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Objective: Dyskinesia in cerebral palsy (CP) is a complex movement disorder that can significantly impact upper limb function. Despite a range of available tools, there is no consensus on best practice assessment of upper limb function in children with CP and dyskinesia. This study aimed to develop a clinical framework for the assessment of the impact of dyskinesia on upper limb function in children with CP., Design: Modified Delphi study using expert consensus., Methods: An expert panel of six highly experienced Australian therapists ranked assessment tools sourced from existing evidence-based literature using a five-point Likert scale. Tools rated as important for use "most" or "all" of the time, by 80% of respondents were accepted into the framework following two survey rounds and a third stage discussion., Results: Of 21 tools, 12 were included in the framework under five categories: (i) screening for dyskinesia; (ii) measuring the severity of dyskinesia; (iii) Classifying upper limb functional ability; (iv) measuring upper limb functional ability; and (v) measuring upper limb movement., Conclusions: The framework for assessing the impact of dyskinesia on upper limb function in CP aims to guide clinicians to improve assessment consistency and facilitate individualized goal-directed management. Further studies with a larger number of expert clinicians and researchers will further strengthen the utility of the framework.

Aims: To explore perspectives of clinicians from interdisciplinary teams on the barriers and facilitators to chronic pain management for children and adolescents with cerebral palsy and dyskinesia., Methods: Interdisciplinary focus groups (n = 2) were conducted at two Australian tertiary pediatric hospitals. Twenty-five experienced clinicians took part, including ten physiotherapists, six pediatricians, four rehabilitation physicians, four occupational therapists, and one speech and language therapist. An external moderator conducted the focus groups and data were analyzed using inductive thematic analysis., Results: Four key themes emerged: "balancing the intersection of pain and dyskinesia," "difficulty communicating between so many providers," "uncertainty surrounding chronic pain education," and "differing priorities." Key barriers were identified including a lack of access to some interdisciplinary team members and formalized guidance for health professionals regarding chronic pain education., Conclusion: Key issues were reported to impact the delivery of coordinated inter-disciplinary chronic pain management at the tertiary level for children and adolescents with cerebral palsy and dyskinesia. In the absence of strong evidence, a strategy for implementing effective chronic pain management for children and adolescents with cerebral palsy and dyskinesia and gaining clinician consensus regarding the best practice management are recommended.

Aim : To describe current practices of physiotherapists and occupational therapists when training two-wheel bike skills in children with cerebral palsy (CP) within an International Classification of Functioning, Disability and Health (ICF) framework. Methods : Ninety-five physiotherapists and occupational therapists working with children with CP in Australia completed a customized online survey. Survey questions related to: eligibility, initial assessment, intervention characteristics, and evaluation of effectiveness. Open-ended responses were analyzed using deductive content analysis. Close-ended questions were analyzed using descriptive statistics. The ICF was used as a framework for coding and reporting. Results : Body structure and function factors were most frequently considered in eligibility (56% of observations) and assessment (47%). Activity and participation-related factors were considered more in intervention (42%) and evaluation (75%). While functional training approaches were predominant, intervention characteristics varied markedly. Excepting goal-related tools, few measures were identified for assessment or evaluation of effectiveness. Environmental and personal factors were seldom considered across practice areas. Conclusions : Current two-wheel bike skills training for children with CP in Australia appears highly variable. Development and testing of bike skills-specific outcome measures and interventions and guidance for therapists on consideration of environmental and personal factors are warranted.

Objective: To examine the inter-rater reliability of the Communication Function Classification System (CFCS), Bimanual Fine Motor Function (BFMF), Surveillance of Cerebral Palsy in Europe (SCPE) classification tree, and Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) and periventricular white matter injury (PWMI) aged 4-11 years., Method: Twenty children were assessed by two raters using the four tools, in addition parents undertook ratings on the Manual Ability Classification System (MACS). Kappa statistics were used to calculate the level of agreement between raters' classifications., Results: Participants comprised 12 males and 8 females with CP and PWMI, mean age 8 years 1 month (standard deviation 2 years 3 months). Inter-rater reliability across the four tools was 0.98 (CFCS, BFMF, and GMFCS) and 0.84 (SCPE)., Implications: These findings suggest that these four tools are reasonably robust to inter-rater variability supporting their routine use along with the MACS in clinical and research applications.

This systematic review focused on the common conventional physiotherapy interventions used with children with cerebral palsy (CP), aged 4 to 18 years, and critically appraised the recent evidence of each of these interventions using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The search strategy yielded 34 articles after inclusion and exclusion criteria were applied. The investigated physiotherapy interventions included strength and functional training, weight-supported treadmill training (WBSTT), and neurodevelopmental treatment (NDT). A category of treatment dosage was also included. Strength training was the most studied intervention with significant improvements found in the strength of selected muscle groups using dynamometry, with fewer studies showing significant improvement in function. Functional training showed improvements in gross motor function, endurance, and temperospatial measures, such as gait speed and stride length. Nonsignificant trends of improvement on the Gross Motor Function Measure (GMFM) and gait velocity were found for WBSTT by a few studies with low levels of evidence (case series). Of three studies that evaluated NDT, one high-level evidence study, i.e., randomized controlled trial (RCT) found significant improvements on the GMFM. All studies reviewing treatment dosage had high levels of evidence (RCTs), yet found no significant differences for different intensities of treatment. These results indicate that the levels of evidence for physiotherapy interventions, particularly strengthening and to a lesser extent functional training, in school-aged children with CP has improved; however, further high-level evidence is needed for other interventions.

This study examined inter-rater reliability of the Functional Mobility Scale (FMS) for children with cerebral palsy (CP) and the presence of rater bias. A consecutive sample of 118 children with CP, 2-18 years old (mean 10.3 years, SD 3.6), was recruited from a hospital setting. Children were classified using the gross motor function classification system (GMFCS) with 13 in Level I, 49 in Level II, 44 in Level III, and 12 in Level IV. Each child was independently scored on the FMS by two raters. Raters were randomly assigned from a sample of 44 orthopaedic surgeons, hospital-based physiotherapists, and community-based physiotherapists. Quadratic weighted kappa coefficients for mobility ratings varied from 0.86 to 0.92 for the three distances, indicating substantial chance corrected agreement. Levels of agreement were similar when administering the scale in person and by telephone, suggesting that the FMS can be administered by either method. There was a tendency for surgeons to rate mobility higher than physiotherapists, however, only one of the comparisons was statistically significant. The FMS is a reliable tool that can be used by clinicians to assess mobility in children with CP.