Search Results (620)

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

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

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/Objectives: We studied the feasibility of incorporating a play-based bimanual ride-on-toy navigation training (RNT) program into an intensive hybrid training camp based on principles of modified constraint induced movement therapy and bimanual training for children with unilateral cerebral palsy (UCP). The bimanual RNT sessions included theme-based play involving navigational exploration and object-based tasks. Methods: We employed a pretest-posttest, mixed methods design. Ten children between 3 and 11 years participated. Camp was 6 h/day and 5 days/week for 3 weeks. Researchers trained camp staff to provide RNT every day. The feasibility of clinician delivery of RNT was assessed using training logs and staff exit questionnaires. The combined effects of the camp programming, inclusive of bimanual RNT, was measured through a combination of standardized tests (Quality of Upper Extremity Skills Test (QUEST), Shriner’s Hospital Upper Extremity Evaluation (SHUEE), and Box and Blocks Test) and video-coding measures. We report on means (M), standard errors (SE), and effect sizes (ES) with 95% confidence intervals for outcome measures. Results: The average session adherence was 90.7%, and staff were able to successfully deliver RNT, despite initial logistical challenges. In combination with camp programming, RNT led to improvements in the total QUEST score (pretest M (SE): 77.54 (5.11), posttest M (SE): 81.46 (5.22)) and SHUEE spontaneous functional analysis score (pretest M (SE): 41.33 (7.48), posttest M (SE): 50.22 (7.88)). Children increased the use of their affected upper extremity (UE) during late RNT sessions and improved in their navigational abilities. Conclusions: RNT is a fun and easily adaptable therapy adjunct that can complement traditional therapies to incentivize spontaneous use of the affected UE in children with UCP. Full article

Background/Objectives: Cerebral palsy (CP) is a non-progressive, permanent syndrome of childhood, with approximately 80% of patients exhibiting spasticity. Untreated spasticity can cause pain, structural changes in bones, muscles, and nerves negatively impacting quality of life and functionality. Photobiomodulation (PBM) has demonstrated biological effects such as tissue regeneration, muscle relaxation, inflammation reduction, and pain relief. The objective of this pilot study is to evaluate the action of PBM on the spasticity of the medial and lateral right gastrocnemius muscles of children and adolescents with spastic cerebral palsy. Methods: This single-blinded, randomized, controlled trial evaluated PBM’s effect on gastrocnemius spasticity in children and adolescents with CP. The study presents pilot preliminary results from twelve children and adolescents (7–16 years) with spastic CP who were randomized into two groups: active PBM (850 nm, 100 mW, 1.5 J/point, 2 points, weekly for 8 weeks) or placebo (same protocol, device off). Both groups received standard rehabilitation exercises. Outcomes were assessed using the Modified Ashworth Scale (MAS), Pediatric Evaluation of Disability Inventory (PEDI), Gross Motor Function Classification System (GMFCS), and ankle range of motion before and after the intervention (8 weeks). Results: MAS and all outcomes improved significantly over time in both groups. No significant differences were found between groups for all outcomes. The PBM effect size on MAS improvement (ANOVA, Analysis of Vari, η² = 0.171) suggests modest but positive benefits. PBM did not worsen spasticity, and no adverse effects were reported. Conclusion: This study represents a pioneering effort in evaluating a safe PBM protocol for the spastics gastrocnemius in children and adolescents with CP. This protocol, used as an adjunct to physiotherapy, demonstrated no short-term adverse effects and no participant dropouts. Future studies should explore this PBM protocol in patients with less severe GMFCS levels, those with minimally preserved functionality, or those with contraindications to physiotherapeutic exercises. Full article

Background/Objectives: There is limited information on the interplay between passive joint motion and joint kinematics from three-dimensional gait analysis (3DGA) and its longitudinal evolution in cerebral palsy (CP). We aimed to associate clinical measurements and gait kinematics over time using a longitudinal study design. Methods: Ambulatory individuals with spastic CP, aged 4–18, who performed a minimum of two 3DGA at the Karolinska University Hospital between 2008 and 2025 were recruited. Primary outcomes were sagittal plane kinematics and maximum passive knee extension (pKE). Canonical correlation (R) with statistical parametric mapping was used to associate passive maximum knee extension with sagittal hip, knee, and ankle angles at two timepoints. Results: the 3DGA data of 31 children (age 4–17 years; mean age 10.4 +/− 2.9) with 22 bilateral (bCP, GMFCS I = 6; II = 13; III = 3) and 9 unilateral CP (uCP, GMFCS I = 8; II = 1) was included. For the whole and bCP groups, respectively, knee flexion/extension and pKE were correlated throughout stance (p < 0.001), with R between −0.47 and −0.57/−0.49 and −0.59 at T1 and between −0.46 and −0.72/−0.50 and −0.76 at T2. Hip flexion/extension and knee pKE were correlated from 17 to 62%/46–52% of the gait cycle (p < 0.001/p = 0.045) for the whole and bCP groups, respectively, with R between −0.41 and −0.57/−0.38 and −0.41 at T1 and from 15 to 64%/17 to 61% with R between −0.50 and −0.57/−0.42 and −0.57 at T2. Conclusions: Reported associations between structural knee properties and knee position during gait demonstrated progression over time, implying that a restricted range of motion may be driven by functional constraints. Combining knee contractures and their longitudinal development with 3DGA is a powerful approach for pre-intervention planning. Full article

Background/Objectives: Robotic therapies are emerging as a potential management strategy for individuals with cerebral palsy (CP). These devices apply mechanical and electrical forces to regulate neural excitability and promote motor learning. This review aimed to systematically assess and synthesize evidence from published systematic reviews and meta-analyses on the therapeutic benefits of robotics and exoskeletons for gait and postural balance in pediatric CP. Methods: A comprehensive search of PubMed, CINAHL, Scopus, and The Cochrane Library was conducted. Two independent reviewers screened records to identify studies that were: (1) written in English and published in peer-reviewed journals; (2) included participants <18 years with a diagnosis of CP; and (3) examined robotic therapies or exoskeletons targeting gait or postural balance. Methodological quality of included reviews was appraised with the Assessment of Multiple Systematic Reviews (AMSTAR) tool, and certainty of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. Results: 18 systematic reviews met the inclusion criteria, encompassing 256 primary studies and 5092 participants. Overall methodological quality of the included reviews was rated as moderate to good. A variety of robotic and exoskeleton systems were noted across studies, with heterogeneous protocols and outcomes. Several reviews reported modest improvements in gait and postural balance; however, the findings were inconsistent, and pooled effects, where available, did not yield definitive conclusions regarding efficacy. Conclusions: Robotic and exoskeleton interventions may offer benefits for gait and postural balance in children and adolescents with CP, but the current evidence base remains inconclusive. Additional high-quality research is required to determine effectiveness more definitively. Full article

One of the most important factors in how infants and young children learn to move is postural control. This systematic review aims to evaluate the machine learning methods in posture-related applications for children aged 0–12. Following PRISMA guidelines, we systematically searched the PubMed, Web of Sciences, SCOPUS, and ProQuest Central databases. Twenty-two studies were included in the qualitative synthesis following screening of 199 articles, with methodological quality assessed as moderate to good using the MINORS scale (scores ranging from 8/16 to 19/24). The reviewed research involved diverse samples of infants and children up to 12 years old, employing sensor-based technologies such as inertial measurement units, force plates, pressure mats, and video cameras to extract kinematic and postural features for machine learning applications. Reported accuracies, typically exceeding 85%, reflected considerable methodological heterogeneity related to sensor modality, data quality, and model architecture. Algorithms such as Random Forest, SVM, and CNN were most frequently and effectively applied for posture classification, early detection of developmental delays, and diagnosis of conditions such as cerebral palsy and autism spectrum disorder, demonstrating promising potential for at-home monitoring and clinical interventions. Full article