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Low back pain is currently the leading cause of disability and absence from work. Physical activity (PA) has shown to be effective for the management of chronic low back pain (CLBP). However, PA remains understudied in low-income countries. We investigated (1) the influence of biopsychosocial factors on activity limitations related to CLBP in Burundi, (2) the biomechanical profile of yoga postures and (3) the effectiveness of collective brisk walking plus yoga (BW+Y) for the management of CLBP. The results highlighted that (1) biopsychosocial factors predict activity limitations related to CLBP, (2) the biomechanical profile of yoga postures provides useful information that help to choose specific yoga program for low back pain management, and (3) collective BW+Y significantly improved the impairments, activity limitations, and participation restrictions related to CLBP in Burundi., (MOTR - Sciences de la motricité) -- UCL, 2023

Stroke is the first leading cause of disability in adults worldwide (GBD, 2021), and low-income countries are the most affected. In these countries, access to health care, particularly rehabilitation, is a great challenge. As the prevalence of stroke is increasing and the number of stroke survivors is rising, the economic charge of stroke rehabilitation will continue to expand, unless appropriate strategies are developed. This thesis contributed by mapping the clinical profile of stroke survivors from a sub-Saharan Africa low-income country to raise awareness of a critical need for cost-effective and accessible rehabilitation intervention. In addition, this thesis demonstrated the feasibility and effectiveness of a mixed community and group-based physical activity intervention. This community-based physical activity would be an efficient way to improve access to rehabilitation in low-income countries., L'accident vasculaire cérébral (AVC) est la première cause de handicap chez l'adulte dans le monde (GBD, 2021) et les pays à faible revenu sont les plus touchés. Dans ces pays, l'accès aux soins de santé, et notamment à la réadaptation, est un grand défi. Comme la prévalence de l'AVC ne cesse d’augmenter et par conséquent, le nombre de survivants d'AVC, la charge économique de la réadaptation post-AVC continuera de croître, à moins que des stratégies appropriées ne soient développées. Cette thèse a contribué à la description du profil clinique des survivants d'un AVC dans un pays à faible revenu d'Afrique subsaharienne, afin de sensibiliser au besoin d’interventions de réadaptation rentable et accessible. En outre, cette thèse a démontré la faisabilité et l'efficacité d'une intervention mixte d'activité physique réalisée en communauté et en groupe. Cette activité physique communautaire serait un moyen efficace d'améliorer l'accès à la réadaptation dans les pays à faible revenu., (MOTR - Sciences de la motricité) -- UCL, 2023

BACKGROUND: Physical exercise therapy is of proven efficacy in the treatment of adults with depression, but corresponding evidence is lacking in depressed adolescent inpatients. The aim of this study was to document the effect of add-on treatment with structured physical exercise in a clinical population of adolescents hospitalized for depression and anxiety in a psychiatric hospital. METHODS: A group of 52 adolescent inpatients was randomly assigned to a physical exercise or control program three to four times per week over a six-week period (20 hours in total). The primary outcome was the Hospital Anxiety Depression Scale (HADS) for evaluation of depression and anxiety symptoms. Secondary outcomes were psychological self-assessments, diagnostic interviews, and physical examinations. RESULTS: Six participants were lost in each group, leaving 20 inpatients each in the intervention and control groups. A linear mixed model with F-test revealed a significant interaction in favor of physical exercise in reducing the mean depression score (HADS-D) by 3.8 points [95% (CI), range 1.8 to 5.7], compared to a mean reduction score of 0.7 [95% (CI), range -0,7 to 2.0] in the control group. No significant interaction was found for anxiety symptoms (HADS-A). LIMITATIONS: The investigation was limited to the six-week hospital window and the small sample size prevented exploring differences in social characteristics. CONCLUSION: Structured physical exercise add-on therapy integrated into the psychiatric hospitalization of adolescents has led to a reduction in their depressive symptoms, demonstrating its effectiveness in the care of adolescent inpatients with depression.

Een recent rapport van het National Institute for Health and Care Excellence vernoemt oefentherapie in groep als eerstelijnsbehandeling voor volwassen patiënten met een depressie, ook voor ernstige gevallen. Het gaat erom tegelijk de symptomen van de depressie terug te dringen, maar ook de slechtere fysieke toestand van de patiënten te verbeteren. Bij adolescenten met een depressie wordt lichaamsbeweging voorgesteld maar niet erkend als aanvullende eerstelijnsbehandeling. Bemoedigende nieuwe studies toonden nochtans een duidelijk effect tegen depressie aan bij jongeren, vooral in psychiatrische ziekenhuizen. De antidepressieve effecten van oefening in groep zouden het gevolg kunnen zijn van neurobiologische (neuroplasticiteit, ontsteking, endocriene respons…) en psychosociale (lichaamsbeeld, gevoel van eigenwaarde, gevoel van zelfredzaamheid, sociale steun…) mechanismen. Een dergelijk oefenprogramma omvat begeleiding door opgeleid personeel en zorgt voor een kader en structuur met sessies die specifiek zijn afgestemd op mensen met een depressie. De lichaamsbeweging moet aeroob zijn, van matige intensiteit met ten minste twee sessies per week bij volwassenen en drie bij adolescenten gedurende ten minste tien weken. Er moet voor worden gezorgd dat het programma aantrekkelijk is en aangepast aan de fysieke en mentale moeilijkheden van elk individu om actieve deelname aan te moedigen.

Un rapport récent du National Institute for Health and Care Excellence inclut la thérapie par l’exercice en groupe parmi les traitements de première ligne auprès des patients adultes souffrant de dépression, y compris dans les cas graves. L’intérêt est à la fois de réduire les symptômes dépressifs mais aussi d’améliorer leur santé physique plus faible. Chez l’adolescent souffrant de dépression, la pratique de l’exercice physique est suggérée mais n’est pas reconnue comme faisant partie des traitements complémentaires de première ligne. Cependant, de nouvelles études encourageantes ont montré un effet antidépresseur notable chez les jeunes, notamment en milieu hospitalier psychiatrique. Les effets antidépresseurs de l’exercice en groupe pourraient être dus à des mécanismes neurobiologiques (neuroplasticité, inflammation, réponse endocrine…) et psycho-sociaux (image de son corps, estime de soi, sentiment d’auto-efficacité, support social…). Un tel programme d’exercices physiques implique une supervision par un personnel qualifié, assurant un cadre et une structure de séances spécialement conçus pour les personnes souffrant de dépression. L’exercice doit être aérobie, d’intensité modérée avec au moins 2 séances par semaine chez l’adulte et 3 chez l’adolescent pendant au moins 10 semaines. Il faudra veiller à ce que le programme soit attrayant et adapté aux difficultés physiques et psychiques de chaque individu pour favoriser sa participation active.

Depression and anxiety in youth are major public health concerns and represent a real challenge for care communities. This issue was further highlighted during the COVID-19 crisis with an increased prevalence and exacerbation of pre-existing symptoms. Yet, this is a crucial issue since psychological suffering in adolescence significantly disrupts daily life and is likely to persist or worsen in adulthood. It is therefore essential to put in place interventions for young people in psychological difficulties. However, there is a lack of evidence for an effective comprehensive strategy to alleviate depression and anxiety in youth. In adults, physical exercise has been introduced recently to the guidelines for depression treatment. Therefore, exercise as a complementary treatment in young people (10-24 years) should be also studied. In this context, the aim of this thesis is to investigate the antidepressant and anxiolytic effects of exercise in youth in school and psychiatric settings., (BIFA - Sciences biomédicales et pharmaceutiques) -- UCL, 2022

We aimed to evaluate the feasibility of an online High-Intensity Interval Training (HIIT) program on clinical psychological symptoms in higher education students in the context of the COVID-19 pandemic lockdown., info:eu-repo/semantics/published

Due to their early brain lesion, children with unilateral spastic cerebral palsy (USCP) present important changes in brain gray and white matter, often manifested by perturbed sensorimotor functions. We predicted that type and side of the lesion could influence the microstructure of white matter tracts. Using diffusion tensor imaging in 40 children with USCP, we investigated optic radiation (OR) characteristics: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). First, we compared the OR of the lesional and non-lesional hemisphere. Then we evaluated the impact of the brain lesion type (periventricular or cortico-subcortical) and side in the differences observed in the lesional and non-lesional OR. Additionally, we examined the relationship between OR characteristics and performance of a visuospatial attention task. We observed alterations in the OR of children with USCP on the lesional hemisphere compared with the non-lesional hemisphere in the FA, MD and RD. These differences were influenced by the type of lesion and by the side of the lesion. A correlation was also observed between FA, MD and RD and the visuospatial assessment mainly in children with periventricular and right lesions. Our results indicate an important role of the timing and side of the lesion in the resulting features of these children’s OR and probably in the compensation resulting from neuroplastic changes., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction Young children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-Aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial. Methods and analysis 60 children with BCP aged 2-5 years, Gross Motor Function Classification System (GMFCS) II-IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Children receiving Preschool HABIT-ILE be provided a written home programme with the aim of achieving an additional 10 hours of home practice (total dose 40 hours). Outcomes will be assessed at baseline, immediately following intervention and then retention of effects will be tested at 26 weeks. The primary outcome will be the Peabody Developmental Motors Scales-Second Edition to evaluate gross and fine motor skills. Secondary outcomes will be gross motor function (Gross Motor Function Measure-66), bimanual hand performance (Both Hands Assessment), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), goal attainment (Canadian Occupational Performance Measure), global performance of daily activities (ACTIVLIM-CP), cognition and adaptive function (Behavior Rating Inventory of Executive Function-Preschool Version), habitual physical activity (ActiGraph GT3X+) and quality of life (Infant Toddler Quality of Life Questionnaire and Child Health Utility

Young children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial. 60 children with BCP aged 2-5 years, Gross Motor Function Classification System (GMFCS) II-IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Children receiving Preschool HABIT-ILE be provided a written home programme with the aim of achieving an additional 10 hours of home practice (total dose 40 hours). Outcomes will be assessed at baseline, immediately following intervention and then retention of effects will be tested at 26 weeks. The primary outcome will be the Peabody Developmental Motors Scales-Second Edition to evaluate gross and fine motor skills. Secondary outcomes will be gross motor function (Gross Motor Function Measure-66), bimanual hand performance (Both Hands Assessment), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), goal attainment (Canadian Occupational Performance Measure), global performance of daily activities (ACTIVLIM-CP), cognition and adaptive function (Behavior Rating Inventory of Executive Function-Preschool Version), habitual physical activity (ActiGraph GT3X+) and quality of life (Infant Toddler Quality of Life Questionnaire and Child Health Utility Index-9). Analyses will follow stand

Cerebral palsy (CP) is highly prevalent in sub-Saharan Africa, where clinically-based studies have shown a considerable over-representation of the severe bilateral subtype. However, children's access to rehabilitation care is limited by many local factors, notably the lacking of rehabilitation services, insufficient knowledge of caregivers and financial constraints. In such a context there is an urgent need for studies of the evidence-based rehabilitation approach. Here, we describe the protocol of a randomised controlled study to investigate the efficacy of Hand-Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in young children with bilateral CP in Benin Republic, a representative low and middle-income country of western Africa. Forty children with bilateral CP aged between 24 and 59 months and with level III-IV in the gross motor function classification will be randomised to either a high intensity conventional therapy or HABIT-ILE therapy. Both therapies will be delivered as a day-camp model over 2 weeks to a total of 50 hours (5 hours per day). The assessor-blinded primary outcomes will include the gross motor function measure and both hands assessment. Secondary outcomes will be the adapted version of the ACTIVLIM-CP questionnaire, the Canadian Occupational Performance Measure, and a perception of CP interview form. Children will be assessed at baseline, after intervention and at 6-week follow-up. A 2 (group)×3 (test sessions) repeated analysis of variance will evaluate changes after the interventions. This study has been approved by the ethics committee of the rehabilitation department of the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, Benin (approval decision: N°01-2019/MS/CNHU-HKM/CEI/CUMPR). All participants' parents/caregivers will provide their written informed consent. Data will be managed with confidentiality. PACTR201911894444879.

Cerebral palsy (CP) is the leading cause of motor disability in children, a family’s predicament. It is widely studied in High-Income Countries where the prevalence of severe cases is declining thanks to the constant development of better prevention and care strategies. Unfortunately, it is still very poorly known in Low and Middle-Income Countries such as in Sub-Saharan Africa where children show poor developmental outcomes and where there is a higher proportion of severe cases and premature deaths. Therefore, this thesis aimed to contribute to the management of CP in Sub-Saharan Africa, typically in Benin in West Africa, with the development of specific assessment tools and intervention strategies., (MOTR - Sciences de la motricité) -- UCL, 2021

Intensive training of the more affected upper extremity (UE) has been shown to be effective for children with unilateral spastic cerebral palsy (USCP). Two types of UE training have been particularly successful: Constraint-Induced Movement Therapy (CIMT) and Bimanual training. Reorganization of the corticospinal tract (CST) early during development often occurs in USCP. Prior studies have suggested that children with an ipsilateral CST controlling the affected UE may improve less following CIMT than children with a contralateral CST. We tested the hypothesis that improvements in UE function after intensive training depend on CST laterality. Eighty-two children with USCP, age 5 years 10 months to 17 years, University laboratory setting. Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST connectivity pattern. Children were stratified by age, sex, baseline hand function and CST connectivity pattern, and randomized to receive either CIMT or Bimanual training, each of which were provided in a day-camp setting (90 h). Hand function was tested before, immediately and 6 months after the intervention with the Jebsen-Taylor Test of Hand Function, the Assisting Hand Assessment, the Box and Block Test, and ABILHAND-Kids. The Canadian Occupational Performance Measure was used to track goal achievement and the Pediatric Evaluation of Disability Inventory was used to assess functioning in daily living activities at home. In contrast to our hypothesis, participants had statistically similar improvements for both CIMT and Bimanual training for all measures independent of their CST connectivity pattern (contralateral, ipsilateral, or bilateral) ( < 0.05 in all cases). The efficacy of CIMT and Bimanual training is independent of CST connectivity pattern. Children with an ipsilateral CST, previously thought to be maladaptive, have the capacity to improve as well as children with a contralateral or bilateral CST following intensive CIMT or Bimanu

BACKGROUND: Intensive motor-learning-based interventions have demonstrated efficacy for improving motor function in children with unilateral spastic cerebral palsy (USCP). Although this improvement has been associated mainly with neuroplastic changes in the primary sensori-motor cortices, this plasticity may also involve a wider fronto-parietal network for motor learning. OBJECTIVE: To determine whether hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) induces brain activation changes in an extensive network for motor skill learning and whether these changes are related to functional changes observed after HABIT-ILE. METHODS: In total, 25 children with USCP were behaviourally assessed in manual dexterity and everyday activities before and after HABIT-ILE. Functional imagery monitored brain activity while participants manipulated objects using their less-affected, more-affected or both hands. Two random-effects-group analyses performed at the whole-brain level assessed the brain activity network before and after therapy. Three other random-effects-group analyses assessed brain activity changes after therapy. Spearman's correlations were used to evaluate the correlation between behavioural and brain activity changes. RESULTS: The same fronto-parietal network was identified before and after therapy. After the intervention, the more-affected hand manipulation elicited a decrease in activity on the motor cortex of the non-lesional hemisphere and an increase in activity on motor areas of the lesional hemisphere. The less-affected hand manipulation generated a decrease in activity of sensorimotor areas in the non-lesional hemisphere. Both-hands manipulation elicited an increase in activity of both hemispheres. Furthermore, we observed an association between brain activity changes and changes in everyday activity assessments. CONCLUSION: Brain activation changes were observed in a fronto-parietal network underlying motor skill learning with HABIT-I

To conduct a pilot study to assess the feasibility and effectiveness of an intensive bimanual intervention on upper limb function in children who have undergone hemispherectomy. Thirteen children received 90 hours of intensive bimanual training (Hand-Arm Bimanual Intensive Therapy, HABIT). The Jebsen-Taylor Test of Hand Function (JTTHF), Box and Block Test (BBT), Assisting Hand Assessment (AHA), ABILHAND-Kids, and Canadian Occupational Performance Measure (COPM) were assessed by a masked clinician twice before, immediately, and 6 months after treatment. Significant improvements over time were found in the JTTHF, AHA, ABILHAND-Kids, and COPM. Completion of HABIT was feasible for children with hemispherectomy. Improvement of bimanual function and functional goals can be related to the nature of the activities prioritized in HABIT training.

Purpose Investigating mothers’ perceptions of Cerebral Palsy (CP) and the impact of caregiving on family life in Benin, a west-African low to middle-income country (LMIC). Methods In this cross-sectional study we interviewed at their homes 88 mothers of children with CP about their perception of the cause of CP and stigmatization issues. Additionally, they completed the Impact on Family Scale and the Family Support Scale questionnaires. Multinomial and ordinal regressions analyses were used (p < 0.05). Results Most mothers (78%) referred to non-biomedical causes of CP (God’s will or curse). Caregivers with a limited education level were more likely to report non-biomedical beliefs. Only 28% reported having received from physicians an explanation of the causes of CP. Around 38% endorsed neighbors considered their children as cursed, which is a source of stigmatization. Mothers perceived a high impact of caregiving on their family life that correlated with non-biomedical beliefs, low education level, and the severity of CP. Conclusion There is a need in Benin, and probably in West-African LMICs generally, to shift to a family-centered care system and to inform the public about the root causes of CP to improve social integration of children with CP and decrease the negative impact on their families. • Implication for rehabilitation • Mothers with a limited education level are more likely to report non-biomedical causes of CP in this LMIC; • mothers’ level of education and non-biomedical beliefs of causes of CP are associated to a high impact of caregiving on family life in this LMIC; • mothers of children with CP in this LMIC do not perceive health-workers helpful.

In a previous study conducted to assess the impact of physical exercise on the symptoms of depression and anxiety in preadolescents in the school environment, which included a subgroup of participants comprising eleven randomly selected teens (aged 9–11) and all enrolled in primary education, it was immediately observed that one participant referred to as Andy was being bullied and teased, and the teachers were completely unaware of this scenario. All the participants of the study were volunteers, and were subjected to low-tomoderate intensity exercise four times a week for five weeks. Psychological self-assessments and physical examinations were performed before and after the program as a part of a blind assessment. In the intervention sessions, the therapists and participants remained unaware of the individual scores. The sessions included the games that highlighted the feeling of movement, postural control, and slow relay races with balancing, in combination with other cooperative, interactive games focused on fun and social contact rather than focusing on the performance. It was reiterated to the participants that mockery was completely prohibited during the program. After the intervention, a significant decrease was observed in the anxiety levels and depression scores of the participants. The most significant change was observed in the participant who was a victim of bullying during the initial training sessions. No changes were observed in the general atmosphere of the classroom. Bullying is quite common (>10%) and is most often completely overlooked. The present study demonstrated a decrease in the symptoms of depression and anxiety in a non-clinical sample of pre-teens attending elementary school when they completed a low-to-moderate exercise program that combined movement and pleasure and encouraged positive and non-competitive interactions among the participants. The program proved to be particularly beneficial for a bullied individual.

Dear Editor, Recent scientific literature supports the use of intensive, activity-based, goal-directed interventions, rather than usual care, to encourage significant motor improvements in children with cerebral palsy (CP) [1], [2], [3]. Among these interventions, the Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) proposes the practice of voluntary movement control, with many movement repetitions and progressive shaping in a child-friendly context. In addition to bimanual coordination, it includes continuous stimulation of lower extremities (LEs) and trunk [4]. Few intensive interventions have targeted young children with CP, mainly focusing on the upper extremity (UE) of children with unilateral CP [5], [6], [7], [8]. Therefore, we perceived a need for intensive early interventions targeting the whole spectrum of CP. [...]

Hip Osteoarthritis is one of the most disabling pathologies of the musculoskeletal system. Pain, the main symptom associated with stiffness, leads to activity limitations, and altered quality of life. The improvement of life conditions and the increase in life expectancy in low income countries would lead in the coming years to an increase in the number of cases and a strengthening of the disparity between the different social classes. However, hip replacement, the most effective treatment, remains inaccessible to much of the population in these countries. For several decades, several therapeutic alternatives have been used to treat hip osteoarthritis. Among these is orthopaedic manual therapy. Its implementation in countries such as Benin is proving to be important. This thesis therefore examined the feasibility of orthopedic manual therapy in the Beninese context. This thesis remains an important contribution to the evaluation and management of these patients. It showed that there was no significant difference between Beninese subjects with primary and secondary hip osteoarthritis in the three domains of the International Classification of Functioning, Disabilities and Health (ICF). Also, did it reveal that the more severe the osteoarthritis, the more the subject is affected. Finally, it showed that orthopedic manual therapy (Maitland passive joint mobilization and self-rehabilitation) improved all three domains of ICF and that Maitland passive joint mobilization was not superior to self-rehabilitation. However, the generalization of our results and conclusions requires more investigations using larger samples., (MOTR - Sciences de la motricité) -- UCL, 2021

The use of virtual devices during motor functions interventions may facilitate the role of therapists, patients’ motivation and enhance treatment efficacy. However, despite the large variety of existing devices, there is no clear evidence for the efficacy of virtual-based interventions for improving motor functions of the upper/lower extremities and transfer of learnings in daily life activities or social participation in children with cerebral palsy. The most likely reason for this lack of efficacy is that none of the existing device has been designed to allow the application of therapeutic principles used in evidence-based motor skill learning based “intensive interventions”. This thesis will first focus on the development of a virtual device allowing the application of all the motor skill learning therapeutic principles. Second, we will test the efficacy of motor interventions implementing the newly developed device in children with cerebral palsy., L’utilisation d’outils virtuels en rééducation motrice peut permettre d’aider les thérapeutes dans leur prise en charge en améliorant la motivation des patients ainsi que l’efficacité du traitement. Cependant, il n'existe pas de preuve claire de l'efficacité des interventions basées sur l’utilisation d’outils virtuels pour améliorer les fonctions motrices ou l’indépendance dans les activités du quotidien pour les enfants atteints de paralysie cérébrale. La raison la plus probable de ce manque d'efficacité est qu'aucun des dispositifs existants n'a été conçu pour permettre l'application des principes thérapeutiques utilisés dans les thérapies « intensives » basées sur l’apprentissage moteur dont l’efficacité est largement démontrée. L’objectif de cette thèse est de travailler au développement d’un dispositif virtuel interactif permettant l'application de ces principes thérapeutiques mais également de tester son utilisation lors de prises en charges motrices., (MOTR - Sciences de la motricité) -- UCL, 2021

No abstract available

Cerebral palsy (CP), which is the leading cause of motor disability during childhood, can produce sensory and cognitive impairments at different degrees. Most recent therapeutic interventions for these patients have solely focused on upper extremities (UE), although more than 60% of these patients present lower extremities (LE) deficits. Recently, a new therapeutic concept, Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), has been proposed, involving the constant stimulation of UE and LE. Based on motor skill learning principles, HABIT-ILE is delivered in a day-camp setting, promoting voluntary movements for several hours per day during 10 consecutive week days. Interestingly, the effects of this intervention in a large scale of youngsters are yet to be observed. This is of interest due to the lack of knowledge on functional, neuroplastic and biomechanical changes in infants with bilateral CP. The aim of this randomized controlled study is to assess the effects of HABIT-ILE adapted for pre-school children with bilateral CP regarding functional, neuroplastic and biomechanical factors. This international, multicentric study will include 50 pre-school children with CP from 12 to 60 months of age, comparing the effect of 50 h (2 weeks) of HABIT-ILE versus regular motor activity and/or customary rehabilitation. HABIT-ILE presents structured activities and functional tasks with continuous increase in difficulty while the child evolves. Assessments will be performed at 3 period times: baseline, two weeks later and 3 months later. The primary outcome will be the Gross Motor Function Measure 66. Secondary outcomes will include Both Hands Assessment, Melbourne Assessment-2, Semmes-Weinstein Monofilament Test, algometry assessments, executive function tests, ACTIVLIM-CP questionnaire, Pediatric Evaluation of Disability Inventory (computer adaptative test), Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadi

Cerebral palsy (CP) causes motor, cognitive and sensory impairment at different extents. Many recent rehabilitation developments (therapies) have focused solely on the upper extremities (UE), although the lower extremities (LE) are commonly affected. Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) applies the concepts of motor skill learning and intensive training to both the UE and LE. It involves constant stimulation of the UE and LE, for several hours each day over a 2-week period. The effects of HABIT-ILE have never been evaluated in a large sample of young children. Furthermore, understanding of functional, neuroplastic and biomechanical changes in infants with CP is lacking. The aim of this study is to carry out a multi-center randomized controlled trial (RCT) to evaluate the effects of HABIT-ILE in pre-school children with unilateral CP on functional, neuroplastic and biomechanical parameters. This multi-center, 3-country study will include 50 pre-school children with CP aged 1-4 years. The RCT will compare the effect of 50 h (two weeks) of HABIT-ILE versus usual motor activity, including regular rehabilitation. HABIT-ILE will be delivered in a day-camp setting, with structured activities and functional tasks that will be continuously progressed in terms of difficulty. Assessments will be performed at 3 intervals: baseline (T0), two weeks later and 3 months later. Primary outcomes will be the Assisting Hand Assessment; secondary outcomes include the Melbourne Assessment-2, executive function assessments, questionnaires ACTIVLIM-CP, Pediatric Evaluation of Disability Inventory, Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, as well as neuroimaging and kinematics measures. We expect that HABIT-ILE will induce functional, neuroplastic and biomechanical changes as a result of the intense, activity-based rehabilitation process and these changes will impa

Cerebral palsy (CP), an umbrella term for a developmental motor disorder caused by early brain injury (EBI)/interference, remains debated. In this essay, we present a narrative, beginning with the original anatomical-clinical description of the so-called paralysie congéniale (congenial paralysis) by the French psychiatrist Jean-Baptiste Cazauvieilh. We then discuss how the concept has evolved over the last 2 centuries. We aim to illustrate these ideas with the biopsychosocial model of health, especially in light of the current neuroscientific and sociological knowledge of human development. We endeavour to integrate 3 connected but distinct entities: (1) the EBI as a seminal turning point of the individual's story; (2) the clinical findings we call CP, when motor impairment and activity limitation related to post-EBI (or other early non-progressive brain interference) appears, and; (3) a post-EBI developmental condition that encompasses the overall consequences of an EBI. This framework should guide individual, familial and collective care discussions and research strategies beyond the scope of CP.

In Australia, 35,000 people have cerebral palsy (CP), and between 60-70% of these people have difficulties with movement on both sides of their body (bilateral CP). We don’t yet have strong research evidence to support intensive therapy for children with bilateral CP to improve their ability to use their hands, walk and perform daily life tasks that are important to them or that they need to do. We do have promising pilot data on a new intervention, called HABIT-ILE. We have received over $1 million AUD from the Australian National Health and Medical Research Council (NHMRC) to test HABIT-ILE in 150 children with bilateral CP and compare results to the usual care that is received. We want to know if HABIT-ILE is effective at improving hand function and gross motor function. We are also going to use special functional Magnetic Resonance Imaging (MRI) to whether HABIT-ILE induces neuroplastic changes in the brain. HABIT-ILE is delivered as a “day camp” model (6.5 hours a day for 10 days around the school holidays – a total of 65 hours of therapy!). Each camp will involve 10-12 children and therapy will be based on the child’s motor abilities, age, interests and self-identified goals. This includes play, craft, cooking, everyday living skills, gaming technologies and practice of goal activities and physical activities. We have commenced recruitment at our Brisbane site and have so far received

Cerebral palsy (CP) is the first cause of pediatric motor disorder. Children with CP present limitations in activities of daily living (ADL). Their performance can be improved after intensive motor-skill learning interventions, which induce functional improvements in a short period of time. Among these intensive interventions, HABIT-ILE, that combines upper and lower extremities training has demonstrated highly promising results. In order to measure ADL changes in activities that combine the use of the upper and lower extremities, we developed ACTIVLIM-CP, a questionnaire specific to children with CP. This tool matches the criteria of an objective measure, is provided with normative values and has a good sensitivity to changes after intervention. In usual rehabilitation, the child’s performance is recommended to be reported by parents. However, after an intensive intervention, due to the influence of parents’ satisfaction on the measure, we propose to videotape and blindly score the items of the questionnaire. At long term follow-up (18 months after the intensive intervention), parents’ scoring can be used again. Research on the influence of parents’ satisfaction on the child’s measure after intensive interventions seems crucial to interpret the results after such processes. This thesis opens the debate for all questionnaires used in this context., (MOTR - Sciences de la motricité) -- UCL, 2019

Children with bilateral cerebral palsy often experience difficulties with posture, gross motor function and manual ability, impacting independence in daily life activities, participation and quality of life (QOL). Hand-Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training. This study aimed to compare HABIT-ILE to usual care in a large randomised controlled trial (RCT) in terms of gross motor function, manual ability, goal attainment, walking endurance, mobility, self-care and QOL. A within-trial cost-utility analysis will be conducted to synthesise costs and benefits of HABIT-ILE compared with usual care. 126 children with bilateral cerebral palsy aged 6-16 years will be recruited across three sites in Australia. Children will be stratified by site and Gross Motor Function Classification System and randomised using concealed allocation to either receiving HABIT-ILE immediately or being waitlisted for 26 weeks. HABIT-ILE will be delivered in groups of 8-12 children, for 6.5 hours per day for 10 days (total 65 hours, 2 weeks). Outcomes will be assessed at baseline, immediately following intervention, and then retention of effects will be tested at 26 weeks. Primary outcomes will be the Gross Motor Function Measure and ABILHAND-Kids. Secondary outcomes will be brain structural integrity, walking endurance, bimanual hand performance, self-care, mobility, performance and satisfaction with individualised goals, and QOL. Analyses will follow standard principles for RCTs using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. Ethics approval has been granted by the Medical Research Ethics Committee of Children's Health Queensland Hospital and the Health Service Human Research Ethics Committee (HREC/17/QRCH/282) of The University of Queensland (20

OBJECTIVE: To investigate the reliability of parents-reported activity questionnaires after a motor-skill learning intervention for children with cerebral palsy (CP). We hypothesize that the intervention process might influence parental judgment. DESIGN: Double-blind randomized trial. SETTING: Conventional therapy was delivered in the usual context while intensive intervention was provided at the Catholic University of Louvain. PARTICIPANTS: Children with CP (N=41; age range 5-18y, Gross Motor Function Classification System I-IV) were randomized to a control group (CG) (n=21, 2 dropouts) receiving conventional therapy or an intervention group (IG) (n=20) receiving hand-arm bimanual intensive therapy-including lower extremities (HABIT-ILE). INTERVENTIONS: Conventional therapy (mostly neurodevelopmental) was delivered as ongoing treatment (1-5 times/wk). HABIT-ILE, based on motor-skill learning, was delivered over 2 weeks. All children were assessed at T1 (baseline), T2 (3wk after baseline) and T3 (4mo after baseline). MAIN OUTCOMES MEASURES: ABILHAND-Kids and ACTIVLIM-CP questionnaires rated by parents (perception) and 2 examiners (videotapes). RESULTS: Agreement (level/range) between examiners was systematically almost perfect (P≤.001). At baseline, moderate to almost perfect agreement (level/range) was observed between parents and examiners (P≤.001). At T2 and T3, a similar agreement (level/range) was observed for the CG. For the IG, a similar level of agreement was observed, but the range of agreement varied from poor to almost perfect (P≤.001), with parents estimating higher performance measures compared to examiners after intervention. Higher performance was associated with higher satisfaction scores of the child's functional goals at T3. CONCLUSION: Parents and examiners have a similar perception of the child's performance at baseline and during conventional therapy. Their perceptions are less congruent after a motor-skill learning intervention, probably due to

Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children’s mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.