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This paper explores whether a structured history-taking tool yields useful descriptions of children's looking skills. Parents of 32 children referred to a specialist communication clinic reported their child's looking skills using the Functional Vision for Communication Questionnaire (FVC-Q), providing descriptions of single object fixation, fixation shifts between objects and fixation shifts from object to person. Descriptions were compared with clinical assessment. 24/32 children were reported to have some limitation in fixation. Limitation was subsequently seen in 30/32 children. Parental report and assessment agreed fully in 23/32 (72%). The largest area of discrepancy was object-person fixation shifts, with five children not observed to show this behavior despite its being reported. Findings indicate a structured questionnaire yields description of fixations, which correspond well with clinical assessment. Descriptions supported discussion between parents and clinicians. It is proposed that the FVC-Q is a valuable tool in supporting clinicians in eliciting information about fixation skills. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the training effects of Virtual Reality (VR) intervention program on reaction time in children with cerebral palsy., Methods: Thirty boys ranging from 7 to 12 years (mean = 11.20; SD = .76) were selected by available sampling method and randomly divided into the experimental and control groups. Simple Reaction Time (SRT) and Discriminative Reaction Time (DRT) were measured at baseline and 1 day after completion of VR intervention. Multivariate analysis of variance (MANOVA) and paired sample t-test were performed to analyze the results., Results: MANOVA test revealed significant effects for group in posttest phase, with lower reaction time in both measures for the experimental group. Based on paired sample t-test results, both RT measures significantly improved in experimental group following the VR intervention program., Conclusions: This paper proposes VR as a promising tool into the rehabilitation process for improving reaction time in children with cerebral palsy.

To examine the reliability and validity of a simple device, the Swaymeter, for measuring trunk control in children with CP. Twenty children with spastic CP participated in this study. Trunk sway was measured while quietly sitting for 30s. Children lean forward or backward as far as possible for measuring dynamic balance range. Test–retest reliability was conducted. The concurrent and construct validity of the Swaymeter was assessed by comparison to the motion capture system and gross motor function measure (GMFM). The reliability of the Swaymeter was moderate to excellent in measuring trunk sway and dynamic balance range (ICCs = 0.696–0.948). Concurrent validity showed good results (r = 0.818–0.997) and construct validity of dynamic balance in anterior direction showed moderate to high correlation with the GMFM (r = 0.599–0.849). Assessment of trunk control in a sitting position using the Swaymeter in this study was valid and reliable in children with CP. [ABSTRACT FROM AUTHOR]

Objective: This article aimed to review the literature to verify the effect of botulinum toxin type A (BTX-A) on the intrinsic properties of spastic muscles and functionality in children with cerebral palsy (CP)., Methods: A literature search was conducted in the following databases: CINAHL, SCOPUS, Web of Science and PubMed. Database searches were limited to the period from January 1993 to March 2014., Results: A total of 2182 papers were identified, and 17 met the inclusion criteria. Only one study analyzed the effect of the toxin on muscle intrinsic properties and others analyzed the effect on functionality., Conclusion: BTX-A application demonstrated no changes in the passive stiffness of spastic muscle. In relation to functional level, the evidence of BTX-A effect was controversial. These studies showed methodological quality limitations that restrict the interpretation of the results for the entire CP population, which justifies the need for further randomized controlled trials.

Purpose: To examine the changes in walking performance between childhood and adulthood in cerebral palsy. Methods: Cohort studies were included if the participants were children with cerebral palsy at Gross Motor Function Classification System (GMFCS) Level I-IV, initial measurement of walking by 13 years of age and follow-up measurement by 30 years of age. Results: At GMFCS Level I+ II, 7% (95% CI 6–8) had declined to GMFCS Level III. At GMFCS Level III, 4% (95% CI 3–6) had declined to GMFCS Level IV and 31% (95% CI 27–34) had improved to GMFCS Level I+ II. At GMFCS Level IV, 2% (95% CI 1–4) had improved to GMFCS Level III and 3% (95% CI 2–4) had improved to GMFCS Level I+ II. Discussion: The results suggest that walking performance is stable from childhood to adulthood at either end of the spectrum of ability but is more changeable for intermediate walkers. [ABSTRACT FROM AUTHOR]

Purpose: Children with cerebral palsy (CP) may present varied ophthalmological problems. Paradoxically, however, investigation of visual function and possible related disorders is not routinely conducted in this population during medical consultations., Method: This paper proposes a simple, practical guide for assessing vision and ocular motricity in children with CP. One-hundred and twenty-three patients (mean age: 8.4 years +/- 2.3) from the Sarah Network of Rehabilitation Hospitals (Brasilia, Rio de Janeiro and São Luis units) were studied. Various parameters were investigated (smooth pursuit movements, strabismus, visual acuity, visual field, visuospatial neglect and nystagmus) using the following assessment tools: adapted smooth pursuit test for ocular motricity; Snellen test for visual acuity; confrontation method for visual field; cancellation test (star test) for visual neglect; and cover test for strabismus. Nystagmus was assessed based on patient observation., Results: Eighty-one children completed all the evaluations. Among these, 38 (47%) had no visual problems (hemiplegia 60.5%; diplegia 41.4%; triplegia 12.5%; mixed tetraplegic 33.3%); 23 had difficulties in one of the tested items; and 20 had problems in two or more areas of vision., Conclusions: Visual and oculomotor tests are of significant importance in children with CP and provide relevant information for creating a rehabilitation programme aimed at the individual as a whole.

In children with cerebral palsy (CP), learning disabilities are well documented, and impairments in executive functions, such as attention, inhibition, shifting and working memory, represent significant burdens on patients, their families and the society. The aim of this study was to evaluate whether Cogmed RM working memory training could improve working memory in children with CP and investigate whether increased working memory capacity would generalize to other cognitive functions. Twenty-eight children completed the training and the results were compared to a waitlist control group (n = 32). The results yielded three main findings. First, children with CP improved with practice on trained working memory tasks. Second, the intervention group showed minimal near transfer effects to non-trained working memory tasks. Third, no effects on cognitive and behavioral far transfer measures were found. [ABSTRACT FROM AUTHOR]

Virtual reality (VR), coupled with motion tracking, can investigate walking in a controlled setting while applying various walking challenges. The purpose of this review was to summarize the evidence on consequences of VR on biomechanical gait parameters in children with cerebral palsy. MEDLINE, Embase and Web of Science were searched. Among 7.574 studies, screened by two independent reviewers, seven studies were included, analyzing treadmill (n = 6) or overground walking (n = 1) under VR. Most frequently reported were the spatiotemporal parameters walking speed, stride length, step width, stance phase, and the kinematic parameters range of knee flexion and peak ankle dorsiflexion. However, methodological approaches and reporting of the results were inconsistent among studies. This review reveals that VR can complement information gained from clinical gait analysis. However, this is still an emerging field of research and there is limited knowledge on the effect of VR on gait parameters, notably during overground walking. [ABSTRACT FROM AUTHOR]

Compare the effectiveness of active and sham transcranial direct current stimulation (tDCS) during the training of a dual task in children with spastic cerebral palsy (CP). Thirty children with CP were submitted to ten sessions of either active (n = 15) or sham (n = 15) tDCS over the motor cortex for 20 minutes during the training of a dual task. Pre-intervention, post-intervention and follow-up evaluations involved measures of functional performance, intellectual performance, functional mobility and cortical excitability. The combination of active tDCS and dual task training led to improvements in functional mobility as well as functional and intellectual performances one month after the end of the intervention. The combination of active tDCS and dual task training demonstrated promising effects for children with spastic CP. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is a movement disorder and majority of children with CP have communication impairments which impact participation with this population. Rapid Syllable Transition Treatment (ReST) is a motor speech intervention primarily for children with Childhood Apraxia of Speech (CAS). A recent pilot study in which ReST was trialed with children with CP showed improved speech performance. Therefore, a single blind randomized controlled trial to compare ReST to usual care with 14 children with moderate-to-severe CP and dysarthria was conducted. ReST was provided on telehealth. ANCOVA with 95% confidence intervals indicated significant group differences in favor of ReST in speech accuracy (F = 5.1, p =.001), intelligibility (F = 2.8, p =.02) and communicative participation on both the FOCUS (F = 2, p =.02) and Intelligibility in Context Scale (F = 2.4, p =.04). ReST was found to be more effective than usual care. [ABSTRACT FROM AUTHOR]

This observational study aims to describe the level of perceived disability in Cerebral Palsy (CP). We described the perception of adults by using the interviewer-administered version of the WHO disability assessment schedule (WHODAS 2.0). In case of intellectual disability (ID), the proxy-administered version was used, and a caregiver was asked to report the difficulties experienced by the patient; 199 patients were enrolled. The level of perceived disability was higher when referred to patients with ID (proxy report) than when referred to patients without ID (p <.001). For all patients, the level of perceived disability varied depending on the severity and the localization of motor impairment (both p <.001). No differences were observed based on the type of motor impairment. The perceived disability was correlated with age only for patients with no ID (p <.05). The WHODAS 2.0 may be a useful tool to explore the perception of disability in CP. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aimed to list the tools used by rehabilitation professionals to test motor abilities in children with cerebral palsy (CP), to determine if these tools have psychometric properties specifically measured for CP, and to identify the main characteristics of these tools.Method: Web of Science, PEDro, PubMed/MEDLINE, Science Direct, and SciELO databases were searched to identify the tools. PubMed/MEDLINE was then searched to identify the studies assessing those tools’ psychometric properties. The agreement-based standards for the selection of health measurement tools and the Terwee criteria were used to assess the quality and the results of each included study, respectively.Results: Eighteen tools were identified. The psychometric properties of many of the tools used with children with CP have not been evaluated for this population.Conclusion: The psychometric properties evaluated often have a poor methodological quality of measurement. Overall, we suggest the tools with most empirical support to evaluate children with CP. [ABSTRACT FROM AUTHOR]

In this randomized clinical trial, we look for the following questions' answer: How does the integration of LMC affect (1) upper extremity (UE) function, (2) grip strength, and (3) lateral and palmar pinch strength in children with cerebral palsy (CP), in comparison with conventional rehabilitation methods? Twenty patients were randomly assigned to LMC (case) or conventional (control) groups. The grip, lateral and palmar pinch forces increased in case group patients more than control group both at the end of intervention (P <.001 for all three), and at 20 weeks' follow-up (P values 0.035, 0.002, and 0.002). The Quality of Upper Extremity Skills Test (QUEST) score changes were similar between two groups, except for grasp score at the end of step 2 and 3 (P =.04 and 0.01, respectively). The addition of LMC to the rehabilitation program of patients with CP may improve the UE motor function outcomes. [ABSTRACT FROM AUTHOR]

Hemiparetic cerebral palsy (HCP), weakness on one side of the body typically caused by perinatal stroke, is characterized by lifelong motor impairments related to alterations in the corticospinal tract (CST). CST reorganization could be a useful biomarker to guide applications of neuromodulatory interventions, such as transcranial direct current stimulation (tDCS), to improve the effectiveness of rehabilitation therapies. We evaluated an adolescent with HCP and CST reorganization who demonstrated persistent heightened CST excitability in both upper limbs following anodal contralesional tDCS. The results support further investigation of targeted tDCS as an adjuvant therapy to traditional neurorehabilitation for upper limb function. [ABSTRACT FROM AUTHOR]

The present work examined canonical babbling ratios longitudinally as a measure of onset and consolidation of canonical babbling in two infants at risk of cerebral palsy (CP) between 5 and 16 months. Ten typically developing infants were included for comparison at 6, 9, 12, and 16–19 months. Canonical babbling ratios (CBRs) were calculated from 5-min segments, and follow-up diagnostic outcomes were collected between 24 and 33 months. The two infants at risk demonstrated low CBR growth trajectories compared to the typical infant group, and slightly different patterns of consolidation. The two infants at risk were later diagnosed with different levels of CP and speech impairment severity. All infants demonstrated greater variability than expected. Studying canonical babbling and other prelinguistic milestones in this population may inform our perspective of the involvement of the motor system in the vocal domain. Additional implications on the analysis of canonical babbling using all-day home recordings are discussed. [ABSTRACT FROM AUTHOR]

To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation. Sixteen clinicians (nurses, physiotherapists, recreational therapists) that participated in a study exploring the feasibility of implementing cycling-based exergames for inpatient children with CP were interviewed. Clinicians' responses were coded using the Theoretical Domains Framework (TDF). Beliefs were generated from each response and relevant domains were identified. Ten domains from the TDF were identified as relevant. Key enablers to clinician participation in future implementation included revision of clinician roles and responsibilities, the belief that children with CP will benefit from exergames, and the belief in potential applicability to other pediatric populations. Barriers included clinician limited time and exergame responsibilities not aligning with perceived clinician roles. This study identifies key barriers and enablers that future inpatient pediatric rehabilitation settings should consider when incorporating exergames into rehabilitation practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare exercise intensity of active video games (AVGs) between hip- and wrist-worn accelerometer data in cerebral palsy (CP). Twenty children and adolescents (9.35 ± 3.71 years) with CP performed two exercise sessions, completing a standardized series of AVGs. Exercise intensity was collected, while one accelerometer was fitted to wrist and hip in separate, counterbalanced sessions. Accelerometer counts per minute and cut-points determined were significantly different between the wrist- and hip-worn outputs (p <.001). Metabolic equivalents (METs) of performing AVGs exceeded the three METs moderate intensity threshold in wrist-worn (3.12 ± 0.86) accelerometer and hip-worn data tend to underestimate intensity (1.16 ± 0.08). Previous studies showed METs required to perform AVGs were related to moderate intensity (3–6 METs) in CP with mild deficits. Wrist-worn accelerometer, exceeding 3 METs, seem to have higher accuracy in measuring exercise intensity of AVGs than hip-worn. [ABSTRACT FROM AUTHOR]

Perinatal stroke causes hemiparetic cerebral palsy (HCP) and lifelong disability. Constraint-induced movement therapy (CIMT) and neurostimulation may enhance motor function, but the individual factors associated with responsiveness are undetermined. We explored the clinical and neurophysiological factors associated with responsiveness to CIMT and/or brain stimulation within a clinical trial. PLASTIC CHAMPS was a randomized, blinded, sham-controlled trial (n = 45) of CIMT and neurostimulation paired with intensive, goal-directed therapy. Primary outcome was the Assisting Hand Assessment (AHA). Classification trees created through recursive partitioning suggested clinical and neurophysiological profiles associated with improvement at 6-months. Both clinical (stroke side (left) and age >14 years) and neurophysiological (intracortical inhibition/facilitation and motor threshold) were associated with responsiveness across treatment groups with positive predictive values (PPV) approaching 80%. This preliminary analysis suggested sets of variables that may be associated with response to intensive therapies in HCP. Further modeling in larger trials is required. [ABSTRACT FROM AUTHOR]

To evaluate the processes and factors that influenced implementation and impact of a home-based bimanual training program in children with unilateral cerebral palsy aged 2 through 7 years. The program encompassed bimanual task-specific training (3.5 hours/week for 12 weeks) adopting either implicit or explicit motor learning. A therapist and remedial educationalist coached parents. This mixed methods study included course attendance monitoring, questionnaires, registration form, video analysis, interviews, focus group discussion, and drop-out monitoring. Fourteen families participated. The program was not fully implemented as intended. Parents positively experienced the training and were well able to provide it. The program was demanding for the children and time-consuming for parents. Several components positively contributed to the program: task-analysis, instructional videos, and coaching by a therapist and remedial educationalist. Several modifications to the program were proposed. Home-based bimanual training forms a demanding but promising therapeutic approach with potential for optimization. [ABSTRACT FROM AUTHOR]

Explore effects of age, sex, and motor ability level on balance capabilities in preschoolers with and without Cerebral Palsy (CP). PBS was administered to 477 children 24 through 59 months: 258 with typical development (TD) and 219 with CP GMFCS levels I, II and III. 3-way ANOVA indicated PBS scores were significantly affected by age (F4,437=26.95, p<0.0001, η2p=0.198), motor ability level (F3,437=482.15, p<0.0001, η2p=0.768) and sex (F1,437=4.64, p<0.03, η2p=0.01) with significant interaction between motor ability level and age (F 12,437=5.25, p<0.001, η2p=0.126). Children's performance on individual items was analyzed by age, sex and motor ability level. Children with TD outperformed children with CP GMFCS level I 36-59 months and children with CP GMFCS levels II and III 24-59 months. Expected performance values for children with TD and children with CP, ages 24-59 months, at GMFCS levels I, II and III are provided. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the effects of inspiratory muscle and balance training on pulmonary function, respiratory muscle strength (RMS), functional capacity, and balance in children with hemiplegic cerebral palsy (CP). Thirty children with hemiplegic CP (Gross Motor Function Classification System I–II) included in this study. The control group (n = 15) underwent conventional physiotherapy rehabilitation program (CPRP) that included balance exercises, and the training group's (n = 15) program included inspiratory muscle training (IMT) in addition to CPRP for 8 weeks. The outcome measures were pulmonary function test, RMS measurement, the six-minute walk test (6MWT), and balance tests. There were no significant differences in the score changes of pulmonary function, balance, and 6MWT distance between groups (p >.05), whereas maximum inspiratory and expiratory pressure further increased in the training group (p >.05). RMS assessment and the identification of children who need it, and adding IMT to CPRP will contribute greatly to the rehabilitative approach of children with CP. [ABSTRACT FROM AUTHOR]

In this study, we investigated the relationship of demographic variables with mental disorders generally encountered by the caregivers. The cohort includes 109 caregivers (38.53 ± 9.62 year-old) of pediatric cerebral palsy patients (1–18 year-old) taken more than 3 months of caregiving. Data were obtained via face-to-face interviews and a 13-questioned survey followed by a statistical correlation with Zarit-Caregiver-Burden-Scale (Zarit-CBS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II scores (BDI-II). BAI scores were lower in the case of collaborative caregiving (p =.034) and a better financial status (p =.045) but higher in families having more than 1 disabled child (p =.019). Zarit-CBS scores were significantly higher in caregiving mothers with older age (p =.027) and lower in families having only 1 disabled child (p =.025). Mental disorders related to caregiving are dependent on the burden directed on the caregivers and having collaboration decreases anxiety. Medical assistance should be provided to caregivers showing signs of a mental disorder. [ABSTRACT FROM AUTHOR]

The primary aim was to describe speech and language abilities in a clinical group of verbal 5-year-old children diagnosed with neurological disability (ND) in infancy, and the secondary aim was to trace precursors to consonant production at age 5 years (T2) in data from 12 to 22 months (T1). The participants (n = 11, with Down syndrome (DS), cerebral palsy, and chromosomal deletion syndromes) were tested with a battery of speech and language tests. Consonant production at T2 was compared to data on consonant use at T1. At T2, two participants had age appropriate speech and language and another three had age-appropriate speech, but low results on language tests. The remaining six participants had severe speech and language difficulties. Participants with DS had significantly lower results on consonant production measures. An association between consonant production at T1 and T2 for participants with DS indicates that number of different true consonants might be a predictive measure when evaluating young children with DS. [ABSTRACT FROM AUTHOR]

Aims: To describe the development and evaluation of a novel task-based measure of powered mobility function: the Powered Mobility Function Scale (PMFS). Methods: PMFS was developed in Hebrew in four phases, with feedback from clinicians and clients. Psychometric properties (inter-rater, test–retest reliability, concurrent, convergent and known-groups validity) were evaluated for N = 49 children and adolescents with Cerebral Palsy (11.1 ± 4.8y) using Powered Mobility Program (PMP), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) Results: PMFS development involved 3 versions over three years. Inter-rater reliability was κ =0.75–0.95 (video/observation). Test–retest reliability was κ =0.93–0.96. Concurrent validity (PMP) was ρ =−0.84-to–0.96. Convergent validity (PEDI-CAT) was ρ =−0.47-to-0.70. Known-groups validity (GMFCS/MACS) demonstrated medium effect sizes (r = 0.33–0.46) Conclusions: PMFS is valid and reliable for measuring powered mobility function in children and adolescents with CP. Future validation of the English version of PMFS is warranted. [ABSTRACT FROM AUTHOR]

Purpose: To explore the child- and parent-related effects of home-based bimanual training in children with unilateral cerebral palsy. Methods: Case series of 14 children (2–7 years) who completed goal-oriented task-specific training for 3.5 hours/week for 12 weeks by a program adopting implicit (n = 5) or explicit (n = 9) motor learning. A therapist and remedial educationalist coached parents. Progression on bimanual goals (Canadian Occupational Performance Measure (COPM)) and therapy-related parental stress (interviews) were of primary interest. Data were collected at baseline (T0), halfway through and at the end of training (T1 and T2), and after 12 weeks (T3). Results: On the COPM performance scale a clinically relevant change was seen in 50% (7/14), 86% (12/14), and 85% (11/13) of the children, at T1, T2, and T3, respectively. Some parents indicated that they had experienced stress because of the training intensity. Conclusion: The child- and parent-related effects of the home-based bimanual training programs are encouraging. [ABSTRACT FROM AUTHOR]

Selective voluntary motor control (SVMC) in the upper extremity is often impaired in individuals with cerebral palsy (CP) and can be assessed quantitatively and qualitatively using the Test of Arm Selective Control (TASC). Fifty-six individuals with spastic CP (5–18 years old) were included. Descriptors associated with administration of the TASC were analyzed according to the type of CP and arm joint using Chi-square and Kruskal-Wallis tests. ABILHAND-Kids scores were compared between participants with and without mirror movements using a t-test. All groups of children with spastic CP had incidence of TASC movement descriptors. There was a main effect of topography of CP on extra movements, decreased active range of motion, tightness, spasticity, and mirroring, and an additional main effect of joint on mirroring. Participants with mirroring had lower ABILHAND-Kids scores than those without mirroring. Systematically observing arm movements using the TASC revealed differences across participants. [ABSTRACT FROM AUTHOR]

Purpose: To explore the relationship of intelligibility, receptive language, executive functioning, and motor skills to nonverbal cognitive skills among children with cerebral palsy (CP) in different speech-language profile groups. Method: Twenty-seven children with CP aged 10–12 years old participated in the study. They completed a battery of standard clinical assessments. The relationship of various skillsets with nonverbal cognitive ability was explored using correlational procedures. Additionally, we examined pairwise differences in nonverbal cognitive skills among profile groups. Cohen's Kappa and Chi-square tests were used to study the consistency of receptive language and nonverbal cognitive performance. Results: Children who showed better nonverbal cognitive abilities demonstrated better motor, receptive language, and intelligibility skills. Nonverbal cognition was generally consistent with receptive language. Conclusion: Nonverbal cognitive impairment often co-occurs with language and speech motor impairment among children with CP. Speech-language profile groups are a useful framework for describing both communication and cognitive abilities. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of intrathecal baclofen therapy (ITB) on health-related quality of life for children with cerebral palsy and neurological conditions. Method: This study is part of a longitudinal, multicentre audit. The primary outcome measure, the Caregiver Priorities and Child Health Index of Life with Disabilities, was completed at baseline, 6 and 12 months post ITB implant. Results: Forty subjects with cerebral palsy and other neurological conditions demonstrated significant improvement in aspects of health-related quality of life following ITB therapy, mean change 42.3 (SD 14.9) at baseline to 53.3 (SD 14.7) at 12 months (p<.001). Conclusion: Evidence to demonstrate the utility of ITB in pediatric populations beyond spasticity and dystonia reduction is limited. Our findings suggest that ITB improves aspects of quality of life, comfort, and ease of caregiving in children with cerebral palsy and other neurological conditions. [ABSTRACT FROM AUTHOR]

Objective: To assess and evaluate the change in functional skills among children with cerebral palsy (CP) who participated in an intensified habilitation program. Methods: In this prospective longitudinal study, a cohort of 39 preschool children (2–5 years) with cerebral palsy (Gross Motor Function Classification System levels I–V) together with their parents participated in an intensified multidimensional habilitation program for 1 year. Activities strengthening functional skills were among the main interventions. The children were evaluated with the Pediatric Evaluation of Disability Inventory before and after the program period. Results: Only children at GMFCS levels I–II showed improvements in mobility and social function on norm-referenced scales. After the intervention period, these children scored similar to the mean for typically developing children of the same age on the social function domain. Conclusions: Functional skills among preschool children with CP, GMFCS levels I–II, seems strengthened after participation in an intensified habilitation program. [ABSTRACT FROM AUTHOR]

To examine receptive language growth in children with cerebral palsy (CP) and anarthria using a parent-reported measure of vocabulary. Scores from 47 children (29 males) with CP and anarthria were obtained from the vocabulary checklists on the MacArthur-Bates Communication Development Inventories (MCDI) and analyzed to examine the distribution of receptive language growth. Linear trajectories of word composite scores were created using a linear-mixed model, incorporating between two and ten data points per child. Three different growth trajectories emerged: approximately 23% grew by 100 or more words per year, 13% grew by 50–100 words per year, and 64% grew by 50 words per year or less. Age-four vocabulary was strongly correlated with rate of increase in vocabulary. Receptive vocabulary scores from the MCDI are increasing at a reduced pace for most children with CP and anarthria. More sensitive measures of language assessment are necessary to gain a complete picture of their language ability levels. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the combined effects of mirror therapy involving power and strength exercises of the upper extremities in children with Unilateral Spastic Cerebral Palsy (USCP). Methods: Thirty children were included in either an experimental group or a control group. All participants were evaluated with the Quality of Upper Extremity Skill Test (QUEST), Canadian Occupational Performance Measure (COPM), and a handheld dynamometer to measure isometric muscle strength. Results: Compared to the control group, greater improvement was found in dissociated movements (p <.001, d = 1.82), grasp (p <.001, d = 1.38), weight bearing (p =.006, d = 0.91), and total scores (p =.001, d = 1.16) of QUEST; performance (p <.001, d = 2.9), satisfaction (p <.001, d = 1.91), and total scores (p <.001, d = 2.87) of COPM; and isometric muscle strength of the biceps brachii (p <.001, d = 1.27) and triceps brachii (p =.002, d = 2.22) of the affected upper limbs in the experimental group. Conclusions: Mirror therapy combined with power and strength exercises is a promising intervention approach to improve activity performance and upper-limb function in children with USCP. [ABSTRACT FROM AUTHOR]

Introduction: Fatigue impacts negatively on everyday activities in individuals with cerebral palsy (CP). More knowledge is needed about how mental fatigue is manifested in this target group. The purpose of this study was to gather evidence about the validity of the modified Mental Fatigue Scale (m-MFS) in adults with CP. Methods: Mixed sequential exploratory design. The respondents were ten persons aged 22–56 with CP (MACS I–II). Results: The respondents perceived the m-MFS as easy to read and understand. Its structure was characterised as straightforward and the text of the rating options was deemed to assist identification with life situations. Very good agreement was seen between the respondents' and the instrument designers' intended meaning for the items in the m-MFS; the weighted kappa was 0.92. Conclusion: This study showed evidence of construct validity, based on response processes and content, for use of the modified MFS in adults with CP. [ABSTRACT FROM AUTHOR]

Background: Children with cerebral palsy (CP) show age-driven development and individual fluctuations in walking capacity. Aim: 1. To precisely quantify 1MWT changes in children with CP, GMFCS level 1 and 2, generating 1MWT percentiles, depicting expected development over 6 months; 2. to assess the effect of a 6-month rehabilitation using whole-body vibration (WBV). Methods: Retrospective data analysis in 210 children with CP, GMFCS 1 and 2 who received standardized rehabilitation (DRKS00011331). 1MWT was assessed before (M0) and after treatment (M6), and at a 6-month follow-up (M12). Centiles were created using the lambda-mu-sigma method. Cohen's d was used to assess effect size. Results: We created 1MWT percentiles using data of all 210 children (M0 data). A small treatment effect size (d = 0.46) was found (M6 and M12 data). Conclusions: Using the generated centiles clinicians may monitor 1MWT changes over 6 months. Combining WBV and conventional physiotherapy may improve 1MWT in children with CP. Abbreviations: 1MWT: One-Minute Walk Test; 6MWT: Six-Minute Walk Test; CP: Cerebral palsy; ES: effect size; GMFCS: Gross Motor Function Classification System; GMFM-66: Gross Motor Function Measure 66; LOESS: Locally Estimated Scatterplot Smoothing; LMS: lambda-mu-sigma; SD: standard deviation; WBV: whole-body-vibration. [ABSTRACT FROM AUTHOR]

Purpose: To re-validate stability and hierarchal ordering of items, test–retest reliability, and construct validity of the Ease of Caregiving for Children measure for parents of children with cerebral palsy (CP) up to 11 years of age. Methods: Participants were 613 parents of children with CP between 1.5 and 11 years of age. Parents completed Ease of Caregiving for Children and both parents and therapists classified children's levels of gross motor, manual and communication functions. Results: Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty. Test–retest reliability was good: ICC = 0.69 (95% CI 0.52–0.81). For construct validity, ease of caregiving was higher for parents of children with higher functioning compared to parents of children with lower functioning, p <.001. Conclusions: Ease of Caregiving for Children is a unidimensional, reliable and valid measure of physical caregiving for parents of children with CP 1.5–11 years. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of accuracy constraints on functional symmetric bimanual coordination for children with Unilateral Spastic Cerebral Palsy (USCP). Methods: Ten children with USCP (average age: 9.6; MACS levels: I–II), ten typically developing children, and ten adults lifted a tray with a water bottle on top. Two accuracy constraints of handle size and cap condition were manipulated. Results: Children with USCP exhibited greater bilateral asymmetry in hand vertical position, timing, upper arm, and elbow control than other groups. Smaller handle decreased bilateral timing differences at lift onset and offset, and decreased bilateral elbow asymmetry at reach and lift offset. Without a cap (accuracy constraint), they showed greater trunk involvement, and less bilateral vertical position and lift offset timing differences (all p <.05). Conclusions: Children with USCP showed impaired symmetric bimanual coordination. Higher accuracy constraints improved some bimanual spatial and temporal control. Therefore, task accuracy constraints should be manipulated carefully for training. [ABSTRACT FROM AUTHOR]

Aim: To critically evaluate single-case design (SCD) studies performed within the population of children/adolescents with cerebral palsy (CP). Methods: A scoping review of SCD studies of children/adolescents with CP. Demographic, methodological, and statistical data were extracted. Articles were evaluated using the Risk of Bias in N-of-1 Trials (RoBiNT) Scale and the Consolidated Standards of Reporting Trials (CONSORT) extension for N-of-1 trials (CENT 2015). Comments regarding strengths and limitations were analyzed. Results: Studies investigated the effects of a wide range of interventions on various outcomes. Most SCD types were adopted in multiple studies. All studies used visual inspection rather than visual analysis, often complemented with basic statistical descriptives. Risk of bias was high, particularly concerning internal validity. Many CENT items were insufficiently reported. Several benefits and limitations of SCD were identified. Conclusions: The quality of evidence from results of SCD studies needs to be increased through risk of bias reduction. [ABSTRACT FROM AUTHOR]

Aim: To determine the feasibility and acceptability of parent-delivered elastic taping to the thumb and wrist in infants with cerebral palsy (CP). Design: Randomized cross-over feasibility trial. Participants: 20 infants (11 male; mean age 22 months) with CP. Intervention: Groups A and B received taping for 4 and 2 weeks, respectively. Outcomes: Primary: Recruitment and retention rates; adherence to protocol; Parent Satisfaction Questionnaire. Secondary: House Thumb score; Zancolli classification; Assisting Hand Assessment (AHA)/mini AHA. Exploratory: Duration of hand regard, thumb in palm, and open hand contact with toys during AHA/mini AHA. Results: Recruitment was feasible (95.2% uptake). Completion rates were 80% and 60% in Groups A and B. Questionnaire feedback was generally positive. Some parents reported increased awareness of the taped hand. Objective improvements were rare though one participant showed consistent improvement in thumb position. Conclusion: Taping proved feasible and acceptable; individual case benefit suggests further research is required. Trial registration: ISRCTN41918400. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of a body weight supported treadmill training (BWSTT) intervention on postural control and gross motor function in three young children with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) levels IV or V. Method: Children (N = 3) between the ages of 2–3 years who were diagnosed with CP classified as GMFCS levels IV and V participated in BWSTT three times per week. The Segmental Assessment of Trunk Control (SATCo) and the gross motor function measure (GMFM-66) were assessed before and after the 6-week intervention. Results: Final testing revealed that all participants improved on the SATCo and GMFM. Conclusion: BWSTT is a viable intervention that may improve trunk control and gross motor outcomes in young children with severe CP. Further research is needed to explore the impact of BWSTT for young children classified as GMFCS levels IV and V. [ABSTRACT FROM AUTHOR]

Purpose: No instrument exists that measures functional strength in both lower and upper extremities in children with cerebral palsy (CP). Therefore, the functional strength measurement (FSM) was tested for feasibility, test–retest reliability and validity in CP. Methods: Thirty-seven children with CP (aged 4–10 years, Gross Motor Function Classification System I and II) participated. The most common compensations for CP were described; new item descriptions were standardized, and one item was removed. Test–retest reliability was examined. To measure convergent validity, correlations between the FSM-CP and isometric muscle strength measured with the handheld dynamometer (HHD) were determined. Results: Test–retest reliability was considered high for all items (intra-class correlation coefficient 0.79–0.95). Significant correlations between the HHD and FSM-CP ranged from r = 0.36 to 0.75. Conclusion: The FSM-CP is feasible, reliable, and valid to use in children with CP. The FSM-CP can be considered as a helpful tool in clinical practice of physical examination of children with CP. [ABSTRACT FROM AUTHOR]

Background: To successfully modify an intervention from an adult population for use with children with cerebral palsy, it is important to understand the components that support a child's motivation and engagement. Method: Ten children who had participated in the Sense© intervention (mean age = 11 years 2 m [SD = 2 years]; four males; Manual Ability Classification System level I = 1, II = 9) and their primary caregivers (N = 11, 10 females) were interviewed. Transcripts were analyzed using framework analysis. Results: Key themes were identified in the core domains of the Synthesis of Child, Occupational Performance and Environment in Time model. Child: children's somatosensory discrimination ability improved; Motivation: incorporating child's goals was essential, as were real-world gains; Environmental: parents were interested in having more involvement in the intervention. Conclusion: The most engaging elements of the intervention for children were the attainment of their self-selected goals. Opportunities to modify the intervention for improved partnership with parents were identified. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to assess the change in their ambulatory capacity and spasticity in children with cerebral palsy (CP) who received botulinum toxin A (BoNT-A) injection and underwent rehabilitation therapy. Methods: Thirty patients with CP, 3–13 years who had varied functional levels and lower extremity spasticity, were randomized in two groups. In Group 1(n = 15), BoNT-A was administered to the affected extremity and underwent rehabilitation. In Group 2 (n = 15), the patients underwent only rehabilitation protocol. The Visual Analogue Scale (VAS), Tardieu Scale (TS), Gross Motor Function Classification System (GMFCS), Selective Motor Control, and Goal Attainment Scale were evaluated 4 and 12 weeks after baseline. Results: The mean scores of the TS (p < 0.001) GMFCS, GAS, and VAS (p < 0.05) significantly improved in Group 1. Conclusion: We think that implementation of rehabilitation protocols with BoNT-A injection is superior to alone rehabilitation therapy and increasing ambulatory capacity in patients with CP. [ABSTRACT FROM AUTHOR]

Purpose: To identify child, family, and service determinants of playfulness of young children with cerebral palsy. Methods: Participants were 429 children, 18–60 months. Children were divided into two groups, Gross Motor Function Classification System levels I-II and III-V. Therapists collected data on body functions and gross motor function; parents provided information about children's health conditions and adaptive behavior, family life, and services. One year after the beginning of the study, therapists assessed children's playfulness. Data were analyzed using structural equation modeling. Results: Higher gross motor function was associated with higher playfulness for both groups. Greater impact of health conditions on daily life was associated with lower playfulness for children in levels I-II. More effective adaptive behavior was associated with higher playfulness, and higher parent perception of therapists' family-centeredness was associated with lower playfulness for children in levels III-V. Conclusion: Supporting gross motor function, health, and adaptive behavior may foster playfulness. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between trunk control in sitting and functionality in children with spastic cerebral palsy (CP). Methods: Fifty-eight children with spastic CP were included in the study. Functional abilities were evaluated with the Gross Motor Function Measurement-88 (GMFM-88) and the Pediatric Evaluation of Disability Inventory Functional Skills domain (PEDI-FSD). Trunk control in sitting was tested with the Trunk Control Measurement Scale (TCMS) and the Trunk Impairment Scale (TIS). The scores of the TCMS and TIS were compared with GMFM-88 and PEDI-FSD with Spearman correlation analysis. Results: The total score of GMFM-88 was significantly correlated with the total score of TCMS (rho = 0.90, p < 0.01) and TIS (rho = 0.78, p < 0.01). The total score of PEDI-FSD was also significantly correlated with the total score of TCMS (rho = 0.76, p < 0.01) and TIS (rho = 0.72, p < 0.01). Conclusions: The evaluation of trunk control can provide valuable information for functional abilities of children with spastic CP. [ABSTRACT FROM AUTHOR]

Purpose: To assess the additional long-term effects of multiple conductive education (CE) courses followed by conventional practice on functional skills and quality of life in children with cerebral palsy (CP) compared to a 4-month CE-course delay including conventional practice. Methods: Twenty-one children with CP, 3-6 years and varied functional levels, were randomized to 3-week CE course(s) followed by conventional practice or 4 months on a waiting list, including conventional practice and followed by CE-courses. Outcomes were measured 8 and 12 months after baseline. A web-based log collected data on conventional practice. Results: We found no interaction between group assignment and time on functional skills and quality of life in children with CP at 8 and 12 months. Two thirds of the children in both groups performed a large amount of conventional practice. Conclusions: No added long-term effects of CE courses were found. Larger controlled CE studies are needed. [ABSTRACT FROM AUTHOR]

Objectives: Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) are broadly studied in high-income countries, but data concerning their functioning are lacking in developing countries. Therefore, we analyzed their reliability and sensitivity to change in children with cerebral palsy in Tanzania. Methods: GMFCS and MACS are two ordinal grading systems used to assess motor functions while observing children's performances. Forty-nine children were classified by two independent physiotherapy students at baseline, after one month and after one year. Reliability and sensitivity to change were analyzed using intraclass correlation coefficient (ICC), effect size (ES), standard response mean (SRM), standard error of measurement (SEM), and minimal detectable change (MDC). Results: Inter- (ICC = 0.97/0.95 for GMFCS/MACS) and intra-rater reliability (ICC = 0.98/0.96 GMFCS/MACS) were excellent. Sensitivity to change was small (ES = −0.14/0.11, SRM = −0.24;/0.24 GMFCS/MACS). SEM was 0.2 points, resulting in MDC = 0.5/0.7 for GMFCS/MACS, respectively. Conclusions: GMFCS and MACS demonstrated excellent reliability, but not sensitivity to change. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the validity and reliability of the Duruöz Hand Index (DHI) in patients with unilateral cerebral palsy (CP). Methods: Assessments of patients (n = 23) were performed using the Modified Ashworth Scale (MAS), the Manual Ability Classification System (MACS), the grip and pinch strength tests, and DHI. Following the data collection, retest of DHI was administered telephonically within a 2-week period. Results: Test-retest reliability and internal consistency of DHI were found to be excellent with a Cronbach's alpha value of 0.93 and an intraclass correlation coefficient value of 0.94. The correlation between the DHI and MACS was detected significantly high (r = 0.840, p = < 0.010). The DHI also correlated with grip and pinch strength in the affected side (r = −0.459, p = < 0.050; r = −0.509, p = < 0.050). Conclusions: DHI is a valid and reliable questionnaire for patients with unilateral CP. [ABSTRACT FROM AUTHOR]

The current study aimed to explore the impact of visual dependence on sensorimotor coupling of postural sway and visual motion in adults and teens with spastic cerebral palsy (CP). We hypothesized that individuals with CP would exhibit greater magnitudes of sway than healthy individuals, and the presence of visual dependence (VD) would produce instability in the direction of visual motion. Participants stood in a virtual environment in which the visual scene remained static or continuously rotated 30 degree/second in pitch-up or pitch-down. Increased center of pressure and center of mass responses were observed in the direction of visual scene motion in those with CP. Those with VD exhibited reduced frequency responses in anterior-posterior direction than those who were visually independent. VD suggests deficient sensorimotor integration that could contribute to postural instability and reduced motor function. Individuals with CP who are visually dependent may benefit from more sensory focused rehabilitation strategies. Abbreviations: AP, anterior-posterior; CP, cerebral palsy; COM, center of mass; COP, center of pressure; MDF, median frequency; ML, mediolateral; PD, pitch down (nose down) rotation; PU, pitch up (nose up) rotation; RFT, rod and frame test; RMS, root mean square; SLP, slope of the fitted line; TD, typical development; VD, visual dependence; VI, visual independence; VOR, vestibulo-ocular reflex; VPI, visual perceptual impairment [ABSTRACT FROM AUTHOR]

Purpose: To examine whether children with or without cerebral palsy (CP) would follow a humanoid robot’s (i.e., Darwin) feedback to move their arm faster when playing virtual reality (VR) games. Methods: Seven children with mild CP and 10 able-bodied children participated. Real-time reaching was evaluated by playing the Super Pop VRTM system, including 2-game baseline, 3-game acquisition, and another 2-game extinction. During acquisition, Darwin provided verbal feedback to direct the child to reach a kinematically defined target goal (i.e., 80% of average movement time in baseline). Outcome variables included the percentage of successful reaches (“% successful reaches”), movement time (MT), average speed, path, and number of movement units. Results: All games during acquisition and extinction had larger “%successful reaches,” faster speeds, and faster MTs than the 2 games during baseline (p < .05). Conclusion: Children with and without CP could follow the robot’s feedback for changing their reaching kinematics when playing VR games. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of a conductive education (CE) course followed by conventional practice, on gross motor function, other functional skills, quality of life, and parents’ experiences of family-centered services in young children with cerebral palsy (CP). Methods: Twenty-one children with CP, 3-6 years old, were randomized to one 3-week CE course followed by conventional practice or conventional practice on a waiting list. Outcomes were measured 4 months after baseline. A web-based log collected data on the conventional practice. Results: No additional improvements in the children’s outcome were found. However, parents in the CE group reported that they received more information than parents in the waiting list group (p = 0.01). Children in both groups performed high amount of conventional practice at home. Conclusions: A 3-week CE course did not add any improvements in the children’s functioning, possibly explained by the large amount of conventional practice reported of both groups. [ABSTRACT FROM AUTHOR]