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Children frequently suffer from motor impairments which hinder their development. Every movement requires stability therefore; musculoskeletal malfunction leads to poor movement. Task-oriented training is one of many methods and techniques used to promote motor skills and daily physical activities in children. The present study's goal is to investigate how task-oriented training contributes to developing motor skills and daily physical activities in learners with cerebral palsy. The study employed a mixed- data collection strategy. The study included a total of 12 students with cerebral palsy. The promotion of a child's motor abilities and regular physical activity can be accomplished with the help of task-oriented training. The study's findings supported our hypothesis that task-oriented training that has been devised and a series of exercises to increase range of motion (flexibility) led to positive dynamics in all groups of indicators regardless of the severity of the pathology. The proposed program allowed children to increase muscle strength and range of motion in the joints. Thus, after the experimental work, the functionalstate of the musculoskeletal system improved and qualitative and significant changes occurred in the independence of learners. It is suggested that teachers use task-oriented training when instructing school-age children who have this disorder.

The COVID-19 pandemic and its demands of social distancing have created challenges in the lives of children/adolescents with developmental disabilities and their families, which would change aspects of children's functioning. The objective of this study was to evaluate changes in some components of functioning of children/adolescents with disabilities following 4 months of social distancing during a period of high contamination rate in the year 2020 in Brazil. Participated 81 mothers of children/adolescents with disabilities, 3-17 years, most of them (80%) diagnosed with Down syndrome, cerebral palsy and autism spectrum disorder. Remote assessments of functioning' aspects including IPAQ, YC-PEM/ PEM-C, Social Support Scale and PedsQL V.4.0. Wilcoxon tests compared the measures, with significance level <0.05. No significant changes in participant's functioning were identified. Social adjustments required to facing the pandemic during two points in time in the midst of the pandemic did not change the evaluated aspects of functioning in our sample of Brazilian.

Objective: Children diagnosed with cerebral palsy have been reported to be at increased risk of executive function deficits and neurodevelopmental disorders. This population-based cohort study aimed to assess executive function, attention, behaviour, and autism symptomatology in school-aged children with CP, using parent-report measures that can provide insight into everyday functioning in these neurodevelopmental domains. Methods: 74 participants (male n = 51) mean age 9 years 9 months, SD 1 year 1.2 months (range 8 years 0 months to 12 years 11 months), GMFCS I = 45 (60.8%), II = 17 (23%), III = 8 (10.8%), and IV = 4 (5.4%), were assessed on measures of attention and behaviour (Conners-3), executive function (BRIEF), and autism symptomatology (AQ10-Child). Analysis was via one-sample t-tests and MANCOVAs. Results: Participants' scores were elevated in comparison to the general population in all domains, while 29.1% of participants scored above the cut-off level on an autism symptomatology screener. Greatest impairment was reported for working memory (M = 60.7, SD = 10.0, t(72) = 9.2, p < 0.001), peer relations (M = 72.7, SD = 16.2, t(73) = 12.0, p < 0.001), and inattention subscales (M = 66.3, SD = 12.5, t(73) = 11.2, p < 0.001). No statistically significant differences were found for different GMFCS levels on domains of executive functioning. A statistically significant difference was found between GMFCS levels for inattention F(3, 71) = 3.83, p = 0.013, [partial eta-squared] = 0.162, with most elevated scores associated with GMFCS level II (M = 74.1, SD = 14.2). Conclusion: EF, attention and behavioural difficulties, and autism symptomatology are commonly reported in school-aged children with CP. Screening for these comorbidities using ratings scales will assist with early diagnosis and targeted intervention.

There is currently limited research related to mental health supports for individuals who use AAC, particularly about the actual lived experiences of AAC users who receive mental health services. There may be alterations to mental health services for individuals who use AAC. The aim of this study was to gain the perspectives of AAC users on accessing and receiving mental health services. Three participants who used AAC and received mental health services shared their experiences related to receiving mental health services. Data were analyzed using an inductive approach in which themes were based on participants' experiences. Five major themes were generated: (a) Time, (b) Communication Partner Skills, (c) Advocacy, (d) Means of Expression, and (e) Diagnosis. Participants described factors that positively or negatively impacted their experiences. Participant experiences were examined in light of Bronfenbrenner's Ecological Systems model. The findings of this study provide insights into the perspectives of individuals who use AAC in accessing mental health services, uncovering various barriers and facilitators within the patient--psychotherapist microsystem. Factors such as time constraints, communication partner skills, advocacy, means of expression, and diagnosis-related challenges significantly influenced the quality of interaction between patients using AAC and their mental health provider. The study also reveals the broader impacts of AAC on interactions within the meso-, exo-, and macro-systems, suggesting the need for improved involvement of speech-language pathologists and policy changes to support effective communication and accessibility for individuals using AAC in mental health settings. Ultimately, future research should involve participants of varying ages, diagnoses, and backgrounds and should include a variety of stakeholders.

This study describes the case of a student with congenital intestinal perforations and her experience with inclusive education in the Czech Republic. She is also a sister of an identical twin with cerebral palsy. The data were gained from semi-structured interviews and bio-graphical narratives of the student during her studies at the grammar school and from her parents. Van Manen's analyses of lived experiences was used to identify important themes for each participant. The overarching themes present in their narratives concerned Lucy's future and the choice of the most appropriate educational environment. The parents' narratives focused more on barriers to inclusive education, benefits of inclusive environments, medical and educational care and family support based on close cooperation with school. For Lucy, the dominant theme was being a sister with a less severe disability and caretaking of her sister. In addition to enhancing the understanding of different needs of a student with congenital malformations and her parents' experiences with inclusive education, it helped us to explore how the specific sibling's constellation within her family and school contexts impacts her personal perspective on life, driven strongly by a wish for independence.

Proper treatment of developmental disabilities requires health workers to have adequate knowledge of etiology and referral procedures. There is a dearth of research on knowledge of developmental disabilities among health workers in Ghana. The purpose of this study was to document knowledge about developmental disorders, causes, and referral procedures among health workers. Researchers used a successive free-listing method to interview 37 health workers. Developmental disabilities which present with physical symptoms were the most salient disorders identified among health workers, while learning disabilities and attention deficit disorder were largely overlooked. The most commonly listed developmental disabilities were cerebral palsy, Down syndrome, and autism spectrum disorder. Respondents had limited knowledge about the causes of and referral resources for developmental disabilities. Results show the need for continuing medical education, public awareness, and enhanced resources to support the identification and care of children with developmental disabilities in Ghana.

Interventions are strongly recommended for preschoolers experiencing participation difficulties in their daily life, regardless of whether or not they have a diagnosis. Best practices recommend that interventions should include the child's significant adults and be delivered in the child's environments. Occupational Performance Coaching (OPC) has shown promising results in improving children's participation by supporting significant adults of school-aged children either with cerebral palsy or without a definite diagnosis, and of preschoolers with developmental coordination disorder. However, this approach has not yet been studied for preschoolers without a definite diagnosis. A multiple case study design was used to explore the interventions's feasibility for this population. Eight parents and three early childhood educators received OPC to help seven children (cases). Intra- and inter-case analyses were conducted to document the effects of the intervention on the children's participation and the caregivers' goals. All children had difficulties in their daily life, and most presented motor, sensory, behavioral and/or adaptive difficulties. Improvements in children's participation and significant adults' satisfaction as well as goal attainment were observed in most cases. Improvements were generally maintained at a three-month follow-up. These findings support the feasibility of OPC for significant adults of preschoolers with participation difficulties in daily life but no definite diagnosis.

Members of Korean American communities have displayed an increasing interest in volunteering opportunities with individuals with severe disabilities that promote social interaction and community engagement among them. However, little is known about community volunteer experiences and how Korean American volunteers can be better supported. In this qualitative study, we documented the voices of Korean American volunteers who work with individuals with severe disabilities. Adopting a phenomenological approach, we interviewed and observed ten Korean American community volunteers to explore the meaning of their experiences and their perceptions of severe disability as well as the social inclusion of individuals with severe disabilities. Through the data analysis, three main themes were identified: changing views on individuals with severe disabilities, inclusion in multifaceted communities, and identified needs of the Korean American community and volunteering system. The results show that the volunteers' initial perceptions of disability evolved during their experiences with individuals with severe disabilities. The data provides practical information about the ethnic community and volunteering system, which foster social integration among the participants and community members regardless of their abilities, race/ethnicity, language, and immigrant status.

Children with cerebral palsy frequently experience challenges and barriers to inclusion in early childhood education and care. However, there is limited research exploring the experiences of children with cerebral palsy and their families. Understanding family perspectives on their experience is likely to provide insights for professionals to improve inclusive practices. Using Bronfenbrenner's bioecological theory, this study evaluates online survey responses of factors that parents believed facilitated -- or created barriers towards -- inclusive early childhood education. Ninety-eight parents shared their levels of satisfaction and perspectives regarding the importance of inclusion practices involving their child in Australian settings. Parents reported overall high levels of satisfaction, highlighting the importance of positive educator attitudes, communication between home and settings and partnerships between home, allied health practitioners and early childhood education and care settings. Concerns related to children's psychological wellbeing were raised, particularly regarding children's experiences and challenges with anxiety including separation anxiety.

Little is known about the relationship between working memory (WM) abilities and reading in children with cerebral palsy (CP) who have age-appropriate communication and language. The aim of this group case study is to analyze the WM abilities and their relationship to reading in children with CP and age-appropriate communication and language. Fifteen children with CP (6:9 to 11:6 years) and age-appropriate communication and language were identified. They were given tests of communication and language, reading (decoding), and three aspects of WM: phonological short-term memory (PSTM); visuospatial short-term memory (VSTM); and the central executive (CE). The children were divided into two groups; five who had age-appropriate reading (Age-appropriate Readers), and ten with very low reading abilities (Developing Readers). The results showed that PSTM was mostly age appropriate in both reading groups and their scores mostly correlated with their reading abilities. VSTM scores were very poor in both groups and not related to reading group membership or reading. CE abilities were mostly as would be expected for the Age-appropriate Readers, but low for the Developing Readers; CE scores correlated with reading abilities. The findings suggest that there are variations in the working memory abilities in this group of children and that the CE may be an important contributor to their reading development.

This study aimed to compare the executive functions (EFs) and occupational performance and perceived occupational proficiency (POP) in children with neurodevelopmental disorders. In this study, 72 children diagnosed with cerebral palsy (CP; n = 22), specific learning disabilities (SpLD; n = 26) or attention deficit and hyperactivity disorder (ADHD; n = 24) were included in the study group and 84 typically developed children were included in the comparison group. All children were evaluated with the Child Occupational Self-Assessment (COSA) and all parents were evaluated with The Executive Function and Occupational Routines Scale (EFORTS) and the Canadian Occupational Performance Measure (COPM). Accordingly, statistically significant differences were found between the study group and the comparison group in terms of total scores of the COSA and EFORTS (p < 0.05). In addition, there was a significant difference between the CP, ADHD, and SpLD diagnosis groups and the comparison group in terms of sub-parameters of COSA and EFORTS score (p < 0.05). The findings showed that children with different diagnoses within neurodevelopmental disorders have difficulties in different EFs and occupational performance areas. Also, the pattern of association between EF and POP was different for each group. Therefore, therapists need to consider occupational performance and POP with EFs in their assessments before planning their intervention.

Background: To investigate the safety and feasibility of six sessions of Hybrid Assistive Limb (HAL) robot-assisted gait training (RAGT) integrated into an inpatient therapy concept and their influence on walking speed and gait parameters in adult CP patients. Methods: Eleven subjects (male = 8, female = 3, mean age: 23 years and 2 months, ± 4.5 years) with spastic CP underwent six 20-minute RAGT sessions with the HAL during an 11-day hospital stay. Additionally, physiotherapy, physician-performed manual medicine, massage and exercise therapy were provided. Pre- (T1) and post- (T2) intervention assessments were: 10-metre walking test (10MWT), 6-minute walking test (6MWT), Gross Motor Function Measure (GMFM-88) and lower extremities passive range of motion (pROM). Results: All subjects completed the study. No adverse events were noted. Walking speed in the 10MWT test increased from 32.5 s (± 24.5 s) at T1 to 27.5 s (± 21.4 s) at T2, without significance. Slight, but non-significant improvements were detected in the 6MWT, GMFM and pROM. Confounding factors did not significantly affect the results. Conclusion: Intensive therapy including HAL training leads to non-significant improvements. Further studies with more patients and longer intervention time could provide further insights into the RAGT therapy of adult patients with CP. Registration DRKS-ID: DRKS00020275.

Children with developmental disabilities (DD) exhibit feeding and swallowing difficulties, which can have an impact on nutritional, developmental, and psychological aspects. The existing tools assess the nature of feeding problems and behaviors only. The present study aimed to assess the physical, functional, and emotional domains in children with DD with feeding issues using Feeding handicap index for children (FHI-C). For clinical validation, FHI-C was administered on the parents/caregivers of 60 children with cerebral palsy, 61 with autism spectrum disorder, 59 with intellectual disability and 60 typically developing children in the age range of 2 to 10 years. The results revealed that the mean scores (Total FHI-C and FHI-C domain scores) were significantly higher for all three clinical groups than for the control group, which revealed good clinical validity. Also, FHI-C was found to have significantly high test-retest reliability. The study presents a valid and reliable tool for assessing the psychosocial handicapping effects of feeding problems in children with DD. FHI-C provides a holistic picture about the psychosocial impact of feeding problems in children with DD and will assist the clinicians in prioritizing the goals for feeding therapy. The scores obtained can be used as reference for pre and post therapy comparison purposes.

Executive functions (EFs) are an umbrella term that includes various cognitive abilities (such as inhibition, planning, goal-setting, monitoring, and shifting). There is common agreement that there are three main EFs: inhibitory control, cognitive flexibility, and working memory. Further studies have reported that compared to typically developing peers, children with cerebral palsy (CP) show deficits in EF skills. This study aims to evaluate children with CP's inhibitory control and cognitive flexibility skills. Forty children with CP between the ages of 7-13 were included in the present study. EF scores of the CP group were compared with scores of typically developing peers matched one-to-one by age and sex. The EF skills were evaluated with Wisconsin card sorting test (WCST), Stroop color-word test (SCWT) TBAG Form, and executive function behavior rating scale parent form (BRIEF-P). It was determined that there was a significant difference in the WCST total trials, total errors, categories completed, and percent conceptual level responses scores (p < 0.05); SCWT-TBAG scores (p < 0.05), and BRIEF-P all scores (p [less than or equal to] 0.01) of children with CP. The results of this study suggest that children with CP are disadvantaged with EF skills in terms of inhibitory control and cognitive flexibility.

The study examined the level of services for cerebral palsy (CP) centers in Jordan from parents' viewpoint during the Corona pandemic. It also examined if there are any differences due to the sex and age of the child with CP. The study sample consisted of 50 parents of children with CP and used a scale for services level of CP centers to collect study data. The results indicated that the level of services during the Corona pandemic was generally moderate. In addition, there were statistically significant differences in the services level due to the sex favor to females, and there were no differences due to the age.

Purpose: Students with multiple disabilities who are beginning communicators require augmentative and alternative communication (AAC) to communicate during school and participate in its academic and social aspects. Triadic gaze is a method for accessing low-tech AAC that minimizes physical demands on access for students with limited mobility, such as students with multiple disabilities. Thus, this study evaluated an instructional protocol for teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Method: Three students with multiple disabilities who were beginning communicators participated in a multiple baseline across participants design with three phases: baseline, treatment, and generalization and maintenance. Participants engaged in instruction around using triadic gaze to communicate by making selections on an eye gaze board. Results: Visual analysis showed that all three participants acquired the use of triadic gaze as a method of accessing low-tech AAC in response to instruction. Effect size estimations suggested instruction was effective. The participants also demonstrated that the newly acquired skill generalized to interactions with familiar communication partners after instruction ended. Conclusions: These findings show that instruction can be effective in teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Future research should explore the effects of using this access method on communicating across school contexts.

This study examines the displayed communicative competence and agency of a non-speaking student at a compulsory school for children with severe learning disabilities. The use of two different speech-generating devices (a single-message versus a multi-message speech-generating device) and the assignment of participation role (having the role of 'student' or 'teacher') were compared in two morning meetings. The two interactional sequences 'question-answers' and 'repair actions' were chosen because they provide participants with opportunities to display communicative competence and agency. The analysis showed that the displayed communicative competence and agency of the non-speaking student differed in relation to the kind of speech-generating device and the associated participatory role. Furthermore, the displayed communicative competence and agency was a product of the close collaboration between the student and the assistant and teachers who scaffolded the process. The study shows that teachers and assistants can influence the communicative competence and agency of non-speaking students.

This article offers a reading of Kate Darbishire's novel Speechless Stickhouse Publishing, London, 2018), following Harriet, a girl with cerebral palsy. It examines her irritation, born of her resentful awareness of her disability, as well as how she grapples with her life as an ordinary schoolgirl. The novel presents Harriet as an everyday child, no more heroic than her peers for her struggles and no less dignified for them, either. The interpretation implements Martha Nussbaum's study of capabilities and disabilities in relation to reading the novel. Her broad assertions of universal qualities that must be native to all humans frames the reading of Harriet. These capabilities manifest in Harriet's judgemental criticisms of what she observes and feels. This work suggests that they afford her the same growth in maturity as other people, closing the novel with an expanded human understanding, as seen in her acceptance of an unseen sibling.

Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader STARTPlay intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.

This research examined an evidence based dialogic shared reading strategy which incorporated aided language modelling and increased communication partner responsiveness with two children with complex physical, cognitive, and sensory needs (CPCSN) who use auditory plus visual partner assisted scanning (PAS) to access a Pragmatic Organised Dynamic Display (PODD) communication book. The dialogic reading strategy prompted the communication partner to comment on the story, invite a communication turn, and respond contingently to the child. A case study design was employed, and data were collected via child and adult communication frequency measures, field notes, observations, and a semi-structured interview with the children's teacher. Overall, the results indicated a positive effect on the children's communication skills, both within the intervention sessions and the classroom. This included increases in turn taking, initiations, efficiency, and conveying meaning. Shared storybook interventions that include strategies such as aided language stimulation, responsiveness and wait time can support the communication outcomes of children with CPCSN who use PAS.

The school function of children with cerebral palsy (CP) are affected by their disability. Cognitive impairments, especially in executive function (EF), can be a reason for these children's failure in school function. This study investigated the association between EF and school function (school participation, school physical activity performance) in children with Cerebral Palsy. This descriptive-analytical cross-sectional study evaluated 98 children with CP who were diagnosed by a pediatric neurologist, aged between 7-12 years, had no simultaneous disabilities (blindness and deafness), were able to follow verbal instructions and had a Wechsler IQ score [greater than or equal to] 70. The children's school function was assessed using the School Function Assessment (SFA), and their EF was evaluated using the Tower of London test and the Behavior Rating Inventory of Executive Function (BRIEF). After collecting data, they were analyzed using SPSS software version 23. The results revealed a significant positive correlation between the some EF components and school function (participation, activity performance). Similarly, there was a significant positive correlation between the total EF score with participation, travel, maintaining/changing position, recreational movement, manipulation with movement, using materials, setup/cleanup, hygiene, clothing management (p < 0.01), as well as eating/drinking, written work, and going up/downstairs (p < 0.05). The findings suggest that executive function is associated with school function (participation and physical activity performance) in children with CP. Therefore, it seems possible to improve children with CP's school function by promoting different EF components.

The purpose of this case study was to explore the communication needs of a child with deafness and cerebral palsy (DCP) and how these needs can be supported by interventions targeting the use of communication approaches and strategies. One semi-structured interview with the child's parents and five observations of the child in different contexts before and after the interventions took place. A rating scale "Checklist of Identified Needs", deriving from the observation data, the "Early Years Foundation Stage (EYFS) Development Matters" assessment and a British Sign Language (BSL) receptive and expressive skills assessment were used to explore the child's communication strategies before and after the intervention. The child completed two parallel school-based interventions lasting seven weeks, (1) one delivered daily which focused on BSL usage and Augmentative Alternative Communication (AAC) and (2) one targeting communication strategies such as initiating and maintaining eye contact using a weekly "social story" and play-based sessions. Our results indicated that the combined use of sign and AAC technology to target key areas of communication use and a targeted approach using social stories to support communication strategies can be effective in enhancing communication skills of children with DCP. Implications for practice are discussed.

This study assessed implementation of the Computer-based Instrument for Low-motor Language Testing (C-BiLLT). The C-BiLLT is an accessible language comprehension assessment tool originally developed for children with cerebral palsy and complex communication needs. The purpose of the current study was to understand the clinical contexts in which the C-BiLLT is used in the Netherlands, Belgium, and Norway and assess barriers and facilitators to implementation. An online survey was distributed to rehabilitation clinicians working in the Netherlands, Dutch-speaking parts of Belgium, and Norway. A total of 90 clinicians reported their training in and use of the C-BiLLT; assessed its acceptability, appropriateness, and feasibility; and commented on perceived barriers as well as advantages of the tool. Acceptability, appropriateness, and feasibility were all rated highly. The C-BiLLT was used with various populations and age groups but most often with children who were younger than 12 years of age, and those with cerebral palsy. The main implementation facilitator was clinicians' motivation; the main barriers were related to resources and complexity of cases. Findings suggest implementation of new assessment tools is an ongoing process that should be monitored following initial training, in order to understand clinical contexts in which the tools are being used.

Purpose: Dysarthria is common among children with cerebral palsy (CP) and results in poor speech intelligibility and subsequently low communicative participation. Neuroplasticity evidence suggests that adherence to principles of motor learning (PML) improves motor speech intervention outcomes. Motor speech interventions aim to improve speech intelligibility and ultimately facilitate participation, but the effectiveness of these interventions and their inclusion of PML are not clear. Aims are as follows: (1) evaluate the effectiveness motor speech interventions in improving speech intelligibility; (2) summarize the aims, outcome measures, and outcomes relating to the International Classification of Functioning and Disability Child and Youth; and (3) summarize the principles of motor learning used in the intervention. Method: Eight databases were searched, complemented by a hand search. Studies of any level of evidence were included if they used a motor speech intervention and measured speech in children with CP aged 0-18 years. Studies before 2000 or not in English were excluded. The review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was rated using the Single Case Experimental Design Scale and Physiotherapy Evidence Database-P rating scales. The strength of evidence was evaluated with Grading of Recommendations, Assessment, Development and Evaluation. Results: Of 1,036 initial articles, 21 were included. Eight interventions were identified including 131 participants aged 3-18 years. All studies aimed to improve speech intelligibility or articulation and reported improvement at sound, word, or sentence level. One study reported improvements in communicative participation. The strength of evidence ranged from very low to moderate for one intervention. Adherence to PML was inconsistent. Conclusions: The quality of evidence is very low to moderate. More research on motor speech interventions that adhere to PML is required.

To pilot Therapy Together, an 8-week parent-led pediatric constraint induced movement therapy (P-CIMT) program for preschool aged children with unilateral cerebral palsy (UCP). Five children with UCP and their caregivers participated in eight, 1 hour group sessions structured by the TEAM approach (topic, encourage, activity, and motivate). Three of the sessions were in person and 5 of the sessions were online due to COVID-19. Parent coaching and therapeutic activities for each weekly session aimed to improve a specific upper limb domain. The caregivers were asked to implement therapeutic activities 1 hour each day at home. The primary outcome measure was the Assisting Hand Assessment (AHA), scored by a blinded rater. The secondary outcome measure was the Canadian Occupational Performance Measure (COPM). Caregivers kept a log of hours completed at home, comments about implementing the program, and rated their child's unilateral and bilateral hand performance weekly. Participants demonstrated clinically significant changes in bimanual performance (AHA) with a large effect size, but statistical significance was not reached. Improvements in occupational performance and satisfaction (COPM) were clinically and statistically significant. Therapy Together is a promising P-CIMT intervention program for preschooler with UCP. The program incorporates caregiver education and coaching with caregiver-led home therapeutic activities to improve children's bimanual hand skills and occupational performance while addressing barriers to intervention access such as caregiver hesitancy in order to reduce health disparities in children with UCP.

Few studies have investigated how individuals with partially intelligible speech choose to communicate, including how, when, and why they might use a speech-generating device (SGD). This study aimed to add to the literature by exploring how this group of individuals use different communication strategies. Qualitative interviews were carried out with 10 participants with partially intelligible speech with the aim of investigating participants' perceptions of modes of communication and communication strategies. Transcripts were analyzed using Framework Analysis to investigate the role of SGDs alongside other communication strategies. Factors that influence why, when, and how a person chooses to communicate were identified and these were interpreted as an explanatory model of communication with partially intelligible speech. Participants described how they made the decision whether to attempt to communicate at all and then which communication method to use. Decision-making was influenced by the importance of the message, how much time is available, past experience, and the communication partner. Each communication attempt adds to an individuals' experience of communicating and influences subsequent decisions. This study suggests that individuals with partially intelligible speech are at risk of reduced communication environments and networks and that current SGDs may not be designed in a way that recognizes their particular needs.

Cerebral palsy is a leading cause of physical impairment worldwide. Community support and acceptance influence the opportunities people with cerebral palsy have to participate in all areas of life, but very little is known about the general community's understanding of cerebral palsy. This study investigated knowledge and perceptions of cerebral palsy in the Australian community. A sample of 1,217 adults responded to an open-ended question: 'What is the first thing that comes to mind when you think about cerebral palsy?' Almost half of the sample indicated some awareness that cerebral palsy is a physical disability involving difficulties with muscle control, movement and coordination; however, 20% of the participants had no knowledge or stated incorrect facts. Wheelchairs were the first thing that came to mind for 10% of the sample. Few participants mentioned common comorbidities such as cognitive or communication difficulties. A substantial minority of responses (8%) were characterised by stigma or insensitivity. Although many people in the general community appear to have accurate knowledge about cerebral palsy, misperceptions and stereotypes are likely to impact on quality of life and personal well-being for individuals with cerebral palsy and their families.

Purpose: Some children with cerebral palsy (CP) have difficulty acquiring conventional reading and writing skills. This systematic review explores the different types of literacy instruction and their effects on the reading and writing skills of children with CP. Method: Relevant studies published between 2000 and 2020 were identified using electronic databases and terms related to CP and literacy. Data on participant characteristics, instruction characteristics, and instruction outcomes were extracted. A standardized measure of effect size was used to quantify reported treatment effects. Results: The systematic search identified 2,970 potentially relevant studies, of which 24 met inclusion criteria. These studies included 66 children with CP aged 5-18 years. One of the included studies utilized a group research design, whereas the remaining used single-subject designs. Studies investigated literacy instruction methods designed to teach phonics, sight-word recognition, reading fluency, reading comprehension, spelling, or written expression skills, or multicomponent instruction (instruction methods encompassing three or more of these skills). Most instruction methods were associated with gains in reading and writing skills with medium to large effects; however, our analysis of methodological rigor suggests that these findings need to be interpreted with caution. Conclusions: We propose that literacy instruction utilizing evidence-based principles can be effective for children with CP, provided instruction is accessible and allows children to demonstrate and receive feedback on their skills; however, further research is greatly needed. Clinical implications and priorities for future research are discussed.

Background: Speech is the most common method of communication. Video-based clinical communication evaluation is a requirement for children with speech-language impairments living in rural areas, and those who have limited mobility. Aims: To determine the validity and reliability of the Turkish version of the Viking Speech Scale (VSS-T) via live and video-based observation for children with cerebral palsy (CP) aged 4-18 years. Methods & Procedures: A total of 142 children (mean age 8.18 ± 3.98 years; 68 female) with CP were included in this study. Their motor, communication, visual and eating-drinking function levels and comorbidities (dental, swallowing, cognitive impairments and epilepsy) were recorded. The Intelligibility in Context Scale (ICS), the Pediatric Evaluation of Disability Inventory-Social Function (PEDI-SF), and the Functional Independence Measure for Children-Communication (WeeFIM-C) were assessed to examine the concurrent validity of the VSS-T. The interrater reliability of the VSS-T was analysed between parents, physical therapists, and speech and language therapists from live and video-based observation. Intra-rater reliability was calculated from ratings made from live and video-based observations taken 3 weeks apart. Outcomes & Results: The VSS-T was strongly related to the ICS (r = -0.830), PEDI-SF (r = -0.819), WeeFIM-C (r = -0.643), other functional classifications (r > 0.432), and the comorbidities (Cramer's V > 0.284, p < 0.001). Good to excellent interrater reliability (?w [greater than or equal to] 0.838) and intra-rater reliability (intraclass correlation coefficient (ICC) = 0.848-0.995) were found between parents and therapists. Conclusions & Implications: Speech and language therapists, physical therapists, and parents can use the VSS-T as a valid and reliable classification system to describe speech intelligibility of 4-18-year-old children with CP. Both live and video-based observations can be used to administer the VSS-T.

Purpose: The purpose of this scoping review was to (a) summarize methodological characteristics of studies examining vocal characteristics of infants at high risk for neurological speech motor involvement and (b) report the state of the high-quality evidence on vocal characteristic trends of infants diagnosed or at high risk for cerebral palsy (CP). Method: The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) extension for scoping reviews was followed for reporting our review. Studies measured prelinguistic vocal characteristics of infants under 24 months with birth risk or genetic conditions known to commonly present with speech motor involvement. Fifty-five studies met criteria for Part 1. Eleven studies met criteria for synthesis in Part 2. Results: A smaller percentage of studies examined infants with or at risk for CP compared to studies examining genetic conditions such as Down syndrome. The median year of publication was 1999, with a median sample size of nine participants. Most studies were conducted in laboratory settings and used human coding of vocalizations produced during caregiver-child interactions. Substantial methodological differences were noted across all studies. A small number of high-quality studies of infants with or at risk for CP revealed high rates of marginal babbling, low rates of canonical babbling, and limited consonant diversity under 24 months. Mixed findings were noted across studies of general birth risk factors. Conclusions: There is limited evidence available to support the early detection of speech motor involvement. Large methodological differences currently impact the ability to synthesize findings across studies. There is a critical need to conduct longitudinal research with larger sample sizes and advanced, modern technologies to detect vocal precursors of speech impairment to support the accurate diagnosis and prognosis of speech development in infants with CP and other clinical populations.

Purpose: Adapted ride-on cars offer an affordable mobility intervention that provides broader access to a child's environment. Such newfound independence is a unique opportunity to examine changes in environmental language and communicative participation as children acquire mobility. New technologies such as the Language Environmental Analysis (LENA) system hold promise for evaluating naturalistic language interactions but have not yet been applied to children with cerebral palsy with physical and/or communication impairments. This study sought to use LENA with a sample of children with cerebral palsy to determine the feasibility of monitoring environmental language patterns during longitudinal mobility intervention. Method: LENA's adult word counts, conversational turns, and child vocalizations were compared across three time points for participants aged 16-49 months with a range of communication skills (indexed by Communication Function Classification System Levels I-IV). Results: Feasibility was established with acceptable criterion validity during active drive time. Results had large effect sizes, likely diluted by sample size and heterogeneity. Conclusions: Limitations include small sample size, nonprescriptive use of powered mobility devices, and lack of control group. Future studies should incorporate these features to more closely examine communication patterns.

To use the International Classification of Functioning, Disability and Health (ICF) to investigate whether children with congenital Zika Syndrome (CZS) show changes in their functioning and disability profile after nine months. This study included children with CZS recruited from a support centre for children with microcephaly in Brazil. The children's functional abilities and limitations were classified using ICF Core Set for children with cerebral palsy. Each ICF category was quantified in two moments with a mean interval of nine months. The study included 81 children (mean age = 38.4 ± 3.3mo). Most children showed changes between assessments. Categories that presented improvements were in body functions (five categories), environmental factors (two categories), and activity and participation (one category) sections. Most children with CZS evaluated improved their functioning and disability profile over time, mainly in body functions. These changes can be related to the course of the disease or to the health programmes that children had access.

Preschool children with cerebral palsy (CP) with no or unintelligible speech need augmentative and alternative communication (AAC), but not all children needing AAC have access to it. This study describes the use and perceived benefit of AAC and explores factors associated with receiving AAC interventions. Using a cross-sectional design, we combined parent-reported data with data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Communication, speech and hand function was classified according to the Communication Function Classification System (CFCS), Viking Speech Scale (VSS), and Manual Ability Classification System (MACS), accordingly. The need for AAC was defined as Levels III-V on the CFCS, without simultaneous classification at VSS Level I, and/or Levels III-IV on VSS. Parents reported on child- and family-directed AAC interventions using the Habilitation Services Questionnaire. Of the 95 children (42 females) with CP (M = 39.4 months, SD = 10.3), 14 had communication aids. Of the 35 children (31.4%) defined as needing AAC, 11 had been provided with communication aids. Parents of children with a communication aid reported satisfaction with and frequent use of the aid. Children at MACS Level III-V (OR = 3.4, p = 0.02) or with epilepsy (OR = 8.9, p < 0.01) were most likely to have received an AAC intervention. The low proportion of children receiving communication aids indicates an unmet need for AAC interventions among preschool children with CP.

Purpose: As evidenced by perceptual learning studies involving adult listeners and speakers with dysarthria, adaptation to dysarthric speech is driven by signal predictability (speaker property) and a flexible speech perception system (listener property). Here, we extend adaptation investigations to adolescent populations and examine whether adult and adolescent listeners can learn to better understand an adolescent speaker with dysarthria. Method: Classified by developmental stage, adult (n = 42) and adolescent (n = 40) listeners completed a three-phase perceptual learning protocol (pretest, familiarization, and posttest). During pretest and posttest, all listeners transcribed speech produced by a 13-year-old adolescent with spastic dysarthria associated with cerebral palsy. During familiarization, half of the adult and adolescent listeners engaged in structured familiarization (audio and lexical feedback) with the speech of the adolescent speaker with dysarthria; and the other half, with the speech of a neurotypical adolescent speaker (control). Results: Intelligibility scores increased from pretest to posttest for all listeners. However, listeners who received dysarthria familiarization achieved greater intelligibility improvements than those who received control familiarization. Furthermore, there was a significant effect of developmental stage, where the adults achieved greater intelligibility improvements relative to the adolescents. Conclusions: This study provides the first tranche of evidence that adolescent dysarthric speech is learnable--a finding that holds even for adolescent listeners whose speech perception systems are not yet fully developed. Given the formative role that social interactions play during adolescence, these findings of improved intelligibility afford important clinical implications.

The present study developed a brief school-based intervention focused on raising awareness about Cerebral Palsy. To assess the effectiveness of the intervention, 91 classes from the fourth and fifth grades were randomly assigned to one of three conditions: Control, Focused on the Domain (Cerebral Palsy), and Non-Focused on the Domain (promotion of inclusion in general). Groups were assessed in three waves: pre-test, post-test, and follow-up. Data from this longitudinal cluster randomised trial showed the efficacy of this brief intervention in decreasing reported social distance and increasing positive attitudes towards individuals with Cerebral Palsy. Results from the Focused on the Domain Group were more positive than the Non-Focused on the Domain Group. Implications for educational practice are discussed.

Purpose: This study examined speech breathing during two connected speech tasks in children with cerebral palsy (CP) and typically developing (TD) peers. Understanding how the respiratory system supports speech production during various speech tasks can help researchers construct appropriate models of speech production and clinicians remediate speech disorders effectively. Method: Four children with CP and four age- and sex-matched TD peers completed two speech tasks, reading and extemporaneous speech. Respiratory kinematic and acoustic data were collected. Dependent variables included utterance length, speech rate, sound pressure level, and lung volume variables. Results: Based on descriptive results, children with CP and speech motor involvement demonstrated reduced utterance length and speech rate, equivalent intensity levels, and changes in lung volume variables indicative of respiratory physiological impairment as compared to their TD peers. However, children with CP and no speech motor involvement exhibited speech production and speech breathing variables in the more typical range. In relation to task effects, the majority of children (CP and TD) produced shorter utterances, slower speech rates, equivalent intensity levels, higher lung volume initiation, termination, excursion, higher percent vital capacity per syllable, and longer inspiratory duration during extemporaneous speech as compared to reading. Conclusions: Two major themes emerged from the data: (a) Children with CP, particularly those with concomitant speech motor involvement, demonstrate different speech production and speech breathing patterns than their TD peers. (b) Speech task impacts speech production and speech breathing variables in both children with CP and their TD peers, but the extemporaneous speech task did not seem to exaggerate group differences.

Purpose: Our purpose was to start examining clinical swallowing and motor speech skills of school-age children with unilateral cerebral palsy (UCP) compared to typically developing children (TDC), how these skills relate to each other, and whether they are predicted by clinical/demographic data (age, birth history, lesion type, etc.). Method: Seventeen children with UCP and 17 TDC (7-12 years old) participated in this cross-sectional study. Feeding/swallowing skills were evaluated using the Dysphagia Disorder Survey (DDS) and a normalized measure of mealtime efficiency (normalized mealtime duration, i.e., nMD). Motor speech was assessed via speech intelligibility and speech rate measures using the Test of Children's Speech Plus. Analyses included nonparametric bootstrapping, correlation analysis, and multiple regression. Results: Children with UCP exhibited more severe (higher) DDS scores (p = 0.0096, Part 1; p = 0.0132, Part 2) and reduced speech rate than TDC (p = 0.0120). Furthermore, in children with UCP, total DDS scores were moderately negatively correlated with speech intelligibility (words: r = -0.6162, p = 0.0086; sentences: r = -0.60792, p = 0.0096). Expressive language scores were the only significant predictor of feeding and swallowing performance, and receptive language scores were the only significant predictor of motor speech skills. Conclusions: Swallowing and motor speech skills can be affected in school-age children with UCP, with wide variability of performance also noted. Preliminary cross-system interactions between swallowing, speech, and language are observed and might support the complex relationships between these domains. Further understanding these relationships in this population could have prognostic and/or therapeutic value and warrants further study.

We studied whether there exist variations in pain responses between different intellectual and developmental disability (IDD) etiologies. Self-reports and facial expressions (Facial Action Coding System = FACS) were recorded during experimental pressure stimuli and compared among 31 individuals with IDD--13 with cerebral palsy (CP), nine with Down syndrome (DS), nine with unspecified origin (UIDD)--and among 15 typically developing controls (TDCs). The CP and DS groups had higher pain ratings and FACS scores compared to the UIDD and TDC groups, and steeper stimulus-response functions. The DS group exhibited the most diverse facial expressions. There were variations in the foci of facial expressions between groups. It appears that different IDD etiologies display distinct pain responses.

After having the son with cerebral palsy and auditory neuropathy, the authors had to learn how to advocate for her son. After 12 years of ups and downs, uncertainties, hard work, determination, and tears, her son James graduated from high school with a regular diploma. In this article, she describes of the struggles she and her son had to go through in order for him to receive an education.

A twice-exceptional student who is gifted but also has an additional exceptionality challenges teachers and educators to deliver the best teaching strategies. This paper reviews the current learning strategies, interventions and practices that specifically focused on twice-exceptional students. Research articles were obtained on online database of published articles. The scope is focused on intervention practices or instructions in the behavioral, developmental, emotional, or educational areas. By making a systematic review, this article summarizes 44 research studies on twice-exceptionality interventions between 2000 and 2018, regardless of the areas of disability. The findings are categorized into five main themes, preceded by the most used in studies which is academic or learning strategy, followed by support, strength or talent-based, art or music, and technology. An effective intervention must be tailored to their strengths and potentials as well as providing remediation and support for their social and emotional needs. This study is vital and meaningful for educators and parents to provide these twice-exceptional students the best intervention that suits their own strengths and needs.

Content validity describes the extent to which a measure represents, and is relevant to, the construct it aims to assess. The International Classification of Functioning, Disability and Health and derived Core/Code Sets (Sets) for autism, attention deficit-hyperactivity disorder, cerebral palsy and early developmental delay and disability are adequate to establish the content validity of measures aiming to assess functioning in young children with neurodevelopmental conditions (NDCs). This article aimed to assess the content validity of comprehensive assessments of functioning for young children with NDCs against these standards. Twenty-two common measures of functioning were evaluated for content validity against the International Classification of Functioning, Disability and Health at a domain level, with 10 measures analysed at the item-level and compared to the Sets relevant to young children with NDCs. Measures covered between 21% and 57% of the combined Set codes and 19% to 63% of codes from specific Sets. Much of this variation was between measures, with some variation due to differences between individual Sets. The percentages reflect that measures heavily focus on activities and participation areas, with environmental factors rarely assessed. These findings are useful for clinicians, policymakers, and researchers in identifying the most appropriate measures for assessing functioning in young children with neurodevelopmental conditions.

This study examined the family emotional climate as assessed by Five Minute Speech Samples and the relation with parenting stress and parenting behaviors among parents of children (6-17 years, 64.7% boys) with autism spectrum disorder, cerebral palsy, Down syndrome, and without any known disability (n = 447). The large majority of parents (79%) showed low levels of Expressed Emotion, an indicator of a positive family climate. In all groups, more Emotional Over-involvement, more Criticism and fewer expressions of Warmth were associated with higher levels of parenting stress. Across groups, Emotional Over-involvement was related to more autonomy-supportive parenting, Criticism to more psychologically controlling and overreactive parenting, and Warmth was associated with more responsive and less psychologically controlling and overreactive parenting.

Caregiver support is an important contextual factor in the daily functioning of children with cerebral palsy (CP), but few studies have examined child-caregiver interactions during collaborative motor tasks to identify characteristics of effective support that should be promoted in clinical interventions. The aims of this exploratory study were to (1) describe the interaction dynamics of children with CP and typically developing (TD) children with their respective caregivers during a collaborative motor task and (2) develop clinically relevant hypotheses regarding features of child-caregiver interactions that relate to effective caregiver support. Twelve child-caregiver dyads (6 including children with CP, 6 including TD children) participated. Each dyad attempted to construct the tallest tower structure in 10 min using marshmallows and raw spaghetti. Time-series of upper extremity positions were obtained through motion capture and used to examine child-caregiver movement coordination. Videos were coded for language structure and number of building materials used. Five TD dyads and one CP dyad successfully constructed a free-standing tower. During periods of increased tower breakage, TD dyads demonstrated increased movement coordination compared to CP dyads. Unsuccessful dyads (most of whom were CP dyads) demonstrated interaction dynamics characterized by the child leading in movement during periods of increased tower breakage. Overall, in TD dyads, caregivers used more interrogatives than imperatives, and children used more imperatives than interrogatives. This pattern was reversed for CP dyads. From these results we identified future hypotheses about aspects of interactions that may facilitate collaborative motor performance (and thus caregiver support) between children with CP and their caregivers.

Ample quantitative studies have shown that parents raising children with neurodevelopmental disabilities are prone to experience more stress and challenges in their parenthood. Notwithstanding the strength of this line of research, qualitative studies are crucial to grasp the complex reality of these parenting experiences. This qualitative study adopted the Self-Determination Theory to analyze parents' described experiences, appraising both challenges and opportunities in parents' psychological need for autonomy, relatedness, and competence. A multi-group comparative design is adopted to examine similarities and differences in the perspectives of 160 parents raising an adolescent with autism spectrum disorder, cerebral palsy, Down syndrome, or without a disability (M age child = 13.09 years, 67.5% boys). Parents' perspectives were examined through speech samples probing parents to talk spontaneously about their child, their relationship with the child, and their parental experiences. Forty samples in each group were randomly chosen from a larger dataset and were analyzed using deductive thematic analysis. Parents of children with a disability described more need-frustrating but also more autonomy-satisfying experiences compared to parents of children without a disability. Parents of children with autism spectrum disorder reported the most challenges concerning their relatedness with their child and their own parental competence. Parents raising a child with cerebral palsy expressed the most worries about their child's future and continuity of care. Parents of a child with Down syndrome described the most need-satisfying experiences in their family life. This study offers a more balanced view on the realm of parenting a child with a neurodevelopmental disability.

A 36-year-old female with severe spastic dysarthria participated in this study. She received 4 weeks of individual, intensive voice-focused treatment. Voice recordings were conducted at three baseline points, immediately posttreatment, and at a 4-month follow-up. The primary outcome variables were selected acoustic measures of vocal function: sound pressure level (SPL), mean fundamental frequency (F0), maximum phonation time (MPT), jitter, shimmer, noise-to-harmonics ratio (NHR), and maximum phonation frequency range (MPFR). Significant pre-to-posttreatment changes (p < 0.05) were found for most acoustic variables. All acoustic gains, except for MPFR, were maintained at the 4-month follow-up. The significant posttreatment changes in the majority of the acoustic measures analyzed suggest that intensive voice-focused treatment may have the potential to improve vocal function in adults with severe spastic dysarthria secondary to cerebral palsy (CP). Evidence-based treatment options for voice disorders in adults with CP are limited. Results emphasize the need for more studies with this population.