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ImportanceCerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years.ObjectiveTo systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support.Evidence reviewThe literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument.FindingsSixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5).Conclusions and relevanceWhen a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.

ImportanceCerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.ObjectivesTo systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.Evidence reviewThis study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.FindingsSix systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.Conclusions and relevanceEarly diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.

Aim: To evaluate the efficacy of the Akwenda Intervention Program on motor, self‐care, and social function of children and young people with cerebral palsy (CP). Method: This was a cluster‐randomized, controlled, single‐blinded, intervention study of 100 participants with CP (2–23 years; 52 males) in rural eastern Uganda. Half were allocated to the intervention program, the remainder served as waitlist controls. Gross Motor Function Measure‐66 (GMFM‐66) and the Ugandan version of Pediatric Evaluation of Disability Inventory (PEDI‐UG) were collected before group allocation and after intervention. General linear models and t‐tests were used to compare changes within and between groups. Cohen's d estimated the effect size of group differences. Change scores were evaluated by age and mobility subgroups. Results: Significant group by time interactions were found for GMFM‐66 (p =0.003) and PEDI‐UG outcomes (p <0.001), except mobility, with the intervention group demonstrating greater changes. Both groups increased their scores on the GMFM‐66 and child PEDI‐UG, while only the intervention group had significant increases in caregiver assistance scores and across all age and mobility subgroups. Cohen's d showed large effect sizes (d >0.8) of differences for PEDI‐UG outcomes except mobility. Interpretation: The Akwenda Intervention Program had a large positive impact on functioning and activity across age and mobility levels. [ABSTRACT FROM AUTHOR]

This letter to the editor is on the commentary by Olusanya on pages 10–11 of this issue. [ABSTRACT FROM AUTHOR]

Background: Validity of the Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI‐UG) was previously investigated on typically developing children. This study aimed to investigate the validity, test–retest reliability and minimal detectable change (MDC) of the PEDI‐UG in children and youth (C&Y) with cerebral palsy (CP). Method: A cross‐sectional study design with 118 C&Y with CP (44.7% girls) aged 10 months–22.5 years were included in the study; 37 of them completed the PEDI‐UG twice to investigate test–retest reliability, determined by calculating the intraclass correlation coefficient (ICC). Additionally, data from 249 typically developing children were used for differential item functioning (DIF) analysis. The validity of the PEDI‐UG was investigated by Rasch analysis. The Kruskal–Wallis test and Spearman's correlation coefficient were calculated to investigate associations between PEDI‐UG scores and external classification systems. Results: The principal component analysis of residuals indicated unidimensionality in all domains. The ICC values were excellent (0.98–0.99), and the MDCs were less than 6 and 13 (on a 0–100 scale) for the functional skills and caregiver assistance parts, respectively. The four‐category caregiver assistance rating scale fulfilled the criteria for the analysis of rating scale functioning. In total, 78 of 189 items in the functional skills domain and two items in the caregiver assistance domain demonstrated DIF between C&Y with CP and TD children. The Kruskal–Wallis test (p < 0.05) and Spearman's correlation (coefficients of −0.93 to −0.78) supported the validity of PEDI‐UG. Conclusion: The current diagnose‐specific version of PEDI‐UG demonstrates evidence for validity as a measure of ability in C&Y with CP in Uganda and other similar settings, being a promising tool for use in clinical practice and research. Conversion tables and MDC values are provided to facilitate clinical adoption of the measure. [ABSTRACT FROM AUTHOR]

A study investigated temporal resolution of auditory perception (TRAP), verbal working memory, and speech perception in 15 children with language impairment and 99 controls. No deficits in TRAP were found in the subjects and thresholds were similar. There were significant differences in performance on speech perception and verbal working memory. (Contains references.) (Author/CR)

Aim: To compare the participation attendance and involvement of children and young people with and without cerebral palsy (CP) in a low‐resource area of Uganda. Method: Eighty‐two children and young people with CP aged 6 to 22 years (49 males, 33 females) and 81 age‐ and sex‐matched peers without CP (6 to 22 years; 48 males, 33 females) participated in this population‐based, cross‐sectional study. Data on attendance and involvement in 20 home and community activities were obtained using Picture My Participation, an instrument intended to measure participation in children with disabilities, particularly in low‐ and middle‐income countries. Non‐parametric statistical methods were used to assess between‐group differences. Effect size estimates were calculated. Results: Pooled attendance across all activities was lower in children and young people with CP than in children and young people without CP (p < 0.001) and for each activity item (p = 0.004 to p < 0.001). The effect sizes for each activity were 0.2 to 0.7. Between‐group differences were larger for community activities than for home activities. Pooled involvement across all activities was less in the group with CP (p < 0.001) and for each activity (p = 0.014 to p < 0.001). The effect sizes for each activity were 0.2 to 0.5. Children and young people in Gross Motor Function Classification System (GMFCS) levels I and II had higher attendance (p < 0.001) and involvement (p = 0.023) than those in GMFCS levels III to V. Interpretation: Participation of young people living with CP in Uganda was restricted, especially for community activities. There is a need to identify context‐specific participation barriers and develop strategies to overcome them. What this paper adds: Children and young people with cerebral palsy (CP) attended all activities less than their peers without CP.Differences in attendance were larger for community‐based activities than home activities.When attending activities, children and young people with CP were less involved than their peers.Children and young people with milder impairments attended less frequently than their peers without CP.Children and young people with milder impairments attended more frequently than their peers with severe impairments. [ABSTRACT FROM AUTHOR]

Objective. This study tested the hypothesis that degeneration of the corticofugal tracts (CFTs) is related to poor functional outcome in the upper limb after stroke. Methods. The authors used diffusion tensor imaging to determine the degree of white matter integrity of the CFT (FAAH/UH) in chronic stroke patients and controls. The functional integrity of the corticospinal pathway was examined using transcranial magnetic stimulation. Recruitment curves and silent period duration were measured. The relationship between FAAH/UH and functional outcome of the upper limb was also assessed using a battery of upper limb function tests. Results. In patients, FAAH/UH correlated positively with the slope of recruitment curves (RCAH/UH) and grip strength. FAAH/UH also correlated negatively with the silent period duration (SPAH/UH). According to the FAAH/UH, patients were also classified into groups with minimal or extensive Wallerian degeneration (WD). Patients with more extensive WD had poorer grip strength, dexterity, and range of movement. Conclusions. The authors' results suggest that structural and functional integrity of the CFT is essential to maintain function of the upper limb after stroke. Key Words: Stroke--Diffusion tensor imaging--Transcranial magnetic stimulation--Corticofugal tracts--Wallerian degeneration--Upper limb--Outcome., Impaired upper limb function after stroke is considered to be caused by reduced cortical control of spinal neurons. (1-3) Degeneration of the corticofugal tracts (CFTs) after a brain lesion has [...]

Objective. To examine whether cerebral activity during passive movements decreases with time after stroke, and if reduced activity in the representation for the upper extremity can be reversed with training. [...]