Computer Vision for Gait Assessment in Cerebral Palsy: Metric Learning and Confidence Estimation.

Assessing the motor impairments of individuals with neurological disorders holds significant importance in clinical practice. Currently, these clinical assessments are time-intensive and depend on qualitative scales administered by trained healthcare professionals at the clinic. These evaluations provide only coarse snapshots of a person's abilities, failing to track quantitatively the detail and minutiae of recovery over time. To overcome these limitations, we introduce a novel machine learning approach that can be administered anywhere including home. It leverages a spatial-temporal graph convolutional network (STGCN) to extract motion characteristics from pose data obtained from monocular video captured by portable devices like smartphones and tablets. We propose an end-to-end model, achieving an accuracy rate of approximately 76.6% in assessing children with Cerebral Palsy (CP) using the Gross Motor Function Classification System (GMFCS). This represents a 5% improvement in accuracy compared to the current state-of-the-art techniques and demonstrates strong agreement with professional assessments, as indicated by the weighted Cohen's Kappa ( κlw = 0.733 ). In addition, we introduce the use of metric learning through triplet loss and self-supervised training to better handle situations with a limited number of training samples and enable confidence estimation. Setting a confidence threshold at 0.95 , we attain an impressive estimation accuracy of 88% . Notably, our method can be efficiently implemented on a wide range of mobile devices, providing real-time or near real-time results.

A Scoping Review on Mobile Health Technology for Assessment and Intervention of Upper Limb Motor Function in Children with Motor Impairments.

Upper limb (UL) motor dysfunctions impact residual movement in hands/shoulders and limit participation in play, sports, and leisure activities. Clinical and laboratory assessments of UL movement can be time-intensive, subjective, and/or require specialized equipment and may not optimally capture a child's motor abilities. The restrictions to in-person research experienced during the COVID-19 pandemic have inspired investigators to design inclusive at-home studies with child participants and their families. Relying on the ubiquity of mobile devices, mobile health (mHealth) applications offer solutions for various clinical and research problems. This scoping review article aimed to aggregate and synthesize existing research that used health technology and mHealth approaches to evaluate and assess the hand function and UL movement in children with UL motor impairment. A scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) model was conducted in March 2023 yielding 25 articles (0.32% of 7891 studies). Assessment characteristics included game or task-based tests (13/25, 52%), primarily for neurological disorders (e.g., autism spectrum disorder [ASD], dystonia, dysgraphia) or children with cerebral palsy (CP). Although several mHealth studies were conducted in the clinical environment (10/25, 40%), studies conducted at home or in nonclinical settings (15/25, 60%) reported acceptable and highly satisfactory to the patients as minimizing the potential risks in participation. Moreover, the remaining barriers to clinical translation included object manipulation on a touch screen, offline data analysis, real-world usability, and age-appropriate application design for the wider population. However, the results emphasize the exploration of mHealth over traditional approaches, enabling user-centered study design, family-oriented methods, and large-scale sampling in future research.

Cognitive Functioning and Assessment in Adults with Cerebral Palsy: A Scoping Review.

In this scoping review, we summarize the current knowledge of cognitive functioning in adults with cerebral palsy (CP), and identify the neuropsychological tests typically used in this population. 39 studies from the period January 1990 - August 2023 were included in the review, and they differ widely in their aims and approach to studying cognition. Very few studies have cognitive assessment as their core aim and use a neuropsychological test battery. The included studies show great variability in reported intelligence and cognitive functioning in adults with CP, and cognitive deficits have been reported in all cognitive domains. Most of the studies suffer from methodological limitations, and there is ample room for improvement within the field. We conclude by suggesting a number of recommendations that may contribute to increasing our understanding of cognitive impairments in adults with CP.

Inter-rater reliability and agreement of the General Movement Assessment and Motor Optimality Score-Revised in a large population-based sample.

BACKGROUND: Prechtl's General Movement Assessment (GMA) at fidgety age (3-5 months) is a widely used tool for early detection of cerebral palsy. Further to GMA classification, detailed assessment of movement patterns at fidgety age is conducted with the Motor Optimality Score-Revised (MOS-R). Inter-rater reliability and agreement are properties that inform test application and interpretation in clinical and research settings. This study aims to establish the inter-rater reliability and agreement of the GMA classification and MOS-R in a large population-based sample. METHODS: A cross-sectional study of 773 infants from birth-cohort in Perth, Western Australia. GMA was conducted on home-recorded videos collected between 12 + 0 and 16 + 6 weeks post term age. Videos were independently scored by two masked experienced assessors. Inter-rater reliability and agreement were assessed using intraclass correlation coefficient and limits of agreement respectively for continuous variables, and Cohen's Kappa and Gwet's Agreement Coefficient, and percentage agreement respectively for discrete variables. RESULTS: The classification of GMA showed almost perfect reliability (AC1 = 0.999) and agreement (99.9 %). Total MOS-R scores showed good-excellent reliability (ICC 0.857, 95 % CI 0.838-0.876) and clinically acceptable agreement (95 % limits of agreement of ±2.5 points). Substantial to almost perfect reliability and agreement were found for all MOS-R domain subscores. While MOS-R domains with higher redundancy in their categorisation have higher reliability and agreement, inter-rater reliability and agreement are substantial to almost perfect at the item level and are consistent across domains. CONCLUSION: GMA at fidgety age shows clinically acceptable inter-rater reliability and agreement for GMA classification and MOS-R for population-based cohorts assessed by experienced assessors.

Comparing Self-Report Fatigue Assessment Tools for Adults with Cerebral Palsy in a Danish Context.

PURPOSE: Many youth and adults with Cerebral Palsy (CP) experience high levels of fatigue. This study aimed to compare three fatigue self-report questionnaires to guide clinicians. METHOD: Thirty youth and adults (age range 17-64) with CP were assessed with Danish versions of the Fatigue Impact and Severity Self-Assessment questionnaire, the Modified Mental Fatigue Scale, and the Multidimensional Fatigue Inventory. Psychometric properties were investigated. Rank order and classification models were compared across questionnaires. RESULTS: The Reduced Motivation and Physical Fatigue subscales of the Multidimensional Fatigue Inventory showed inadequate internal consistency. Participants were frequently ranked differently with the questionnaires. There were issues related to the conceptualization of physical fatigue. CONCLUSION: The choice of assessment tool should be based on assessment purpose as the questionnaires assess different aspects of fatigue severity, impact, and management. Also, test selection can have important implications on the conclusions that are made about fatigue type and severity.

General movement assessment efficacy for assessment of nervous system integrity in children after hypoxic-ischemic encephalopathy in middle income countries.

BACKGROUND: Many infants who survive hypoxic-ischemic encephalopathy (HIE) face long-term complications like epilepsy, cerebral palsy, and developmental delays. Detecting and forecasting developmental issues in high-risk infants is critical. AIM: This study aims to assess the effectiveness of standardized General Movements Assessment (GMA) and Hammersmith Infant Neurological Examinations (HINE) in identifying nervous system damage and predicting neurological outcomes in infants with HIE. DESIGN: Prospective. SUBJECTS AND MEASURES: We examined full-term newborns with perinatal asphyxia, classifying them as Grade 2 HIE according to Sarnat and Sarnat. The study included 31 infants, with 14 (45.2 %) receiving therapeutic hypothermia (Group 1) and 17 (54.8 %) not (Group 2). We evaluated general movements during writhing and fidgety phases and conducted neurological assessments using the HINE. RESULTS: All infants exhibited cramped-synchronized - like movements, leading to cerebral palsy (CP) diagnosis. Three children in Group 1 and four in Group 2 lacked fidgety movements. During active movements, HINE and GMA showed high sensitivity and specificity, reaching 96 % and 100 % for all children. The ROC curve's area under the curve (AUC) was 0.978. CONCLUSION: Our study affirms HINE and GMA as effective tools for predicting CP in HIE-affected children. GMA exhibits higher sensitivity and specificity during fidgety movements. However, study limitations include a small sample size and data from a single medical institution, necessitating further research.

Validity and reliability of the Sitting Assessment Scale in cerebral palsy.

AIM: The aim of this study was to examine the validity and reliability of the Sitting Assessment Scale (SAS) in individuals with cerebral palsy (CP). METHODS: The study included 34 individuals with a diagnosis of spastic CP. Individuals were evaluated with the Gross Motor Function Classification System and the Manual Ability Classification System. SAS and Trunk Control Measurement Scale (TCMS) were applied to the participants. The intraclass correlation coefficient (ICC) was calculated to determine the intraobserver and interobserver reliability of the scale scored by three different physiotherapists at two different time intervals. Internal consistency was calculated with Cronbach's ⍺ coefficient. The fit between SAS and TCMS for criterion-dependent validity was evaluated using Pearson Correlation Analysis. RESULTS: According to the GMFCS level, 79.41% of the children were mildly (Level I-II), 14.71% were moderately affected (level III), and 5.88% were severely affected (level IV). Intra > observer and interobserver reliability values of SAS were extremely high (ICCinterrater > 0.923, ICCintrarater > 0.930). It was observed that the internal consistency of SAS had high values (Cronbach ⍺test > 0.822, Cronbach ⍺retest > 0.804). For the criterion-dependent reliability; positive medium correlations found between SAS with Total TCMS Static Sitting Balance (r = 0.579, p < 0.001), with TCMS Selective Movement Control (r = 0.597, p < 0.001), with TCMS Dynamic Reaching (r = 0.609, p < 0.001), and with TCMS Total (r = 0.619, p < 0.001). CONCLUSION: SAS was found to have high validity and reliability in children with CP. In addition, the test-retest reliability of the scale was also high. SAS is a practical tool that can be used to assess sitting balance in children with CP.

Longitudinal assessment of brain lesions in children with cerebral palsy and association with motor functioning.

BACKGROUND: The semi-quantitative scale of structural brain Magnetic Resonance Imaging (sqMRI) is a valid and reliable measure of brain lesion extent in children with cerebral palsy (CP) >3-years. This system scores lesion burden for each major brain region. The sum of the scores gives a global score ranging from 0 to 48. PURPOSE: To investigate how sqMRI scores changed from infancy to school-age, and whether these were associated with lesion load, age at first assessment, and gross motor function and its changes. MATERIALS AND METHODS: Twenty-eight children with CP underwent MRI and motor (Gross Motor Function Measure-66; GMFM-66) assessments when <40-months and again when 8-12-years. We investigated whether (i) toddler/preschool-age sqMRI scores (Time 1) reflected school-age sqMRI scores (Time 2); (ii) temporal changes in sqMRI scores (Time 1-Time 2 difference) were related to the child's age at Time 1 and lesion extent; (iii) early or later sqMRI scores were associated with motor functioning; (iv) sqMRI scores' longitudinal changes were associated with motor changes. RESULTS: Except for the corticosubcortical (grey-matter only) layers, sqMRI scores were significantly higher ('higher lesion load') at Time 1 than at Time 2. Age at Time 1 was not associated with temporal changes in global sqMRI scores. Higher lesion load at Time 2, but not at Time 1, was associated with smaller temporal changes in the global sqMRI score. The sqMRI scores were associated with concurrent, but not future or past motor GMFM-66 scores. Longitudinal changes in sqMRI scores were not associated with longitudinal changes in motor GMFM-66 scores. CONCLUSION: sqMRI scores of brain lesion extent at school-age are lower and a better indication of later-life motor functioning than very early life sqMRI scores. It may be best to interpret MRI white matter lesions with caution in very early life due to possible changes in lesion appearance and the unpredictable role of functional plasticity.

Validation of the Gait Outcomes Assessment List questionnaire and caregiver priorities for individuals with cerebral palsy.

AIM: To expand upon previous validation of the Gait Outcomes Assessment List (GOAL) questionnaire in individuals with cerebral palsy (CP), to rank items by importance, and to summarize written-in (free text) goals. METHOD: For this cross-sectional study, the parent-version 5.0 of the GOAL was completed by 310 consecutive caregivers of 310 individuals aged 3 to 25 years with CP (189 males, 121 females; mean [SD] age: 10y [4y 2mo]; Gross Motor Function Classification System [GMFCS] levels I-IV) concurrent with a gait analysis. Distribution properties and validity were quantified using questionnaires, kinematics, and oxygen consumption. Items classified as at least 'difficult' to perform and 'very important' to improve were considered caregiver priorities and rank ordered. Free text goals were categorized. Results were summarized for everyone and by GMFCS level. RESULTS: Most scores were normally distributed. Validity was acceptable, with concurrent greater than construct validity. Among all 310 caregivers, fatigue was the highest priority, followed by gait pattern and appearance items. The rank of priorities varied by GMFCS level. Common free text goals included toileting independently as well as improved fine motor and ball sport skills. INTERPRETATION: The GOAL is a valid tool that can help prioritize goals across GMFCS levels I to IV. Identifying the top goals may improve shared decision-making and prioritize research for this sample.

Artificial intelligence to improve efficiency of administration of gross motor function assessment in children with cerebral palsy.

AIM: To create a reduced version of the 66-item Gross Motor Function Measure (rGMFM-66) using innovative artificial intelligence methods to improve efficiency of administration of the GMFM-66. METHOD: This study was undertaken using information from an existing data set of children with cerebral palsy participating in a rehabilitation programme. Different self-learning approaches (random forest, support vector machine [SVM], and artificial neural network) were evaluated to estimate the GMFM-66 score with the fewest possible test items. Test agreements were evaluated (among other statistics) by intraclass correlation coefficients (ICCs). RESULTS: Overall, 1217 GMFM-66 assessments (509 females, mean age 8y 10mo [SD 3y 9mo]) at a single time and 187 GMFM-66 assessments and reassessments (80 females, mean age 8y 5mo [SD 3y 10mo]) after 1 year were evaluated. The model with SVM predicted the GMFM-66 scores most accurately. The ICCs of the rGMFM-66 and the full GMFM-66 were 0.997 (95% confidence interval [CI] 0.996-0.997) at a single time and 0.993 (95% CI 0.993-0.995) for the evaluation of the change over time. INTERPRETATION: The study shows that the efficiency of the full GMFM-66 assessment can be increased by using machine learning (self-learning algorithms). The presented rGMFM-66 score showed an excellent agreement with the full GMFM-66 score when applied to a single assessment and when evaluating the change over time.

Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy.

BACKGROUND: Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. METHODS: A cross-sectional observational study was conducted at SNS L'Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). RESULTS: A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II-III of EDACS, and 31.3% required PEG; furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH. CONCLUSION: MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.

Interrater and test-retest reliability of the Hand Assessment for Infants.

AIM: To evaluate the interrater and test-retest reliability, standard error of measurement (SEM), and the smallest detectable difference (SDD) of the Hand Assessment for Infants (HAI). METHOD: HAI assessments of 55 infants (26 females, 29 males), 25 with clinical signs of unilateral cerebral palsy (CP) and 30 typically developing (mean [SD] age 6.8mo [2.4], range 3-11mo), were scored individually by three therapists. Three clinically experienced occupational therapists (OT 1-OT 3) with extensive experience in using the HAI, independently scored the video recorded HAI play sessions. Analysis of the combined group of infants and just the infants with clinical signs of unilateral CP (12 females, 13 males; mean age 7.6mo [2.1]) were conducted. Intraclass correlation coefficients (ICC, 2.1), Bland-Altman plots, SEM, and SDD were calculated. RESULTS: Interrater and test-retest reliability were excellent for the Both Hands Measure (BoHM) and the Each Hand Sum score (EaHS), with ICCs of 0.96 to 0.99. For individual items, the interrater and test-retest reliability was good to excellent (ICC 0.81-0.99). The SDD for the EaHS was 2 points, and for the BoHM the SDD it was 3 HAI units for infants with signs of unilateral CP. INTERPRETATION: The HAI results showed good to excellent reliability. The SDDs were low, indicating that results beyond these levels exceed the measurement error and, thus, can be considered true changes. What this study adds The Hand Assessment for Infants (HAI) shows excellent reliability. A change of ≥3 HAI units is considered a true change. The HAI yields reliable measures for research and clinical practice.

Early Identification of Cerebral Palsy Using Neonatal MRI and General Movements Assessment in a Cohort of High-Risk Term Neonates.

BACKGROUND: Cerebral palsy (CP) is the most common motor disability of childhood. Its early identification is an important priority for parents and is critical for access to early intervention resources, which may optimize function. METHODS: A prospective cohort of term neonates at high risk for CP was assessed by neonatal magnetic resonance imaging (MRI) to determine myelination of the posterior limb of the internal capsule, General Movements Assessment to assess typical fidgety movements at age three months, and followed to at least age two years to determine diagnosis of CP based on neurological examination. RESULTS: Seven of 58 children developed CP (12%), two with moderate/severe CP. Sensitivity and specificity for abnormal myelination of the posterior limb of the internal capsule were (PLIC) was 29% and 94%, and for absent fidgety movements, 29% and 98%, respectively. Negative predictive value of both absent myelination of the PLIC and absent fidgety movements was 90% (79% to 96%) for any CP and 98% (90% to 100%) for moderate/severe CP cerebral palsy. None of the children with both normal PLIC and normal fidgety movements had moderate/severe CP. CONCLUSION: Normal neonatal MRI and General Movements Assessment at age three months are reassuring that a high-risk term-born child is at low risk for moderate/severe CP. These results are important for counseling parents and individualizing therapy resources in the community.

Dystonia assessment in children with cerebral palsy and periventricular leukomalacia.

OBJECTIVE: To describe the frequency, motor phenotype, clinical patterns and functional consequences of dystonia in patients with cerebral palsy (CP) in the setting of periventricular leukomalacia. METHODS: Retrospective analysis of a cohort of 31 patients with CP and periventricular leukomalacia. Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were used to classify functional ability. Spasticity was rated using the Modified Ashworth Scale. Presence of dystonia was assessed by reviewing video recordings, and its severity by using the Burke-Fahn-Marsden Dystonia Rating Scale. RESULTS: All patients showed evidence of dystonia involving upper and/or lower limbs, neck, trunk, mouth and eyes in order of frequency. In 29% of patients dystonia involved only the limbs and in 71% it was multifocal. Dystonia severity ranged from slight to severe. Severity and distribution of dystonia did not correlate with gender, age, weeks of gestation or duration of neonatal unit stay. GMFCS and MACS correlated with dystonia but not with spasticity. CONCLUSIONS: Severity of dystonia, but not spasticity is associated with the severity of motor functional disability in CP patients with periventricular leukomalacia and demonstrates the key role of dystonia in the motor function of these patients.

Assessment of mirror movements in children and adolescents with unilateral cerebral palsy: reliability of the Woods and Teuber scale.

AIM: To investigate the inter- and intrarater reliability of the Woods and Teuber scale to detect mirror movements in children and adolescents with unilateral cerebral palsy (CP). METHOD: A convenience sample of children and adolescents with unilateral CP (n=68; 31 males, 37 females; mean age 12y 2mo, SD 3y 6mo) in Manual Ability Classification levels I to III was recruited from Norway, Australia, and Belgium. Three therapists scored mirror movements according to the Woods and Teuber scale from three video-recorded tasks at two separate time points. A two-way, mixed model regression was used to calculate intraclass correlation coefficients (ICCs) reflecting overall inter- and intrarater reliability. In addition, ICCs for each hand and task were calculated separately. RESULTS: The overall interrater reliability ICC was 0.90 and the corresponding intrarater reliability ICC was 0.92. The ICCs for each hand ranged from 0.86 to 0.92 and for each task from 0.63 to 0.89. INTERPRETATION: The Woods and Teuber scale shows excellent reliability for scoring mirror movements in children and adolescents with unilateral CP. The assessment is easy to administer with no need for specific equipment and scoring can be determined from short video recordings, making it a feasible instrument in research and clinical practice.

Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy.

AIM: To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut-off values for this purpose. METHOD: A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut-off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI. RESULTS: Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63-0.91) to 0.95 (95% CI 0.90-1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. INTERPRETATION: HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5 months of age, when appropriate HAI cut-off values for different ages were applied. What this paper adds The Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy. HAI cut-off values can guide clinical practice for early identification and diagnosis of unilateral CP.

Impact of COVID-19 outbreak on mental health and perceived strain among caregivers tending children with special needs.

BACKGROUND: While COVID-19 outbreak has had adverse psychological effects in children with special needs, the mental state and burden on their caregivers during this pandemic has yet to be reported. AIMS: The objectives of this study were to describe the mental health status and the change in perceived strain among caregivers during the COVID-19 outbreak. METHODS AND PROCEDURES: Two hundred sixty four caregivers completed an online survey that assessed demographics, use and perspective on tele-rehabilitation, homecare therapy, caregiver's strain and mental health. OUTCOMES AND RESULTS: The prevalence of depression, anxiety and stress symptoms were found to be 62.5 %, 20.5 % and 36.4 % respectively. A significant difference in caregiver strain (p <  0.001, effect size = 0.93) was observed during the outbreak compared to levels pre-outbreak (pre-outbreak strain was measured retrospectively). Caregivers not using tele-rehabilitation along with a perception of it being a poor medium for rehabilitation were at greater risks for poor mental health whereas a negative perception on homecare therapy were strongly associated with higher psychological symptoms and strain. CONCLUSIONS AND IMPLICATIONS: This study identified a high prevalence of depression and significant change in strain displayed by caregivers during the COVID-19 outbreak. We identified several factors associated with poor mental health and perceived strain that can be used to help safeguard caregivers.

[General movement assessment as a tool for determining the prognosis in infantile cerebral palsy in preterm infants: a systematic review]. / Valoración de movimientos generales como herramienta pronóstica de parálisis cerebral infantil en prematuros: revisión sistemática.

INTRODUCTION: Cerebral palsy is considered to be the main cause of physical disability in childhood. General movements are an assessment tool in order to predict the neurological and long-term outcome of the newborn. AIM: To analyze the current evidence on the general movements assessment in preterm infants as cerebral palsy prognostic tool. SUBJECTS AND METHODS: Systematic review following PRISMA statements. Databases consulted were: PubMed/Medline, Lilacs, IBECS, Cochrane, PEDro, Cinhal, Sport Discuss, Phyinfo, Academic Search Complete, Web of Science, and SciELO. We included studies that evaluated general movements in the first 20 weeks premature newborns. We excluded studies where the sample submit other pathologies or medication was administered. Newcastle-Ottawa Scale was used to assessment the risk of bias. RESULTS: Ten cohort studies form this review. 2243 premature, with an average of 30.9 weeks of gestation, were analyzed. General movements recording was carried out between 5 and 30 minutes. When there are abnormal general movements, the chances of neurological involvement increase during development, whereas when normal general movements are evaluated, there will rarely be a subsequent cerebral palsy diagnosis. CONCLUSIONS: The predictive validity of the preterm general movements assessment is confirmed as a tool to predict cerebral palsy early. Since preterm infants are more likely to trigger abnormal general movements, it is interesting to promote this type of assessment.

TITLE: Valoración de movimientos generales como herramienta pronóstica de parálisis cerebral infantil en prematuros: revisión sistemática.Introducción. La parálisis cerebral infantil se considera la principal causa de discapacidad física en la infancia. La valoración de los movimientos generales es una herramienta de evaluación con el fin de pronosticar la afectación neurológica y el desenlace a largo plazo del recién nacido. Objetivo. Analizar la evidencia científica sobre la valoración de los movimientos generales en recién nacidos prematuros como medida pronóstica de parálisis cerebral infantil. Sujetos y métodos. Revisión sistemática siguiendo la normativa PRISMA. Se consultaron las bases de datos PubMed/Medline, Lilacs, IBECS, Cochrane, PEDro, Cinhal, Sport Discuss, Phyinfo, Academic Search Complete, Web of Science y SciELO. Se incluyeron estudios donde se valoraban movimientos generales en las primeras 20 semanas de recién nacidos prematuros y se excluyeron aquellos donde la muestra presentaba otras patologías o administraba medicación. Se utilizó la Newcastle-Ottawa Scale para valorar el riesgo de sesgo. Resultados. Se seleccionaron 10 estudios de cohortes para esta revisión y se analizaron un total de 2.243 prematuros, con una media de 30,9 semanas de gestación. Se llevó a cabo la grabación de movimientos generales entre 5 y 30 minutos. Cuando se observan movimientos generales anormales, aumentan las posibilidades de afectación neurológica durante el desarrollo, mientras que cuando se valoran movimientos generales normales, raramente habrá un posterior diagnóstico de parálisis cerebral. Conclusiones. Se confirma la validez predictiva de la valoración de los movimientos generales en prematuros para pronosticar parálisis cerebral de forma precoz. Como los recién nacidos prematuros tienen mayor posibilidad de desencadenar movimientos generales anormales, es interesante promover este tipo de valoración.

Participation in Leisure Activities by Portuguese Children With Cerebral Palsy.

Leisure participation contributes to the health and wellbeing of children with and without physical disabilities. In the present cross-sectional study, we aimed to assess the influence of child and family factors on leisure activity participation of children with cerebral palsy (CP) aged 8-18 years. A convenience sample of 69 participants with CP (M age = 12.75 years, SD = 2.95; 45 males) responded to the Children's Assessment of Participation and Enjoyment questionnaire to report participation diversity, frequency, companies, environment and enjoyment in leisure activities. From these questionnaires, we used descriptive statistics to summarize overall participation, two activity domains (formal and informal) and five activity types (recreational, social, active physical, skill-based, and self-improvement). Regression analysis assessed child and family factors' influence on participation. On average, children with CP were involved in 21 leisure activities in the last four months. Within activity types, social and recreational activities were the most frequently reported. Participation in physical and skill-based activities was low. Overall children with CP experienced high enjoyment with engagement in leisure activities. Collectively, factors of age, cognitive function, gross motor function, and mother's education level predicted 33% of activity diversity and 30% of activity frequency. We concluded that children with CP show diverse leisure activity participation and high leisure activity enjoyment. Health, education and sports professionals should consider the child's functional profile and family context when promoting participation.

The Pediatric Subjective Global Nutrition Assessment Classifies More Children With Cerebral Palsy as Malnourished Compared With Anthropometry.

BACKGROUND: Nutrition assessment is multidimensional; however, much of the literature examining the nutritional status of children with cerebral palsy (CP) focuses on a single dimension. OBJECTIVE: The aim of the study was to evaluate nutritional status in children and adolescents with CP by comparing results from the Pediatric Subjective Global Nutrition Assessment (SGNA) with results from traditional anthropometric measures. DESIGN: This study was a cross-sectional observational study. PARTICIPANTS/SETTING: This study was conducted in a tertiary hospital outpatient setting in Brisbane, Australia, from February 2017 to March 2018. A total of 89 children (63 boys) with CP aged between 2 and 18 years of age were included. All Gross Motor Function Classification System levels were observed. The majority of children were in Gross Motor Function Classification System I and II (57, 64%) compared with Gross Motor Function Classification System III to V (32, 36%). Children with feeding tubes and those acutely unwell or hospitalized were excluded. MAIN OUTCOME MEASURES: Children were classified as well nourished, moderately malnourished, or severely malnourished by dietitians using the SGNA. Weight, height, body mass index (BMI), triceps skinfold thickness, subscapular skinfold thickness, and mid upper arm circumference were measured and converted to z scores to account for age and sex differences. Moderate malnutrition was defined by z scores -2.00 to -2.99 and severe malnutrition as ≤-3.00 z scores. STATISTICAL ANALYSIS PERFORMED: Multinomial logistic analyses were used to compare results from the SGNA and each single measurement. Continuous outcomes were transformed into z scores. Agreement was assessed with 2 categories: not malnourished and malnourished. Comparison statistics included percent agreement, sensitivity, and specificity. RESULTS: More children were classified as moderately or severely malnourished by SGNA than any of the anthropometric z score cutoffs. The majority of children were well nourished (n = 63) with 20 (22%) moderately malnourished and 6 (7%) severely malnourished by SGNA. The SGNA classified 11 children as malnourished that were not classified as malnourished by BMI. Children with moderate or severe malnutrition by SGNA had lower weight (P < .001, P < .001), BMI (P < .001, P < .001), mid upper arm circumference (P < .001, P < .001), triceps skinfold thickness (P = .01, P = .007), and subscapular skinfold thickness (P = .005, P = .02) z scores than well-nourished children. CONCLUSION: The SGNA identified more potentially malnourished children including children classified as well nourished by the single measurements such as BMI, height, and weight. The SGNA provided a clinically useful multidimensional approach to nutrition assessment for children with CP.