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PURPOSE: Cerebral palsy (CP) is a major cause of childhood disability. Children with CP often lack motor skills to effectively perform activities of daily living. The aim is to assess the effectiveness of a functional intensive therapy program focused on improving individual goals in the domain of mobility and self-care in children and adolescents with CP. MATERIAL AND METHODS: Thirty-five CP patients, aged 11-19 years, GMFCS I-IV, received daily 6-7 h of functional therapy for 15 days. Outcomes were assessed at baseline, immediately after the program and at three months follow-up. RESULTS: Significant post-intervention improvement was seen on all primary and secondary outcome measures; personal goals (GAS score; COPM performance and COPM satisfaction), daily activities (ACTIVLIM), hand function (ABILHAND-Kids), mobility (ABILOCO-Kids; GMFM-66-IS score). There was no loss to follow up during the program and after three months. At follow-up, improvements were retained except for ABILOCO and GMFM-66-IS. CONCLUSIONS: Functional intensive therapy appears feasible and seems to be effective in improving treatment goals focused on mobility and self-care, even in older and more severely affected children and adolescents with CP. After three months, these possible effects were still present.Implications for rehabilitationShort intensive functional training is feasible and showing no loss to follow up in the older and more severely affected children and adolescents with cerebral palsy (CP).Short intensive functional training appears effective in improving individual goals in children and adolescents with CP and improvements endorse three months.Short intensive functional training seems to be effective on both mobility and self-care domains of the ICF-CY.

Aims: To develop a consensus on which upper limb treatment approach is appropriate for children with unilateral USCP and to formulate a practical guideline for clinical reasoning based on the criteria of functional therapy. Method: The FuncRehab-Cycle, coreset of tests, specific therapy components and ICF is used as a framework for clinical reasoning to enable choices for specific functional therapy approaches in upper limb treatment. Results: Practical guideline for clinical reasoning based on criteria of functional therapy was developed to make choices between Modified CIMT, Hybrid-CIMT, BIMT or BoNT-A and BIMT or functional bimanual strength training. Conclusions: Consensus was reached to realize a framework for clinical reasoning as a guidance for BIMT and H-CIMT, but not for M-CIMT and treatment options prior to BIMT or H-CIMT Aims: To develop a consensus on which upper limb treatment approach is appropriate for children with unilateral USCP and to formulate a practical guideline for clinical reasoning based on the criteria of functional therapy. Method: The FuncRehab-Cycle, coreset of tests, specific therapy components and ICF is used as a framework for clinical reasoning to enable choices for specific functional therapy approaches in upper limb treatment. Results: Practical guideline for clinical reasoning based on criteria of functional therapy was developed to make choices between Modified CIMT, Hybrid-CIMT, BIMT or BoNT-A and BIMT or functional bimanual strength training. Conclusions: Consensus was reached to realize a framework for clinical reasoning as a guidance for BIMT and H-CIMT, but not for M-CIMT and treatment options prior to BIMT or H-CIMT as a very helpful decision tool in rehabilitation.

Children with cerebral palsy have problems using their arms and hands, partly due to muscle weakness. Because of the impairments in arm-hand functioning, children with CP have limitations in performing activities of daily life (ADL). Rehabilitation is mainly aimed to improve motor function, so children with CP increase the ability to perform activities and become more independent. During therapy it is common to measure strength. However, no measures were yet available to measure strength in a functional manner. Therefore, the TAAC was developed. The TAAC measures functional strength: strength while performing an ADL task. The TAAC contains a sensor, which measures the strength while the child lifts or pushes an ADL object. When a new measure, such as the TAAC, is developed it is important that it is in line with the demand of the clinical practice and that it has sufficient clinimetric properties for its purposes. As the TAAC is developed for diagnostic and evaluative purposes, the reliability, validity and responsiveness were investigated.

Children with cerebral palsy have difficulties using their arms and hands. These difficulties can be caused by for example weakness, coordination issues but also by fatigability. However, there is no consensus on the use of a protocol for testing fatigability in children with unilateral cerebral palsy. In this doctoral dissertation, reliability and validity is tested for two new motor fatigability protocols (one static and one dynamic) which means it was investigated whether it is possible to test reliably, when using the test on consecutive days and it was investigated whether the protocols test what we aim to test with them. The latter was investigated by comparing children with unilateral spastic cerebral palsy with typically developing children and by investigating the relation of our protocols with other measurements that are already used for children with unilateral cerebral palsy.

For this research, home training programmes were developed to improve the two-handed skills of children with unilateral Cerebral Palsy (brain damage occurring before, during or shortly after birth). To prevent an increase in parental stress, the programs distinguished themselves through interdisciplinary coaching of parents by a physio/ergo therapist and orthopaedic educationalist. During the training, the two-handed skills of the children (for example closing a zipper) seemed to improve, without increasing parental stress. Although the programs proved to be demanding for parents and children, parents were able to get the therapy and positively experienced the home training.