Search Results (281)

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 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

School-aged children are routinely exposed to additional physical stress due to carrying school backpacks. These backpacks often exceed recommended limits and can contain not only books and notebooks but also laptops, water bottles, and other personal items. The present study aimed to evaluate the impact of different backpack loads (10%, 15%, and 20% of body weight) on dynamic gait parameters in 7-year-old girls and boys. Twenty-six children (13 girls, 13 boys) participated in the study. Gait analysis was performed using the Footscan® system (RSscan International, Olen, Belgium; 2 m × 0.4 m × 0.02 m, 16,384 sensors) equipped with Footscan software version 7 (Gait 2nd generation), examining peak force (FMAX), peak pressure (PMAX), contact area (CA), and time to peak force (Time to FMAX) across five anatomical foot zones. The study revealed significant changes in all parameters, particularly at loads of 15% and 20% of body weight. Increases in plantar pressure, contact area, and asymmetry were observed, along with delays in time to peak force. These findings support the recommendation that children’s backpack loads should not exceed 10% of their body weight to prevent potential adverse effects on postural and musculoskeletal development. Full article

Recent research in the area of physical literacy has revealed that the early years are a period that has not been well studied. Our research team designed a deductive review with the aim of investigating how preschool children’s physical literacy manifests across affective, physical, cognitive and social domains. The review includes scientific publications from the last four years, which investigate the elements of physical literacy in preschool children: motivation, confidence, motor competence, knowledge, understanding and use of physical activity. The characteristics of the elements were systematised into four domains, affective, physical, cognitive and social, as engagement in physical activities. Results. The majority of the articles explained physical literacy behaviours in 4- to 5-year-old children. The physical domain was most frequently described, mainly including the three basic motor skills of postural stability, object control, and locomotion, as well as physical qualities of movement. The second most frequently described domain was the social domain of the application of physical activities in preschool stages, including the types and amounts of physical activity used in both organised and leisure time. Conclusions. Physical literacy of preschool children is a purposefully organised and guided process, during which a child is given the opportunity to try and apply age-appropriate movement skills, without being limited by the child’s gender, parental attitudes, sporting choices, or the traditions of sport culture. Full article

Background/Objectives: Spasticity in children with cerebral palsy (CP) can impair motor-related functions. The objective of this exploratory, prospective study was to examine if transcutaneous electrical nerve stimulation (TENS) in a whole-body suit leads to changes in spasticity and other related effects. Methods: Thirty-one children with CP GMFCS III–V, with a median age of 11.0 years (age range of 7–17 years), were consecutively included, and they used the suit with TENS for 24 weeks. The primary outcome was spasticity measured using the Modified Ashworth Scale (MAS). Functional motor-related tasks were evaluated by the Goal Attainment Scale (SMART GAS). The Modified Tardieu Scale (MTS), passive Range of Motion (pROM), GMFM-66, and Posture and Postural Ability Scale (PPAS) assessments were performed. Results: Seventeen subjects (17/31) completed the 24 weeks. Dropout was due to difficulty in donning the suit. The level of overall spasticity, most pronounced in the proximal arms and legs, was reduced according to the MAS, but not the MTS or pROM. Subject-relevant motor-related goals improved significantly in standing/walking and hand/arm function. Changes in the GMFM-66 and PPAS were not significant. Conclusions: Although there were statistically significant but underpowered changes in the MAS after 24 weeks, there were no clinically relevant effects. Exploratorily, we found observer-reliant motor-related functional improvements, which, however, we were unable to detect when trying to quantify them. Donning the suit led to dropout throughout the study. Caregivers need to allocate time, mental capacity and have the physical skill set for donning the suit for long-term use. Full article

Cerebral palsy (CP) is one of the most common disorders in childhood that significantly impacts quality of life. Background/Objectives: This study conducted a literature review of physical activity (PA)-based interventions for children and adolescents with CP, highlighting the physical, cognitive, and social benefits, as well as the factors and barriers that influence practice. Methods: The PRISMA methodology was used to identify and analyze the most relevant studies up to December 2024 through specific search equations and the databases Science Direct, Scopus, and Dialnet. Of the 707 articles identified, a total of 62 publications were selected for further analysis. These were subjected to a quality assessment through a checklist based on seven items. Results: The practice of PA guaranteed improvements in balance, postural control, strength, socialization, and self-confidence. On the other hand, some programs, such as Makey Makey, Ballet, aquatic PA, and Matrogymnasia, among others, were highlighted because they promoted an increase in physical practice among the population. However, there are still some barriers, such as sedentary lifestyles (90%), limited accessibility, and a lack of qualified professionals that hinder the intervention and ensure motivation and interest in its practice for those individuals who have not yet begun to practice it. Conclusions: PA is an effective tool to favor quality of life in children and adolescents, as it contributes to their integral development and social inclusion. The need for interdisciplinary strategies to reduce barriers and increase the benefits of PA is emphasized. A joint effort to promote integration in leisure time could promote optimal long-term results. Full article

Background/Objectives: Adolescent Idiopathic Scoliosis (AIS) is a lateral curvature of the spine combined with rotation and associated postural changes. Curves are classified according to direction and the spinal region, with right thoracic curves being a common presentation. Curve magnitude is measured using Cobb angles on radiographs and is used to monitor curve progression, with one of the main aims of treatment being prevention of progression to surgical levels. Treatment options may include observation, physiotherapeutic scoliosis-specific exercises (PSSE), thoracolumbosacral orthotic (TLSO) bracing, or surgery and are dependent on curve magnitude, risk of progression, and patient goals. Methods: This case series includes five patients (four female and one male, mean age of 14.8 y) who received previous non-surgical treatment without success and had severe right thoracic AIS with an average Cobb angle measurement of 53.4°, involving spinal curve magnitudes that warrant surgical recommendation. Results: These patients’ curves were successfully reduced to nonsurgical levels utilizing a non-surgical, multimodal treatment approach combining 3D corrective TLSO bracing using the ScoliBrace^®, PSSEs, and spinal rehabilitation over an average of 37.0 months. The average Cobb angle reduced from 53.4° to 29.6° (44.6% reduction) after being weaned off treatment. Conclusions: This series has shown successful, clinically significant improvement in Cobb angle and trunk symmetry in five patients with severe AIS using a non-surgical, multimodal approach combining 3D corrective TLSO bracing using the ScoliBrace^® and spinal rehabilitation procedures. Further investigation into this multimodal non-surgical approach for children, parents, and healthcare providers and policymakers seeking an alternative to surgical intervention for AIS is warranted. Full article

Background and Objectives: Children with cerebral palsy (CP) improve walking abilities through partial body weight-supported treadmill training (PBWSTT) and loaded treadmill training (LTT), but there is no consensus on the most effective method. This study aimed to evaluate the effects of PBWSTT and LTT on spatiotemporal gait parameters in children with CP. Materials and Methods: A randomized clinical trial involved 25 children aged 12+ with spastic diplegic CP from various outpatient clinics in Taif and Makkah between January 2024 and January 2025. Participants were randomly assigned to PBWSTT (30% body weight support, n = 12) or LTT (60% lower limb weight loading, n = 13) with 45 min sessions three times per week for eight weeks, including conventional therapy. Results: The spatiotemporal gait parameters (such as gait speed, cadence, stride length, swing phase, and swing width) significantly improved within the PBWSTT and LTT groups, but no significant difference was found between the groups. The gross motor function measure, dimension E (for walking, running, and jumping), showed significantly higher improvement in the PBWSTT group compared to the LTT group (p = 0.047). Conclusions: This study indicates that PBWSTT and LTT can improve gait parameters in children with CP, with PBWSTT promoting postural control and LTT improving mobility. These findings suggest that the proposed rehabilitation strategies can significantly improve the functional outcomes of pediatric cerebral palsy patients. Full article

Background/Objectives: Non-invasive spinal cord transcutaneous stimulation (scTS) has expanded the therapeutic landscape of spinal cord injury (SCI) rehabilitation, offering potential benefits beyond compensatory approaches to paralysis. Children with SCI are particularly susceptible to developing neuromuscular scoliosis due to trunk muscle paralysis and ongoing skeletal growth, making targeted interventions crucial. As demonstrated in adults and pediatrics with SCI, the ability of scTS to acutely and safely enable an upright posture and trunk control could be leveraged as a therapeutic adjunct. Activity-based locomotor training (AB-LT) alone significantly improves trunk control in children with SCIs; combining it with scTS may enhance outcomes. This pilot study evaluated the safety, feasibility, and cumulative effects of AB-LT combined with scTS on trunk control in children with SCI. Methods: Three children with SCI completed 19 to 64 sessions of combined AB-LT and scTS. Adverse effects were monitored session to session, and trunk control was assessed pre- and post-intervention. Results: Across 130 interventions in three participants, 88.5% of sessions were free from adverse effects. Reported adverse events included autonomic dysreflexia (5.4%), skin redness at electrode sites (4.6%), and headaches (1.5%). No significant impact of scTS on fatigue or central hemodynamic parameters was observed. Post-intervention, all participants demonstrated improved trunk control during quiet and perturbed sitting. Conclusions: These findings provide the first evidence supporting the safety and feasibility of this combinatorial approach in pediatric SCI rehabilitation while emphasizing the importance of monitoring skin integrity and signs of autonomic dysreflexia. This intervention shows potential synergistic benefits, warranting further research to confirm efficacy and optimize therapeutic protocols. Full article

Genetic dystonias are a heterogeneous group of movement disorders characterized by involuntary, sustained muscle contractions that cause repetitive movements and abnormal postures. Often beginning in childhood, they can significantly affect quality of life. Although individually rare, genetic causes are collectively relevant in pediatric dystonias, with over 250 associated genes. Among these, TOR1A, SGCE, and KMT2B are the most frequently reported in pediatric forms. Diagnosis is challenging due to the wide clinical and genetic variability. Recent advances in genetic testing, including whole-exome and whole-genome sequencing, have improved the early identification of causative variants. Functional data on selected mutations are helping to refine genotype–phenotype correlations. Management typically requires a multidisciplinary approach. Symptomatic treatments include anticholinergics, benzodiazepines, and botulinum toxin, while deep brain stimulation can be effective in refractory cases, especially in patients with TOR1A variants. Disease-modifying therapies are also emerging, such as gene therapy for AADC deficiency, highlighting the potential of precision medicine. This review provides an updated overview of pediatric genetic dystonias, with a focus on differential diagnosis and treatment strategies. Early and accurate diagnosis, together with personalized care, is key to improving outcomes in affected children. Full article

Background/Objectives: Adverse effects of a sedentary lifestyle on an individual’s overall health are inevitable. With reference to primary-school-aged children, the establishment of effective postural hygiene is critical as it not only promotes optimal musculoskeletal development but also significantly influences their long-term well-being and productivity. This study aimed to develop and internally validate a regularized regression model to predict static postural loading (SPL) in primary school children. Methods: The outcome and predictors of SPL were shortlisted through a systematic review of the literature and expert panels. Data were derived from 258 primary school children. We developed regularized elastic net (EN) and used multiple linear regression (MLR) as a reference. Both models were fitted through five-fold cross-validation with 10 iterations. The grid search technique was used to find the optimal combination of hyperparameters α and λ for the EN. We conducted a permutation importance analysis to obtain and compare predictor rankings for each model. Results: Both models presented a good and comparable fit, with the EN marginally outperforming the MLR in error metrics. Postural risk, sedentary behavior, task duration, and BMI were the most important predictors of SPL in primary school children. Conclusions: The proof of a direct impact of a sedentary lifestyle on children’s overall health is both credible and alarming. Hence, proper identification and management of contributing factors to static postural loading in this age group is critical. In various clinical settings, where the objective is to develop a model that accurately forecasts the outcome, advanced regularized regression methods have evidently shown great performance. Full article

Background/Objectives: Children with diplegic spastic cerebral palsy (CP) often present with impaired postural control, poor balance, and gait abnormalities that negatively affect their functional mobility and independence. Core stability, which is the ability to control the position and movement of the trunk, is considered a critical component in maintaining postural alignment and improving gross motor function. This study aimed to investigate the impact of a structured core stability exercise program on the standing ability, functional balance, and gait parameters of children diagnosed with diplegic spastic CP. Methods: Forty children (28 males, 12 females) aged 4–10 years with a clinical diagnosis of diplegic spastic cerebral palsy were randomly allocated into two groups (n = 20 each). The study group underwent a 12-week core stability exercise program in addition to a standardized physiotherapy regimen, which was conducted three times per week. The control group received the physiotherapy program alone. Functional outcomes were assessed pre- and post-intervention using the Gross Motor Function Classification System (GMFCS), Pediatric Balance Scale, and Kinovea software for gait analysis. Results: Both groups demonstrated statistically significant improvements in all measured variables after the intervention. However, the study group showed significantly greater improvements in standing ability (9%), balance (9%), and gait parameters (p < 0.05), particularly in knee flexion, ankle dorsiflexion, and plantar flexion, during gait cycles. Conclusions: Core stability training resulted in superior enhancements in balance, standing, and gait performance compared with physiotherapy alone in children with diplegic spastic cerebral palsy. Full article

Objectives: Different types of exercises that aim in the development of balance, motor function, and gait are necessary for patients with motor disorders. Equine-assisted therapy could play an important role in the rehabilitation of these participants. Methods: The purpose of this study was to examine the effects that equine-assisted therapy can exert on balance, motor function, spasticity, posture and gait, as well as quality of life on individuals with motor disorders. Clinical trials, published up to 20 April 2022, comparing equine-assisted therapy with conventional rehabilitation were systematically searched. Two independent reviewers performed data extraction and assessed the quality of studies using the Downs and Black quality assessment tool. Results: Out of 27 studies that satisfied the inclusion criteria for systematic review, 15 included appropriate data for further comparative meta-analysis. Statistically significant differences were found in Dimension E (walking, running, jumping) of Gross Motor Function Measure in children with CP (0.009) and in Time Up and Go in Elderly and post-stroke participants (p = 0.006). Specifically, children with CP improved in walking, running, and jumping, as well as improved mobility in the elderly. The systematic review showed that the intervention had positive results, as well as in other domains, even though these were not statistically significant. Conclusions: Equine-assisted therapy is beneficial for individuals with impairments in balance, gross motor function, gait, spasticity, and coordination. Full article

Background. Poor posture is a common musculoskeletal concern in children and adolescents and may lead to spinal discomfort and long-term structural issues. While excess weight has been linked to altered sagittal alignment, the impact of sports participation on spinal posture remains unclear. This study aimed to investigate the associations between weight status, sports participation, and sagittal spinal alignment in a pediatric population. Methods. This cross-sectional study was conducted within the “Ferrari Formula Benessere” corporate wellness program and included 698 children aged 5 to 16 years. Sagittal Index (SI) was measured using a standardized plumb line technique. Body mass index (BMI) was calculated and classified according to the WHO growth standards. Sports participation was self-reported and grouped into five categories: sedentary, skill-based, power-based, mixed, and endurance sports. Results. Age was the only significant independent predictor of the SI (β = 2.45, p < 0.001), with older children exhibiting higher SI values. Although a weak correlation was observed between BMI and SI (Spearman’s r = 0.24, p < 0.001), BMI was not a significant predictor when controlling for age. No significant differences in the SI were found between active and non-active children. Among sport disciplines, the SI was lowest in power-based sports (56.7 ± 22.3 mm) and higher in endurance (62.7 ± 24.4 mm), mixed (64.5 ± 23.2 mm), skill-based (61.1 ± 22.0 mm), and non-sport (64.2 ± 24.0 mm) groups, although these differences did not reach statistical significance (ANOVA p = 0.224). Conclusions. Age appears to be the primary factor associated with sagittal spinal alignment in children, while BMI and general sports participation showed no independent effect. Although some differences emerged between sport types, these findings were not statistically significant and should be interpreted with caution. These findings underscore the need for sport-specific, longitudinal research using objective posture assessment methods. Full article

Background: Visual impairment significantly affects balance and motor skills in children, often leading to postural instability and locomotor difficulties, thereby affecting lifestyle and general health. The aim of this study was to assess balance level and fundamental motor skills in the locomotion of youth with regard to their level of visual impairment. Methods: The pilot study included 25 physically active young people with visual impairments, divided into three groups (B1, B2, B3) based on the severity of impairment. Balance was assessed using the AMTI AccuSway platform, both with eyes open and eyes closed. Locomotor skills were evaluated using the TGMD-3. Statistical analysis involved Kruskal–Wallis, ANOVA, and correlation tests. Results: Significant differences in balance were found between the B1 and B2 groups, with poorer balance in individuals with more severe visual impairments, particularly in static conditions. No significant differences in locomotor skills were observed between groups. However, girls performed better in balance tests, particularly with eyes closed. A positive correlation was found between balance and locomotor skills in the B2 and B3 groups. Conclusions: Visual impairment negatively impacts balance, particularly in individuals with more severe impairments. However, no significant differences were found in locomotor skills between the groups. Regular physical activity supports motor development. Targeted interventions are necessary to improve balance and locomotor skills, especially in children with more severe visual impairments. Full article