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Introduction: Despite being a primary impairment in individuals with cerebral palsy (CP), selective motor control (SMC) is not routinely measured. Personalized treatment approaches in CP will be unattainable without the ability to precisely characterize the types and degrees of impairments in motor control. The objective of this study is to report the development and feasibility of a new methodological approach measuring muscle activation patterns during singlejoint tasks to characterize obligatory muscle co-activation patterns that may underly impaired SMC. Methods: Muscle activation patterns were recorded during sub-maximal voluntary isometric contraction (sub-MVIC) tasks at the hip, knee, and ankle with an interactive feedback game to standardize effort across participants. We calculated indices of co-activation, synergistic movement, mirror movement, and overflow (indices range 0-2, greater scores equal to greater impairment in SMC) for each isolated joint task in 15 children - 8 with typical development (TD) (mean age 4.7 ± 1.0 SD years) and 7 with CP (mean age 5.8 ± 0.7 SD years). Indices were compared with Mann-Whitney tests. The relationships between the indices and gross motor function (GMFM-66) were examined with Pearson's r. Results: Mean indices were higher in the CP vs. the TD group for each of the six tasks, with mean differences ranging from 0.05 (abduction and plantarflexion) to 0.44 (dorsiflexion). There was great inter-subject variability in the CP group such that significant group differences were detected for knee flexion mirroring (p = 0.029), dorsiflexion coactivation (p = 0.021), and dorsiflexion overflow (p = 0.014). Significant negative linear relations to gross motor function were found in all four indices for knee extension (r = -0.56 to -0.75), three of the indices for ankle dorsiflexion (r = -0.68 to -0.78) and in two of the indices for knee flexion (r = -0.66 to -0.67), and ankle plantarflexion (r = -0.53 to -0.60). Discussion: Indices of coactivation, mirror movement, synergy, and overflow during single-joint lower limb tasks may quantify the type and degree of impairment in SMC. Preliminary concurrent validity between several of the indices of SMC and gross motor function was observed. Our findings established the feasibility of a new methodological approach that quantifies muscle activation patterns using electromyography paired with biofeedback during single-joint movement. [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]

Background: Family empowerment in families of young children with cerebral palsy (CP) is an important consideration because the first few years of life can be overwhelming for parents. The purpose of this research was to investigate the relationship between family empowerment, fine motor (FM), gross motor (GM) and cognitive development in children with CP who were under 3 years of age. Methods: Forty‐one children with a mean age of 23.8 months participated in this study. The Family Empowerment Scale (FES) was completed by the participants' parents, whereas the FM, GM and cognitive subscales of the Bayley Scales of Infant and Toddler Development Third edition (B‐III) were administered by physical therapists. Results: Statistically significant positive correlations were found between the FES total and B‐III raw scores for FM, GM and cognitive subscales with coefficients ranging from 0.35 to 0.41. Significant relationships were also found between the FES Community subscale and the B‐III FM, GM and cognitive subscales. Conclusions: This study provides evidence of a relationship between family empowerment and FM, GM and cognitive abilities in young children with CP, with a greater severity of impairments related to lower levels of caregiver empowerment. [ABSTRACT FROM AUTHOR]

We investigated the role of rate limiting factors in development using walking as a model system. The achievement of bipedal posture and locomotion are among the most significant achievements in an infant's first year, with poor balance and weak muscles long proposed as the rate limiting factors. Compensating for either may reveal upright motor skill that has not yet emerged in the infant's natural repertoire. To probe this question, we unweighted prewalking infants and measured their performance in various standing and walking behaviors while unweighted compared to baseline. Our secondary objective was to determine if the influence of unweighting was related to infants' locomotor experience. Infants stood unsupported for longer durations with 20% or 40% unweighting. Infants took more independent steps and more steps with one hand held with 40% unweighting. No differences in transition to/from standing were observed. Locomotor experience was related to the influence of unweighting during cruising and walking with a push toy. This is the first report of more advanced motor skills—longer periods of unsupported standing and the emergence of independent walking—revealed by unweighting infants. We interpret our observations to suggest that the refinement of motor control needed to support bipedal posture and locomotion precedes the functional emergence of these skills in infants. In other words, the musculoskeletal components required for walking are slower to develop than the neurological factors – and consequently may be the rate limiters. We further suggest that training regimens including unweighting should be explored in infants with motor delays. [ABSTRACT FROM AUTHOR]