Search

The article presents abstracts of free papers for the 2011 Annual Meeting of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) which includes the studies on the efficacy of intramuscular Botulinum Toxin A injections (BoNT-A) combined with therapy in children with cerebral palsy (CP), on the integration of three groups of signals during standardized passive movements in lower limb joints, and on the proportion of Norwegian children with CP who received BoNT injections.

An abstract of the article "Baseline findings from a pilot study to evaluate the use of postural support, constructed using Appropriate paper-based technology (APT), to be used with children with Cerebral Palsy in Kenya" by Rachel Lindoewood and others is presented.

The article presents abstracts on topics related to developmental medicine and child neurology, including aetiological risk factors for children with cerebral palsy born at term, children with cerebral palsy and periventricular white matter injury, and risk of hip displacement in young children after acquired brain injury.

Aim: Taping is popular in a variety of paediatric clinical settings. The purpose of this study was to investigate the effectiveness of taping on the rehabilitation of children with cerebral palsy (CP).Method: We used MEDLINE, Embase, PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials as the electronic databases for the review. We reviewed all relevant studies published up to May 2015. We also analysed pertinent secondary references. We used Sackett's Levels of Evidence and the guidelines for critical review of McMaster University to criticize the reviewed articles.Results: Nine papers met the inclusion criteria. Five of these were randomized controlled trials, three were case series, and one was a single case study. Four papers were high quality according to the methodological critical forms of this review, and two of these found that taping was effective in increasing activity in children with CP.Interpretation: Although benefits of taping were found in the population, and functional gains according to the International Classification of Functioning, Disability and Health were obtained, the evidence was not conclusive. Randomized controlled trials with larger sample sizes and with more specific taping procedures are required to strengthen the evidence for the effectiveness of taping on children with CP. [ABSTRACT FROM AUTHOR]

This section presents abstracts of papers on cerebral palsy (CP), including the influence of gait analysis on the decision-making for lower extremity surgery (LES) in children with CP, the relationship of patella alta to dynamic knee position in ambulatory adolescents with CP and the effectiveness of hip adductor surgery in preventing or treating early hip displacement in children with CP.

Aim: To describe the aetiological risk factors, clinical characteristics, access to rehabilitation, and educational status of children with cerebral palsy (CP) in Suriname. Method: Hospital‐based surveillance of children with CP aged younger than 18 years was conducted at the Academic Hospital Paramaribo, Suriname (known as the Suriname CP Register [SUR‐CPR]). Data were collected on sociodemographic characteristics, aetiological risk factors, clinical characteristics, rehabilitation, and educational status. Registry data on aetiological risk factors were compared with available national prevalence rates in Suriname. Descriptive statistics were reported. Results: Between August 2018 and March 2020, 82 children with CP (mean [SD] age 5 years 10 months [3 years 10 months]) attending the Academic Hospital Paramaribo were registered in the SUR‐CPR. The mean (SD) age at diagnosis was 5 years 5 months (4 years 1 month). Spastic CP was predominant in 90.8% of children and 58.8% were classified in Gross Motor Function Classification System levels III to V. Overall, 43.9% had preterm birth compared with 13.9% reported nationally (p < 0.001) and 61.6% had birth‐related complications compared with 15% reported nationally (p < 0.001). Additionally, 39.1% had birth asphyxia and 23.2% had early feeding difficulties. Sixty‐two percent were admitted to the neonatal intensive care unit, 54.0% of whom required ventilation. Most children (82.5%) had CP acquired pre‐ or perinatally and 17.5% had CP acquired postneonatally. Seventeen percent had never received any rehabilitation services, and 31.9% of the school‐aged children were not enrolled in any education system. Interpretation: The high burden of known aetiological risk factors, delayed diagnosis, and severe functional impairment among children with CP registered at the Academic Hospital Paramaribo is concerning. Public health interventions targeting early diagnosis and early intervention could improve the functional outcome of children with CP in Suriname. What this paper adds: Almost half of the children with cerebral palsy (CP) had preterm birth, low birthweight, and signs of birth asphyxia.Most of the children were diagnosed after 5 years of age.Overall, 52.5% of children had severe forms of CP of whom only 36.6% received any assistive devices. What this paper adds: Almost half of the children with cerebral palsy (CP) had preterm birth, low birthweight, and signs of birth asphyxia.Most of the children were diagnosed after 5 years of age.Overall, 52.5% of children had severe forms of CP of whom only 36.6% received any assistive devices. This original article is commented by van der Woerd and Soekhai on pages 1404–1405 of this issue. [ABSTRACT FROM AUTHOR]

The article presents abstracts on topics related to developmental medicine and child neurobiology, including the effectiveness of task-oriented intervention and trunk restraint on the quality of upper limb movement in children with cerebral palsy, the motor proficiency of school-age children with developmental speech and language disorders (DSLD) and geographical variability in the provision of support for families of children with severe disabilities and the factors affecting this variability.

The article presents abstracts on medical topics which include clinical presentation of constipation in children with cerebral palsy, construct validity of the Infant Motor Profile (IMP) and the association between 2D:4D fetal testosterone marker and multidimensional attention in children with attention-deficit-hyperactivity disorder (ADHD).

Aim: To investigate how children with cerebral palsy (CP) perform in the Danish school system and which factors are associated with school performance. Method: This was a population‐based cohort study including 463 126 children born from 1997 to 2003. Data were extracted from seven national registries. The study encompassed 818 children with CP (483 [59.0%] males, 335 [41.0%] females) and 417 731 without CP (214 535 [51.4%] males, 203 196 [48.6%] females). We evaluated two primary outcomes: not completing 10 years of elementary school, defined as attending fewer than eight final mandatory exams; and grade point averages (GPAs). Mann–Whitney U tests were used to analyse differences in GPAs and logistic regressions were used to calculate odds ratios (ORs). Results: Among children with and without CP, 62.6% and 12.4% did not complete elementary school respectively (OR = 11.85 [10.28–13.66]). Additionally, children with CP who attended all final exams achieved lower overall GPAs than children without CP (6.6 vs 7.3, p = 0.001). In children with CP, comorbidities, maternal education, severity of motor impairments, and intellectual deficits were associated with increased odds of not completing elementary school. Notably, one‐third of children with CP with apparent normal intelligence did not complete school, despite special educational measures. Interpretation: Danish children with CP rarely complete elementary school despite initiatives for a more supportive educational system. The complexity of individual needs in children with CP may be challenging for an inclusive school environment. What this paper adds: Children with cerebral palsy (CP) have a high risk of not completing elementary school.Children with CP achieve lower overall grades than children without CP.Motor impairment, comorbidities, and maternal education are associated with poor school performance.Intellectual impairment is the most important predictor of poor school performance. What this paper adds: Children with cerebral palsy (CP) have a high risk of not completing elementary school.Children with CP achieve lower overall grades than children without CP.Motor impairment, comorbidities, and maternal education are associated with poor school performance.Intellectual impairment is the most important predictor of poor school performance. This original article is commented on by Lebeer on pages 1273–1274 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To describe caregiver experiences, perceptions, and device preferences between a modified ride‐on car (MROC) and an Explorer Mini, including perceived changes in participation, barriers, and benefits for young children with cerebral palsy (CP) classified in Gross Motor Function Classification System (GMFCS) level V. Method: A subset of data were analyzed from a larger multisite study. Semi‐structured interviews were conducted with 10 caregivers of children with CP in GMFCS level V across a 16‐week trial with two mobility devices. Each interview was audio‐recorded, transcribed verbatim, and analysed using constant comparison methods. Results: Seven of 10 caregivers preferred the Explorer Mini over the MROC. Four themes emerged. One related to the perceived benefits and barriers of each device (ease and convenience is essential) and three related to perceived changes in participation: (1) autonomy enacted through mobility; (2) belonging and being present; and (3) participation recognized as an area of growth. Interpretation: Despite limited consideration of powered mobility for this population, caregivers of children in GMFCS level V reported similar benefits and barriers compared to children in other GMFCS levels shown in the literature. Particularly, caregivers perceived positive changes in their child's participation and recognized the ability for continued improvements in participation when using powered mobility. What this paper adds: Children with cerebral palsy classified in Gross Motor Function Classification System level V are often excluded from powered mobility use and research.Despite this, caregivers reported positive experiences for their children.Caregivers felt that participation in powered mobility led to increased autonomy and overall sense of inclusion and belonging for their children.Most caregivers preferred the Explorer Mini over the modified ride‐on car but recognized that both devices had benefits and barriers to use. What this paper adds: Children with cerebral palsy classified in Gross Motor Function Classification System level V are often excluded from powered mobility use and research.Despite this, caregivers reported positive experiences for their children.Caregivers felt that participation in powered mobility led to increased autonomy and overall sense of inclusion and belonging for their children.Most caregivers preferred the Explorer Mini over the modified ride‐on car but recognized that both devices had benefits and barriers to use. This original article is commented on by Jahan and Islam on pages 276–277 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To establish the burden of respiratory illness in cerebral palsy (CP) on the Western Australian health care system by quantifying the costs of respiratory hospitalizations in children with CP, compared with non‐respiratory hospitalizations. Method: A 2‐year (2014–2015) retrospective study using linked hospital data (excluding emergency department visits), in a population of children with CP in Western Australia aged 18 years and under (median age at hospitalization 7 years; interquartile range 5–12 years). Results: In 671 individuals (57% male) there were 726 emergency hospitalizations, and 1631 elective hospitalizations. Although there were more elective hospitalizations, emergency hospitalizations were associated with longer stays in hospital, and more days in an intensive care unit, resulting in a higher total cost of emergency hospitalizations than elective hospitalizations (total costs: emergency AU$7 748 718 vs elective AU$6 738 187). 'Respiratory' was the leading cause of emergency hospitalizations, contributing to 36% of all emergency admission costs. For a group of high‐cost inpatient users (top 5% of individuals with the highest total inpatient costs) the most common reason for hospitalization was 'respiratory'. Where non‐respiratory admissions were complicated by an additional respiratory diagnosis, length of stay was greater. Interpretation: Respiratory hospitalizations in CP are a significant driver of health care costs. In the paediatric group, they are a burden for a subgroup of children with CP. What this paper adds: Respiratory illness is the most costly area for unplanned, emergency hospitalizations for children and young people with cerebral palsy.The top 5% of individuals with the highest total inpatient costs account for a disproportionate amount of health care costs. What this paper adds: Respiratory illness is the most costly area for unplanned, emergency hospitalizations for children and young people with cerebral palsy.The top 5% of individuals with the highest total inpatient costs account for a disproportionate amount of health care costs. [ABSTRACT FROM AUTHOR]

Aim: To better understand parents' beliefs about causation in cerebral palsy (CP) and the emotions related to those beliefs. Method: We surveyed 226 parents of children with CP aged 1 to 18 years, recruited from the Victorian Cerebral Palsy Register, to evaluate their beliefs about the causes of CP, including genetic causes, causes specific to their own child, and their attitudes and emotions in relation to these. Results: Although 92% of participants reported that understanding the causes of their child's CP was important, uncertainty about the cause was expressed by 13%. The most frequently endorsed causal factors, in general and in their own child respectively, were intrapartum hypoxia (81%, 36%) or brain damage (69%, 22%), brain damage during pregnancy (73%, 28%), and preterm birth (66%, 28%). Genetic causes were deemed relevant by 13% of participants and hospital or professional error by 16%. Parents shared related feelings of anger (59%), sadness (80%), guilt (61%), and confusion (53%); parental anger was more likely when their child's CP was attributed to intrapartum events. Interpretation: Substantial parental interest in understanding the causes of CP, together with uncertainty about the causes, parents' causal attributions, and significant emotional sequelae, highlight a strong need for provision of information and support for families of children recently diagnosed with CP. What this paper adds: Understanding the causes of their child's cerebral palsy (CP) was important to parents.Parents most often endorsed intrapartum factors as a cause of CP.Parents reported experiencing strong emotions about the causes of their child's CP. What this paper adds: Understanding the causes of their child's cerebral palsy (CP) was important to parents.Parents most often endorsed intrapartum factors as a cause of CP.Parents reported experiencing strong emotions about the causes of their child's CP. This original article is commented on by Vasyutin on page 148 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To validate a novel equation to estimate weight from mid‐upper arm circumference (MUAC) among children with cerebral palsy (CP) in rural Bangladesh. Method: Children with CP aged 2 to 18 years registered in the Bangladesh CP Register were randomly selected. Data on sociodemographics, Gross Motor Function Classification System level, and anthropometric measurements were extracted. Bland–Altman plots with a 95% agreement limit and Lin's concordance correlation coefficient with 95% confidence intervals (CI) were reported to measure agreement between observed and estimated weight. Percentage error was used to determinate the method's accuracy. Results: There were 497 participants with a mean age at assessment of 9 years (SD 4 years 11 months) (47.7% female). Lin's concordance correlation coefficient between the observed and estimated weights was 0.90 (95% CI 0.89–0.92). Bland–Altman plots showed a reasonable accuracy of the equation in the study cohort. The mean percentage error of the equation was 5.04%. The average difference between observed and estimated weights was −1.02 kg (SD 5.1). The differences between observed and estimated weights were significantly greater among children with weight‐for‐age, height‐for‐age, or BMI‐for‐age z‐scores less than or equal to −4. Interpretation: It is possible to predict the weight of children with CP from MUAC with sufficient accuracy. The equation can be used for populations in low‐resources and low‐ and middle‐income countries. What this paper adds: The equations predict the weight of children with cerebral palsy from their mid‐upper arm circumference reasonably accurately.The difference between observed and estimated weights ranged between 0 kg and ± 5 kg in 81.5% of children.Sex and Gross Motor Function Classification System level did not affect the accuracy of the equations.The equations were less accurate for estimating the weight of severely undernourished children. What this paper adds: The equations predict the weight of children with cerebral palsy from their mid‐upper arm circumference reasonably accurately.The difference between observed and estimated weights ranged between 0 kg and ± 5 kg in 81.5% of children.Sex and Gross Motor Function Classification System level did not affect the accuracy of the equations.The equations were less accurate for estimating the weight of severely undernourished children. [ABSTRACT FROM AUTHOR]

Aim: To develop a core set of outcome domains to be measured in clinical studies on lower limb orthopaedic surgery for ambulant children with cerebral palsy (CP) that represents the priorities of an international multi‐stakeholder group (children, parent/carers, and health professionals). Method: Potential outcome domains were identified through literature review and qualitative interviews with key stakeholders. These were scored in an international two‐round Delphi survey, using a 9‐point Likert scale. A final consensus meeting with key stakeholders agreed on the most important outcome domains and refined the core outcome set (COS). Results: One hundred and sixty‐one health professionals and 36 individuals with CP and their parents/carers rated 21 of 41 outcomes as important in the Delphi survey. The final consensus group agreed 19 outcomes within eight domains to be included in the final COS: pain and fatigue, lower limb structure, motor function, mobility (daily life activities), gait‐related outcomes, physical activity, independence, and quality of life. Interpretation: A COS for lower limb orthopaedic surgery for children with CP was developed. Incorporating this in the design of future clinical studies will provide a more holistic assessment of the impact of treatment while allowing meaningful comparisons and future synthesis of results from primary studies. What this paper adds: Eight core outcome domains were identified as important to measure in future clinical research.Key stakeholders perceived pain, balance and fall, and independence as very important outcomes.Six contextual factors were identified as essential in surgical decision‐making. What this paper adds: Eight core outcome domains were identified as important to measure in future clinical research.Key stakeholders perceived pain, balance and fall, and independence as very important outcomes.Six contextual factors were identified as essential in surgical decision‐making. This original article is commented on by Shrader on pages 153–154 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To investigate spoken language comprehension (SLC), single‐word comprehension (SWC), functional communication development, and their determinants, in children with cerebral palsy. Method: This was a prospective cohort study in the Netherlands spanning 2 years 6 months. The main outcomes were SLC and SWC, assessed by the Computer‐Based instrument for Low motor Language Testing (C‐BiLLT) and the Peabody Picture Vocabulary Test‐III‐NL (PPVT‐III‐NL) respectively; and functional communication, measured by a subscale of the Focus on the Outcomes of Communication Under Six‐34 (FOCUS‐34). Linear mixed models were used to determine developmental trajectories, which were compared with norm and reference data. Potential determinants, for example intellectual functions, speech production, functional communication level (classified with the Communication Function Classification System, CFCS), and functional mobility, were added to assess their effects. Results: Children with cerebral palsy (n = 188; mean age 59 months, range 17–110) were monitored for 2 years 6 months. Developmental trajectories for SLC (C‐BiLLT) and SWC (PPVT‐III‐NL) were nonlinear; those for functional communication (FOCUS‐34) were linear. Compared with norm and reference groups, significantly delayed SLC, SWC, and functional communication development were found. Determinants for SLC and SWC were intellectual functions and functional communication level (CFCS); and for functional communication development (FOCUS‐34), speech production and arm–hand functioning. Interpretation: Children with cerebral palsy showed delayed SLC, SWC, and functional communication development compared with norm and reference groups. Remarkably, functional mobility was not associated with the development of SLC, SWC, or functional communication. What this paper adds: Children with cerebral palsy have delayed spoken language comprehension (SLC), single‐word comprehension (SWC), and functional communication development, compared to norm and reference data.Determinants for SLC and SWC development are intellectual functions and functional communication level.Determinants for functional communication development are speech production and arm–hand functioning.Functional mobility is not associated with SLC, SWC, or functional communication. What this paper adds: Children with cerebral palsy have delayed spoken language comprehension (SLC), single‐word comprehension (SWC), and functional communication development, compared to norm and reference data.Determinants for SLC and SWC development are intellectual functions and functional communication level.Determinants for functional communication development are speech production and arm–hand functioning.Functional mobility is not associated with SLC, SWC, or functional communication. Video Podcast: https://youtu.be/x09Tac7tsz0 [ABSTRACT FROM AUTHOR]

Aim: To describe the clinical course of pain intensity in individuals with cerebral palsy (CP) resulting from usual care or specific interventions. Method: We conducted an exploratory prognostic systematic review searching electronic databases from inception to 31st December 2021. Evidence from low and moderate risk‐of‐bias studies was synthesized. Results: We retrieved 2275 citations; 18 studies met the inclusion criteria and 10 were synthesized. The course of pain intensity in children with CP receiving usual care was stable over 15 weeks (χ2[2] = 1.8, p = 0.5). Children who received continuous intrathecal baclofen (CITB) reported significant pain intensity reduction (visual analogue scale [VAS] = −4.2 out of 10, 95% confidence interval [CI] = −6.3 to −2.1]) 6 months postinsertion but similar children receiving usual care had no significant change over 6 months (VAS = 1.3 out of 10, 95% CI = −1.3 to 3.6). Children receiving botulinum neurotoxin A (BoNT‐A) injections had significant decreases in pain after 1 month (numeric rating scale = −6.5, 95% CI = −8.0 to −5.0). Adults with chronic pain receiving usual care reported stable pain intensity over time; pain intensity improved in ambulatory adults exercising and those treated surgically for cervical myelopathy. Interpretation: The course of pain intensity in individuals with CP is unclear. Evidence suggests that children and adults receiving usual care had stable pain intensity over the short or long term. Interventions (CITB and BoNT‐A in children and exercise and surgical treatment for cervical myelopathy in adults) had pain intensity reduction. Larger study samples are needed to confirm these results. What this paper adds: Pain intensity was stable in children with cerebral palsy (CP) receiving usual care.Adults with CP and chronic pain receiving usual care had stable, persistent pain intensity.Children receiving continuous intrathecal baclofen via pump and botulinum neurotoxin A reported significantly lower pain intensities.Adults with chronic pain and dyskinetic CP and cervical myelopathy reported significantly lower pain intensity with exercise or cervical decompression.Limited high‐quality evidence exists describing non‐procedural pain changes in individuals with CP. What this paper adds: Pain intensity was stable in children with cerebral palsy (CP) receiving usual care.Adults with CP and chronic pain receiving usual care had stable, persistent pain intensity.Children receiving continuous intrathecal baclofen via pump and botulinum neurotoxin A reported significantly lower pain intensities.Adults with chronic pain and dyskinetic CP and cervical myelopathy reported significantly lower pain intensity with exercise or cervical decompression.Limited high‐quality evidence exists describing non‐procedural pain changes in individuals with CP. [ABSTRACT FROM AUTHOR]

Aim: To compare the risks of adverse events 3 months after Onabotulinumtoxin‐A and Lanbotulinumtoxin‐A injections in children with cerebral palsy (CP) and to identify risk factors and associations. Method: A total of 1037 children (682 males, 355 females; mean age 5 years 2 months [SD 3 years]; age range 2 years–17 years 10 months) with CP underwent 1013 Onabotulinumtoxin‐A injections and 418 Lanbotulinumtoxin‐A injections from 2012 to 2021. Information was recorded in a purpose‐built database. Results: The adverse event rates of Onabotulinumtoxin‐A and Lanbotulinumtoxin‐A were reported as 13.92% and 11.96% respectively. Most adverse events were mild and self‐limiting. Children in Gross Motor Function Classification System (GMFCS) levels IV to V had a higher risk of adverse events than those in GMFCS levels I to III (odds ratio [OR] [95% confidence interval {CI}] = 3.65 [1.56, 5.40], p < 0.01). The history of recent illness and higher dose increased the likelihood of adverse events (OR [95% CI] = 2.00 [1.55, 3.00] and 2.20 [1.53, 3.07] respectively, p < 0.01). Sex, age, and the number of injections had no significant effect on adverse event rates (p > 0.05). The incidence of upper respiratory tract infection and lower respiratory tract infection after injections was weakly correlated with the incidence before injections (r = 0.36 and r = 0.27 respectively, p < 0.01). Interpretation: Occurrence of adverse events was similar between Onabotulinumtoxin‐A and Lanbotulinumtoxin‐A in children with CP. Dose, GMFCS level, and health background were risk factors. What this paper adds: The prevalence of adverse events was similar between Onabotulinumtoxin‐A and Lanbotulinumtoxin‐A in children with cerebral palsy (CP).The prevalence of adverse events increased with the severity of CP and the injected dose.Sex, age, and number of injections had no significant effect on the prevalence of adverse events. What this paper adds: The prevalence of adverse events was similar between Onabotulinumtoxin‐A and Lanbotulinumtoxin‐A in children with cerebral palsy (CP).The prevalence of adverse events increased with the severity of CP and the injected dose.Sex, age, and number of injections had no significant effect on the prevalence of adverse events. This original article is commented on by Hastings‐Ison and Graham on pages 10–11 of this issue. [ABSTRACT FROM AUTHOR]

Aim Method Results Interpretation To map the ingredients of non‐invasive interventions provided to young ambulant children with cerebral palsy.Articles were screened and each study's characteristics extracted. The intervention ingredients were described in terms of the Rehabilitation Treatment Specification System and linked to the ‘F‐words’. Results were interpreted and validated by a patient and public involvement group.Sixty‐one papers were included, of which 55.5% were classified as randomized controlled trial design studies. The selected studies included a total of 2187 children (mean age range 3 months to 5 years 11 months), most from high‐income countries. The included studies investigated a total of 27 interventions, which together presented ingredients representing all F‐words, in the following order of frequency: ‘fitness’ (e.g. strength and endurance training), ‘functioning’ (e.g. active and repetitive practice of a task), ‘family’ (e.g. context‐focused therapy), ‘fun’ (e.g. inclusion of child‐friendly activities), ‘friends’ (e.g. group activities), and ‘future’ (e.g. didactic information sharing). Thus, ingredients related to the F‐word ‘future’ were the most infrequently reported.Therapists and families need to be aware of the most appropriate match between the F‐word goals, ingredients, and targets. Finally, ‘fun’, ‘friends’, and ‘future’ should be addressed as potential outcomes in future studies. [ABSTRACT FROM AUTHOR]

Aim: To investigate the efficacy of aerobic exercise on the functioning (participation, activities, and body functions and structures) and quality of life (QoL) of children and adolescents with cerebral palsy (CP). Method: A systematic review with meta‐analysis was performed. A comprehensive search of articles was performed using the electronic databases Embase, PubMed, PEDro, and CINAHL. Methodological quality and certainty of evidence were evaluated with the PEDro and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scales respectively. The effects of aerobic exercise on functioning were assessed using meta‐analytic techniques. However, given the broad nature of outcomes related to functioning and QoL, different instruments can be used to measure them; this made it impossible to synthesize results in a meta‐analysis for some of the outcomes. Results: Fifteen randomized controlled trials with 414 participants with CP were included. Analysis of the methodological quality of the studies revealed a low risk of bias. The effect of aerobic exercise compared to usual care or other interventions was significant for aerobic capacity (standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.16–1.47; p < 0.002; I2 = 68%), gross motor function (SMD = 0.70; 95% = CI 0.21–1.19; p = 0.005; I2 = 49%), mobility (SMD = 0.53; 95% CI = 0.05–1.05; p = 0.03; I2 = 27%), balance, and participation (SMD = 0.74; 95% CI = 0.10–1.39; p = 0.02; I2 = 0%). Aerobic exercise was not effective for muscle strength, spasticity, gait parameters, and QoL (p > 0.05). The certainty of evidence for most comparisons was moderate to low. Interpretation: This review provides the most up‐to‐date evidence on the efficacy of aerobic exercise on the functioning and QoL of children and adolescents with CP. What this paper adds: Aerobic exercise improves gross motor function but not gait parameters in cerebral palsy (CP).It improves participation but not quality of life in children and adolescents with CP.It is more effective than usual care or other interventions in improving mobility, aerobic capacity, and balance in CP.It is no more effective than usual care or other interventions in improving muscle strength and spasticity. [ABSTRACT FROM AUTHOR]

Aim: To estimate the burden of disease and evaluate which factors affect health care resource use (HCRU) in young children with cerebral palsy (CP). Method: Data were collected as part of a prospective, longitudinal cohort study of children with CP born in Queensland, Australia between 2006 and 2009. HCRU questionnaires were administered at six time points. Data on resource use, socio‐demographics, and disease severity were collected. Costs were sourced from Medicare, the Australian National Hospital Cost Data Collection, and market prices. A generalized linear model was used to identify factors influencing CP‐related costs. Results: A total of 794 questionnaires were completed by 222 participants (mean = 3.6 per participant). Physiotherapy (94%, n = 208) was the most widely accessed allied health care therapy; almost half of the participants (45%; 354 of 794) reported one or more hospital admissions. From the health care funder perspective, a child with CP costs on average A$24 950 per annum (A$12 475 per 6 months). Higher costs were associated with increased motor impairment (Gross Motor Function Classification System, p < 0.001) and increased comorbidities (p = 0.012). Interpretation: HCRU in preschool children with CP can be analysed according to disease severity. Both increased motor impairments and increased comorbidities were associated with higher health care costs. What this paper adds: Children with a higher number of comorbidities had higher health care costs, and more specifically, higher hospitalization costs.No significant change in costs was found over time as children aged from 18 months to 5 years. [ABSTRACT FROM AUTHOR]

Aim: To investigate the prevalence and clinical manifestations of reading, writing, and mathematics disorders in children with cerebral palsy (CP). We explored how the clinical profile of these children differed from those with specific learning disorders (SLDs), taking into account several factors, particularly IQ scores, neuropsychological aspects, and the presence of a visual impairment. Method: A prospective cross‐sectional study was conducted in 42 children with CP (mean age 9 years 8 months; SD = 2 years 2 months) and 60 children with SLDs (mean age 10 years; SD = 1 year 7 months). Clinical characteristics, neuromotor and cognitive profiles, neuropsychological aspects (speech performance, academic skills, visual attention, phonological awareness, working memory), and signs of visual impairment (visual acuity, contrast sensitivity, visual field, oculomotor functions) were assessed. A machine learning approach consisting of a random forest algorithm, where the outcome was the diagnosis and the covariates were the clinical variables collected in the sample, was used for the analyses. Results: About 59% of the children with CP had reading, writing, or mathematics disorders. Children with CP with learning disorders had a low performance IQ, normal phonological awareness, and working memory difficulties, whereas children with SLDs had normal performance IQ, impaired phonological awareness, and mild working memory difficulties. There were no differences in verbal IQ between the two groups. Interpretation: Learning disorders are frequently associated with CP, with different clinical characteristics, compared with SLDs. Assessment of academic skills is mandatory in these children, even if the IQ is normal. At school age, specific interventions to promote academic skills in children with CP could be a major rehabilitative goal. What this paper adds: Reading, writing, and mathematics disorders in cerebral palsy have specific clinical characteristics.Their underlying mechanisms differ from those described in specific learning disorders.Working memory impairment can be considered a hallmark of learning disorders in children with cerebral palsy. [ABSTRACT FROM AUTHOR]

Aim: To investigate clinicoradiological features associated with epilepsy, its resolution, and drug resistance in children with cerebral palsy (CP). Method: Data were gathered from the New South Wales/Australian Capital Territory CP Register, encompassing children with CP born between 2003 and 2015 (n = 1916). Clinical features and the severity of impairments were compared among three groups: children with current epilepsy (n = 604), those with resolved epilepsy by age 5 years (n = 109), and those without epilepsy (n = 1203). Additionally, a subset of the registry cohort attending Children's Hospital Westmead (n = 256) was analysed to compare epilepsy and treatment characteristics between drug‐responsive (n = 83) and drug‐resistant groups (n = 147) using logistic regression and hierarchical cluster analysis. Results: Manual Ability Classification System levels IV and V, intellectual impairment, and vision impairment were found to be associated with epilepsy in children with CP on multivariable analysis (p < 0.01). Moderate to severe intellectual impairment and bilateral spastic CP were independent positive and negative predictors of epilepsy persistence at the age of 5 years respectively (p < 0.05). Microcephaly and multiple seizure types were predictors of drug‐resistant epilepsy (area under the receiver operating characteristic curve of 0.83; 95% confidence interval 0.77–0.9). Children with a known genetic cause (14%) and CP epilepsy surgery group (4.3%) formed specific clinical subgroups in CP epilepsy. Interpretation: Our study highlights important clinical associations of epilepsy, its resolution, and treatment response in children with CP, providing valuable knowledge to aid in counselling families and identifying distinct prognostic groups for effective medical surveillance and optimal treatment. What this paper adds: Severe motor and non‐motor impairments in cerebral palsy (CP) increase epilepsy risk.Epilepsy more likely resolves in bilateral spastic and milder CP impairments.Epilepsy in CP often manifests at an early age with multiple seizure types and high drug resistance.Children with a known genetic cause and CP epilepsy surgery group represent distinct clinical subgroups. [ABSTRACT FROM AUTHOR]

Aim: To explore the perceptions of parents of children with cerebral palsy (CP) participating in a modified sports intervention, Sports Stars Brazil. Method: Parents of children with CP (n = 15, 6–12 years old, nine males, six females), classified in Gross Motor Function Classification System levels I and II, who participated in the Sports Stars Brazil intervention, were recruited for this descriptive qualitative study. Children received the 8‐week (1 hour per week) modified sports intervention. After the intervention, parents participated in a focus group. The F‐word (fitness, family, fun, functioning, friends, and future) interpretation of the International Classification of Functioning, Disability and Health was used to guide the discussion. Participants were invited to report their experience of participating in the intervention using the F‐words for a childhood disability model. Transcripts were coded using content analysis. Results: Parents reported positive experiences of the Sports Stars Brazil intervention, including a decrease in sedentarism (fitness), improvement of motor skills (functioning), greater connection between child and family (family), better socialization (friends), increased participation in pleasurable activities (fun), and awareness of the importance of physical activity (future). All positive experiences were interconnected. Interpretation: This study presents the ability of the Sports Stars Brazil intervention to integrate all aspects of functioning and supports its role as an engaging and promising intervention option for ambulant children with CP. What this paper adds: The parents of children participating in Sports Stars Brazil perceived benefits across all F‐words.This modified sports intervention integrated all F‐words into one concept. [ABSTRACT FROM AUTHOR]

Aim: To evaluate mammillary body abnormalities in school‐age children without cerebral palsy treated with therapeutic hypothermia for neonatal hypoxic–ischaemic encephalopathy (cases) and matched controls, and associations with cognitive outcome, hippocampal volume, and diffusivity in the mammillothalamic tract (MTT) and fornix. Method: Mammillary body abnormalities were scored from T1‐weighted magnetic resonance imaging (MRI) in 32 cases and 35 controls (median age [interquartile range] 7 years [6 years 7 months–7 years 7 months] and 7 years 4 months [6 years 7 months–7 years 7 months] respectively). Cognition was assessed using the Wechsler Intelligence Scale for Children, Fourth Edition. Hippocampal volume (normalized by total brain volume) was measured from T1‐weighted MRI. Radial diffusivity and fractional anisotropy were measured in the MTT and fornix, from diffusion‐weighted MRI using deterministic tractography. Results: More cases than controls had mammillary body abnormalities (34% vs 0%; p < 0.001). Cases with abnormal mammillary bodies had lower processing speed (p = 0.016) and full‐scale IQ (p = 0.028) than cases without abnormal mammillary bodies, and lower scores than controls in all cognitive domains (p < 0.05). Cases with abnormal mammillary bodies had smaller hippocampi (left p = 0.016; right p = 0.004) and increased radial diffusivity in the right MTT (p = 0.004) compared with cases without mammillary body abnormalities. Interpretation: Cooled children with mammillary body abnormalities at school‐age have reduced cognitive scores, smaller hippocampi, and altered MTT microstructure compared with those without mammillary body abnormalities, and matched controls. What this paper adds: Cooled children are at higher risk of mammillary body abnormalities than controls.Abnormal mammillary bodies are associated with reduced cognitive scores and smaller hippocampi.Abnormal mammillary bodies are associated with altered mammillothalamic tract diffusivity. [ABSTRACT FROM AUTHOR]

Aim: To examine nutritional screening methods for children and adolescents with cerebral palsy. Method: A scoping review was performed using established methodologies. In June 2020 we searched PubMed, Embase, CINAHL Complete, and the Cochrane Central Register of Controlled Trials to identify articles on tools/methods for nutritional screening of our target groups. Results: Thirty studies were included, containing various tools/methods used to identify under‐ and/or overnutrition by weight/height, circumferences, skinfolds, questionnaires, and/or technically advanced or invasive methods. Questionnaires, weight/height, circumferences, and skinfolds were considered feasible based on clinical utility, whereas bioelectrical impedance analysis and blood samples were not. Interpretation: We identified two screening tools for undernutrition that include no physical measurements, but did not find any screening tools for overweight and obesity. Most of the studies recommended one or more methods, indicating that determining nutritional status most likely includes a combination of methods, not all of which may be feasible in clinical practice. What this paper addsNo nutritional screening tool using anthropometry or body composition was discovered.Heterogenous methods to identify under‐ and/or overnutrition are recommended.Preferable methods for nutritional screening include assessment of body composition.A validated nutritional screening tool for identification of overweight is warranted. What this paper adds: No nutritional screening tool using anthropometry or body composition was discovered.Heterogenous methods to identify under‐ and/or overnutrition are recommended.Preferable methods for nutritional screening include assessment of body composition.A validated nutritional screening tool for identification of overweight is warranted. [ABSTRACT FROM AUTHOR]

Aim: To investigate if a sit‐to‐stand exercise programme for children with cerebral palsy (CP) would improve self‐care and mobility. Method: Thirty‐eight children with CP (19 males, 19 females; mean age 8y 0mo, SD 2y 4mo, age range 4y 0mo–12y 4mo) classified in Gross Motor Function Classification System (GMFCS) levels III and IV and their caregivers were randomly allocated to sit‐to‐stand training plus routine physiotherapy (balance and gait training) or routine physiotherapy only (controls). Task‐specific sit‐to‐stand training was completed five times a week for 6 weeks under physiotherapist (twice weekly) and caregiver (three times weekly) supervision. Blinded outcome assessments at week 7 were the self‐care and mobility domains of the Functional Independence Measure for Children, Five Times Sit‐to‐Stand Test (FTSST), and Modified Caregiver Strain Index (MCSI). Results: The sit‐to‐stand group self‐care increased by 2.2 units (95% confidence interval [CI] 1.3–3.1) and mobility increased by 2.2 units (95% CI 1.4–3.0) compared to the control group. In the sit‐to‐stand group, the FTSST was reduced by 4.0 seconds (95% CI −4.7 to −3.2) and the MCSI was reduced by 0.8 units (95% CI −1.2 to −0.4) compared to the control group. Interpretation: A sit‐to‐stand exercise programme for children with CP classified in GMFCS levels III and IV improved sit‐to‐stand performance and resulted in small improvements in self‐care and mobility, while reducing caregiver strain. What this paper addsSit‐to‐stand training improved independence in self‐care and mobility for children with cerebral palsy (CP).Home‐based sit‐to‐stand training programmes for children with CP can reduce the burden on supervising caregivers. What this paper adds: Sit‐to‐stand training improved independence in self‐care and mobility for children with cerebral palsy (CP).Home‐based sit‐to‐stand training programmes for children with CP can reduce the burden on supervising caregivers. [ABSTRACT FROM AUTHOR]

Aim: To outline the development and examine the content and construct validity of a new tool, the Dyskinetic Cerebral Palsy Functional Impact Scale (D‐FIS), which measures the impact of dyskinesia on everyday activities in children with cerebral palsy (CP). Method: D‐FIS content was informed by a systematic review of dyskinesia outcome measures, in collaboration with children with dyskinetic CP, parents, caregivers, and expert clinicians. The D‐FIS uses parent proxy to rate impact of dyskinesia on everyday activities. Construct validity was determined by examining internal consistency; known groups validity with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), and Eating and Drinking Ability Classification System (EDACS); and convergent validity with the Barry‐Albright Dystonia Scale (BADS). Results: Fifty‐seven parents of children (29 males, 28 females, mean [SD] age 11y 8mo [4y 4mo], range 2y 6mo–18y) completed the D‐FIS. Correlation between D‐FIS and GMFCS was r=0.86 (95% confidence interval [CI]: 0.77–0.91, p<0.001); MACS r=0.84 (95% CI: 0.73–0.90, p<0.001); CFCS r=0.80 (95% CI: 0.67–0.88, p<0.001); and EDACS r=0.78 (95% CI: 0.66–0.87). Correlation between D‐FIS and BADS was r=0.77 (95% CI: 0.64–0.86, p<0.001). Cronbach's alpha was 0.96. Interpretation: The D‐FIS demonstrates good construct validity and high internal consistency. The D‐FIS will be useful for identifying priorities for intervention. It adds to the measurement tool kit for children with dyskinetic CP by addressing functional impact of dyskinetic movements and postures. What this paper addsThe Dyskinetic Cerebral Palsy Functional Impact Scale (D‐FIS) assesses the perceived impact of dyskinesia on daily activities in children with cerebral palsy (CP).The D‐FIS demonstrates good construct validity and high internal consistency.The D‐FIS is a clinically feasible, family‐centred tool that fills a current gap in the dyskinetic CP assessment toolkit. What this paper adds: The Dyskinetic Cerebral Palsy Functional Impact Scale (D‐FIS) assesses the perceived impact of dyskinesia on daily activities in children with cerebral palsy (CP).The D‐FIS demonstrates good construct validity and high internal consistency.The D‐FIS is a clinically feasible, family‐centred tool that fills a current gap in the dyskinetic CP assessment toolkit. This original article is commented by Himmelmann on page 1370 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To describe the development of hand use during bimanual activities among children with unilateral cerebral palsy (CP). Method: A cohort of 166 children (79 females, 87 males; age range 18mo–13y, mean [SD] age at first assessment 37.6mo [20.5mo]) with unilateral CP, registered in the Norwegian CP Follow‐up Program with two or more Assisting Hand Assessments (AHAs), were included in this longitudinal study comprising 524 AHAs. Developmental limits and rates were estimated by non‐linear mixed effects models and compared between a stable limit model (SLM) and a peak and decline model. Development was described according to Manual Ability Classification System (MACS) levels and AHA performance at 18 months of age (AHA‐18). Results: Children in MACS level I, or in the high AHA‐18 group, reached highest limits and had the most rapid development (p<0.001). The developmental trajectories were different between MACS levels I, II, and III and between the high, moderate, and low AHA‐18 groups. Seventy‐five per cent of the children reached 90% of their estimated limit at 5 years 10 months or earlier. The SLM showed the best model fit (Akaike information criterion: 4008.99). Interpretation: Most children approached a steady performance limit before 6 years of age. Although children in MACS levels I and II reached 90% of the expected limit at 3 and 4 years respectively, the corresponding age was 8 years for children in MACS level III. The better model fit for the SLM indicates that children with unilateral CP maintain their attained limit of hand use to at least the age of 13 years. What this paper addsDevelopment of hand use between 18 months and 13 years follows a stable‐limit pattern.Most children reach a steady limit on the Assisting Hand Assessment before 6 years of age.Manual Ability Classification System levels I, II, and III represent distinct developmental trajectories, level III having a slower rise.Early hand use is an important indicator of future development. What this paper adds: Development of hand use between 18 months and 13 years follows a stable‐limit pattern.Most children reach a steady limit on the Assisting Hand Assessment before 6 years of age.Manual Ability Classification System levels I, II, and III represent distinct developmental trajectories, level III having a slower rise.Early hand use is an important indicator of future development. [ABSTRACT FROM AUTHOR]

Aim: To analyse the efficacy of Nintendo Wii therapy (NWT) on functional balance in children with cerebral palsy (CP). Method: A systematic review with meta‐analysis (PROSPERO identification number CRD42020169510) was performed using randomized controlled trials (RCTs) that examined the effect of NWT on functional, dynamic, and static balance in children with CP, assessed with the Pediatric Balance Scale, the Timed Get Up and Go Test, and the One Leg Stance Test respectively. The pooled effect was calculated using the Cohen's standardized mean difference (SMD). Results: Eleven RCTs with 270 children (when sex was reported: 43% females, 57% males) with CP (mean age [SD] 10y 1mo [1y 1mo], range 5–16y) were included. On functional balance, we found very low‐quality evidence with a large effect of NWT compared with no intervention (SMD 0.95, 95% confidence interval [CI] 0.02–1.89) and moderate‐quality evidence for using NWT plus conventional physical therapy (CPT) versus CPT (SMD 0.78, 95% CI 0.20–1.35) in sessions of approximately 30 minutes (SMD 0.86, 95% CI 0.20–1.52) and interventions lasting longer than 3 weeks (SMD 1.03, 95% CI 0.58–1.47). For dynamic balance, very low‐quality evidence for a medium effect for using NWT plus CPT versus CPT (SMD 0.70, 95% CI 0.12–1.29) was found. Interpretation: NWT can be considered an effective treatment for improving functional and dynamic balance in children with CP, especially when combined with CPT in 30‐minute sessions with interventions lasting longer than 3 weeks. What this paper addsModerate‐quality evidence with a large effect of Nintendo Wii therapy (NWT) on functional balance, compared with conventional physical therapy (CPT).Moderate‐quality evidence with medium effect of NWT plus CPT on functional and dynamic balance, compared with CPT.Appropriate NWT sessions should be equal to or slightly less than 30 minutes.NWT interventions must be longer than 3 weeks. What this paper adds: Moderate‐quality evidence with a large effect of Nintendo Wii therapy (NWT) on functional balance, compared with conventional physical therapy (CPT).Moderate‐quality evidence with medium effect of NWT plus CPT on functional and dynamic balance, compared with CPT.Appropriate NWT sessions should be equal to or slightly less than 30 minutes.NWT interventions must be longer than 3 weeks. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions. Method: A comprehensive search of 22 databases identified eligible systematic reviews with and without meta‐analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews‐2 (AMSTAR‐2) to appraise methodological quality. Results: Eighty‐three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR‐2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR‐2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. Interpretation: Most of these systematic reviews are considered unreliable according to AMSTAR‐2. Current recommendations for treating children with CP based on these flawed systematic reviews need re‐evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high‐level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper addsConfidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP).Quality issues in the sample were not limited to systematic reviews of non‐randomized trials, or to those about certain populations of CP or interventions.The inclusion of meta‐analysis did not improve the level of confidence in these systematic reviews.Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve. What this paper adds: Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP).Quality issues in the sample were not limited to systematic reviews of non‐randomized trials, or to those about certain populations of CP or interventions.The inclusion of meta‐analysis did not improve the level of confidence in these systematic reviews.Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve. This original article is commented by Negrini et al. on page 1244 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To describe: (1) the frequency and types of sleep problems, (2) parent‐rated satisfaction with their child's and their own sleep, and (3) child factors related to the occurrence of sleep problems in children with cerebral palsy (CP) and their parents. The secondary objective was to compare the sleep outcomes of children with CP with those from typically developing children and their parents. Method: The Sleep section of the 24‐hour activity checklist was used to assess the sleep of children with CP and their parents and the sleep of typically developing children and their parents. Results: The sleep outcomes of 90 children with CP (median age 5y, range 0–11y, 53 males, 37 females, 84.4% ambulatory) and 157 typically developing peers (median age 5y, range 0–12y; 79 males, 78 females) and their parents were collected. Children with CP were more likely to have a sleep problem than typically developing children. Non‐ambulatory children with CP were more severely affected by sleep problems than ambulatory children. The parents of non‐ambulatory children were less satisfied about their child's and their own sleep. Waking up during the night, pain/discomfort in bed, and daytime fatigue were more common in children with CP and more prevalent in children who were non‐ambulatory. Interpretation: These findings highlight the need to integrate sleep assessment into routine paediatric health care practice. What this paper addsChildren with cerebral palsy (CP) are more likely to have a sleep problem than typically developing peers.Non‐ambulatory children with CP are more severely affected by sleep problems.One‐third of parents of children with CP report feeling sleep‐deprived often or always compared to a quarter of parents of typically developing children. What this paper adds: Children with cerebral palsy (CP) are more likely to have a sleep problem than typically developing peers.Non‐ambulatory children with CP are more severely affected by sleep problems.One‐third of parents of children with CP report feeling sleep‐deprived often or always compared to a quarter of parents of typically developing children. This original article is commented by McDonald on page 1247 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To systematically review and meta‐analyse the measurement properties of the Gross Motor Function Classification System (GMFCS), Gross Motor Function Classification System‐Expanded & Revised (GMFCS‐E&R), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) in children with cerebral palsy (CP). Method: Six databases were searched. Articles on the measurement properties of the GMFCS, GMFCS‐E&R, MACS, and CFCS administered to children with CP were included. Quality was assessed by means of the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The level and grading of evidence were defined for each measurement property. Results: Forty‐four articles were included in the systematic review and 37 articles were included in the meta‐analysis. The level (grading) of evidence was strong (positive) for reliability and construct validity. Content validity displayed an unknown level of evidence for the GMFCS, limited evidence (positive) for the MACS, and moderate evidence (positive) for the CFCS. There was moderate (positive) evidence for measurement error in the GMFCS and MACS. The level of evidence for responsiveness was unknown. No studies investigated cross‐cultural validity. Interpretation: These instruments can be used by health care professionals and caregivers to quantify the constructs needed to measure ability in children with CP. Current high‐quality evidence supports the use of these tools to classify ability in children with CP. Adopting the COSMIN guidelines, content, and cross‐cultural validity should be investigated further. What this paper addsStrong evidence supports the reliability and construct validity of the GMFCS, GMFCS‐E&R, MACS, and CFCS as functional classification systems in children with cerebral palsy.The GMFCS, GMFCS‐E&R, MACS, and CFCS can be used by both health care professionals and caregivers.The GMFCS, GMFCS‐E&R, MACS, and CFCS should not be used to detect change. What this paper adds: Strong evidence supports the reliability and construct validity of the GMFCS, GMFCS‐E&R, MACS, and CFCS as functional classification systems in children with cerebral palsy.The GMFCS, GMFCS‐E&R, MACS, and CFCS can be used by both health care professionals and caregivers.The GMFCS, GMFCS‐E&R, MACS, and CFCS should not be used to detect change. This systematic review is commented by Palisano on page 1242 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To characterize the patterns of care of children with cerebral palsy (CP) in a tertiary healthcare system. Method: Electronic health record data from 2009 to 2019 were extracted for children with CP. Machine learning hierarchical clustering was used to identify clusters of care. The ratio of in‐person to care coordination visits was calculated for each specialty. Results: The sample included 6369 children with CP (55.7% males, 44.3% females, 76.2% white, 94.7% non‐Hispanic; with a mean age of 8y 2mo [SD 5y 10mo; range 0–21y; median 7y 1mo]) at the time of diagnosis. A total of 3.7 million in‐person visits and care coordination notes were identified across 34 specialties. The duration of care averaged 5 years 5 months with five specialty interactions and 21.8 in‐person visits per year per child. Seven clusters of care were identified, including: musculoskeletal and function; neurological; high‐frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care. Network analysis showed shared membership among several clusters. Interpretation: Coordination of care is a central element for children with CP. Medical informatics, machine learning, and big data approaches provide unique insights into care delivery to inform approaches to improve outcomes for children with CP. What this paper addsSeven primary clusters of care were identified: musculoskeletal and function; neurological; high‐frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care.The in‐person to care coordination visit ratio was 1:5 overall for healthcare encounters.Most interactions with care teams occur outside of in‐person visits.The ratio of in‐person to care coordination activities differ by specialty. What this paper adds: Seven primary clusters of care were identified: musculoskeletal and function; neurological; high‐frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care.The in‐person to care coordination visit ratio was 1:5 overall for healthcare encounters.Most interactions with care teams occur outside of in‐person visits.The ratio of in‐person to care coordination activities differ by specialty. This original article is commented by Scholtes and Kolh on page 1246 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To study the association between the Hammersmith Infant Neurological Examination (HINE) at age 2 years and neurocognition at age 11 years in children born very preterm. We hypothesized that the HINE at 2 years would be associated with neurocognition, that is, neurological, motor, and cognitive outcomes at 11 years. Method: A total of 174 children (mean gestational age 29.0wks, SD 2.7; minimum 23.0, maximum 35.9; 95 [55%] males, 79 [45%] females) born very preterm (birthweight ≤1500g/gestational age <32wks), were included in a prospective cohort recruited from 2001 to 2006 in Turku, Finland. The HINE was performed at 2 years' corrected age. Neurocognition at 11 years was assessed with the Touwen neurological examination, Movement Assessment Battery for Children, Second Edition (MABC‐2), and full‐scale IQ (Wechsler Intelligence Scale for Children, Fourth Edition). Results: The HINE global score was associated with the results of the Touwen neurological examination (odds ratio [OR]=0.9, 95% confidence interval [CI] 0.8–0.9, p=0.001), MABC‐2 (β=1.4, 95% CI 0.7–2.2, p<0.001), and full‐scale IQ (β=1.2, 95% CI 0.8–1.7, p<0.001), even when adjusted. When children with cerebral palsy (CP) were excluded, the HINE was still associated with full‐scale IQ (unadjusted β=1.2, 95% CI 0.3–2.1, p=0.01). Interpretation: A higher HINE global score at 2 years was associated with better general intelligence at 11 years even in children without CP. The HINE may be a useful tool to detect children at risk for later cognitive impairment. What this paper addsA Hammersmith Infant Neurological Examination (HINE) global score at 2 years was associated with long‐term neurocognitive function.Severe cognitive impairment was significantly more common in 11‐year‐old children with complex minor neurological dysfunction compared to typically developing children.The HINE performed at 2 years detects risks of cognitive impairment at 11 years in children born very preterm.A higher HINE score at 2 years was associated with better general intelligence at 11 years. What this paper adds: A Hammersmith Infant Neurological Examination (HINE) global score at 2 years was associated with long‐term neurocognitive function.Severe cognitive impairment was significantly more common in 11‐year‐old children with complex minor neurological dysfunction compared to typically developing children.The HINE performed at 2 years detects risks of cognitive impairment at 11 years in children born very preterm.A higher HINE score at 2 years was associated with better general intelligence at 11 years. This article is commented on by Bos on page 891 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of repeated onabotulinum neurotoxin A injections for the treatment of drooling in children with neurodisabilities. Method: This was a retrospective cohort study, in which the first, second, and third onabotulinum neurotoxin A injection were compared within children treated between 2000 and 2020. Primary outcomes included drooling quotient, visual analogue scale (VAS), and treatment success defined as ≥50% reduction in drooling quotient and/or VAS 8 weeks after treatment. Each outcome was obtained at baseline and 8 weeks posttreatment. Results: Seventy‐seven children were included (mean age at first injection: 8y 3mo, SD 3y 7mo, range 3–17y; 44 males, 33 females; 51.9% with cerebral palsy, 45.5% wheelchair‐bound). The objective (drooling quotient) and subjective (VAS) effect after the second injection was lower compared to the first injection. The third injection showed less objective and significantly less subjective effect compared to the first injection. An overall success rate of 74.0%, 41.6%, and 45.8% were found for the first, second, and third injection respectively. Interpretation: Although onabotulinum neurotoxin A remained effective throughout the entire treatment course, there is less effect of subsequent onabotulinum neurotoxin A injections compared to the first. Although there might be a loss of effect after repeated injections, there is continued improvement for most children. What this paper addsRepeated injections show a diminished treatment effect after the second injection.A continued improvement is seen in most patients. What this paper adds: Repeated injections show a diminished treatment effect after the second injection.A continued improvement is seen in most patients. [ABSTRACT FROM AUTHOR]

Muscle‐tendon unit surgery for correction of deformities and movement dysfunction in children with cerebral palsy (CP) is fairly complicated. An understanding of basic muscle‐tendon unit properties and their adaptation to both CP and surgery are important to develop advances in this field. In this review, we provide information to therapists, surgeons, and scientists regarding the short‐ and long‐term adaptations of the muscle‐tendon unit. Surgical releases, lengthening, and transpositions are discussed, as are some of the tissue, cellular, and molecular adaptations. What this paper addsMuscle strength, tone, and control must be considered in surgical interventions for cerebral palsy (CP).Muscle‐tendon unit lengthening causes significant and lasting weakness requiring prolonged rehabilitation.Sarcomere length increases in CP muscle may be one of the underlying causes of muscle weakness.Muscle satellite cells are decreased and epigenetically modified in a way that may limit muscle growth in CP. What this paper adds: Muscle strength, tone, and control must be considered in surgical interventions for cerebral palsy (CP).Muscle‐tendon unit lengthening causes significant and lasting weakness requiring prolonged rehabilitation.Sarcomere length increases in CP muscle may be one of the underlying causes of muscle weakness.Muscle satellite cells are decreased and epigenetically modified in a way that may limit muscle growth in CP. [ABSTRACT FROM AUTHOR]

Aim: To describe the use of upper‐limb botulinum neurotoxin A (BoNT‐A) treatment in a population‐based sample of children with cerebral palsy (CP), by investigating whether factors may be related to a first upper‐limb BoNT‐A treatment and whether passive range of motion (ROM) is related to a first BoNT‐A treatment after adjustment for confounders. Method: Data from five regions in Sweden, in the national registry and follow‐up programme for CP (CPUP), were collected for children with spastic or dyskinetic CP assessed between 2000 and 2017. CP subtypes, functional classification levels, and traffic‐light‐based passive ROM categories were investigated. Data were analysed with logistic regression (odds ratios). Results: Of a total of 496 children (317 males, 179 females; median 2 years, interquartile range 1–5 years, range 1–15 years at first measurement occasion), 22% (n = 108) had received upper‐limb BoNT‐A treatment, 45% of whom by 1 to 3 years of age. Those classified in Manual Ability Classification System levels IV and V showed the highest crude odds ratio for a first upper‐limb BoNT‐A treatment. Children with full passive ROM with tightness at the end of the movement range were most likely to receive an upper‐limb BoNT‐A treatment, also after adjustment for confounders. Thumb and forearm muscles were the most targeted at the first upper‐limb BoNT‐A treatment. Interpretation: Full passive ROM with tightness at the end of the movement range increases the likelihood of a first upper‐limb BoNT‐A treatment. This new traffic‐light category is an aspect to consider in the dialogue about upper‐limb BoNT‐A. What this paper adds: Among children receiving upper‐limb botulinum neurotoxin A (BoNT‐A), 45% had their first treatment before the age of 4 years.Thumb and forearm muscles were the most treated with BoNT‐A, finger flexor muscles the least.Full passive range of motion with tightness was related to first upper‐limb BoNT‐A treatment. [ABSTRACT FROM AUTHOR]

Aim: To examine the prevalence and temporal trends of cerebral palsy (CP) overall and by population characteristics. Method: We identified 2 110 177 live births born in the province of Ontario, Canada, between 2002 and 2017 using administrative health data and estimated CP prevalence in children aged 0 to 16 years overall and by specific population characteristics. We also examined temporal trends in CP rates – overall and by characteristics – in young children (0–4 years) by their year of birth between 2002 and 2013 (n=1 587 087 live births) to allow for an equal follow‐up time (4 years and 364 days) for all children. Results: Overall CP prevalence among children aged 0 to 16 years was 2.52 (95% confidence interval 2.45–2.59) per 1000 live births. CP rates in ages 0 to 4 years peaked at 2.86 in 2007 births, but steadily declined afterwards to 1.94 per 1000 live births in 2013. CP rates were higher in children born preterm, small for gestational age, males, multiples, children with congenital malformations, and in children of young (<20 years), old (≥40 years), primiparous, or grand multiparous (≥4) mothers; differences by these characteristics decreased over time. We observed socioeconomic disparities in CP rates that persisted over time. Interpretation: Despite the decreasing trend of CP rates overall, CP rates varied by the child and maternal characteristics over time. What this paper adds: Overall cerebral palsy (CP) prevalence was 2.5 per 1000 live births among children born from 2002 to 2017.CP prevalence peaked in children born in 2007 then steadily decreased between 2007 and 2013.Changes in CP rates varied over time by child and maternal characteristics.Socioeconomic inequalities in CP persisted and remained stable over the study period. [ABSTRACT FROM AUTHOR]

Aim: We systematically examined the relationship between mirror movements and brain lesion type, corticospinal tract (CST) organization, and hand function to determine the relevance between mirror movements, brain lesion, the CST pattern, and hand function in children with unilateral cerebral palsy (CP). Method: Forty‐eight children (mean age 9y 9mo [SD 3y 3mo], range 6–18y; 30 males, 18 females) with unilateral CP participated. Mirror movements, brain lesion type, CST pattern identified by transcranial magnetic stimulation, and clinical outcomes were evaluated. Children performed four unilateral tasks: hand opening/closing, finger opposition, individuation, and finger 'walking'. Mirror movements induced in the contralateral hand were scored using standardized criteria (scores 0–4 using the Woods and Teuber scale). Results: We found that children with periventricular lesion may have stronger mirror movement scores induced in either hand than those with middle cerebral artery lesion (more affected hand: p=0.02; less affected hand: p<0.01). The highest mirror movement score a child exhibits across the tested tasks (i.e. scores of 3–4 using the Woods and Teuber scoring criteria) may potentially be an indicator of an ipsilateral CST connectivity pattern (p=0.03). Significant correlations were observed between higher mirror movement scores when performing hand opening/closing as well as finger walking and better unimanual dexterity (Spearman's rank correlation coefficient rs=0.44, p=0.002; rs=0.46, p=0.002 respectively). Interpretation: Brain lesions may be predictive of the strength of mirror movements in either hand in children with unilateral CP. Our findings warrant further studies to extensively investigate the relationship between mirror movements and the underlying brain pathology. What this paper adds: Brain lesion type may be predictive of mirror movement scores induced in either hand in children with unilateral cerebral palsy.The highest mirror movement score a child exhibits across the tested tasks may indicate corticospinal tract connectivity pattern in children with unilateral cerebral palsy. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To explore relationships between category classifications for children's rehabilitation goals, outcomes, and participant characteristics. Method: Children with hemiparetic cerebral palsy due to perinatal stroke rated self‐selected goals with the Canadian Occupational Performance Measure (COPM) and completed the Assisting Hand Assessment (AHA) and Box and Block Test (BBT), at baseline and 6 months, in a randomized, controlled 10‐day neuromodulation rehabilitation trial using repetitive transcranial magnetic stimulation. Goals were classified with the Canadian Model of Occupational Performance and Engagement and the International Classification of Functioning, Disability and Health. Analysis included standard linear regression. Results: Data for 45 participants (mean age 11y 7mo, SD 3y 10mo, range 6–19y, 29 males, 16 females) on 186 goals were included. Self‐care goal percentage corresponded with baseline BBT by age (standardized ß=–0.561, p=0.004). Leisure goal percentage corresponded with baseline BBT (standardized ß=0.419, p=0.010). AHA change corresponded with productivity goals (standardized ß=0.327, p=0.029) and age (standardized ß=0.481, p=0.002). COPM change corresponded with baseline COPM and age by AHA change (p<0.05). Interpretation: Younger children with lower motor function were more likely to select self‐care goals while those with better function tended to select leisure goals. Functional improvement corresponded with older age and productivity goals. COPM change scores reflected functional improvement among older children. Children chose functionally and developmentally appropriate goals. Consequently, children should be free to set goals that matter to them. What this paper adds: Children in a brain stimulation trial chose divergent upper extremity functional goals.Younger children with lower ability chose more self‐care goals.Children with higher ability chose more leisure goals.Older children's goal ratings reflected objective functional motor gains.Children chose goals appropriate to their function and level of development. What this paper adds: Children in a brain stimulation trial chose divergent upper extremity functional goals.Younger children with lower ability chose more self‐care goals.Children with higher ability chose more leisure goals.Older children's goal ratings reflected objective functional motor gains.Children chose goals appropriate to their function and level of development. [ABSTRACT FROM AUTHOR]

Aim: To determine the predictors of magnitude of change in response to a participation‐focused leisure‐time physical activity intervention in children with cerebral palsy (CP) using the ParticiPAte CP protocol. Method: We included 33 children (16 males, 17 females) aged 8 to 12 years (mean age=10y, SD=1y 6mo) with CP with pre/postintervention data from a wait‐list randomized trial. The hypothesized linear predictors of change in primary outcomes (Canadian Occupational Performance Measure [COPM]‐performance and COPM‐satisfaction, Belief in Goal Self‐Competence Scale (BiGSS), and minutes per day moderate‐to‐vigorous physical activity [MVPA]) were: age; Gross Motor Function Classification System level; comorbid autism spectrum disorder (ASD); Goal Attainment Scaling T score; Problems in Schools Questionnaire; Physical Activity Climate Questionnaire; Motives for Physical Activities Measure‐Revised; and stage of behaviour change. Multivariable models were selected using the Bayesian information criterion. Results: Overcoming barriers to participation, age, and comorbid ASD explained 49% of the variance in change in COPM‐performance. Being motivated by interest and/or enjoyment and age explained 32% of the variance in change in COPM‐satisfaction. Being motivated by physical activity competence or appearance (extrinsic motivation) explained 24% of the variance in change in BiGSS. Parental autonomy supportiveness, overcoming barriers to participation, appearance motivation, and baseline MVPA explained 59% of the variance in change in MVPA. Interpretation: These findings support a behaviour paradigm for conceptualizing physical activity in children with CP. What this paper adds: Children who met their treatment goals showed a greater increase in physical activity participation.Children who were more intrinsically motivated by physical activity at baseline improved more.Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy. What this paper adds: Children who met their treatment goals showed a greater increase in physical activity participation.Children who were more intrinsically motivated by physical activity at baseline improved more.Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy. Editor's Choice More and more, participation in any life situation is rightly highlighted as a goal for intervention, and a most relevant outcome measure.1 This contrasts with previews views that focused on the ability to perform tasks as expected. My Editor's Choice for the May issue is this study of change observed in children with cerebral palsy following an individualized family‐centred, ecological leisure‐time physical activity intervention focused on motivation and participation. It illustrates that participation can be supported meaningfully by organizing therapy in settings that are natural to the child and family. REFERENCE 1. Imms C, Green D, editors. Participation: Optimising Outcomes in Childhood‐Onset Neurodisability. London: Mac Keith Press, 2020. [ABSTRACT FROM AUTHOR]

Aim: To see if three‐dimensional (3D) methods could bring new understanding to acetabular changes in shape and orientation in the spastic hip and in which direction(s) acetabular orientation might change, which is crucial for planning appropriate hip correction surgery. Method: We performed a retrospective study of pelvic computed tomography (CT) examinations in 20 consecutive patients (10 females, 10 males). The mean age of patients was 12 years 9 months (SD 2y; range: 9–16y) at the time of the CT examination. The control group consisted of 18 consecutive pelvic CT examinations (36 acetabula) of deceased individuals (six females, 12 males) aged 4 to 17 years (mean age: 10y 6mo; SD 5y 2mo) whose whole‐body CT scans were taken shortly after their death. We compared 3D CT reconstructions of 28 unstable and dislocated hips in children with bilateral cerebral palsy (Gross Motor Function Classification System levels IV and V) with the unaffected side and typically developing controls to assess spatial orientation (inclination, anteversion, and tilt), acetabular volume, and surface area. Additionally, we analysed the multiple factors that may lead to structural and spatial changes of the acetabulum. Results: Patients with dislocated and spastic hips had significantly lower anteversion (−3.2° and −1.4° respectively, p<0.001), increased inclination (85.2° and 85.3° respectively, p<0.001), and decreased tilt (24.6° [p=0.014] and 20.7° [p=0.013] respectively) compared with typically developing individuals. Regarding acetabular volume and surface area, dislocated and unstable hips had significantly lower volume (17.6ml vs 31.5ml respectively, p<0.001) and surface area (28.9cm2 vs 36.2cm2 respectively, p<0.001) than unaffected hips. Among several factors, only Reimer's migration index had an influence on acetabular orientation (i.e. anteversion, p=0.01), volume (p<0.001), and surface (p=0.004). Interpretation: Acetabula in patients with spastic hip disease were severely retroverted with increased steepness; acetabular orientation was distorted superoposteriorly. In rare cases, acetabular orientation was distorted only superiorly or superoanteriorly. What this paper adds: Acetabular orientation was distorted superoposteriorly in most patients with severe bilateral cerebral palsy.More pronounced acetabular changes were found in hips with a higher Reimer's migration index. What this paper adds: Acetabular orientation was distorted superoposteriorly in most patients with severe bilateral cerebral palsy.More pronounced acetabular changes were found in hips with a higher Reimer's migration index. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between self‐care and bimanual performance in children aged 8 to 12 years with cerebral palsy (CP). Method: This was a cross‐sectional study of 74 children with CP (unilateral n=30, bilateral n=44; 48 males, 26 females; median age 9y 8mo [25th, 75th centiles 9y 1mo, 10y 8mo], Manual Abilities Classification System level I=30, II=28, III=16). Self‐care was measured using the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI‐CAT), and bimanual performance using the Assisting Hand Assessment (AHA) and Both Hands Assessment (BoHA). Measures of cognition, behavioural regulation, inattention, and gross motor function were included. Analyses used a directed acyclic graph to select variables for linear regression modelling. Results: Higher AHA and BoHA scores were associated with higher PEDI‐CAT scores. An increase of 1 AHA unit was associated with an increase of 0.12 PEDI‐CAT scores, and a 1 BoHA unit increase was associated with an increase of 0.17 PEDI‐CAT scores. The BoHA accounted for 57% of variance in PEDI‐CAT scores for children with bilateral CP, while BoHA and cognition accounted for 68% of variance. The AHA accounted for 40% of variance in PEDI‐CAT scores for unilateral CP with no effect of cognition on self‐care. Interpretation: Self‐care was strongly and positively associated with bimanual performance. Associations between self‐care and bimanual performance differed for those with unilateral and bilateral CP. What this paper adds: There is a strong positive relationship between self‐care and bimanual performance for unilateral and bilateral cerebral palsy (CP).Both Hands Assessment (BoHA) scores have a stronger association with self‐care than Assisting Hand Assessment scores.BoHA scores also account for more variation in self‐care.There is a strong positive relationship between self‐care and cognition overall.The effect of cognition on self‐care performance differed for bilateral and unilateral CP. What this paper adds: There is a strong positive relationship between self‐care and bimanual performance for unilateral and bilateral cerebral palsy (CP).Both Hands Assessment (BoHA) scores have a stronger association with self‐care than Assisting Hand Assessment scores.BoHA scores also account for more variation in self‐care.There is a strong positive relationship between self‐care and cognition overall.The effect of cognition on self‐care performance differed for bilateral and unilateral CP. This article is commented on by Konigorski on page 498 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To determine whether inequities in health outcomes for Indigenous Canadians are also present in cerebral palsy (CP) by comparing CP profiles between Indigenous and non‐Indigenous children. Method: Using the Canadian Cerebral Palsy Registry, we conducted a cross‐sectional study. CP motor subtype, gross motor severity, comorbidities, perinatal adversity, preterm birth, and parental education were compared between 94 Indigenous (53 males, 41 females) and 1555 non‐Indigenous (891 males, 664 females) children (all >5y). Multivariate analysis was done to analyze adverse CP factors, defined as CP gross motor severity and comorbidities. CP etiologies, either prenatal/perinatal or postnatal, were also compared. Results: Indigenous children with CP have higher odds of having low parental education (odds ratio [OR] 6.15, 95% confidence interval [CI] 3.36–11.3) and comorbidities (OR 4.46, 95% CI 1.62–12.3), especially cognitive (OR 4.52, 95% CI 2.27–9.05), communication (OR 2.66, 95% CI 1.54–4.61), and feeding (OR 2.25, 95% CI 1.33–3.83) impairment. Indigenous children also have higher CP gross motor severity (p=0.03). Indigenous children are also more likely to have non‐accidental head injury (n=4; OR 8.18, 95% CI 1.86–36.0) as the cause of their postnatal CP. Interpretation: Indigenous populations have worse health outcomes as a result of intergenerational impacts of colonization. Our study shows that Indigenous children with CP have increased comorbidities and higher CP gross motor severity, reinforcing the need for a multidisciplinary approach to management. Furthermore, targeted prevention programs against preventable causes of CP, such as non‐accidental head injury, may be beneficial. What this paper adds: Indigenous children with cerebral palsy (CP) have more severe motor impairment and more comorbidities.Non‐accidental head injury is a significant cause of postnatal CP. What this paper adds: Indigenous children with cerebral palsy (CP) have more severe motor impairment and more comorbidities.Non‐accidental head injury is a significant cause of postnatal CP. This article is commented on by King on page 500 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To compare the 66‐item Gross Motor Function Measure (GMFM‐66) with the reduced version of the GMFM‐66 (rGMFM‐66) with respect to the detection of clinically relevant changes in gross motor function in children with cerebral palsy (CP). Method: The study was a retrospective single centre analysis of children with CP who participated in a rehabilitation programme. Overall, 1352 pairs of GMFM‐66 and rGMFM66 measurements with a time interval of 5 to 7 months were available. To measure clinically relevant changes in gross motor function, the individual effect size (iES) was calculated. Results: The study population consisted of 1352 children (539 females), mean age 6 years 4 months (SD 2 years 4 months). The iES based on the GMFM‐66 and the rGMFM‐66 showed a significant correlation (r = 0.84, p < 0.001). The analysis of the area under the receiver operating characteristic curve showed an excellent agreement for clinically relevant gross motor improvement (Cohen's d ≥ 0.5; area under the curve = 0.90 [95% confidence interval 0.88–0.92]) or deterioration (Cohen's d ≤ −0.5; area under the curve = 0.95 [95% confidence interval 0.92–0.97]). Interpretation: Performing the rGMFM‐66 saves time compared to the full GMFM‐66. The rGMFM‐66 showed good agreement with the GMFM‐66 with respect to the detection of clinically relevant changes in gross motor function in children with CP, so its use in everyday clinical practice seems justifiable. What this paper adds: The reduced version of the 66‐item Gross Motor Function Measure (rGMFM‐66) detects clinically relevant changes in gross motor function in children with cerebral palsy.The rGMFM‐66 correlates highly with the full GMFM‐66.The rGMFM‐66 can be used in clinical practice when the time schedule is limited. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of iMOVE (Intensive Mobility training with Variability and Error) therapy with dose‐matched conventional therapy on gross motor development and secondary outcomes in young children with cerebral palsy. Method: This single‐blind, randomized controlled trial included repeated assessments of gross motor function (using the Gross Motor Function Measure) and secondary outcomes during a 12‐ to 24‐week intervention phase and at three follow‐up points after treatment. Treatment was delivered three times per week in both groups. Forty‐two children aged 12 to 36 months were stratified by age and motor function to ensure equivalence between groups at baseline. Results: Thirty‐six children completed treatment and follow‐up phases. Treatment fidelity was high and adherence was equivalent between groups (77.3% conventional therapy, 76.2% iMOVE). There were no group differences on the primary (gross motor function after 12 weeks p = 0.18; after 24 weeks p = 0.94) or any secondary (postural control p = 0.88, caregiver satisfaction p = 0.52, child engagement p = 0.98) measure after treatment or at the follow‐up points. However, one‐third of total participants exceeded predicted change after 12 weeks and 77% exceeded predicted change after 24 weeks of treatment. Interpretation: Our observations indicate a potential dose–response effect of rehabilitation therapy. We further demonstrated that individual therapeutic ingredients can be manipulated. When delivered consistently, both iMOVE and conventional therapy interventions might both be more effective than standard care. What this paper adds: Those receiving iMOVE therapy demonstrated more independent practice time, error, and child‐initiation than those receiving the dose‐matched control.iMOVE therapy was not superior to the control (conventional physical) therapy.Most participants exceeded predicted change after 24 weeks of treatment. [ABSTRACT FROM AUTHOR]

Aim: To predict ambulatory status and Gross Motor Function Classification System (GMFCS) levels in patients with cerebral palsy (CP) by applying natural language processing (NLP) to electronic health record (EHR) clinical notes. Method: Individuals aged 8 to 26 years with a diagnosis of CP in the EHR between January 2009 and November 2020 (~12 years of data) were included in a cross‐sectional retrospective cohort of 2483 patients. The cohort was divided into train‐test and validation groups. Positive predictive value, sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated for prediction of ambulatory status and GMFCS levels. Results: The median age was 15 years (interquartile range 10–20 years) for the total cohort, with 56% being male and 75% White. The validation group resulted in 70% sensitivity, 88% specificity, 81% positive predictive value, and 0.89 AUC for predicting ambulatory status. NLP applied to the EHR differentiated between GMFCS levels I–II and III (15% sensitivity, 96% specificity, 46% positive predictive value, and 0.71 AUC); and IV and V (81% sensitivity, 51% specificity, 70% positive predictive value, and 0.75 AUC). Interpretation: NLP applied to the EHR demonstrated excellent differentiation between ambulatory and non‐ambulatory status, and good differentiation between GMFCS levels I–II and III, and IV and V. Clinical use of NLP may help to individualize functional characterization and management. What this paper adds: Natural language processing (NLP) applied to the electronic health record (EHR) can predict ambulatory status in children with cerebral palsy (CP).NLP provides good prediction of Gross Motor Function Classification System level in children with CP using the EHR.NLP methods described could be integrated in an EHR system to provide real‐time information. [ABSTRACT FROM AUTHOR]

Aim: To examine pro‐ and anti‐inflammatory cytokines in children with cerebral palsy (CP) at baseline and in response to endotoxin (lipopolysaccharide), and correlate outcomes compared with age‐matched comparisons, to evaluate their ability to mount an immune response. Method: Serum cytokines were assessed in 12 children (eight males, four females; mean age 10y 1mo [SD 1y 8mo], 6–16y) with CP against 12 age‐matched comparisons (eight males, four females; mean age 9y 1mo [SD 1y 1mo]). Pro‐ and anti‐inflammatory cytokines (interleukin‐1β, interleukin‐2, interleukin‐6, interleukin‐8, interleukin‐10, interleukin‐18, tumour necrosis factor [TNF]‐α, TNF‐β, interferon‐γ, granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], vascular endothelial growth factor [VEGF], erythropoietin, and interleukin‐1 receptor antagonist) were measured at baseline and in response to in vitro simulation with lipopolysaccharide by multiplex enzyme‐linked immunosorbent assay. Results: Significantly higher erythropoietin was found at baseline in children with CP compared with the comparison group. There was a strong response to lipopolysaccharide for interleukin‐8, VEGF, TNF‐α, and GM‐CSF in both children with CP and the comparison group; however, there was significant lipopolysaccharide hyporesponsiveness in children with CP compared with the comparison group for interleukin‐1α, interleukin‐1β, interleukin‐2, and interleukin‐6. Interpretation: Altered cytokine responses in children with CP compared with the comparison group demonstrate an altered inflammatory state that may contribute to ongoing sequelae and could be a target for therapy. What this paper adds: Altered inflammatory responses persist in children with cerebral palsy (CP).Erythropoietin is elevated in children with CP compared with the comparison group.Children with CP have reduced interleukin‐1α, interleukin‐1β, interleukin‐2, and interleukin‐6 inflammatory responses to lipopolysaccharide. What this paper adds: Altered inflammatory responses persist in children with cerebral palsy (CP).Erythropoietin is elevated in children with CP compared with the comparison group.Children with CP have reduced interleukin‐1α, interleukin‐1β, interleukin‐2, and interleukin‐6 inflammatory responses to lipopolysaccharide. This article is commented on by Schleiss on pages 365–366 of this issue. [ABSTRACT FROM AUTHOR]

Aim: To conduct a systematic review and meta‐analysis on the effectiveness of physical therapy interventions to improve sitting ability in young children with or at risk for cerebral palsy (CP). Method: A systematic literature search was performed using five databases. Study selection criteria were randomized controlled trials published in English on physical therapy interventions targeting sitting, reporting developmental or functional sitting outcomes, and focused on young children with or at risk for CP (mean age ≤5y). Risk of bias (ROB) was assessed using the Cochrane ROB 2.0 tool. Results: Twelve unique studies met the inclusion criteria and were categorized into one of two categories: (1) comparison of two physical therapy interventions or (2) physical therapy plus adjunct versus physical therapy alone. The combined pooled effect size (g) for the 10 studies included in meta‐analysis was large (g=0.78) but non‐significant. Pooled effect for category 1 was small (g=–0.06) and non‐significant. Interventions in category 2 showed a large and significant effect (g=1.90, p=0.022). Interpretation: There is a lack of strong evidence for physical therapy interventions targeting sitting in young children with or at‐risk for CP due to limitations in methodological rigor and sample sizes. Components of impairment remediation combined with functional balance training should be explored to improve sitting in children diagnosed with CP. Given the benefits of early achievement of sitting, strong evidence‐based research is needed. What this paper adds: Strong evidence is lacking for physical therapy interventions to improve sitting ability in young children with/at risk for cerebral palsy (CP).Kinesio‐taping may be an effective adjunct to conventional physical therapy in improving sitting ability in children with spastic bilateral CP.Task‐specific, intensive, and child‐initiated intervention components show promise for improving sitting in young infants at risk for CP. What this paper adds: Strong evidence is lacking for physical therapy interventions to improve sitting ability in young children with/at risk for cerebral palsy (CP).Kinesio‐taping may be an effective adjunct to conventional physical therapy in improving sitting ability in children with spastic bilateral CP.Task‐specific, intensive, and child‐initiated intervention components show promise for improving sitting in young infants at risk for CP. [ABSTRACT FROM AUTHOR]