The effects of perceived therapist guidance and advice on adherence to home-based exercise programs in mothers of children with cerebral palsy in Rwanda.

Background: The alarming prevalence of non- or poor adherence to Home-based Exercise Programs (34-79.2 %, HEP) in parents of Children with Cerebral Palsy (C-CP) is a global health concern due to its detrimental effect on treatment outcomes. Objective: To examine whether Perceived Therapist Guidance and Advice (TGA) or social support moderate the effects of PTSD, depression, parenting stress, low self-efficacy, the burden of care, or the effects of perceived family stigma on adherence to HEP. Method: A stratified random sample of 301 mothers of C-CP attending the largest seven physical rehabilitation hospitals or centres in Rwanda participated in this study. Data were collected using validated measures of all investigated constructs. We conducted hierarchical multiple linear regressions, and the nature of moderation was scrutinized using the process macro 4.1 model number 1 within SPSS version 28. Results: The prevalence of adherence to HEP in the present sample was 32.9 %. Mothers' TGA and social support were positively associated with adherence to HEP; whereas mothers' stressors, including PTSD, parenting stress, depression symptoms, low self-efficacy, burden of care, and family stigma were negatively associated with adherence to HEP. In addition, TGA significantly moderated the associations of the different mothers' stressors with adherence to HEP, leading to increased HEP adherence for mothers with high stressor levels. Social support did not moderate any of these associations. Our respondents often reported poor family and friends' social support due to family stigma-related to caring C-CP. Conclusions: Therapists play a vital role by providing education, support, and counselling to parents, emphasizing the importance of adherence, and addressing any stigma-related concerns, especially for mothers who experience high levels of stress. Therapists should be aware that mothers of C-CP frequently relied solely on their support to improve adherence to HEP.

Reliability and validity of the Chinese version of the selective control assessment of the lower extremity in children with spastic cerebral palsy.

Objective: To assess the reliability and validity of the Chinese version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy (CP). Methods: Forty-five children with spastic CP (mean age 7.29 years, SD 2.87 years, rang 4-16 years) were recruited. Internal consistency was measured using Cronbach's α, while test-retest and inter-rater reliability were evaluated using intra-class correlation coefficients (ICC). Construct validity was established through correlation and confirmatory factor analyses. Discriminative validity was assessed by comparing SCALE scores across varying GMFCS levels. Results: The Chinese version of SCALE demonstrates high internal consistency (Cronbach's α = 0.91) and good reliability with ICCs exceeding 0.76 for test-retest and inter-rater assessments. It shows significant correlations with GMFCS (r = -0.76, p < 0.001) and Fugl-Meyer scales (r = 0.79, p < 0.001), confirming its validity. Confirmatory factor analysis supports a well-fitting model (χ 2/df = 1.58, RMSEA = 0.08, SRMR <0.001, GFI = 0.98, AGFI = 0.90, CFI = 0.99, TLI = 0.98), with the latent variable's AVE at 0.59 and CR at 0.88. Discriminative validity is evident in significant differences across GMFCS levels (p < 0.001), notably between levels I and II, I and III, and I and IV (p < 0.05). Conclusion: The Chinese version of SCALE shows good reliability and validity for assessing lower limb selective movement control in children with spastic cerebral palsy in China. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=205380, identifier ChiCTR2400083880.

Growing Up With Neurogenic Bladder: Navigating the Challenges and Controversies in Pediatric to Adult Transition and Lifelong Care: A Report From the Neurogenic Bladder Research Group (NBRG).

OBJECTIVE: Young adults with spina bifida (and other congenital neurologic diseases) have their own aspirations that may include education, employment, relationships and having children. As they move from pediatric to adult care, they must eventually transition to an adult healthcare team. The objective of this paper is to review the challenges and controversies in the transitional and adult care of people with congenital neurourological diseases. METHODS: The Research Group convened a meeting of its members and invited guests to better understand the healthcare challenges faced by these patients as they become adults. The group examined potential research opportunities focused on people with these diagnoses and themes related to their healthcare. RESULTS: Trust and clear communication are essential for effective patient transition. Ideally parents are involved in the transition to help reinforce independent self-care and responsibility. Adolescents require education about sexual health and independence, which may not be part of the core skillset of a urologist. The healthcare team must promote self-management and autonomy as early as practical. One of the major limitations is that adult care lacks the coordination of pediatric care, and patients may not have a "medical home." Multidisciplinary clinics are ideal but face logistical barriers in adult medicine. Additional barriers include limited physicians with the required specialized training. In the adult system, financial constraints are a key challenge for patients and providers. CONCLUSION: Collaboration, supported by institutions and new research, is vital for improving the neurourological care of young adults with complex diseases. TRIAL REGISTRATION: This study reports on the proceedings of a meeting, and therefore clinical trial registration was not necessary.

Changes in Lower Extremity Passive Range of Motion and Muscle Strength After Selective Percutaneous Myofascial Lengthening and Functional Physiotherapy in Children With Cerebral Palsy.

Background Children with cerebral palsy (CP) often experience motor and postural disorders, along with spasticity, muscle weakness, muscle-tendon contractures, and decreased joint range of motion (ROM). Muscle-tendon contractures are typically addressed through orthopaedic surgery to improve joint ROM, which can result in further muscle weakness. This study aimed to investigate the impact of selective percutaneous myofascial lengthening (SPML) combined with functional physiotherapy on joint passive ROM and isometric muscle strength in the lower extremities of children with spastic CP. Methods A single-group pre- and post-test design was utilised in this study. Twenty-six children aged five to seven years with spastic CP and Gross Motor Function Classification System levels II-IV underwent the SPML procedure and received nine months of postoperative functional strength training physiotherapy. Joint passive ROM and isometric muscle strength were measured using a universal goniometer and a digital hand-held dynamometer, respectively. Paired-sample t-tests were conducted to compare baseline and follow-up measurements. Results Significant improvements (p < 0.05) were observed in passive ROM of hip abduction, straight leg raise, popliteal angle, and ankle dorsiflexion, as well as in isometric strength of hip flexors, extensors, abductors and adductors, knee extensors, and ankle dorsiflexors. Conclusions The SPML procedure supported by postoperative functional physiotherapy can effectively address fixed contractures by significantly increasing passive joint ROM and muscle strength. Further research with longer-term follow-up measurements is necessary to confirm and expand upon these findings.

Complications of intrathecal baclofen therapy in children and young adults.

OBJECTIVE: The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions. METHODS: The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children's hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling). RESULTS: One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts. CONCLUSIONS: Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.

Relation between stretch and activation of the medial gastrocnemius muscle during gait in children with cerebral palsy compared to typically developing children.

Stretch hyperreflexia is often a target for treatment to improve gait in children with spastic cerebral palsy (CP). However, the presence of stretch hyperreflexia during gait remains debated. Therefore, we assessed the relation between gastrocnemius medialis muscle-tendon stretch and muscle activation during gait in children with CP compared to typically developing (TD) children. 3D gait analysis including electromyography (EMG) and dynamic ultrasound was carried out to assess, respectively gastrocnemius medialis activation and fascicle, belly, and tendon stretch during treadmill walking. Musculotendon-unit stretch was also estimated using OpenSim. Ratios of EMG/peak lengthening velocities and accelerations were compared between CP and TD. Velocity and acceleration peaks prior to EMG peaks were qualitatively assessed. EMG/velocity and EMG/acceleration ratios were up to 500% higher for CP (n = 14) than TD (n = 15) for most structures. Increased late swing muscle activation in CP was often preceded by fascicle and musculotendon-unit peak lengthening velocity, and early stance muscle activation by peaks in multiple structures. Increased muscle activation in CP is associated with muscle-tendon stretch during gait. Concluding, late swing muscle activation in CP appears velocity-dependent, whereas early stance activation can be velocity- and acceleration-dependent. These insights into stretch reflex mechanisms during gait can assist development of targeted interventions.

Effects of hippotherapy on motor function of children with cerebral palsy: a systematic review study.

Cerebral palsy includes a spectrum of neurodevelopmental disorders caused by brain damage, leading to impairment of movement, posture, and balance for a lifetime. There are many therapeutic interventions for cerebral palsy. One of them is hippotherapy, an alternative physical therapy. It is a type of equine-assisted activity and therapy where children with cerebral palsy and motor function skills interact with a horse. We aimed to study the effects of hippotherapy, as an alternative therapy, on the motor function of children with cerebral palsy. We performed a review of the latest literature on hippotherapy and cerebral palsy. The criteria we used were specific keywords, publication date, age of the subjects/studied population, and article type. The outcome of our research resulted in ten relevant studies. The findings demonstrate improvements in various aspects of motor function - more specifically in gross motor function skills, balance, coordination, gait parameters, and muscle strength. Two of ten studies used the Horse-Riding Simulator with significant improvements in postural control in sitting, motor function, and hip abduction range of motion. Hippotherapy can improve motor function skills of children between 2 and 14 years of age with cerebral palsy, affecting their well-being and overall quality of life. It can have a positive effect either as a standalone treatment or as a part of other traditional therapies. Extended research is needed to assess whether hippotherapy may present significant long-term changes in motor skills in children with cerebral palsy.

Impairment in understanding grasping movements in egocentric and allocentric perspectives in children with cerebral palsy due to periventricular leukomalacia.

Recognizing and understanding the actions of others through motion information are vital functions for social adaptation. Conditions like neurological disorders and motor impairments can impact sensitivity to biological motion, highlighting the intricate relationship between perceiving and executing movements. Our study centred on assessing the ability of children, encompassing both those with typical development and those diagnosed with cerebral palsy due to periventricular leukomalacia (PVL), to discriminate between depicted grasping of a small cylinder and a large cube. This discrimination task involved observing a point-light animation depicting an actor grasping the object, presented from either an allocentric perspective (observing others) or an egocentric viewpoint (observing oneself). Notably, children with PVL exhibited a pronounced and specific impairment in this task, irrespective of the viewpoint, as evidenced by thresholds increasing by nearly a factor of two. When comparing this impairment to difficulties in form or motion perception, we identified a robust correlation between egocentric biological motion and form sensitivity. However, there was no similar correlation between motion and biological motion sensitivity, suggesting a deficit in the visual system rather than the visuo-motor control system. These findings contribute to our understanding of the intricate interplay between motor and visual processing in individuals with congenital brain lesions, shedding light on the significant involvement of the visual system in cases of PVL.

Preoperative neurologic comorbidity and unanticipated early postoperative reintubation: a multicentre cohort study.

BACKGROUND: The risk of respiratory complications is highest in the first 72 h post-surgery. Postoperative respiratory events can exacerbate pre-existing respiratory compromise and lead to reintubation of the trachea, particularly in patients with neurologic disorders. This study examined the association between neurologic comorbidities and unanticipated early postoperative reintubation in children. METHODS: This multicentre, 1:1 propensity score-matched study included 420 096 children who underwent inpatient, elective, noncardiac surgery at National Surgical Quality Improvement Program reporting hospitals in 2012-22. The primary outcome was unanticipated early postoperative reintubation within 72 h after surgery. The secondary outcome was prolonged postoperative mechanical ventilation, defined as ventilator use >72 h. We also evaluated 30-day mortality in patients requiring reintubation. RESULTS: Cerebral palsy was associated with the highest risk of early reintubation (adjusted relative risk [RRadj]: 1.97, 95% confidence interval [CI]: 1.44-2.69; P<0.01), followed by seizure disorders (RRadj: 1.87, 95% CI: 1.50-2.34; P<0.01), neuromuscular disorders (RRadj: 1.76, 95% CI: 1.41-2.19; P<0.01), and structural central nervous system abnormalities (RRadj: 1.35, 95% CI: 1.13-1.61; P<0.01). Unanticipated early postoperative reintubation was associated with an eight-times increased risk of 30-day mortality (adjusted hazard ratio: 8.1, 95% CI: 6.0-11.1; P<0.01). Risk of prolonged postoperative mechanical ventilation was also increased with neurologic comorbidities, particularly seizure disorders (RRadj: 1.73, 95% CI: 1.55-1.93; P<0.01). CONCLUSIONS: Children with neurologic comorbidities have an increased risk of unanticipated early postoperative reintubation and prolonged mechanical ventilation. Given the high mortality risk associated with these outcomes, children with neurologic comorbidities require heightened monitoring and risk assessment.

Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study.

This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting.

Compare the effectiveness of two treatments, behavioral activation and acceptance and commitment therapy, on depression and mental rumination in mothers of children with cerebral palsy in Ilam city.

BACKGROUND: Since in most families, mothers are more responsible for taking care of children and have more responsibility than fathers for monitoring the child, taking care of a disabled child can have a more negative effect on the psychological state of mothers. This study aimed to investigate the effectiveness of behavioral activation (BA) and acceptance and commitment therapy (ACT) in depression and rumination in mothers with children with cerebral palsy. MATERIALS AND METHODS: This research was quasi-experimental field research with a pre-posttest and control group. The study population comprised 237 mothers with children who had cerebral palsy and were referred to occupational therapy centers in Ilam, Iran. The sample consisted of 60 participants selected by convenience sampling, who were randomly divided into two experimental groups (BA and ACT) and a control group (n = 20 per group). Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 27.0 with descriptive and inferential statistics, such as mean, standard deviation, and multivariate analysis of covariance (MANCOVA). RESULTS: The results of both BA and ACT were effective in reducing depression (P < 0.01) and rumination (P < 0.01) in the two experimental groups compared with the control group in the posttest phase. Furthermore, the effectiveness of the ACT in reducing depression and rumination was found to be more significant than the effectiveness of BA (P ≤ 0.05). CONCLUSION: The findings of the study suggest that both BA and ACT are effective in reducing depression and rumination in the research participants. However, the study also found that ACT was more effective than BA in reducing depression and rumination. Thus, both approaches can be used to strengthen treatment interventions to lessen depression and rumination in the research participants.

COL4A1 Gene Mutation Masquerading as Cerebral Palsy: Report of a Rare Case.

The Collagen Type 4 alpha 1 (COL4A1), is an important component of nearly all vascular basement membranes. Pathogenic mutation of this gene results in varied manifestations. In this report, we describe a two-and-a-half-year-old boy with an eventful perinatal period, global developmental delay, and epileptic spasms. Examination revealed microcephaly, nystagmus, and spasticity in limbs. Electroencephalogram showed multifocal epileptiform discharges and MRI brain demonstrated periventricular white matter changes, intracerebral bleeds, and porencephalic cysts. CT brain showed intracranial calcifications and screening for congenital infection was negative. The molecular genetic evaluation was later confirmed with a heterozygous mutation of the COL4A1 gene on exon 37 (variant - p.Gly1050Ala) with an autosomal dominant inheritance pattern. Currently, the child has developed drug-refractory epilepsy requiring polypharmacy and the ketogenic diet. COL4A1 gene mutations are close mimickers of Cerebral Palsy, hence a high index of suspicion should be exercised while approaching a child with spastic quadriplegia in order to promptly diagnose and manage such children for a better neurological outcome.

The Effect of Mobility Assistance Dogs on Quality of Life in Children with Physical and Neurological Impairments.

AIMS: To measure the quality of life in children with impaired walking who receive a mobility assistance dog (MAD). METHODS: The parents of ten children who received a MAD completed the cerebral palsy quality of life questionnaire, before receiving their dog and at one, three, and six-month follow-up. Data were analyzed to assess changes for each participant and to the group. RESULTS: The group showed a positive change in the domains of social well-being and acceptance, feelings about functioning, and emotional well-being and self-esteem after six months. Children with less impairment (GMFCS I-II) showed a change in social-wellbeing and acceptance, feelings about functioning, participation, physical health, and emotional-wellbeing and self-esteem after six months. Children with more impairment (GMFCS III-IV) showed no change at any timepoint measured. CONCLUSIONS: This novel therapeutic area of receiving a MAD demonstrated some positive quality of life changes after six months for a small group of children with impaired walking. These are preliminary findings in a small sample and this intervention would benefit from further study.

Feasibility and usefulness of video-based markerless two-dimensional automated gait analysis, in providing objective quantification of gait and complementing the evaluation of gait in children with cerebral palsy.

BACKGROUND: Gait analysis aids in evaluation, classification, and follow-up of gait pattern over time in children with cerebral palsy (CP). The analysis of sagittal plane joint kinematics is of special interest to assess flexed knee gait and ankle joint deviations that commonly progress with age and indicate deterioration of gait. Although most children with CP are ambulatory, no objective quantification of gait is currently included in any of the known international follow-up programs. Is video-based 2-dimensional markerless (2D ML) gait analysis with automated processing a feasible and useful tool to quantify deviations, evaluate and classify gait, in children with CP? METHODS: Twenty children with bilateral CP with Gross Motor Function Classification Scale (GMFCS) levels I-III, from five regions in Sweden, were included from the national CP registry. A single RGB-Depth video camera, sensitive to depth and contrast, was positioned laterally to a green walkway and background, with four light sources. A previously validated markerless method was employed to estimate sagittal plane hip, knee, ankle kinematics, foot orientation and spatio-temporal parameters including gait speed and step length. RESULTS: Mean age was 10.4 (range 6.8-16.1) years. Eight children were classified as GMFCS level I, eight as II and four as III. Setup of the measurement system took 15 min, acquisition 5-15 min and processing 50 min per child. Using the 2D ML method kinematic deviations from normal could be determined and used to implement the classification of gait pattern, proposed by Rodda et al. 2001. CONCLUSION: 2D ML assessment is feasible, since it is accessible, easy to perform and well tolerated by the children. The 2D ML adds consistency and quantifies objectively important gait variables. It is both relevant and reasonable to include 2D ML gait assessment in the evaluation of children with CP.

Enhancing motor performance through brief skin cooling: exploring the role of enhanced sympathetic tone and muscle spindle sensitivity.

BACKGROUND: Although brief skin cooling (BSC) is widely used in sports medicine and rehabilitation for its positive effects on motor performance, the mechanism underlying this motor facilitation effect remains unclear. OBJECTIVES: To explore the hypothesis that BSC enhances muscle force generation, with cold-induced sympathetic activation leading to heightened muscle spindle sensitivity, thereby contributing to this effect. METHODS: The study involved two experiments. Experiment 1 included 14 healthy volunteers. Participants submerged their hand in ice water for 3 min. Sympathetic activity was measured via heart rate (HR), muscle force generation was assessed through plantar flexor strength during maximum voluntary contraction (MVC), and cortical contribution to force generation via the volitional wave (V-wave) with and without the cold pressor test (CPT). Experiment-2 involved 11 healthy volunteers and focused on muscle spindle sensitivity and Ia synapse efficacy, assessed using soleus T-reflex and H-reflex recordings before, during, and after CPT. RESULTS: Experiment 1 showed significant increases in HR (7.8%), MVC force (14.1%), and V-wave amplitude (93.4%) during CPT compared to pre-CPT values (p = 0.001, p = 0.03, and p = 0.001, respectively). In Experiment-2, hand skin temperature significantly decreased during CPT and remained lower than pre-CPT after 15 min (p < 0.001). While H-reflex and background EMG amplitudes remained unchanged, T-reflex amplitude (113.7%) increased significantly during CPT and returned to pre-CPT values immediately afterward (p < 0.001). A strong correlation was also observed between HR and T-reflex amplitude (r = 0.916, p = 0.001). CONCLUSION: BSC enhances muscle spindle sensitivity via the sympathetic nervous system, promoting more significant muscle force generation. The method used in this study can be safely applied in clinical practice.

Group-based progressive functional, high-intensity training in adolescents and young adults with unilateral cerebral palsy - a tool to improve gross motor function, endurance and gait? - a pilot study.

PURPOSE: This pilot study assessed the safety and effects of progressive functional high-intensity training in a group setting for adolescents with unilateral cerebral palsy (CP) on daily function indicators. METHODS: Nine adolescents (mean age 16.9 years, GMFCS levels I-II) participated in 12 weeks of training (2x/week). Evaluations included 3D gait analysis, the 6-min walking test (6MWT), clinical exams, and the Gross Motor Function Measure-66 (GMFM-66). RESULTS: No adverse events occurred, and GMFM-66 scores significantly improved (p = .031, Δ = 2.19%). Although increases in 6MWT (p = .09, Δ = 29.8 m) performance and propulsion ratio (p = .067, Δ = 5.4%) for the affected leg were observed, they were not statistically significant. DISCUSSION: The study suggests that this training is safe and may enhance gross motor function, endurance, and gait asymmetry in unilateral CP. Future research should include upper limb evaluations and out-of-clinic motion analysis with wearable inertial measurement units (IMUs) to provide a more comprehensive assessment of functional movements.

Functional classification systems in Brazilian children with cerebral palsy: Reliability and associations between functional levels.

Children with Cerebral palsy (CP) present movement and posture disorders. The Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Ability Classification System (EDACS), and Visual Function Classification System (VFCS) enhance the understanding of their performance. We verified inter-rater reliability and associations between the classification levels. Physical therapists classified 100 Brazilian children with CP (3-17 years) according to GMFCS, MACS, CFCS, EDACS, and VFCS. To evaluate inter-rater reliability (Intraclass Correlation Coefficient-ICC) two independent examiners concurrently assessed a subset of 60 participants. According to Spearman's correlation coefficients, there were associations between GMFCS/MACS (r = 0.81), GMFCS/CFCS (r = 0.70), MACS/CFCS (r = 0.73), GMFCS/VFCS (r = 0.61), MACS/VFCS (r = 0.61), CFCS/EDACS (r = 0.58), CFCS/VFCS (r = 0.50), and EDACS/VFCS (r = 0.45) (p < .05). The inter-rater reliability ranged from excellent (ICC = 0.93-0.99) to good (ICC = 0.89), p < .05. The classification systems are reliable, and the levels associated with each other in Brazilian children, especially the GMFCS, MACS, and CFCS.

Benefits of inspiratory muscle training therapy in institutionalized adult people with cerebral palsy: A double-blind randomized controlled trial.

BACKGROUND: Respiratory health problems are one of the main causes of morbidity and mortality in adult people with cerebral palsy (CP). The influence of respiratory muscle training has not yet been studied in this population group. The objective of the study was to evaluate and compare the efficacy of two protocols with inspiratory muscle training (IMT), low intensity and high intensity, to improve respiratory strength and pulmonary function in adults with CP. METHODS: The study was a controlled, randomized, double-blind trial with allocation concealment. Twenty-seven institutionalized CP patients were recruited and randomly distributed in the high-intensity training group (HIT) or low-intensity training group (LIT). Over 8 weeks, an IMT protocol was followed 5 days/week, 10 series of 1 min with 1 min rest between them. HIT trained with a load of 40% of the maximum inspiratory pressure (MIP) and LIT with 20%. Respiratory strength and pulmonary function were evaluated. RESULTS: After IMT intervention, MIP, maximum expiratory pressure, forced expiratory volume in 1 s (FEV1) and peak expiratory flow increased in both groups; in HIT 29%, 19%, 13%, and 8%, respectively (p = 0.000, p = 0.000, p = 0.002, p = 0.001) and in LIT 17%, 7%, 3%, and 4%, respectively (p = 0.000, p = 0.000, p = 0.049, p = 0.113). All the improvements were significantly higher in HIT than in LIT. CONCLUSION: Inspiratory muscle training improved respiratory muscle strength and pulmonary function in adults with CP. Training with a 40% MIP load improved all the evaluated parameters and was the most effective treatment for adults with CP.

Presumed Perinatal Ischemic Left Middle Cerebral Artery Stroke With Cerebral Palsy, Developmental Delay, and Epilepsy: A Case Report.

The perinatal period is a high risk for ischemic events to occur leading to lifelong morbidity. Various patterns of ischemic injury to the fetal and neonatal brain have been studied depending on gestational age as well as the degree of hypoxia/ischemia. We present a case of presumed perinatal ischemic left middle cerebral artery stroke diagnosed by magnetic resonance imaging (MRI) in a child with global developmental delay, cerebral palsy, and epilepsy. Interestingly, the typical features of middle cerebral artery stroke are often not present in perinatal strokes, and hence these are not imaged perinatally. Since studies and research into neuroplasticity and neuromodulation are current topics of interest and several research studies are being conducted, we wish to add this case to the available scientific literature.

Co-Construction of a Dance Class Adapted for Adolescents with Cerebral Palsy.

AIM: To co-construct a dance class adapted for adolescents with cerebral palsy (CP). METHOD: A three phase co-construction process with study collaborators was used to (1) define the objectives and the obstacles and opportunities related to offering a dance class in the community through three focus groups with adolescents, their parents and study partners; (2) co-create the dance class based on the results of step 1, the expertise of the research team and the logic model of the dance class; and (3) test the dance class to evaluate its effects in relation to the defined objectives. RESULTS: Three objectives were identified: to have fun, promote movement, and social interaction. A weekly dance class (60 min./10 wk) was continuously tested on the adolescents and adapted by the dance facilitators. CONCLUSION: To improve practices and support the implementation of dance classes for young people with CP, eight recommendations are proposed relating to the creation of adapted classes and the evaluation of their desired effects.