Search Results (594)

Functional near-infrared spectroscopy (fNIRS) is a portable, non-invasive tool for studying cortical function in children with neurodevelopmental and neurological disorders. Although fNIRS use is increasing, heterogeneous study paradigms and cortical targets have limited cross-condition comparisons and the identification of shared research priorities. This systematic review maps cortical regions and reporting patterns in five key conditions—autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), cerebral palsy (CP), hypoxic–ischemic encephalopathy (HIE), and epilepsy (Ep)—from January 2015 to December 2025. A systematic search across five databases identified 72 relevant studies meeting PRISMA 2020 criteria, revealing both similarities and differences across disorders. The prefrontal cortex (PFC) was studied in all five conditions (5/5: 100%), making it the most consistently investigated cortical region. The parietal and temporal cortices were studied in 4 of 5 conditions (80%). The frontal cortex had the most regions investigated, while the temporal cortex showed the most consistent coverage across conditions (2.25 conditions per region). Beyond regional preferences, condition-specific patterns were aligned with their disorder phenotypes: social brain networks in ASD, prefrontal executive systems in ADHD, sensorimotor changes in CP, cerebrovascular monitoring in HIE, and state-dependent changes in Ep. Across conditions, researchers found altered prefrontal activity, disrupted connectivity, and compensatory brain responses, supporting broader frameworks. Collectively, these findings identify the PFC as a shared target for transdiagnostic fNIRS investigations while highlighting important gaps in regional coverage and methodological consistency. Despite methodological differences, fNIRS shows promise for identifying both shared and unique brain patterns in pediatric neurodevelopmental and neurological disorders. This review provides a framework for prioritizing cortical targets and guiding future standardized fNIRS research in pediatric populations. Full article

Three-dimensional instrumented gait analysis is widely used to guide surgical decision-making in children with cerebral palsy (CP), but its interpretation is time-consuming and prone to inter-rater variability. In this single-centre pilot study, we investigated whether a generative large language model (LLM) could consistently generate gait deviation findings and surgical procedure suggestions that align with expert judgement. Kinematic features for lower-limb joints across the gait cycle, stance, and swing were extracted from eight children with unilateral CP using the open-source GaitSharing Toolkit and a structured prompt, then submitted three times per patient to OpenAI’s GPT-5.5 model. The model assessed 28 kinematic deviations and 12 surgical procedure groups using majority voting. One gait analyst and two paediatric orthopaedic surgeons independently rated outputs on a 0–2 ordinal scale, blinded to all clinical information beyond the kinematic curves and diagnosis. Agreement was summarised descriptively as the percentage of the maximum attainable score with 95% confidence intervals (CIs), and quadratic-weighted Cohen’s kappa was used to quantify inter-surgeon agreement. Agreement with the gait expert was highest at the hip (90.6%) and lowest at the knee, particularly in the transverse plane (65.2%). For surgical procedures, agreement with the LLM reached 83.9% and 73.4% for the two surgeons, with the tibialis anterior procedure showing the lowest concordance. Inter-surgeon agreement was 79.2% (95% CI 71.9–85.4) with a kappa of 0.59 (0.47–0.70), indicating moderate agreement. The LLM showed high self-consistency (>90% across runs). These preliminary findings suggest that generative LLMs may be feasible as assistive tools in clinical gait analysis for deviation detection and future treatment planning and should be interpreted as hypothesis-generating, warranting confirmation in larger, more diverse cohorts. Full article

Background/Objectives: To evaluate the long-term outcomes of strabismus treatment in children with cerebral palsy (CP) and to investigate factors associated with postoperative alignment success and the development of consecutive strabismus. Methods: The retrospective, single-center study included 73 children with CP and strabismus who were followed from January 2015 to December 2024. Demographic characteristics, ophthalmological findings, treatment methods, and postoperative outcomes were assessed. Ocular deviation was measured through prism and alternate cover testing or a modified Krimsky test, and surgical success was defined as a final deviation of ≤10 prism diopters (PD). Patients were assessed at the patient level. Comparisons between exotropic and esotropic patients and between patients who had consecutive exotropia and those who had successful alignment were made using appropriate statistical tests. Results: Study participants included 55 patients with esotropia (75.3%) and 18 patients with exotropia (24.7%). The mean follow-up period was 32.6 ± 7.18 months. A successful ocular alignment was achieved in 32 of 46 patients (69.6%) with esotropia and in 10 of 17 patients (58.8%) with exotropia following surgical treatment and/or BTA. Consecutive exotropia developed exclusively in patients initially treated for esotropia (39.1% vs. 0%, p = 0.001). Patients with consecutive exotropia underwent surgery at a younger age and had larger preoperative deviation angles than those who had successful alignment, but these differences were not statistically significant. Conclusions: Strabismus treatment provides satisfactory long-term motor alignment in many children with cerebral palsy. However, consecutive exotropia following esotropia surgery remains a common postoperative condition and is the principal source of alignment instability in this population. Younger surgical age and larger preoperative deviations were more common among patients with consecutive exotropia, but no statistically significant associations between the evaluated clinical variables and consecutive exotropia were identified in the exploratory univariate analyses. Full article

Background and Objectives: Children with cerebral palsy (CP) are at increased risk for oral health problems, yet prospective evidence on the impact of dental rehabilitation on oral health-related quality of life (OHRQoL) in this population remains limited. This study aimed to prospectively evaluate the effects of comprehensive chairside dental rehabilitation on OHRQoL in children with spastic-type CP across two age groups, and to compare outcomes with healthy controls over a 12-month follow-up period. Materials and Methods:This prospective controlled pilot study included 22 children (11 with spastic-type CP, 11 healthy controls), individually matched by age, sex, and caries index (dmft/DMFT). Participants were divided into two subgroups based on dentition stage: the primary dentition group (n = 12; 6 CP, 6 controls; ages 4–6, assessed with the parent-reported ECOHIS) and the mixed dentition group (n = 10; 5 CP, 5 controls; ages 7–10, assessed with the POQL, which incorporates both child-reported and parent-reported forms). OHRQoL was measured at baseline, 3, 6, and 12 months. Comprehensive chairside dental rehabilitation was performed in accordance with AAPD guidelines. The Friedman test and Mann–Whitney U test were used for within-group and between-group comparisons, respectively. Effect sizes (Kendall’s W and r) and 95% confidence intervals were calculated for statistically significant findings. Results: Parent-reported POQL scores demonstrated statistically significant improvement over 12 months in both the CP (p = 0.004) and control (p = 0.007) groups, with the most pronounced change occurring between baseline and the 12th month. ECOHIS scores and child-reported POQL scores decreased across time points without reaching statistical significance. No significant between-group differences were detected at any time point. Conclusions: Comprehensive chairside dental rehabilitation was associated with significant improvements in parent-reported OHRQoL in both children with CP and healthy controls, whereas ECOHIS and child-reported POQL scores showed numerical improvements that did not reach significance. These findings indicate that high-functioning children with spastic-type CP can benefit from dental rehabilitation comparably to their healthy peers, though larger and more heterogeneous samples are needed to confirm and generalize these preliminary results. Full article

Background/Objectives: Although cerebral palsy (CP) is a leading cause of childhood disability, population-based data on long-term growth trajectories and domain-specific developmental outcomes remain limited. This study aimed to investigate the prevalence of growth failure and neurodevelopmental delay, along with the associated perinatal risk factors, in Korean children with CP. Methods: We conducted a nationwide, retrospective cohort study using data from the National Health Insurance Service. A birth cohort of 1,256,934 infants born between 2013 and 2015 was linked to claims and infant health screening data, followed through 2020. Longitudinal outcomes were assessed at 30–36 months and 54–60 months. Multivariable logistic regression identified risk factors for growth failure (height/weight/head circumference < 3rd percentile) and developmental delay (K-DST score < −2 SD). Results: The overall prevalence of CP was 0.18%. Outcomes for affected children progressively worsened over time. Specifically, the relative disparity in developmental delay between children with and without CP widened over time, with the adjusted odds ratio increasing from 30–36 to 54–60 months. In the multivariable analysis, CP diagnosis showed the strongest independent association with adverse outcomes. Regarding neonatal morbidities, hypoxic–ischemic encephalopathy (HIE) and necrotizing enterocolitis (NEC) were associated with the most pronounced and persistent deficits across the overall cohort, independently of CP. The association between bronchopulmonary dysplasia and developmental delay was attenuated and no longer significant at 54–60 months, whereas its association with growth failure persisted. Conclusions: Children with CP face profound and widening deficits in somatic growth and neurodevelopment throughout early childhood. Persistent growth failure, particularly in patients with HIE or NEC, underscores the critical need for early multidisciplinary nutritional intervention to mitigate long-term adverse outcomes. Full article

Background/Objectives: Cerebral palsy (CP) hip displacement requires longitudinal surveillance, frequently imposing significant burden on caregivers. While Multimodal Large Language Models (MLLMs) offer a potential solution to the health literacy gap, their accuracy in interpreting pediatric pelvic radiographs remains unproven. This study evaluates the effectiveness and safety of MLLMs in addressing caregiver concerns regarding CP hip management. Methods: Fifteen deidentified pediatric pelvic radiographs representing a spectrum of hip displacement severities were processed through three MLLMs: GPT-4o, Claude 3.5, and Gemini 1.5 Pro. Nine standardized caregiver prompts (n = 95 total responses per model) were utilized to simulate common clinical queries. Outcome measures included response word count, interactive characteristics, frequency of medical disclaimers, and diagnostic accuracy. Results: Quantitative analysis revealed that Claude 3.5 produced significantly shorter responses compared to other models (p < 0.01). GPT-4o demonstrated the highest safety alignment, with a 96.9% disclaimer rate, significantly exceeding Claude (60.0%) and Gemini (76.8%) (p = 0.03). Diagnostic “hallucinations” were observed, notably Claude misidentifying non-operative cases as bilateral hip replacements. While management recommendations were clinically relevant, they remained generic rather than patient-specific, failing to measure or apply migration percentage thresholds. Encouragingly, all models consistently directed users to consult an orthopaedic surgeon. Conclusions: MLLMs represent an opportunity to enhance health literacy by providing accessible management summaries and emphasizing professional consultation. However, significant radiographic hallucinations and a lack of specific, evidence-based guidance preclude their use as standalone diagnostic tools. Currently, MLLMs should be viewed as educational adjuncts requiring expert oversight in the pediatric orthopaedic care continuum. Full article

Background/Objectives: Severe brain injury (SBI) in very preterm infants includes heterogeneous lesions with distinct timing, burden and outcomes. We used cranial ultrasound (CUS) to describe SBI entity, documented timing, three-domain burden, deaths following documented withdrawal, withholding or non-escalation of life-sustaining treatment for poor neurological prognosis (neuro-WWLST), and survivor outcomes. Methods: Retrospective single-center cohort (1991–2020) of 2841 very preterm infants (<32 weeks’ gestation and/or birth weight ≤ 1500 g) with complete CUS within 48 h after birth. CUS was summarized by four windows, three domains—parenchymal lesion, intraventricular hemorrhage (IVH) and ventriculomegaly—and three mutually exclusive entities: periventricular hemorrhagic infarction (PVHI), cystic periventricular leukomalacia (cPVL and grade 3 IVH without PVHI/cPVL (IVH3 entity). Cross-outcome analyses used common maximal-burden CUS. Results: SBI occurred in 286/2841 infants (10.1%) and neuro-WWLST death in 45/2841 infants (1.6%); 43/45 occurred within SBI, and 43/89 SBI deaths (48.3%) followed documented neuro-WWLST. Using common maximal-burden CUS, severe three-domain involvement was more frequent among neuro-WWLST deaths than survivors (37.2% vs. 8.6%). Among SBI survivors with follow-up, cerebral palsy (CP) occurred in 87/176 (49.4%) and clinically classified school-age cognitive sequelae in 50/155 (32.3%). Outcomes varied by entity, with mainly ambulatory unilateral CP after PVHI, more frequent non-ambulatory bilateral CP after cPVL, and a heterogeneous IVH3 profile. Severe three-domain involvement identified a small subgroup with higher outcome burden, but outcomes were not deterministic. Conclusions: A structured, descriptive CUS approach separating lesion entity, documented timing and multidomain burden may support transparent cohort-level description of SBI trajectories, documented neuro-WWLST deaths and survivor outcomes. Full article

Children with developmental disabilities are less physically active and at increased risk for chronic conditions that physical activity might ameliorate. This study examined the relationships between the impact of physical activity (e.g., muscles burning, body tiredness), physical activity time and fatigue in children with Cerebral Palsy (CP) and Down Syndrome (DS) in comparison to typically developing (TD) children. A convenience sample of children and parents was enrolled. All children were between 4 and 10 years, ambulatory, medically stable, not taking sleep-aid medications and were either TD (n = 20) or diagnosed with CP (n = 14) or DS (n = 5). Children and parents separately answered questionnaires about participation in physical activity and fatigue during the past week, yielding retrospective data. Additionally, they completed prospective questionnaires for 3 consecutive days. Repeated measures multivariate and univariate analyses (post hoc) of variance, along with correlations between variables were completed. Analyses of retrospective data yielded no specific findings. Prospectively, all groups of parents reported that as the impact of physical activity increased, perceptions of fatigue decreased (r = −0.349; p < 0.001). Parents of children with Cerebral Palsy noted a negative relationship between the time spent doing physical activity and perceptions of fatigue (r = −0.553; p < 0.001). Between-group differences in perceptions of fatigue occurred for children with CP compared to TD (F = 8.248; p < 0.001). Parent-reported findings suggest potential associations between physical activity participation and perceptions of fatigue across diagnostic groups. Full article

Non-contact physiological monitoring based on remote PPG (rPPG) offers a viable alternative for the care of pediatric populations, particularly for children with cerebral palsy (CP) who present unique communication and mobility challenges. This paper presents a review of the literature on the use of rPPG for the estimation of vital signs and its application in emotional monitoring. Following the PRISMA 2020 guidelines as a methodological framework for searching and filtering, an exhaustive search was conducted in the IEEE Xplore and Scopus databases covering the period from 2017 to 2024. A total of 35 studies were selected for analysis. The review examines the evolution of rPPG algorithms—from classical mathematical approaches to recent deep-learning-based architectures—identifying critical technical challenges such as motion artifacts caused by spasticity and variations in lighting conditions. The results reveal that while rPPG has reached technical maturity for monitoring core physiological parameters such as heart rate, its application to robust emotion detection in children with CP remains limited. The main limitation identified across the surveyed literature is the critical scarcity of public or clinical datasets featuring pediatric CP cohorts. Finally, the potential of multimodal integration—combining rPPG with eye-tracking and wearable sensors—is discussed as a promising pathway toward objective emotional monitoring. Such an approach could enhance communication, support rehabilitation processes, and ultimately improve the quality of life of children with cerebral palsy and their caregivers. Full article

Background/Objectives: Early motor intervention is increasingly recognized as a critical component in the management of infants with, or at high risk of, cerebral palsy (CP). This systematic review aimed to synthesize recent evidence on early motor interventions in infants aged 0–2 years and to identify current gaps in knowledge. Methods: We performed a systematic literature review across PubMed, Embase, CINAHL, and Scopus. Studies published between 1 January 2020 and 5 October 2024 were included. Eligible studies were Randomized Controlled Trials (RCTs), non-randomized trials, and cohort studies that involved infants aged 0–2 years diagnosed with CP or classified as at high risk of CP who received early motor interventions targeting motor outcomes. Study selection and data extraction were executed by two independent reviewers following standardized protocols. The Rob2 Checklist was used to assess the risk of bias. This systematic review protocol was registered on PROSPERO with the ID 506784. Results: Six articles representing four RCTs were included. Although intervention protocols varied, shared therapeutic principles emerged across studies. Most participants were approximately 12 months old; only one study included infants younger than 3 months, highlighting limited evidence in the earliest detectable risk period. No consistent superiority of experimental interventions over standard care was observed; however, notable within-group improvements in motor and developmental domains were reported across both study arms. Major limitations included heterogeneity of outcome measures, limited use of CP-specific standardized tools, and insufficient assessment of functional and goal-based outcomes. Conclusions: Current evidence indicates a shift toward meaningful, family-centered early motor interventions, emphasizing active participation and parental involvement. Five core principles were identified: early initiation, task specificity, active experience, guided support, and engagement of both the child and caregivers. Future research should focus on earlier intervention timing, standardized outcome measures, and caregiver-related outcomes to optimize early intervention strategies during critical developmental windows. Full article

Background/Objectives: Neurological impairments in children with Cerebral Palsy (CP) often lead to altered muscle architecture and function, resulting in calf muscle contractures. Orthotic immobilization aims to promote muscle–tendon unit lengthening through sustained stretch but may also induce disuse atrophy. This study investigated whether combining immobilization with daily activity yields different effects on muscle strength and gait function compared with immobilization alone. Methods: Fourteen ambulant children with spastic CP and equinus deformity (8 unilateral, 6 bilateral; mean age 9.93 ± 3.0 years; GMFCS I: 10, GMFCS II: 4) participated in a 12-week randomized controlled trial. Participants were assigned to either continuous immobilization (23 h/day) using a dynamic ankle–foot orthosis or a combined protocol consisting of 14 h/day immobilization and 10 h/day of activity involving ankle mobility and calf muscle activation. Outcomes included isometric muscle strength, joint range of motion, gait parameters, and functional measures (Gait Outcomes Assessment List (GOAL) and the Paediatric Outcome Data Collection Instrument (PODCI)). Data were analyzed using linear mixed models with Bonferroni correction. Results: Significant time effects were observed for the knee angle at initial contact (IC), the ankle angle at IC, maximum dorsiflexion, and maximum dorsiflexion during swing. A significant group × time interaction was found only for hindfoot-tibia angle at IC. Within-group improvements were noted in activities of daily living, body image and self-esteem, and basic mobility. No significant changes were found for muscle strength or for most questionnaire subscales. Conclusions: The findings indicate time-related improvements in gait, with no consistent advantage of the combined intervention. Further studies with larger samples are needed to evaluate potential long-term effects. Full article

Background/Objectives: Fatigue is a common symptom in adults with cerebral palsy (CP), characterized by fluctuations across the day. This pilot study aimed to evaluate the feasibility, reliability, and validity of ecological momentary assessment (EMA) for capturing these temporal dynamics in adults with CP. Methods: Ten adults with CP (60% female, mean age = 44 years, Gross Motor Function Classification System levels I–III) and eight typically developed controls (62% female, mean age = 39 years) completed a 20-item EMA survey ten times daily for seven days using the SEMA³ smartphone application. Feasibility was evaluated through retention rates, response rates, and qualitative interviews. Intraindividual variability, within-person reliability, measurement reactivity, and convergent validity with the Fatigue Severity Scale (FSS) were examined using mixed-effects regression and multilevel measurement error autoregressive (MEAR) models. Results: No participants dropped out. Average response rates were 76% (CP) and 75% (control). The protocol was perceived as acceptable overall, though demanding by some participants. In the CP group, 61% of total variability in momentary fatigue was attributable to within-person fluctuations, and within-person reliability was 0.73 (SEM = 1.13). No evidence of reactivity to self-monitoring was found in fatigue ratings or qualitative interviews. FSS scores were positively associated with person-level average momentary fatigue, β = 0.51, p = 0.048. Conclusions: EMA is feasible in adults with CP and reveals substantial within-person fluctuations in fatigue. These findings provide initial proof-of-concept and inform methodological amendments for a future large-scale study of fatigue dynamics aiming to advance symptom management in this population. Full article

Background/Objectives: Within a family-centered care framework, families of children with cerebral palsy (CP) rely on both informal and formal support systems to manage caregiving demands, yet the adequacy and perceived helpfulness of this support vary. This study aimed to examine the availability of different support sources for families of children with CP in Saudi Arabia, explore their perceived helpfulness, and evaluate the influence of child-, parent-, geographical-, and household-related characteristics on the level of family support helpfulness. Methods: A cross-sectional study was conducted among 223 caregivers of children diagnosed with CP across Saudi Arabia. The participants completed the Child and Family Questionnaire and the Family Support Scale (FSS), and the children were classified on the Gross Motor Function Classification System (GMFCS). Kruskal–Wallis H and Mann–Whitney U tests examined the differences in perceived support helpfulness across family, child, and household characteristics. Results: Spousal and kinship support were perceived as the most helpful sources, with families of children with bilateral spastic CP and more severe GMFCS perceiving less support. Overall, informal social support was significantly perceived as more helpful than formal support. Conclusions: Families of children with CP rely mainly on spouses and relatives for support, with lower perceived helpfulness among those facing greater caregiving demands, highlighting the need to improve the accessibility, coordination, and quality of support services. Full article

Background: Low-cost virtual reality exergames may help maintain and improve postural control in children with spastic hemiplegia cerebral palsy (CP). This study aimed to evaluate the comparative effectiveness of the same six-week, low-cost exergame programme delivered via telerehabilitation (TR) and face-to-face (FF) in CP children. Methods: In this randomised controlled trial, 15 CP patients completed 18 sessions over 6 weeks. The TR group received remotely delivered sessions, whereas the FF control group completed in-person sessions with a physiotherapist. Outcomes were assessed at baseline; weeks 2, 4, and 6; and follow-ups at weeks 8 and 10. Postural control (centre-of-pressure sway area; CoP_sway) was measured during eyes open (EO), eyes closed (EC), voluntary mediolateral sway to a 30 bpm auditory cue (EO/EC), and during exergames targeting mediolateral (ML-WS) and anteroposterior (AP-WS) weight-shifting. Timed Up and Go (TUG) and Modified Modified Ashworth Scale (MMAS) were also assessed. Results: At week 6, both TR and FF significantly reduced CoP_sway (TR: p = 0.001, EC; FF: p = 0.01, EO). TR also improved dynamic postural control (p < 0.05) and TUG scores (p = 0.03), with functional gains sustained until week 10. Between-group comparisons revealed that TR achieved significantly greater reductions in AP weight-shifting (SD_ML, p = 0.001; V_ML, p = 0.004) and TUG (p = 0.009) than FF, with these advantages persisting throughout follow-up as revealed by post hoc analysis. Conversely, only FF significantly reduced ankle muscle tone (MMAS, p = 0.05). TR demonstrated broader improvements in secondary CoP metrics and superior long-term retention of functional mobility gains. Conclusions: Both six-week exergame interventions led to improvements in postural control. This trial demonstrated that telerehabilitation is a viable, comparable alternative to face-to-face delivery. Long-term retention suggests both modalities are complementary, offering flexible solutions to enhance routine physiotherapy service pathways. These findings provide a basis for validating these models across larger clinical cohorts. Full article

Background: Parents of children with cerebral palsy (CP) experience several challenges in providing care, which can impact the child’s quality of life. CP is one of the most common neurological conditions that demand a great deal of time and effort from caregivers. Purpose: To explore the psychological and social effects experienced by Saudi families while rearing children with CP. Methods: This research utilizes qualitative research methods. The purposive sampling method was used to select 13 caregivers of children with CP from the Children with Disability Association in Riyadh, Saudi Arabia. Personal interviews were conducted with a group of parents, then these interviews were analyzed to derive the experiences of the participants. Results: The findings highlighted the difficulties that these families go through from the moment the diagnosis was made, as well as other care burdens, including costs, isolation, and continuous anxiety and worries about the future of the children. Conclusions: This study identifies the need for organized psychological and social support, which has a significant impact on enhancing adaptability and the lives of the children. Full article