Home-based motorised cycling in Non-ambulant adults with cerebral palsy: a feasibility study.

PURPOSE: The primary aim was to establish feasibility of a home-based motorised cycling intervention in non-ambulant adults with cerebral palsy (CP). The secondary aim was to investigate perceived outcomes on pain, sleep, fatigue, and muscle stiffness. MATERIALS AND METHOD: Non-ambulant adults with CP were recruited from a specialist clinic. Feasibility encompassing recruitment, retention, adherence, acceptability, practicality, and safety, was the primary outcome., Cycling frequency and duration data were downloaded from the device and augmented by a usage diary and participant survey. Participant satisfaction was rated using a 5-point Likert scale where 1 = very satisfied. Quantitative data and open-ended survey responses were analysed using descriptive statistics and content analysis, respectively. RESULTS: Ten non-ambulant adults with CP (5 female), 18 to 32 years, participated. The median (IQR) days cycled per week was 4 (3,5) with no serious adverse events recorded. The median (IQR) time cycled per session was 13.9 min, (10.2,19.8), per day. Participant satisfaction was high, median (IQR) 2 (1,2.5). Perceived benefits in pain, sleep, fatigue, stiffness, leg function, mood, behaviour, and social interactions were reported alongside occasional problems with spasms and foot placement. CONCLUSION: This study provides preliminary data to support the feasibility of motorised cycling for non-ambulant adults with CP.

Motorised cycling appears a safe form of physical activity for non-ambulant adults with cerebral palsy.Home based motorised cycling was an acceptable form of physical activity for non-ambulant adults with cerebral palsy.Pain, sleep, fatigue, spasticity, and mood may be positively influenced in non-ambulant adults with cerebral palsy through a home-based motorised cycling intervention.

Participation experiences of young people with cerebral palsy in key life situations: A qualitative study.

AIMS: To explore the participation experiences of adolescents and young adults with cerebral palsy (CP) in key life situations of young adulthood and investigate the impact of a government-funded, disability insurance scheme on participation and health service access. METHOD: We conducted a qualitative descriptive study using semi-structured interviews. Sixteen young people with CP (aged 16-30 years; mean age = 24 years 4 months) participated. Interviews were audio-recorded and transcribed verbatim before thematic analysis. RESULTS: An overarching theme of 'branching out into adulthood' was identified. Participants described early adulthood as a time of change, choice, and challenge. The sub-themes were: (1) making sense of my CP as an adult; (2) people's attitudes towards disability and the impacts on me; (3) roadblocks and workarounds; and (4) participation at the time of the COVID-19 pandemic. Participants reported complex views on the new disability insurance scheme. While access to services and support increased, participants experienced significant difficulty negotiating appropriate funding, resulting in frustration and reduced confidence in the scheme. INTERPRETATION: Young people with CP experience complexity as they participate during young adulthood. Alongside exploring how their identity is intertwined with having CP, they face significant barriers to participation when navigating relationships, accessing services, and being involved in the community.

Health literacy in adolescents and young adults with cerebral palsy: a mixed methods systematic review.

PURPOSE: To identify evidence of health literacy in young people with cerebral palsy (13-38 years), describe current strategies they use to access and build their health knowledge, and explore associations between health literacy and quality of life (QoL). METHODS: Four electronic databases were systematically searched (2001 to June 2023) to identify studies describing components of health literacy in this population. Two reviewers screened for eligibility, then extracted data and assessed methodological quality of included studies. Data were synthesised using a convergent integrated analysis framework and summarised with a narrative synthesis. RESULTS: Eleven studies were included (N = 363). Evidence of health literacy was demonstrated through a range of strategies young people employed to identify their specific information needs, develop health literacy skills, and learn experientially. The preferred method for building health knowledge was obtaining information from trusted sources. Information gaps were identified in topics such as ageing with cerebral palsy, sexuality and navigating intimate relationships. There were minimal data on health literacy and QoL. CONCLUSIONS: Young people with cerebral palsy want tailored and credible health information to increase participation in making informed health-related decisions. Building capacity and development of self-efficacy may assist with the identification of emerging health literacy needs.

Despite health literacy being a key indicator of quality chronic disease self-management for people with disabilities, outcomes are infrequently measured in young people with cerebral palsy.Capacity building, development of identity and self-management skills were identified as important components of health literacy in young people with cerebral palsy.Topic areas of unmet health information include relationship management, sexual health and how to navigate the bodily changes associated with ageing with cerebral palsy.Providing adolescents with cerebral palsy earlier opportunities to build health literacy may facilitate increased autonomy in healthcare decision making during the transition to adulthood.

Community-based physical activity interventions for adolescents and adults with complex cerebral palsy: A scoping review.

AIM: To identify implementation strategies and safety outcomes (adverse events) of community-based physical activity interventions for adolescents and adults with complex cerebral palsy (CP). METHOD: Five electronic databases were systematically searched to April 2022. Data were extracted on the implementation and safety of physical activity interventions for adolescents and adults with CP, classified in Gross Motor Function Classification System (GMFCS) levels IV and V, delivered in a community setting. RESULTS: Seventeen studies with 262 participants (160 participants classified in GMFCS levels IV or V) were included. Community settings included schools (n = 4), participants' homes (n = 3), gymnasia (n = 2), swimming pools (n = 2), and other settings (n = 4). Most studies specified medical or safety exclusion criteria. Implementation strategies included pre-exercise screening, use of adapted equipment, familiarization sessions, supervision, physical assistance, and physiological monitoring. Attendance was high and attrition low. Nine studies reported non-serious, expected, and related events. Four studies reported minor soreness and four studies reported minor fatigue post-exercise. Serious adverse events related to exercise were infrequent (reported for 4 of 160 participants [<2%]: three participants withdrew from an exercise programme and one participant ceased exercise for a short period). Most frequently reported was pain, requiring temporary exercise cessation or programme change, or study withdrawal (three participants). INTERPRETATION: For most adolescents and adults with CP classified in GMFCS levels IV and V, physical activity interventions can be safely performed in a community setting, without post-exercise pain or fatigue, or serious adverse events. WHAT THIS PAPER ADDS: Supervised community-based physical activity interventions can be safely performed by people with complex cerebral palsy. Post-exercise pain or fatigue was not common among those classified in Gross Motor Function Classification System levels IV or V. Serious adverse events are infrequent when exercising in community settings, with safety strategies.

Physical Activity in People With Motor Neuron Disease: Validity of the Physical Activity Scale for the Elderly as a Measuring Tool.

OBJECTIVE: This study aimed to investigate whether the physical activity scale for the elderly (PASE) is a valid tool in measuring physical activity (PA) in people with motor neuron disease (MND) and to identify the demographic and clinical factors that predict PA participation in this population. DESIGN: A prospective, observational study involving 100 ambulant participants with MND. SETTING: This study was conducted at a multidisciplinary specialist MND clinic. The clinic is fully funded by the local public health system and patients receiving care here are not expected to pay for their consultation. PARTICIPANTS: 190 patients with MND who had a physiotherapy appointment at the specialist clinic between July and October 2018 were screened. Of these, 100 participants (mean age 67 years [SD=12], 64% [n=64] men) who were ambulant (with or without assistance) were recruited (N=100). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PASE questionnaire, amyotrophic lateral sclerosis functional rating scale-Revised (ALSFRS-r), forced vital capacity (FVC). RESULTS: The results showed that engagement in PA is generally low, with median PASE score of 57. The PASE had fair-moderate correlation with ALSFRS-R total scores (rho=0.607; P<.000) and FVC (rho=0.250; P=.030). Standard multiple regression analyses showed that disease severity (ALSFRS-R total score) was the strongest predictor of PA levels (ß= 0.54; 95% confidence interval 0.02,0.06). The most frequently selected physical activities of choice for people with MND were activities around their homes and the biggest barrier to participation is fatigue. CONCLUSION: Present findings suggest that the PASE can be used to measure PA participation in people with MND. Details about activity of choice and barriers to participation present important considerations in designing exercise programs in this population to maximize compliance and therefore effectiveness.

The feasibility and acceptability of a falls prevention e-learning program for physiotherapists.

OBJECTIVE: To examine the feasibility and acceptability of a falls prevention e-learning program for physiotherapists working with people with osteoarthritis (OA). METHODS: A prospective pre-post quasi-experimental approach was adopted. An e-learning program on falls prevention specific to the OA population was developed and delivered. Feasibility and acceptability data were obtained from recruitment records, MoodleTM activity logs, multiple choice quizzes and customized surveys. RESULTS: Of the 65 physiotherapists and near-graduate physiotherapy students who met the eligibility criteria, 50 (77%) completed the e-learning program. Participants were satisfied and considered the program to be acceptable. The program met their expectations (n = 45; 90%) and was highly relevant to their work (median 8-10 [interquartile range (IQR)] 2; range 0 [not at all relevant] to 10 [extremely relevant]). An overall improvement in knowledge was also observed (mean percentage difference 8%; 95% CI -3.49, -1.27). DISCUSSION: Given a heightened risk of falls among people with OA, ensuring physiotherapists are skilled in falls prevention is important. Our acceptability and outcomes data indicate that a falls prevention e-learning program can be feasibly delivered to physiotherapists working in OA care. Future research should assess subsequent changes in clinical practice to determine whether physiotherapists deliver care reflective of contemporary falls prevention evidence.

Exploration of physiotherapists' use of motor control strategies for the treatment of idiopathic toe walking in children: a qualitative study.

OBJECTIVES: To explore how motor control interventions are conceptualised during treatment of children with idiopathic toe walking (ITW) by physiotherapists in Australia and USA. DESIGN: A thematic content framework qualitative design was used to triangular the theories underpinning motor control interventions and participant responses. PARTICIPANTS: Ten paediatric physiotherapists were recruited from Australia and USA. Participation was only open to physiotherapists who provided treatment to children with ITW. RESULTS: Physiotherapists defined the motor control interventions used for children with ITW as having the following non-hierarchical key elements: use of repetition; task scaffolding; encouraging error recognition; and, active and/or passive movements. Physiotherapists also described two superordinate themes; (1) We see motor control through the lens of how we view management and (2) Idiopathic toe walking treatment is a game with rules that are made to be broken. CONCLUSIONS: Treatment of ITW continues to challenge clinicians. Physiotherapists viewed their approach to ITW management being evidence- informed, underpinned by motor learning theories, movement strategies and organisational treatment frameworks or guidelines to fit their individual childrens' needs. Future research should investigate if this approach affords more favourable outcomes for children with ITW gait.

International collaboration to improve physiotherapists' training, Viet Nam.

Problem: Like most low- and middle-income countries, Viet Nam has a scarcity of rehabilitation professionals and lacks training programmes that meet international standards. Approach: In 2018, four Vietnamese medical universities, the Université Catholique de Louvain, the Université Libre de Bruxelles, the Humanity & Inclusion charity and World Physiotherapy agreed to collaborate on strengthening pre-service education for physiotherapists in the country. Local setting: Viet Nam has a favourable environment for nurturing rehabilitation services and education: development funds have been available; government investment is increasing; and rehabilitation education has existed for many decades. Relevant changes: The collaboration resulted in the establishment of: (i) a 4-year, competency-based, entry-level curriculum for physiotherapists (bachelor's degree); (ii) opportunities for continuing professional development; (iii) a 2-year master's programme for physiotherapy lecturers and clinical supervisors; and (iv) a national physiotherapy association. In addition, four students were supported in studying for PhD degrees. Strong collaboration and comprehensive and complementary interventions have laid the foundations for sustainable, high-quality, educational programmes for physiotherapists, which will improve access to, and the standard of, rehabilitation services in Viet Nam, thereby leading to better patient outcomes. Lessons learnt: Curricula for entry-level physiotherapy programmes should be competency-based, be actively managed by national educators and meet international standards while being responsive to local priorities. To strengthen the rehabilitation workforce, educators involved in teaching and supervising training programmes should have the skills and knowledge required. A national professional physiotherapy association should be established to provide continuing professional development for physiotherapists and to take part in international collaborations.

Children with idiopathic toe walking display differences in lower limb joint ranges and strength compared to peers: a case control study.

BACKGROUND: Idiopathic toe walking (ITW) is an exclusionary diagnosis. There has been limited exploration of lower limb active range of motion and strength measures in children with ITW. This researched aimed to determine any differences in lower limb muscle active range of motion and strength in children who have ITW, compared to normative data collected from children who displayed typical gait. METHODS: Children were recruited with had a diagnosis of ITW, aged between 4 and 10 years, and no recent treatment. Data collected included parent reported data such as time spent toe walking, percentage of time spent toe walking, and clinician collected data such as age, height and weight. Joint ranges of motion and strength measures were collected by an experience clinician. Active and weight bearing joint ranges of motion were evaluated with a goniometer or digital inclinometer. Lower limb muscle strength measures were evaluated with a hand-held dynamometer. Published normative data sets were used for comparison. Measures were analysed with regression analyses to determine differences between groups in different measures, considering measures known to impact range and strength. Odds ratios (OR), 95% confidence intervals (CI) and p values were reported. RESULTS: Twenty-six children with ITW participated. Reduced weight bearing ankle range of motion, when measured with the knee bent, was associated with being in the ITW group (p = 0.009), being older (p < 0.001) and weighing less (p < 0.001). Reduced ankle plantar flexion range was only associated with being in the ITW group (p = 0.015). For all lower limb strength measures, excluding hip external rotation, children who displayed greater strength, did not toe walk (p < 0.002), were older (p < 0.001) and weighed more (p < 0.014). with ITW. CONCLUSION: Children with ITW displayed reduced overall plantar and dorsiflexion at the ankle, compared to non-toe walking children. Reduced plantarflexion is children with ITW has not been described before, however reduced dorsiflexion is commonly reported. Children with ITW were weaker in many lower limb measures, even when age and weight were considered. This should lead clinicians and researchers to pay greater attention to lower limb strength measures in this population.

Physical activity and quality of life in children with idiopathic toe walking: a cross sectional study.

OBJECTIVES: To determine if children with idiopathic toe walking (ITW) reach Australian 24-hour movement guidelines. Additional objectives were to identify any factors associated with moderate to vigorous physical activity time of children with ITW. DESIGN: Cross sectional. SETTING: Private practice, public health outpatient, community clinics. PARTICIPANTS: Children between 4 and 14 years, who toe walked and had no medical conditions known to cause ITW. OUTCOME MEASURES: Physical activity intensity, sedentary behaviour and sleep data were collected via an ActiGraph. Physical activity level intensity data were triangulated with the Child Leisure Activities Study Survey (CLASS) to highlight the subjective nature of parent-reported measures. Health related quality of life information was collected using the Parent-Proxy and Child-Self Report Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scale. Regression analyses were used to explore individual factors associated with moderate to vigorous physical activity. RESULTS: Twenty-seven participants, 17(63%) male, age mean = 6.62 (SD = 2.29) years, provided information on physical activity (CLASS n = 18, ActiGraph n = 22), physical functioning and psychosocial functioning domains on the PedsQL (Parent-Proxy n = 25, Child n = 22). All participants exceeded Australian recommendations for physical activity, 44% (8/18) met recommended screen time amounts, and two (9%) met recommended sleep times. The Child-Self Report PedsQL scale score of social functioning was the only factor associated with an increase in physical activity (Coef = 0.48, 95%CI = 0.09 to 0.87, p = 0.019). CONCLUSION: Participants achieved high levels of daily moderate to vigorous physical activity, and this was associated with social functioning. Given current uncertainty regarding benefits and effectiveness of treatment choices for children who have ITW, these findings should encourage clinicians to consider how their treatment recommendations interact with the PA level and sleep of children with ITW. Any treatment choice should also be implemented with consideration of how it may impact social functioning. This study had a small sample size therefore results should be cautiously interpreted and not generalised to all children with ITW.

What web-based information is available for people with Parkinson's disease interested in aquatic physiotherapy? A social listening study.

BACKGROUND: Aquatic physiotherapy is becoming a more frequently utilised treatment for people with Parkinson's Disease (PD). Consumers are increasingly accessing information regarding health choices online, and it is not known what type or quality of information regarding aquatic physiotherapy is available. METHODS: Web-based platforms (Facebook™, Twitter™, YouTube™, Instagram™, blogs and the web) were searched using the Awario© social listening software. Webpages had to be in English, mention PD, aquatic physiotherapy and its effects. Quality of webpages was assessed using a modified DISCERN tool and content analysis summarised reported effects. RESULTS: Awario© identified 2992 entries, with 133 assessed using the modified DISCERN tool. A small number (n = 31, 24%) described the effects of aquatic physiotherapy for people with PD. Quality of webpages was low, with many lacking information regarding clear sources of information, contraindications to aquatic physiotherapy and descriptions of the therapeutic environment. Content analysis showed several themes; general physical, PD-specific and psychosocial effects. More than a third of webpages indicated that aquatic physiotherapy would improve strength, balance, pain and aid relaxation. A large number (n = 96, 72%) described at least one hydrodynamic or hydrostatic property of water, most commonly buoyancy (n-83, 62%). CONCLUSIONS: Overall quality of information was poor, and it is recommended that webpages list all potential contraindications to aquatic physiotherapy and direct consumers to discuss potential participation with their healthcare professionals. Webpages also should include information regarding the therapeutic environment, disclose sources of information and focus on enablers to exercise to improve engagement of people with PD in aquatic physiotherapy.

Emergency department usage by adults with cerebral palsy: A retrospective cohort study.

OBJECTIVE: To retrospectively profile the ED usage for a cohort of adults with cerebral palsy (CP). METHODS: Five years of ED data from a Victorian hospital network was analysed to identify participants with CP using the Victorian Emergency Minimum Dataset supplemented with scrutiny of inpatient admission data to identify cases because of limited ED coding of CP. Presentation frequency, emergency diagnoses (International Classification of Diseases, 10th Revision codes) and presentation sequelae were calculated and described. An investigation into rates of low urgency presentations was conducted. Differences between adult and paediatric cohorts were described. RESULTS: Participants with CP constituted 1586 ED presentations. Adults represented 43% (n = 689) of these. Thirty percent of adults presented more than five times over the study period, with respiratory (25%), gastrointestinal (17%) and epilepsy/convulsion diagnoses (11%) being the most common presentations. Rates of inpatient hospital admissions from the ED increased with age in adults (P < 0.001). Low urgency presentations made up 8.9% of total adult presentations. CONCLUSIONS: The high rates of respiratory diagnoses and epilepsy/convulsions, both ambulatory care-sensitive conditions, may be indicative of transitional challenges between paediatric and adult healthcare, potentially highlighting difficulties in accessing primary care services. Relatively low rates of 'low urgency' presentations may suggest perceived medical fragility in this vulnerable population. People with CP who present to ED and were not admitted may be underrepresented in this data. National expansion of this research will aid the development of an evidence-based model of care for CP in Australia.

Caregiver perspectives of managing chronic pain in children and adolescents with dyskinetic and mixed dyskinetic/spastic CP with communication limitations.

PURPOSE: Caregivers provide unique insights into managing chronic pain in children and adolescents with dyskinetic and mixed dyskinetic/spastic cerebral palsy with communication limitations. This study explored the personal challenges caregivers face in supporting their child's everyday pain management, including barriers and facilitators to effective chronic pain management. METHODS: Semi-structured interviews were undertaken with ten caregivers (all mothers) of children with either dyskinetic or mixed dyskinetic/spastic cerebral palsy. All children had chronic pain (> 3 months), were aged from 5 to 15 years, had significant functional limitations, and had either limited or no capacity to self-report their pain. Interpretative phenomenological analysis was used to explore caregivers' subjective experiences of managing their child's chronic pain within family, school, and healthcare contexts. RESULTS: Five superordinate themes emerged: 1. the continual challenge of problem solving pain and dyskinesia; 2. the pursuit of a solution; 3. unfulfilled preferences within pain management; 4. all-encompassing effects on families; and 5. the ongoing impacts of pain and dyskinesia with age. CONCLUSION: There is a need for structured pain education and resources targeted towards caregivers and support workers that account for the complex overlay of dyskinesia. There is a further need to ensure caregiver preferences for non-pharmacological pain treatments are met within family-centred care models.

Maternal and child factors associated with the health-promoting behaviours of mothers of children with a developmental disability.

BACKGROUND/AIM: Mothers caring for their child or adult with a developmental disability can experience mental health disparity. Protective factors such as healthy behaviours are under-researched. This study investigated relationships between mental health, healthy behaviours, and disability factors. METHODS: The cross-sectional online survey included: Depression Anxiety Stress Scales (DASS); Family Empowerment Scale (FES); Health Promoting Activities Scale (HPAS); and a measure of childhood quality of life (QoL). RESULTS: All mothers were raising offspring (aged 3-36 years) with a developmental disability. Fifty-two percent of mothers (N = 81) had a mental health diagnosis. DASS scores were elevated for depression (58 %), anxiety (52 %) and stress (68 %). Mothers participated in health promoting activities infrequently and reported low satisfaction with community health-supporting facilities. Depressive symptoms, maternal empowerment and two indicators of child-related QoL explained 29.7 % of the variance in healthy behaviours. Depressive symptoms were the most important predictor of lack of health promoting behaviours. CONCLUSIONS: Better mental health predicted more frequent participation in health promoting behaviour. Future research might explore the extent to which health promoting behaviours protect mental health. Service changes including family health focused services, and custom designed health promotion or coaching programs may improve the health behaviours of mothers with high care responsibilities.

Progression of Postural Asymmetry in Young Adults With Cerebral Palsy Who Are Not Walking: An Exploratory Study.

PURPOSE: Young adults with cerebral palsy (CP) who are not walking are at risk of developing or increasing musculoskeletal asymmetries affecting the rib cage, spine, pelvis, and hips. This longitudinal study aimed to explore postural change using the Goldsmith Indices of Body Symmetry (GIofBS) over an 18-month period in adults with CP who are not walking. METHODS: Demographic and medical data were accessed from participant's history. Posture was recorded using the GIofBS to collect data during an 18-month period following skeletal maturity. RESULTS: All participants had postural asymmetry at study onset with evidence of minimal change in some GIofBS outcome measures and fluctuations in other outcomes over 18 months. CONCLUSIONS: Physical therapists may use the GIofBS across the lifespan to screen for deterioration in musculoskeletal status or in assessing longer-term outcomes of interventions impacting posture in this complex population. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A314.

Perceptions of aquatic physiotherapy and health-related quality of life among people with Parkinson's disease.

BACKGROUND: Enablers for people with Parkinson's disease (PD) participating in aquatic physiotherapy have been identified, and exercise improves health-related quality of life (HRQoL) but it is unclear whether all enablers and barriers for aquatic physiotherapy specific to the PD population have been explored. OBJECTIVE: To describe HRQoL in people with PD who have undertaken aquatic physiotherapy, and explore their perceptions and attitudes regarding the programme. METHODS: Twenty-one participants who participated in a pilot trial on aquatic physiotherapy were included. Participants completed a survey regarding their experiences. The Parkinson's Disease Questionnaire-39 (PDQ-39) and Personal Well-being Index-Adult (PWI) were used to quantify HRQoL, whilst focus groups were conducted to explore their perceptions and attitudes. Descriptive statistics were used to summarize HRQoL scores. Focus group data were analysed using the deductive coding method. RESULTS: Most participants felt that the aquatic programme was worthwhile (n = 20/21, 95%). However, they had poor overall well-being (mean 41.6, SD 13.5) and HRQoL (mean 31.0, SD 13.2) as measured by the PWI and PDQ-39. Several barriers to aquatic therapy including safety when getting dressed, fatigue and transport were identified although many enablers were also identified, including an improvement in function, less falls and group socialization. CONCLUSIONS: Aquatic physiotherapy was well-accepted. Participants felt their function improved and felt safe in the water. HRQoL is lower in individuals with PD when compared to Australian norms; thus, interventions to optimize HRQoL need to be explored further. PATIENT OR PUBLIC CONTRIBUTION: Patients participated in the aquatic intervention, survey and focus groups.

Pain and its relationship with postural asymmetry in adults with cerebral palsy: A preliminary exploratory study.

BACKGROUND: Pain in adults with cerebral palsy (CP) is commonly reported, with muscular and skeletal dysfunction resulting in postural asymmetry as potential contributors to multifactorial causes of pain. The relationship between pain and postural asymmetry of the thoracic cage, pelvis and hips in non-ambulatory adults with CP however is unknown, particularly in those with cognitive and communication limitations. OBJECTIVE: The primary aim of this study was to describe and quantify day and night pain in non-ambulatory adults with CP. Secondary aims were to investigate any relationship between pain and postural asymmetry and to describe current pain management strategies utilised. METHODS: Pain was measured using the Non Communicating Adult Pain Checklist (NCAPC). Posture was measured using the Goldsmith Indices of Body Symmetry (GIofBS) and radiographs. Correlations between pain scores and posture (GIofBS and radiographs) were assessed using non-parametric analysis. Information regarding pain management strategies was gained from medical records and carer interviews. RESULTS: Seventeen non-ambulatory adults with CP were recruited. High levels of day pain were experienced by ≥ 50% of participants with a high incidence of prescribed medications targeting pain. Strong positive correlations between day and night NCAPC scores, chest right left ratio and night pain, Cobb angle and day pain and between Cobb angle and night pain were evident. CONCLUSION: The incidence and severity of pain in non-ambulatory adults with CP is high with postural asymmetry a potential contributor. Pain remains difficult to assess and manage in adults with significant cognitive and communication impairments and warrants further investigation.