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Background: For children with Osteogenesis Imperfecta (OI), a rare genetic bone disease, walking can be difficult to carry out due to a combination of bone fragility and deformity, muscle weakness, joint hypermobility, and pain. Bisphosphonate treatment has facilitated more children being able to walk, but for many, foot and ankle hypermobility is a limiting factor. Current evidence on foot orthoses in children with OI is sparse. This study aimed to evaluate gait characteristics in children with OI walking barefoot as compared to walking with foot orthoses. Methods: Twenty-three children with OI and hypermobility (mean age 8.3 ± 3.0 years) were included in this cross-sectional study. Children conducted three-dimensional gait analysis barefoot, and with foot orthoses and appropriate foot wear (stable yet light-weight), respectively. Walking speed, step length, lower limb kinematics and kinetics were collected. Differences in gait characteristics between test conditions were evaluated using paired sample t-tests. Results: When walking with foot orthoses, the external foot progression angle was reduced, peak ankle dorsiflexion angle increased, and peak plantarflexion moment increased as compared to barefoot. No difference was found in walking speed between test conditions, however, children with OI walked with longer steps with foot orthoses as compared to barefoot. Conclusion: The observed gait alterations suggest that foot orthoses, aiming to support the foot and ankle joint, contributed to reduced overall foot rotation as measured by external foot progression, increased peak plantarflexion moment, and increased step length. In a wider perspective, the ability to walk provides the opportunity to be physically active, and thereby increase skeletal loading and prevent fractures, thus, foot orthoses may be an important treatment option to consider in children with OI. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To determine whether a strength‐based home‐visiting program enhances parent–child interaction during the first year at home for children born extremely preterm (gestational age < 28).A randomised controlled trial of 130 infants born extremely preterm 2018–2021 in Stockholm, allocated to either the Stockholm preterm interaction‐based intervention (SPIBI) (n = 66) or an extended follow‐up program (n = 64). The intervention group received ten home visits during the first year by a trained interventionist following SPIBI guidelines: an interaction‐based intervention supporting sensitive parental responses to infants' signals. The primary outcome of emotional availability was assessed at 12 months corrected age (CA) using the emotional availability scales (EAS).At 1‐year CA, data were collected from 115/130 (89%) of the included children. There were no significant group differences in emotional availability at 12 months CA. A secondary analysis showed an effect modifier in families with mothers self‐rated as depressed at discharge, with the outcome favouring intervention in the EAS dimension of child involvement.The SPIBI had no significant main effect on emotional availability at 12 months CA. Children of self‐reported depressed mothers displayed superior involvement behaviour in the intervention group, prompting further research on risk groups and potential modifications of post‐discharge interventions. [ABSTRACT FROM AUTHOR]

To explore the presence of pain, how pain was addressed by physicians and parents, and how pain affected everyday life in young children with cerebral palsy (CP). Children with CP, aged 5–10 years, participated in this cross-sectional study. Data were collected from medical records spanning a period of two years and by a standardized parental interview that included six structured questions and the Pain Interference Index. A total of 118 children, with a mean age of 7.4 years (SD 1.5), participated in the study. The parents of 81% of these children were interviewed. Pain was reported in 52% of the children, and pain was present at all severity levels. The prescription of analgesics was documented in 25% of these children's medical records. Fifty-nine percent of the children with pain received analgesics from their parents. Pain restricted the children's everyday lives particularly concerning sleep, school work and being with friends. Half of this group of young children with CP were reported to have pain. Pain restricted the children's everyday lives and seemed to be under-treated. If pain can be addressed early, the children's everyday lives are likely to be improved. There is a need to early identify and treat pain in young children. Important to discuss pain with parents irrespectively of the child's age and severity level. Pain interference assessment gives valuable information. Early treatment of pain might improve children's everyday life. [ABSTRACT FROM AUTHOR]

Aim: To describe health-related quality of life (HRQoL), pain, fatigue, and other health variables in young adults with cerebral palsy (CP), and to explore associations with the Gross Motor Function Classification System - Expanded and Revised (GMFCS-ER) and physical activity.Method: This was a cross-sectional study of 61 young adults at a mean age of 21 years 2 months (standard deviation 8mo, range 20-22y) with CP, from a geographically defined area. Data collection included: Short Form 36 version 2 for HRQoL, Brief Pain Inventory - Short Form, Fatigue Severity Scale, level of physical activity, medical history, and physical examination.Results: Overall HRQoL equalled that of population norms; however self-reported physical health was lower in GMFCS-ER levels III to V compared to GMFCS-ER levels I to II. Self-reported mental health was, inversely, lower in GMFCS-ER levels I to II compared to GMFCS-ER levels III to V. Pain prevalence was 49%, and pain was present across all GMFCS-ER levels. Fatigue, as well as sleep problems, had 41% prevalence, with fatigue severity decreasing with increasing level of physical activity.Interpretation: General HRQoL in young adults with CP was comparable to population norms. Pain and fatigue are important to address in high motor-functioning individuals also. Physical activity could be a possible protective factor against fatigue.What This Paper Adds: Health-related quality of life in young adults with cerebral palsy (CP) was comparable to population norms. Pain, fatigue, and sleep problems occurred at all Gross Motor Function Classification System levels. There is a possible protective effect of physical activity on fatigue. [ABSTRACT FROM AUTHOR]

Aims:To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP).Method: A consecutive selection of 40 children, ages 4–12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I–II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections.Results: A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months.Conclusion: The treatments’ positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome. [ABSTRACT FROM PUBLISHER]

Purpose: To investigate gross motor function and goal attainment in children with cerebral palsy before, during and after goal-directed functional therapy (GDT), to evaluate body functions, and explore relationships., Method: Prospective longitudinal intervention study. Twenty-two children, uni- or bilateral CP, 1-6 years (mean: 46 months SD: 16 months), classified in GMFCS and MACS level I-IV participated. Outcome measures were Gross Motor Function Measure (GMFM-66), performed at seven occasions, Goal Attainment Scale, assessments of passive range of motion, spasticity and selective motor control (SMC). Baseline, the GDT-intervention and the follow-up period were 12 weeks each., Results: Improvements were demonstrated in GMFM-66 during the intervention (mean difference: 5.07, CI: 3.8-6.4, p < 0.001). The baseline and follow-up assessments were stable. Evaluations of ankle dorsiflexion displayed small improvement (mean difference: 9 degrees , CI: 5-13, p < 0.001). Estimations of spasticity and SMC did not demonstrate significant changes. Goal attainment to the expected level or higher was achieved in 93/110 goals and further improved at the long-term follow-up (103/110)., Conclusion: Gross motor function improved during GDT, and was maintained 12 weeks later. The goals were reached to a high extent, and the children gradually progressed towards their goals after the end of the intervention. The therapy did not induce any deterioration of body functions.

Objective: To compare the effects of goal directed functional therapy (GDT) to activity focused therapy (AT) for preschool children with cerebral palsy (CP) on everyday activities and gross motor function. Another aim was to evaluate goal attainment in the GDT group., Methods: A prospective intervention study comparing two types of intervention carried out in ecological settings. Forty-four children with CP, (25 boys, 19 girls; mean age 4 year 1 month [SD 1 year 5 month]), Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels I-IV participated. Twenty-two children were recruited to the GDT group and 22 to the AT group. Outcome measures were the Pediatric Evaluation of Disability Inventory (PEDI), and the Gross Motor Function Measure-66. Furthermore, goal attainment scaling (GAS) was used in the GDT group. The assessments were performed before and after an intervention period of 12 weeks., Results: The children in the GDT group improved more in most aspects of everyday activities measured by the PEDI than the children in the AT group (p < 0.001). Only functional skills in social function did not differ between the groups. Furthermore, gross motor function improved more in the GDT group than in the AT group (p < 0.001). Goal attainment to the expected level or higher was achieved in 93/110 goals in the GDT group. The variance of improvements in the different PEDI scales in the GDT group could not be explained by either age, sex, distribution of CP, GMFCS or MACS levels., Conclusion: GDT demonstrated clear gains for children with cerebral palsy in everyday activities and gross motor function in comparison to AT.