficulties complemented by 32 caregiver and stakeholder interviews. Undernutrition was defined using WHO z-scores, MUAC, and anemia cutoffs. Associations were examined using Pearson’s chi-squared tests and adjusted odds ratios from logistic regression. Results: Over half of participants were boys (56.1%) and 65.9% were <24 months old. Common conditions included cleft lip/palate (55.4%) and cerebral palsy (38.6%). Undernutrition was prevalent: 45.2% were underweight, 38.3% stunted, 16.1% wasted (by MUAC), and 39.5% anemic. Being at risk for feeding difficulties (67.2% of children) increased the odds of underweight [AOR = 2.28 (1.23–4.24)], stunting [2.46 (1.26–4.79)], and wasting [2.43 (1.10–5.35)] after adjusting for covariates. Bottle-feeding increased the odds of stunting [3.09 (1.24–7.70)] in infants with cleft lip/palate <12 months old. Poor access to services, food insecurity, and feeding challenges were key barriers to optimal nutrition. Most caregivers reported using practices that support responsive feeding. Conclusions: Reported barriers to services and high levels of undernutrition, strongly linked to feeding difficulties, underscore the need for targeted feeding interventions and better access to inclusive nutrition services in Uganda. Full article

Background: Flexible flatfoot is a common pediatric condition. Surgical intervention is indicated for symptomatic cases unresponsive to conservative treatment. This study evaluates the outcomes of two established procedures, Grice extraarticular subtalar arthrodesis and subtalar arthroereisis, in children treated for symptomatic flatfoot. Methods: A retrospective analysis was conducted on 158 patients (286 feet) treated between 2013 and 2024. Among them, 34 underwent Grice arthrodesis and 124 underwent arthroereisis. Demographic and procedural data were collected, including age, sex, neurological impairment (cerebral palsy), laterality, and concurrent Achilles tendon lengthening. Radiographic parameters assessed pre- and postoperatively included Meary’s, Pitch, and Kite’s angles (frontal and sagittal view), uncovering of the talus, and Cyma line. Only patients with both pre- and postoperative measurements were included in paired analysis. Statistical tests included paired t-tests within groups and Welch’s t-tests for between-group comparisons. Results: Grice patients were younger (mean age 9.0 ± 3.1 years) and included all cerebral palsy cases (18/34; 52.9%), while arthroereisis patients were older (10.8 ± 2.6 years) and typically neurologically normal. Achilles tendon lengthening was performed in 100% of Grice and 48% of arthroereisis cases. Both groups showed significant radiographic improvement across all measured parameters (all p < 0.05). Grice arthrodesis produced greater reductions in Meary’s angle (right Δ = −19.8° ± 9.2 vs. −13.1° ± 7.5; p = 0.024), while arthroereisis yielded larger increases in Pitch angle (left Δ = +9.2° ± 7.2 vs. +5.5° ± 6.2; p = 0.055). Other angular improvements (Kite’s, uncovering, and Cyma line) were statistically significant within both groups but not between groups. Conclusions: Symptomatic flat-valgus foot in children remains a relevant public health issue. Treatment should be individualized, while cases secondary to unrecognized or untreated congenital conditions often require surgery to restore normal foot biomechanics. Full article

Functional electrical stimulation (FES) is widely used to improve gait in individuals with neurological impairments; however, early responses in adults with congenital conditions, such as cerebral palsy, who are newly exposed to FES, remain poorly understood. This study investigated the orthotic and therapeutic effects of FES in short- and long-term users using standardized three-dimensional gait analysis. In this longitudinal study, short-term users (G1; n = 13; mean age 31.7 ± 18.1 years) were evaluated both without and with FES and followed over a 4–12-week insurance-covered trial period. Long-term users (G2; n = 11; mean age 32.2 ± 11.0 years), who had used FES for at least one year, were reassessed over a standardized 12-week interval. Linear mixed-effects models assessed the effects of FES and time, with subjects included as random effects to account for inter-individual variability. G1 showed significant therapeutic adaptations, including increased walking speed and step length and reduced step width, accompanied by decreased dorsiflexion during stance and swing, while no significant orthotic effects were observed. G2 demonstrated clear orthotic responses, such as increased dorsiflexion at heel strike and during swing and improved walking speed and step length, with minimal evidence of additional therapeutic adaptation. The initial reduction in dorsiflexion in G1 warrants further investigation. These findings suggest that evaluation timelines may need to be extended and that outcome measures beyond foot clearance should be considered, particularly given the heterogeneity and severity of congenital neurological conditions. Full article

Background: Our study aimed to investigate whether the general movements assessment (GMA) and Amiel-Tison Neurologic Examination performed at term-equivalent age (TEA) and 12 weeks corrected age (CA) could predict the occurrence of cerebral palsy (CP) and delayed gross motor milestones in a sample of term and preterm infants and whether the predictive values could be increased by using the two examinations during the same visit. Methods: A total of 70 infants (62 preterm and 8 at term) were examined at TEA and 12 weeks CA using GMs (General Movements) and Amiel-Tison (AT) examinations. We determined the correlation between the results of the examinations and several selected items (scarf sign, popliteal angle, and axial tone) and neuromotor outcomes (presence of cerebral palsy (CP), independent sitting, and independent walking). We attempted to build binary logistic regression models using items from both examination techniques to assess whether the combined use of the two exams could have a better predictive value than using one technique alone. Results: We analyzed the entire group and, separately, the subgroup of preterm infants. For the whole group, there was a statistically significant correlation between the GM examinations at TEA and 12 weeks CA (p < 0.008) as well as between the results of GM and AT exams performed at TEA (p < 0.001) and 12 weeks CA (p < 0.001). The strongest individual predictor for CP in the whole group was the absence of fidgety movements at 12 weeks CA (AUC (Area Under the Curve) = 0.873; CI (confidence interval) 95%: 0.748–0.998; p < 0.001) and a non-optimal result at the synthesis of findings of AT exam at 12 weeks CA (AUC = 0.755; CI 95%: 0.617–0.892; p < 0.003). In the subgroup of 62 premature neonates, absent fidgety movements at 12 weeks CA (AUC = 0.925; CI 95%: 0.819–1.031; p < 0.001) and a non-optimal result in the synthesis of findings of AT exam at 12 weeks CA (AUC = 0.772; CI 95%: 0.620–0.924; p < 0.005) were statistically significant predictors for the risk of CP. In the case of delayed sitting and delayed/absent walking, absent fidgety movements and non-optimal results in the AT exam at TEA and 12 weeks CA were the strongest individual predictors in the whole group as well as in the subgroup of preterm infants. The following exploratory logistic regression models reached statistical significance: one model combining absent fidgety + abnormal scarf sign + abnormal popliteal angle at 12 weeks CA for CP in the whole group (p < 0.032) and preterm infants (p < 0.034) and for delayed sitting in preterm infants (p < 0.041) and a second model combining absent fidgety + abnormal scarf + abnormal popliteal + abnormal axial + abnormal synthesis for CP risk (p < 0.046) and delayed sitting (p < 0.001) in preterm infants at 12 weeks CA. Conclusions: The absence of fidgety movements at 12 weeks CA represented the strongest individual predictor for the occurrence of CP and delayed gross motor milestones in our sample, both in the whole group and the subgroup of preterm infants. The combination of GM and AT findings reached statistical significance for the detection of CP risk in the whole group and CP risk and delayed sitting in the subgroup of preterm infants. Due to sample size limitations, the results should be regarded with caution, and larger studies are needed before robust conclusions can be drawn. Full article

Introduction: Parents of children presenting global developmental delay (GDD) need to be involved in their therapy to intensify treatment. Vojta therapy (VT) is an intensive physiotherapeutic treatment that can be administered at home. Whilst parental experience of Home-Based Program (HBP) for preterm or cerebral palsy is well documented, there is a lack of understanding about parents of GDD children on HBP with VT. Objectives: The aim of this work was to describe parents’ perspectives concerning their participation in, concerns with, and perception of the results of an HBP with VT. Methods: A qualitative case design based on an interpretative approach was presented. A purposeful sampling was used. Data was collected in two stages: firstly, semi-structured interviews, and secondly, photo-elicitation. An inductive thematic analysis was used. Results: Seventeen parents were included. Three themes emerged from parents’ perspectives. Firstly, parents’ active participation in VT, which includes their desire to become an active agent to contribute to their child’s improvement, their implication of compromise, learning process, time required, effort, and factors that influence their adherence and continuity. Secondly, parents’ perception of the results achieved: motor improvement and better resting, feeding, and breathing; and time and commitment required to achieve them. Thirdly, parents’ initial concerns about suitability, daily implementation, therapy functioning, or evidence, as well as concerns about emotional bonds. Conclusions: Parents universally perceive that their commitment and efforts were rewarded. They recognized that the emotional bond with their child was strengthened by the therapy. The results regarding the beneficial effects perceived by the parents should be treated with caution, as no instruments for assessing the effect or efficacy were used in this study. Full article

Introduction: To explore whether antenatal and preoperative factors predict disability-free survival of preterm newborns with biventricular complex congenital heart defects (CHD). Methods: Retrospective cohort study, using the prospectively designed database of Complex Pediatric Therapies Follow Up Program and a chart review of mother–newborn dyads, born under 37 weeks’ gestation with biventricular complex CHD, between 1997 and 2019, who had open heart surgery up to 6 weeks corrected age. Surviving children had neurodevelopmental assessments between 18 and 24 months corrected age. Bayley Scales of Infant Development, 2nd edition, and Bayley Scales of Infant and Toddler Development, 3rd edition, assessed cognitive, language, and motor skills; Adaptive Behavior Assessment System, 3rd edition, assessed adaptive skills. Univariate and multivariate analyses assessed predictors of mortality, disability (cerebral palsy, visual impairment, permanent hearing loss), and neurodevelopmental delay. Results: Of 84 preterm newborns (34.6 ± 2.1 weeks’ gestation, 2321 ± 609 g, 57% males), 8 (9.5%) died by 2 years of age; 69 (91%) survived without and 7 (9%) with disability. Chorioamnionitis was associated with death [Hazard ratio 7.92 (95% CI 1.3, 33.3), p = 0.025]; prolonged rupture of membranes was associated with disability [Odds Ratio 9.7 (95% CI 1.99, 46.9), p = 0.005]. Maternal diabetes, antenatal diagnosis of CCHD, birth head circumference, cardiopulmonary resuscitation, and chromosomal anomalies were associated with adverse neurodevelopment. Conclusions: Chorioamnionitis and prolonged rupture of membranes are associated with worse outcomes in preterm newborns with biventricular complex CHD up to 2 years of age. Adverse neurodevelopmental outcomes are associated with maternal diabetes and antenatal diagnosis of CCHD. Prospective studies are needed to confirm these results. Full article

Neurodevelopmental disorders (NDDs) are defined as a group of conditions that result from impaired brain development. Disorders that are commonly classified under NDDs include intellectual disability (ID), autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), communication and learning disorders, developmental delay (DD), brain malformations, cerebral palsy, Down syndrome, schizophrenia, and childhood epilepsies. A significant hinderance in the development of targeted treatments for NDDs are gaps in understanding how underlying genetic changes alter cellular physiology and how these changes may converge or diverge across NDDs with similar symptoms. Here, we focus on the genetic overlap between epilepsy, ASD, and other NDDs to identify common cellular and molecular mechanisms that may inform future treatments for each of these disorders individually or together. We describe several genes—including CDKL5, TSC1/2, SCN1a, and TANC2—that have been associated with epilepsy, ASD, or other NDD phenotypes that play a critical role in regulating one or more stages of brain development or function but differ widely in their disease-causing mechanisms. We also describe genotype–phenotype relationships. Finally, how a gene may cause NDDs through distinct functional pathways, or where different types of pathogenic variants within the same gene can have significantly different phenotypic outcomes is detailed. Full article

Cerebral palsy (CP) is a neuromotor disorder that affects movement and posture, causing functional limitations and musculoskeletal deformities that persist into adulthood. Variability in motor expression makes identifying the functional level a clinical challenge; achieving greater accuracy in this assessment enables detection of risk factors for postural deterioration. This study analysed a sample of 56 adults with CP to evaluate the ability of different machine learning (ML) models to discriminate between levels IV and V of the Gross Motor Function Classification System (GMFCS), using a total of 78 clinical variables such as spasticity, range of motion, deformities, and postural asymmetries. Different supervised learning models were compared, and a relabelling procedure was applied to improve classification consistency. The results indicate that there is valuable information in the collected standardised variables for classifying levels IV and V. The best performances were subsequently obtained by the neural network and the linear logistic regression, achieving the latter, which has explanatory properties interesting for clinicians, accuracy, F1-score and AUC metrics of 92.83%, 93.44% and 99.35%, respectively. These findings suggest that ML could emerge as a useful and explanatory tool for functional assessment of CP in adults and for the design of personalised rehabilitation strategies. Full article

Cerebral palsy (CP) often causes mobility limitations that require assistive devices such as Ankle Foot Orthoses (AFOs) to enhance functional stability. This study aims to develop an optimized 3D-printed AFO design that improves comfort, structural durability, and production efficiency for children with CP. The research applies a Design of Experiment approach using the Taguchi method to optimize 3D printing parameters, supported by tensile testing to identify the best material configuration. Design alternatives were prioritized using the Analytical Hierarchy Process, while Finite Element Analysis was conducted to evaluate mechanical performance under physiological loading. The selected PETG configuration (33% infill density and 0.15 mm layer thickness) demonstrated improved tensile strength and flexibility, contributing to enhanced structural behavior. A prototype was produced and validated using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) questionnaire. Results showed higher overall user satisfaction for the optimized 3D-printed AFO compared to conventional devices, particularly in safety, comfort, and durability. The integration of optimized material parameters, systematic design evaluation, and user-centered assessment provides an effective pathway toward improving AFO performance and supporting the mobility and quality of life of children with cerebral palsy. Full article

Background/objectives: Communication difficulties are highly prevalent among children with cerebral palsy (CP) and have a significant impact on participation, psychosocial development, and quality of life. The Communication Function Classification System (CFCS) was developed to provide a standardized framework for describing functional communication performance across five ordinal levels. While the CFCS has been validated internationally, evidence on its psychometric properties in Italian pediatric populations remains limited. The objective of this study was to examine the inter-rater and intra-rater reliability of the Italian version of the CFCS and to explore construct validity through a single association with the Gross Motor Function Classification System Expanded and Revised (GMFCS E&R). Methods: A cross-sectional study was conducted with 66 children with CP (mean age 8.8 years, SD = 4.9) recruited from the Bambino Gesù Children’s Hospital in Rome. Two trained raters independently classified each child using the CFCS and GMFCS E&R, with CFCS reassessments performed after 14–20 days to evaluate intra-rater stability. Agreement was assessed using linear weighted Cohen’s Kappa (κᵂ) coefficients, and construct validity was analyzed using Spearman rho correlation (r) between CFCS and GMFCS E&R levels. Results: The CFCS demonstrated almost very good agreement for both inter-rater and intra-rater reliability, with κᵂ values exceeding 0.90. Construct validity was supported by a strong and statistically significant correlation with GMFCS E&R (r = 0.82, p < 0.01), indicating that greater motor impairment was associated with more severe communication limitations. Conclusions: The Italian version of the CFCS is a highly reliable classification system and shows evidence of construct validity based on a single convergent association in children with CP. These findings support its use for descriptive and classificatory purposes in clinical and research contexts, while further studies are needed to examine additional psychometric properties. Full article

Early identification of motor difficulties is essential in infancy and early childhood, and current American Academy of Pediatrics recommendations emphasize that motor surveillance should accompany routine clinical visits. One standardized tool widely used for evaluating motor development is the Peabody Developmental Motor Scales–Second Edition (PDMS-2). This review summarizes the theoretical foundations and psychometric properties of the PDMS-2, the principles of administering and scoring the assessment, and evidence from validation and standardization studies conducted in different countries. A non-systematic literature search was conducted in PubMed, Scopus, and Google Scholar (2000–February 2025) using the terms “PDMS-2” OR “Peabody Developmental Motor Scales Second Edition” combined with “reliability”, “validity”, “norms”, “reference”, or “standardization”. Original and review articles published in English were included without geographical restrictions. The PDMS-2 is widely applied in both clinical and research contexts. It has been used as an outcome measure in randomized controlled trials, interventional, and observational studies involving preterm infants, children with genetic syndromes, metabolic disorders, cerebral palsy, congenital heart defects, HIV, oncological conditions, and typically developing children. Key strengths of the PDMS-2 include its broad age range, the ability to assess both gross and fine motor skills, and its quantitative scoring system, which supports diagnosis, therapeutic planning, and monitoring of developmental change. Although the tool has been validated and standardized in multiple countries, additional work is still needed to establish normative data for underrepresented populations. Full article

Background/Objectives: Hypoxic–ischemic encephalopathy (HIE) is a common neurological outcome of perinatal asphyxia, with cerebral palsy (CP) being the most severe lasting effect. Perinatal brain injury activates the immune system and induces the release of inflammatory mediators. Matrix Metalloproteinases (MMPs) play a crucial role in neuroinflammation and neurodegeneration. This study explored the potential link between MMP2 promoter polymorphisms and the development of CP in children with a history of perinatal asphyxia. Methods: We enrolled 212 patients (130 males and 82 females) with documented perinatal asphyxia, who underwent a comprehensive neurological assessment and neuroimaging, including ultrasound and magnetic resonance imaging (MRI). We genotyped the MMP2 promoter polymorphisms rs243866, rs243865, and rs243864 using real-time polymerase chain reaction. Haplotype frequencies were calculated using Haploview software. Results: As expected, patients with HIE are more likely to develop CP (p = 0.000). In a study of 104 patients who developed CP, the frequencies of the A (rs243866), T (rs243865), and G alleles (rs243864) were nearly twice as high compared to those without CP (p = 0.008, p = 0.019, and p = 0.008, respectively). Haplotype analysis supported these findings, showing that the ATG haplotype was significantly more common among patients who developed CP (p = 0.004). Additionally, in patients with MRI-confirmed brain damage, the ATG haplotype was more frequently observed (p = 0.019). Conclusions: The ATG haplotype of the MMP2 promoter may indicate a risk factor for developing cerebral palsy (CP) in patients who experience perinatal asphyxia and could serve as a potential diagnostic predictor of CP. Full article

Background/Objectives: Social capital is a multifaceted concept that comprises structural and cognitive portions, and from the perspective of caregivers, it enables access to assistance and participation, improving well-being in resource-constrained settings. In low- and middle-income countries (LMICs) like Bangladesh, mothers are often the sole carers of children with cerebral palsy (CP), which may affect their social capital and livelihood; however, evidence in this regard is limited. This study assessed the effectiveness of integrated microfinance and community-based rehabilitation (IMCBR) on caregivers’ social capital in rural Bangladesh. Methods: This study was part of a randomized controlled trial (RCT) conducted in Shahjadpur, Sirajganj, with three study arms. Children aged ≤5 years with CP and their primary caregivers were enrolled. Twenty-four clusters (10–14 child–caregiver pairs per cluster) were randomly assigned to Arm-A: IMCBR, Arm-B: community-based rehabilitation (CBR) only, and Arm-C: standard care. Data were collected at the baseline, midline (6 months), and endline (12 months) using a structured questionnaire. Social capital was measured using the Short Adapted Social Capital Assessment Tool (SASCAT), which assesses structural and cognitive dimensions; higher scores indicated greater social capital. The SASCAT was culturally adapted and validated for use in Bangladesh. Descriptive, bivariate, and multivariate analyses were performed. Results: There were 251 dyads enrolled into the trial. At baseline, Arm-A had the lowest social capital scores but showed the greatest improvement by endline (60.0%), followed by Arm-B (54.1%) and Arm-C (6.0%). Structural social capital increased significantly in Arm-A compared with Arm-C (mean difference 2.88; 95% CI: 2.45–3.31; p < 0.001) and in Arm-B compared with Arm-C (mean difference 2.46; 95% CI: 2.04–2.87; p < 0.001). Cognitive social capital increased the most in Arm-B (10.7%), though group differences were not significant (p > 0.05). In Arm-A, improvements in social capital were inversely associated with the child’s Gross Motor Function Classification System (GMFCS) level (β = −0.69; 95% CI: −1.28 to −0.10; p < 0.05). Conclusions: IMCBR significantly improved caregivers’ social capital, particularly its structural components, in rural Bangladesh. Full article

Background: There is a critical need for feasible, non-equipment based, safe, and cost-effective exercise interventions to promote muscle strength, dynamic postural balance, and independent mobility in adolescents with cerebral palsy (CP) or spina bifida (SB). Objectives: This study aimed to examine the feasibility and preliminary response of a novel exercise program: Functionally Loaded High-Intensity Circuit Training (FUNHIT) and conventional High-Intensity Circuit Training (HIT) in adolescents with CP/SB. Methods: Enrolled participants were allocated to FUNHIT or HIT or Controls in our randomized control trial. The interventions were delivered 2×/week × 4 weeks. Feasibility was assessed through process, operational, and scientific metrics. Outcome measures included maximum walking speed, Four Square Step Test (FSST), Timed Up and Go (TUG) and its dual-task variants, Lateral Step-Up Test (LSUT), Fear of Falling (FoF) and physical activity (PA) questionnaires. Results: We tested 5 participants (1 CP, 4 SB) in our study. Recruitment and retention rates were acceptable (63% enrollment, 100% retention and adherence). FUNHIT (n = 2) participants showed improvements in maximum walking speed (8–12%), FSST (15–29%), LSUT (22–33%), and TUG (4%). The HIT participant (n = 1) demonstrated improved TUG dual-task performance (40%) and FSST (30%) only. Control participants (n = 2) had varied changes (from 0–24%) in mobility, strength, balance. No adverse events were reported. Participants successfully followed (100%) the prescribed exercise dosage over the four-week period. Conclusions: FUNHIT and HIT are feasible and safe interventions for adolescents with ambulatory CP and SB who retain motor function, showing promising preliminary improvements in muscle strength, dynamic balance, and independent mobility. Our findings need to be validated in larger samples. Full article

Disabled people commonly report experiencing predetermined perceptions and assumptions of disability that form barriers towards understanding and treating disabled people equally. This process is known as ableism; a specific type of ableism called benevolent ableism intends to help and solicit assistance towards disabled people, but instead dismisses their capacity to advocate for their own needs, resulting in help that is deemed overly enforced, assumptive, and unwanted. A focus group and one informal interview were conducted to investigate the views and experiences of people living with cerebral palsy (CP), highlighting how benevolent ableism operates in their own lives, with additional forms of ableism also explored. Thematic analysis (TA) was applied to the data, resulting in three broad themes: benevolent ableism, strategies to improve and reduce ableism, and othering. The findings revealed that benevolent ableism was present when help was assumed, overly requested despite rejections of help, and belittling in nature; positive forms of assistance allowed the person with CP to instigate help and was accommodating; other forms of ableism were encountered, such as invasive staring, being treated like a child, charitable praise, being ignored within the medical setting, and lowered perceptions of capabilities. In order to diminish these difficult experiences and encourage practices, behaviours, and ideologies that promote less prejudice, participants mentioned education and improved interaction as being important aspects. Furthermore, this research poses wider implications for family members, teachers, medical professionals, and the general public to learn appropriate approaches toward disabled people and gain a better understanding of disability. Full article