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Aim: To explore clinical factors associated with perinatal arterial ischemic stroke (AIS) and periventricular venous infarction (PVI) in infants who develop unilateral cerebral palsy (CP). Method: This was a case–control study. Data current to 2019 was extracted from the Canadian Cerebral Palsy Registry (CCPR). Cases were infants born at term with confirmed unilateral CP. Magnetic resonance images were stratified by expert review of reports as definitive perinatal stroke (AIS or PVI). Controls with common data elements were recruited from a population‐based study in Alberta. Multivariable regression analyses were performed to estimate associations expressed as odds ratios with 95% confidence intervals. Results: Of 2093 cases from the CCPR, 662 had unilateral CP, of whom 299 (45%) had perinatal stroke: AIS 169 (57%) and PVI 130 (43%). Median age at diagnosis for AIS was 11.9 months (interquartile range: 6.2–25.7mo; range 0.17–104.1mo), and 58.6% were male. Median age at diagnosis for PVI was 25.3 months (interquartile range: 14.5–38mo, range 0.7–114.7mo) and 57.7% were male. Independent associations for both AIS and PVI on multivariable analysis were chorioamnionitis, illicit drug exposure, diabetes, gestational age, and maternal age. Variables associated with AIS alone were low Apgar score and prolonged rupture of membranes. Variables associated with PVI alone were small for gestational age and primigravida. Interpretation: Controlled analysis of disease‐specific unilateral CP may offer unique perspectives on its pathophysiology. Acute intrapartum factors are mainly associated with AIS, while in utero factors are associated with PVI. This original article is commented by Ganesan on page 9 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 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]

Preterm germinal matrix-intraventricular hemorrhage (GMH-IVH) grading can be applied to fetuses. Almost all the currently known risk factors for GMH-IVH pertain to the extra-uterine environment and its effect on the immature brain, and studying in utero GMH-IVH presents a unique opportunity to better understand the pathophysiology of GMH-IVH distinct from the stressors imposed by preterm delivery. Exclusion criteria Cases were excluded if they were duplicates, had a postnatal diagnosis of GMH-IVH only, intraventricular hemorrhage (IVH) secondary to extension of parenchymal hemorrhage or tumor, or insufficient information to confirm GMH-IVH such as specification only of intracranial hemorrhage without specifying the site. Grade III was defined as GMH-IVH with hydrocephalus or ventricular dilatation as described by the authors; it was not always possible to distinguish between acute dilatation that is a criteria for grade III hemorrhage, and post-hemorrhagic ventricular dilation which can occur after any grade of hemorrhage. Term defined as 37 weeks gestational age or greater. gl Hydrocephalus and postnatal surgical intervention Hydrocephalus was present in 0 out of 27 out of those with grade I/II GMH-IVH, 100 out of 100 of those with grade III, and 89 out of 93 (96%) of those with PVHI. [Extracted from the article]

Aim: To characterize fatigue in children with hemiparesis with perinatal stroke and explore associations with measures of motor performance and corticospinal excitability.Method: Forty-five children (16 females, 29 males), aged 6 to 18 years (mean [SD] 12y [4]), with magnetic resonance imaging-confirmed perinatal stroke participated. Associations between fatigue (Pediatric Quality of Life Inventory Version 3.0 cerebral palsy module fatigue subscale), motor performance (Assisting Hand Assessment [AHA], Box and Blocks Test, grip strength), and excitability of corticospinal projections to both hands were examined using ranked tests of correlation, robust regression, and the Mann-Whitney U test.Results: Nearly half of the participants (n=21) reported experiencing fatigue in the previous month. Function in the less affected hand (Box and Blocks Test, grip strength) was correlated with fatigue scores. Participants with preserved ipsilateral projections to the more affected hand had less fatigue, and scores correlated with the excitability of these projections. Fatigue scores were not associated with age, sex, or AHA score.Interpretation: Fatigue is common in children with hemiparesis with perinatal stroke and is associated with motor performance and the presence and excitability of ipsilateral corticospinal projections from the contralesional hemisphere to the more affected hand.What This Paper Adds: Fatigue is common in children with hemiparesis with perinatal stroke. Fatigue was associated with motor performance and strength in the less affected, but not the more affected, hand. Fatigue was associated with the presence and excitability of ipsilateral corticospinal projections from the contralesional hemisphere. [ABSTRACT FROM AUTHOR]

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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.)