Search Results (127)

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

This study aimed to compare cognitive, language, and motor development outcomes among children attending public and private Early Childcare Centers (ECCs), considering birth factors and family and daycare environments. Additionally, it examined the proximal and distal factors influencing children’s development. Cognitive, language, and motor skills were assessed in the children, along with evaluations of ECC quality, teacher practices, and knowledge of child development. Results indicated that children enrolled in public ECCs achieved higher scores in cognitive and language development, despite coming from families with lower socioeconomic status and having lower birth weights. They also benefited from longer periods of breastfeeding. Teachers in public ECCs demonstrated greater daily practices, providing enhanced movement opportunities for children. Private ECCs offered more suitable outdoor spaces, whereas public ECCs had better indoor spaces. Regression analysis revealed that daily practice, teachers’ experience, and the availability of gross motor toys explained 41% of the variance in motor development. The duration of breastfeeding explained 24% of the variance in cognitive development. Teachers’ knowledge about children’s development and attendance at public ECCs explained 31% of the variance in language development. These findings underscore the importance of prioritizing teacher education in both public and private ECCs to optimize children’s overall development. Full article

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

Strong competencies in actual motor competence (AMC) and perceived motor competence (PMC) support lifelong physical activity. However, assessing MC is time-consuming, requiring multiple AMC and PMC evaluations. Streamlining these assessments would improve efficiency at a national level. This study used machine learning (ML) classification to (1) identify AMC assessments that can be accurately predicted in an Irish context using other AMC and PMC assessments, and (2) examine prediction accuracy differences between genders. AMC was measured using the Test of Gross Motor Development (3rd Edition) and the Victorian Fundamental Motor Skills Manual, while PMC was assessed with the Pictorial Scale of Perceived Movement Skill Competence. Five ML classification models were trained and tested on an Irish MC dataset (n = 2098, mean age 9.2 ± 2.04) to predict distinct AMC assessment outcomes. The highest prediction accuracies (>85%) were found for the Catch (female and gender-combined subsets) and Bounce (male subset) AMC assessments. These assessments could potentially be removed from the current Irish testing battery for their respective gender groups. Our findings highlight the effectiveness of ML classification in optimising Irish MC assessment procedures, reducing redundancy, and enhancing efficiency. 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: Physical activity is generally recommended, but youth with disabilities present increased sedentary behaviors. This is often due to limited or inaccessible exercise options. The aim of this systematic review was to report on the state of knowledge about the role of adapted physical activity (APA) in improving gross motor performance (query 1), participation and QoL (query 2) of children and adolescents with neurological motor disability. Methods: Pubmed, Scopus and Cinahl databases were enquired in October 2023 and updated in May 2025. Inclusion criteria were the following: any type of physical activity; pediatric subjects with any neuromotor disease; and any type of outcome measure regarding gross motor performance, participation or QoL. The risk of bias (RoB) was assessed by means of ROB 2, Robins-I and JBI tools. Results were synthetized focusing on the outcome measures and the type of activity proposed. Results: Thirteen and seven studies were included relative to queries 1 and 2, respectively. They all were RCTs, and some presented randomization RoB. Several types of APA (e.g., resistance, high-intensity circuit, running, cycling, aquatic and dance training) and of outcome measures were enquired, mostly focusing on subjects with cerebral palsy or Down syndrome. An increased time of moderate-to-vigorous physical activity, improvement in timed functional tests, muscle strength and stability were observed. Conclusions: APA may improve functioning, social participation and promote active lifestyle in pediatric persons with neuromotor disabilities, without adverse effects. In the future, more specific indications based on the functioning profile are advisable to orient professionals to define individualized safe training programs. Full article

Cerebral palsy generates an elevated burden on both patients and health-care systems. Cost-effective therapies such as action observation therapy (AOT), have been proposed to enhance motor performance in these patients. Objective: This systematic review with meta-analysis aimed to evaluate the effectiveness of AOT in children and adolescents with CP and describe its prescription parameters. Results: Fourteen studies involving a total of 393 patients with CP were included. Most studies presented some concerns on risk of bias. Meta-analyses compared AOT to placebo (no motor content) observation and found inconclusive results for the following: unilateral upper limb function (g = 0.565; 95% CI −0.174, 1.305), assisting hand function during bimanual activities (g = 0.200; 95% CI −0.742, 1.143), manual function daily activities (g = −0.022; 95% CI −3.134, 3.090), and hand grip strength (MD (kg) = 1.175; 95% CI −0.280, 2.630). Meta-analysis comparing AOT and physical therapy also yielded inconclusive findings for standing (g = 0.363; 95% CI −5.172, 5.898), as well as the combined dimension of walking, standing, and jumping (g = 0.798; 95% CI −8.821, 10.417) within gross motor function. Conclusions: Current evidence is imprecise and does not support definitive conclusions regarding the effectiveness of AOT over placebo observation, or over physical therapy, on functional outcomes including upper limb, hand, and lower limb functioning parameters. Current findings prevent recommending AOT for its employment in clinical practice. Further evidence is required to draw precise conclusions. Full article

Objective: The objective of this study was to examine 7 years of clinical physical therapy measures in a child with spastic diplegic cerebral palsy (CP) who received multiple botulinum toxin type A (BoNT-A) injections. Methods: A boy diagnosed with spastic diplegic CP, Gross Motor Function Classification System level II, received four episodes of BoNT-A from ages 4 to 10 years. Serial clinical measures of muscle strength, spasticity, lower extremity passive range of motion, gait kinematics, and gross motor function were collected in the gait analysis lab from age 3 to 10 years. Results: After improvements from ages 3 to 7 years, gait and motor function declined from ages 8 to 10 years with no improvement in spasticity or range of motion measurements. Muscle testing and gait kinematics defined a loss of plantarflexion strength. Conclusions: A decline in gross motor skills and gait is not typical for a child with spastic diplegia at age 8 years and its association with BoNT-A injections needs to be considered. This case demonstrates the importance of evaluating treatment outcomes for youth with spastic CP utilizing a set of reliable, and clinically useful measures of strength, spasticity, contracture, gait, and motor function. Critical examination of impairment and functional level measures defines goals, guides treatment, and evaluates outcomes. With this approach, pediatric therapists can empower families to make well-informed decisions. 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

Background/Objective: Children with disabilities experience greater participation restrictions in life activities than children without disabilities. This study aimed to explore differences in participation of children/youth with and without cerebral palsy (CP) across home, school, and community settings, and examine participation of children with CP across gross motor function levels, age groups, gender, and income levels. Methods: This was a cross-sectional survey study of parents of children with CP (n = 20) and without CP (n = 20) over a three-month period to investigate the frequency of participation/level of involvement across settings. Participation was assessed using the Participation and Environment Measure for Children and Youth© (PEM-CY), a parent-report measure for children and youth, ages 5 to 17 that explores communication in home, school, and community environments. Results: Significantly greater frequency of participation at home and in the community was found in children without CP. Participation at school was not significantly different between the groups and there were no differences in level of involvement, gender, or income. In children with CP, motor function impacted participation in home and school, and age significantly influenced school participation. Conclusions: Participation in life activities is important for overall child development, health, and well-being; however, children with CP participate less than their typically developing peers. The ability to collect and analyze the frequency of participation and level of involvement across home, school, and community environments using one outcome measure provides valuable information for programming, intervention planning, and potential environment modifications that could improve participation in children with CP. Full article

Background and Objectives: Brain-computer interface (BCI) technology is revolutionizing stroke rehabilitation by offering innovative neuroengineering solutions to address neurological deficits. By bypassing peripheral nerves and muscles, BCIs enable individuals with severe motor impairments to communicate their intentions directly through control signals derived from brain activity, opening new pathways for recovery and improving the quality of life. The aim of this study was to explore the beneficial effects of BCI system-based interventions on upper limb motor function and performance of activities of daily living (ADL) in stroke patients. We hypothesized that integrating BCI into occupational therapy would result in measurable improvements in hand strength, dexterity, independence in daily activities, and cognitive function compared to baseline. Materials and Methods: An observational study was conducted on 56 patients with subacute stroke. All patients received standard medical care and rehabilitation for 54 days, as part of the comprehensive treatment protocol. Patients underwent BCI training 2–3 times a week instead of some occupational therapy sessions, with each patient completing 15 sessions of BCI-based recoveriX treatment during rehabilitation. The occupational therapy program included bilateral exercises, grip-strengthening activities, fine motor/coordination tasks, tactile discrimination exercises, proprioceptive training, and mirror therapy to enhance motor recovery through visual feedback. Participants received ADL-related training aimed at improving their functional independence in everyday activities. Routine occupational therapy was provided five times a week for 50 min per session. Upper extremity function was evaluated using the Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and dynamometry to assess gross manual dexterity, fine motor skills, and grip strength. Independence in daily living was assessed using the Functional Independence Measure (FIM). Results: Statistically significant improvements were observed across all the outcome measures (p < 0.001). The strength of the stroke-affected hand improved from 5.0 kg to 6.7 kg, and that of the unaffected hand improved from 29.7 kg to 40.0 kg. Functional independence increased notably, with the FIM scores rising from 43.0 to 83.5. Cognitive function also improved, with MMSE scores increasing from 22.0 to 26.0. The effect sizes ranged from moderate to large, indicating clinically meaningful benefits. Conclusions: This study suggests that BCI-based occupational therapy interventions effectively improve upper extremity motor function and daily functions and have a positive impact on the cognition of patients with subacute stroke. Full article

Mesenchymal stromal cells (MSCs) have been under clinical investigation for the treatment of cerebral palsy (CP) for over a decade. However, the field has been limited by study heterogeneity and variable reports of efficacy. We conducted a scoping review of published and registered reports of MSC treatment for CP, with meta-analysis of Gross Motor Function Measure (GMFM) outcomes to summarize research and provide future recommendations. Thirty published reports and 10 registered trials were identified, including 1292 people with CP receiving MSCs. Most received ≥2 doses (72%) of umbilical cord tissue MSCs (75%), intrathecally (40%) or intravenously (38%), and 31% were treated via compassionate/Expanded access. MSC treatment was safe and meta-analyses demonstrated that MSCs conferred significant improvements in GMFM at 3 − (1.05 (0.19–1.92), p = 0.02), 6 − (0.97 (0.30–1.64), p = 0.005) and 12 months (0.99 (0.30–1.67), p = 0.005) post-treatment. Whilst MSCs are safe and improve GMFM outcomes in CP with large effect sizes, study and participant variability continues to confound data interpretation and limits subgroup analyses. With no published Phase 3 trials and high rates of compassionate access, the field would benefit from well-designed trials with unified outcomes. Additionally, data sharing to enable Individual Participant Data Meta-Analysis would support the determination of optimal source, route and dose to progress towards regulatory approval. Full article

Background: Neurobehavioral developmental disorders significantly affect children’s future well-being and contribute to the global disease burden. While prenatal micronutrient supplementation is crucial for fetal neural development, their individual and combined effects on subsequent neurobehavioral outcomes in childhood remain poorly understood. This study aimed to examine the individual and combined effects of prenatal micronutrient supplementation on neurobehavioral developmental disorders in preschool children, and to explore their effects across specific developmental domains. Methods: 15,636 mother-child dyads were recruited from the 2022 children’s survey in Shenzhen, China. Mothers provided information on prenatal supplementation of calcium, folic acid, iron, and multivitamins. Five domains of children’s neurobehavioral functioning were assessed using the Ages and Stages Questionnaire-Third Edition (communication, gross motor, fine motor, problem-solving, and personal-social status). Logistic regression models were used to estimate the effect of micronutrient supplementations on NDDs across crude, adjusted, and full-inclusion models. Combined effects were assessed by multiplicative and additive interactions calculated from crossover analysis. Results: 11.7% of preschool children were identified as at risk for neurobehavioral developmental disorders, with the highest prevalence in the gross motor domain. Prenatal multivitamin supplementation showed a protective effect against neurobehavioral developmental disorders (OR = 0.73, 95% CI = 0.66–0.81). Interaction analysis revealed that the combination of iron and multivitamins further enhanced this protection, with both multiplicative (IOR = 1.26, 95% CI = 1.02–1.57) and additive interactions (RERI = 0.18, 95% CI = 0.02–0.35). The problem-solving domain consistently showed the greatest benefit from the supplementation of these micronutrients individually and in combination. Conclusions: Prenatal multivitamin supplementation reduces the risk of neurobehavioral developmental disorders, especially when combined with iron supplementation. These findings highlight the potential benefits of prenatal co-supplementation strategies to improve neurobehavioral outcomes in offspring. Further studies are recommended to confirm these findings and explore underlying mechanisms. Full article

Background: People with cerebral palsy (CP) present with limitations in gait and functionality, with a great impact on participation. Physiotherapy interventions based on goal-directed training (GDT), treadmill gait training (TGT), and action observation treatment (AOT) showed to be effective for improving functionality, gait and balance in children and adolescents with CP. On the other hand, since COVID-19 lockdown, telecare has an increased role in physiotherapy interventions. The aim of this randomized controlled trial (RTC) is to analyze the effectiveness of a multimodal intervention that combines face-to-face PT sessions of GDT and TGT and online PT sessions of a family-centered education program, which includes AOT activities and is effective to improve participation, gross motor function, gait and balance in children and adolescents with CP. Methods: A single-blinded RCT is proposed for 48 children and adolescents with CP (6–17 years old) who will be randomly allocated into two groups: the experimental group will receive six weeks of a multimodal PT intervention with 12 face-to-face sessions (GDT and TGT) and 6 online sessions of a family-centered telecare EP, which includes AOT activities. Participants in the control group will carry on with their regular PT treatment plus the EP as the experimental group. The outcome variables of participation (CAPE); gait speed and endurance (10 mm/6 mm); gross motor function (GMFM-88-SP); and dynamic and static balance (PBS) will be collected at baseline, after group interventions and 12 weeks from baseline and will be compared following standard principles for RCTs. Conclusions: The implementation of a multimodal PT intervention that combines face-to-face sessions of GDT and TGT and online sessions of a family-centered EP, which includes AOT activities, may be effective to improve participation, gross motor function, gait and balance in children and adolescents with CP. Trial registration: ClinicalTrials.gov with ID: NCT04778930. Full article

Background: Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability and decrease dysplasia in children with neurological disability. Some children with cerebral palsy (CP) are treated with bisphosphonates for bone insufficiency, which leaves a dense growth arrest band in the bone at the time of treatment. The aim of this study was to develop a novel approach to understand the growth and maturation impact on hip development in children with CP using this growth arrest band. Methods: Pelvic radiographs of children with CP Gross Motor Function Classification System (GMFCS) level IV/V treated with bisphosphonate were analyzed. We measured neck–shaft angle (NSA), head–shaft angle (HSA), and migration percentage (MP) based on pamidronate bands (PamMP), NSA based on pamidronate bands (PamNSA), and HSA based on pamidronate bands (PamHSA). These measurements were compared using t-test. Results: Seven children (two GMFCS IV and five GMFCS V) were included. The mean age of the radiographic assessment was 11.4 ± 1.3 (range, 8.6–12.5) years, mean MP 22 ± 7% (range, 13–39%), PamMP 33 ± 7% (range, 18–46%), NSA 151 ± 7° (range, 140–161°), PamNSA 153 ± 4° (range, 142–163°), HSA 164 ± 12° (range, 142–175°), and PamHSA 169 ± 8° (range, 154–175°). MP decreased by 10.5% compared with PamMP (p < 0.001). NSA compared with PamNSA (p = 0.117) and HSA compared with PamHSA (p = 0.325) were not statistically different. Conclusions: This novel assessment method demonstrates that ossification of the lateral acetabulum and femoral head in children with CP GMFCS IV/V from age 8 to 12 years undergoes a mean decrease of 10% MP. A decrease of 10% MP after proximal femoral-guided growth has been reported as a positive outcome. However, based on the current measurements, this may be due to normal development. HSA and NSA remained unchanged. Full article