Cognitive functioning in children with cerebral palsy

The impact of perinatal brain injury on siblings: a scoping review

PURPOSE

(a) To analyze the extent and nature of research available on the impact of childhood perinatal brain injury (PBI) on siblings, (b) to synthetize results in a descriptive manner.

METHOD

A literature search of 4 databases was performed up to October 2023. Studies addressing issues around siblings of children with PBI, cerebral palsy (CP) or Profound Intellectual and Multiple Disabilities (PIMD) were included. The protocol was drafted using Arksey and O'Malley's framework and the review followed PRISMA reporting guideline.

RESULTS

35 articles were identified and analyzed, all focused on CP/PIMD. They highlight the impact of CP/PIMD on family functioning, siblings' roles, and relationships. We grouped results in three categories: (1) impact of CP/PIMD on family functioning, (2) impact on the relationships with the person with CP/PIMD and (3) experience of CP/PIMD. Siblings' relationship with the person with CP/PIMD is particularly impacted. Siblings' trajectory and quality of life are modified. CP/PIMD cause psychological, behavioral and cognitive difficulties. Siblings report various support and ways of coping.

CONCLUSION

Few and heterogeneous studies are available. CP/PIMD significantly impacts siblings' life trajectory. Further studies appear necessary to precisely analyze the issues, study coping strategies, and develop, propose and implement appropriate support for siblings.

A Pilot Investigation on the Relationship Between Infant Vocal Characteristics at 12 Months and Speech Motor Impairment at 4-5 Years

PURPOSE

The objective of this pilot study was to investigate the relationship between infant vocal characteristics and later speech motor impairment in children at risk for cerebral palsy (CP) to inform the early prediction of speech motor impairment.

METHOD

Vocal complexity, volubility, and consonant inventories of 13 infants at risk of CP were examined at approximately 12 months. We examined their association with later levels of speech motor impairment as measured by the Viking Speech Scale (VSS).

RESULTS

Children in our sample with greater speech motor impairment at age 4 years produced lower rates of developmentally complex vocalizations in infancy but showed no significant differences in vocal stage attainment, volubility, or consonant diversity.

CONCLUSIONS

Our results are in line with trends found in prior literature examining vocal characteristics of infants at risk for speech motor involvement. These results can inform data-driven hypotheses in future studies aimed at the early prediction of speech motor impairment through the study of infant vocal production.

Assessment of Gaze Fixations and Shifts in Children with Cerebral Palsy: A Comparison of Computer- and Object-Based Approaches

Background/Objectives: Gaze behaviours, such as fixation on single objects, and switching gaze between two objects are important for signaling messages, making choices or controlling a computer for children with cerebral palsy (CP) and similar movement disabilities. Observing these behaviours can be challenging for clinicians, with a lack of agreement on how they can be objectively quantified or rated. Methods: This study compares two methods of eliciting and observing gaze behaviours: a computer presentation using an eye tracker and an object presentation scored by two independent observers in order to explore the utility of each to clinicians working in this area. Children with CP (n = 39) attempted single-target fixation (STF) and target-target fixation shift (TTFS) tasks using both presentations and the results were compared. Results: Six children were unable to calibrate the eye tracker to the accuracy level required. Significantly higher scores for both STF (81.3% object presentation and 30.3% computer presentation, p < 0.01) and TTFS (70.1% and 26.9%, p < 0.01) were seen on the object presentation, with children's performance not predicted by developmental age, severity of CP or presence or absence of strabismus. It is not possible to definitively state which method gives the "correct" result; however, the difference in reported success rate merits further discussion. Conclusions: Whilst eye tracking may present an "entry barrier" for some children in terms of its accuracy and calibration requirements, object presentation carries with it the risk of over-interpreting children as having fixated. Conversely, eye tracking may be better at recording fixations in children with strabismus, where object-based paradigms may offer more flexible administration for clinicians. The variability in children's performance on both presentations underlines the risk of assuming these skills to be present and the importance of assessing gaze behaviours in individual children.

The UK C-BiLLT: Validity and reliability of an online assessment of spoken language comprehension for children with severe motor disorders

BACKGROUND

Current UK measures of early spoken language comprehension require manipulation of toys and/or verbal responses and are not accessible to children with severe motor impairments. The Computer-Based Instrument for Low motor Language Testing (C-BiLLT) (originally validated in Dutch) is a computerized test of spoken language comprehension that children with motor disorders control using their usual response methods.

AIMS

To create a UK version of the C-BiLLT, evaluate its validity and reliability, and assess its practicability for children with motor disorders.

METHODS & PROCEDURES

The C-BiLLT was translated into British English and items were adapted to ensure familiarity to UK children. A total of 424 children (233 females, 191 males) aged 1:6-7:5 (years:months) without developmental disabilities were recruited from North East England. Children completed the UK C-BiLLT and Preschool Language Scales 5 (PLS-5) for convergent validity evaluation and either the visual reception subtest of the Mullen Scales of Early Learning (MSEL) (children aged 1:8-5:5) or Ravens Coloured Progressive Matrices (CPM) (ages 5:6-7:5) to assess divergent validity. A total of 33 children completed the UK C-BiLLT within 4 weeks of initial assessment for test-retest reliability assessment (intraclass correlation coefficient-ICC). Internal consistency was assessed using Cronbach's alpha and exploratory factor analysis examined structural validity. A total of 24 children (10 female, 14 male; aged 4-12 years) with non-progressive motor disorders who use augmentative and alternative communication (AAC), rated the UK C-BiLLT's ease of use and completed British Picture Vocabulary Scales (BPVS) and CPM as for convergent and divergent validity testing.

OUTCOMES & RESULTS

Internal consistency was high for children without motor disorders (α = 0.96). Exploratory factor analysis extracted two factors, together explaining 68% of the total variance. Test-retest reliability was excellent (ICC = 0.95; 0.90-0.98 95% confidence interval-CI). UK C-BiLLT scores correlated highly with PLS-5 (r = 0.91) and MSEL (r = 0.81), and moderately with CPM (r = 0.41); and increased across full-year age-bands (F(6, 407) = 341.76, p = < 0.001, η2 = 0.83). A total of 19 children with motor disorders rated the UK C-BiLLT as easy/ok to use; two judged it hard; three declined to rate the ease of use. Their UK C-BiLLT scores correlated highly with BPVS (r = 0.77) and moderately with CPM (r = 0.57).

CONCLUSIONS & IMPLICATIONS

The UK C-BiLLT is a valid, reliable measure of early spoken language development and is potentially practicable for children with motor disorders. It may facilitate international research on the language development of children with motor disorders and evaluation of intervention at the national level.

WHAT THIS PAPER ADDS

What is already known on the subject Young children with motor disorders have difficulties accessing standardized assessments of language comprehension that require children to handle objects or to speak a response. What this paper adds to the existing knowledge This study demonstrates the validity and reliability of a UK translation of the C-BiLLT and suggests that the measure is feasible for children with motor disorders who use AAC and have a reliable method of response via computer access. What are the potential or clinical implications of this work? The UK C-BiLLT is a useful addition to the limited tools currently available to assess early spoken language comprehension of children with motor disorders.

Assessment of Cognition and Language Using Alternative Response Modalities

Assessing cognition and language using standardized tests is challenging when the individual has severe speech and motor impairments. Tests with a multiple-choice format may be adapted without compromising standardization using alternative response modes like partner assisted scanning (PAS) and eye-pointing (EP). Standardization of such assessment is little researched. The study investigates the (a) reliability of, (b) transparency of, and (c) adherence to assessment protocols using PAS and EP. The participants were students from special needs education and speech and language therapy, who worked in dyads (n = 39). Two observers recorded a number of errors made in protocol delivery, independently of each other. The dyads made between 0 and 81.5 errors. Number of errors was not related to response mode, t(38) = -0.21, p = .839. The observers were in high agreement, with an intraclass correlation coefficient of .97, p < .001. The study suggests that assessing language involving alternative modes of responding can be successfully taught to novice practitioners.

Segmental trunk control and developmental parameters in children with cerebral palsy aged 24 to 42 months: A cross-sectional study

This study aimed (1) to investigate the relationship between segmental trunk control and motor, cognitive, and language development parameters in children with cerebral palsy (CP) and (2) to compare segmental trunk control levels and motor, language, and cognitive development in children with CP and typically developing (TD) peers. A cross-sectional observational study was conducted with 63 children aged between 24 and 42 months, including those with typical and atypical development. The atypical development group included 30 children with CP ranged from Gross Motor Function Classification System levels I to V (70.0% males, median age: 29 months, interquartile range: 25-36 months), and 33 children in the TD group (69.7% males, median age: 29 months, interquartile range: 26-36 months) included age-matched. Motor, language, and cognitive development domains were evaluated using the Bayley Scales of Infant and Toddler Development, Third Edition, and the level of trunk control was evaluated using the Segmental Assessment of Trunk Control. In children with CP, segmental trunk control was found to be strongly correlated with motor, cognitive, and language development (all P < .001, Spearman r ranged from 0.767-0.927). Furthermore, children with CP had lower segmental trunk control levels and cognitive, language, and motor development results than their TD peers (all P < .001). The strong relationship between segmental trunk control levels and developmental parameters can guide clinicians and therapists in planning and implementing intervention programs designed for children with CP who have difficulties in trunk control.

Learning About Their Condition: The Gradual Path of Young People With Childhood-Onset Motor Disabilities

AIM

Young people with childhood-onset motor disabilities face unique challenges in understanding and managing their condition. This study explored how they learnt about their condition.

METHOD

A descriptive qualitative study was conducted in 2023-2024 at a Swiss paediatric neurorehabilitation unit. Ten participants aged 15-24 years were recruited through purposive sampling, representing diverse conditions and socio-educational backgrounds. Inductive thematic analysis was conducted on interview transcripts.

RESULTS

Four themes emerged. First, learning paths revealed that participants gradually acquired knowledge about their condition. Early explanations often involved parents and visual aids, with moments of awareness and evolving information needs shaping their learning over time. Second, building blocks of understanding showed that knowledge was constructed through interactions with physicians, therapists, parents, peers and the Internet. Third, interacting with healthcare professionals highlighted the importance of trust and continuity in relationships with healthcare professionals to support learning. Last, improving the learning process suggested strategies such as dedicated consultations for recapping information during adolescence and increasing disability awareness in schools.

CONCLUSION

Young people with motor disabilities require information and support tailored to their individual learning needs. Adapting these resources could enhance their understanding of their condition, supporting the development of their autonomy and self-advocacy within healthcare.

Executive function is associated with behaviour problems in children and adolescents with cerebral palsy and intellectual disability

BACKGROUND

Children and adolescents with cerebral palsy (CP) commonly have behaviour problems. The present study aimed to determine which of the most common clinical features experienced by children and adolescents with CP and intellectual disability are associated with behaviour problems.

METHOD

We investigated 11 possible associated variables including epilepsy, visual and hearing impairments, motor difficulties, communication and speech difficulties, pain, sleep disturbance, executive function (EF) deficits, type of CP, and parent stress. Thirty-eight parents or guardians of children aged 6 to 17 years with CP and intellectual disability (parent informed) completed proxy and self-report standardised questionnaires.

RESULTS

EF deficits and parent stress were significantly associated with behavioural problems.

CONCLUSION

For children and adolescents with CP and intellectual disability, the present study suggests close attention should be placed on specific clinical features including EF deficits and parent stress when considering variables associated with behaviour problems.

Cognitive functioning in children and adolescents with cerebral palsy: protocol for the Danish CPCog-Youth study

BACKGROUND

Many children and adolescents with cerebral palsy (CP) experience cognitive difficulties, impacting their academic, social, and emotional well-being. A Danish study from 2023 revealed that merely 40% of individuals with CP complete their elementary school education, and previous neuropsychological studies have found that most children and adolescents with CP experience cognitive difficulties. Yet, cognitive functioning is often assumed rather than assessed, and CP follow-up programs focus predominantly on physical functioning. Recognizing this gap, we aim to investigate cognitive functioning in children and adolescents with CP in mainstream schools in Denmark, using standardized neuropsychological tests. Our objective is to provide valuable insights to guide clinical practice on cognitive assessment and intervention, ultimately fostering a more effective support system for individuals with CP.

METHODS

The study employs a cross-sectional design, involving 100 children and adolescents with CP aged 11-15 years attending mainstream schools in Denmark. Cognitive assessment includes the core battery from a proposed Nordic test protocol for children and adolescents with CP - the CPCog - encompassing general cognitive functioning (intelligence), executive functions, and visuo-motor skills. Supplementary tests cover verbal and nonverbal short-term memory, attention, fatigue, and mental health. The assessment protocol will also be evaluated by parents of participating children and adolescents with CP. The project is conducted collaboratively by the neuropsychological teams at three assessment sites, in conjunction with the Center for Cerebral Palsy, Rigshospitalet, Aarhus University Hospital, and Aalborg University Hospital. The study benefits from an external advisory board comprising leading international CP experts.

DISCUSSION

Cognitive difficulties in children and adolescents with CP are often overlooked. Few cognitive studies exist, with some providing only estimated cognitive functioning. The CPCog-Youth study will help advance our understanding of the cognitive challenges experienced by children and adolescents attending mainstream schools. The findings will contribute to the development of targeted cognitive assessment and intervention programs for individuals with CP, addressing this commonly neglected aspect of care. By also seeking feedback from participating families and the involved neuropsychologists, we aim to investigate whether the proposed cognitive assessment is feasible and beneficial in real-world settings.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov on June 27, 2023 (ID: NCT05921422).

Is Whole-Body Cryostimulation Useful in Modulating Spasticity in Adults with Cerebral Palsy? A Case Study

Background: This case study investigates the effect of a five-session whole-body cryostimulation (WBC) cycle on a 55-year-old female patient with cerebral palsy (CP) and lower limb spasticity (LLS) with a typical diplegic gait pattern. CP is a common physical disability characterized by motor impairments, including spasticity, which significantly impacts mobility and quality of life. The current treatments for spasticity often have limited efficacy and considerable side effects, making alternative therapies like WBC an area of interest. Methods: The patient underwent a 10-day inpatient rehabilitation program integrated with five WBC sessions at -110 °C for 2 min. The treatment effects were assessed immediately before and after the five WBC sessions using the Ashworth Scale, Fugl-Meyer Assessment, H-reflex test, and gait analysis. Psychosocial outcomes were measured with the SF-36, WHO-5, PSQI, ESS, and BDI questionnaires. Results: Immediately after the WBC cycle, gait analysis showed increased walking speed (0.48 to 0.61 m/s left; 0.49 to 0.57 m/s right) and step length (0.30 to 0.38 m left; 0.30 to 0.35 m right). The H/M ratio in the H-reflex test improved, indicating a better neuromuscular efficiency. Psychosocial assessments revealed a 42.5% reduction in pain and a 24% improvement in overall quality of life and well-being. Discussion and Conclusions: The objective improvements in gait parameters and neuromuscular modulation, along with the subjectively reported enhancements in functional abilities, highlight the potential of WBC as a valuable addition to rehabilitation strategies for this population. Further research is needed to confirm these findings and assess long-term outcomes.

Visual inspection time as an accessible measure of processing speed: A validation study in children with cerebral palsy

OBJECTIVE

This study examined the validity of a visual inspection time (IT) task as a measure of processing speed (PS) in a sample of children with and without cerebral palsy (CP). IT tasks measure visualization speed without focusing on the motor response time to indicate decision making about the properties of those stimuli.

METHODS

Participants were 113 children ages 8-16, including 45 with congenital CP, and 68 typically developing peers. Measures were a standard visual IT task that required dual key responding and a modified version using an assistive technology button with response option scanning. Performance on these measures was examined against traditional Wechsler PS measures (Coding, Symbol Search).

RESULTS

IT performance shared considerable variance with traditional paper-pencil PS measures for the group with CP, but not necessarily in the typically developing group. Concurrent validity was found for both IT task versions with traditional PS measures in the group with CP. IT classification accuracy for lowered PS showed modest sensitivity and good specificity particularly for the modified IT task.

CONCLUSIONS

As measures of PS in children with CP who are unable to validly participate in traditional PS tasks, IT tasks demonstrate adequate concurrent validity and may serve as a beneficial alternative measure of PS in this population.

Relationship between cerebral palsy severity and cognition, aids and education

BACKGROUND

Cerebral palsy (CP) refers to a non-progressive permanent lesion of the developing brain, which can manifest with motor function disability and various comorbidities and complications. However, there is little data on the correlation between motor and mental function in CP, as cognitive assessments are rarely the main focus of studies on children with CP.

METHODS

We studied a large cohort of 381 children and adolescents with CP. We analyzed the relationship between severity of CP and the presence of developmental disturbances (motor, motor-linguistic, global) including cognition, the number of aids and education.

RESULTS

We found a strong correlation between the severity of CP according to the Gross Motor Function Classification System (GMFCS) and developmental disturbances. In line with this finding, the number of aids per individual also correlated significantly with CP severity and the extent of developmental disturbance. Going beyond the number of aids most patients already received special education in kindergarten. Later, the type of schooling correlated significantly with severity of CP and developmental disturbance. While developmental disturbance and cognition correlated, this was not the case for CP severity and cognition. The latter indicates a wide range in individual manifestation and resources.

CONCLUSIONS

Our data underline that cognition does not necessarily correlate with CP severity. Thus, in addition to the evaluation and treatment of motor deficits, cognitive assessment should be offered early-on to improve patient-centered counselling and support with respect to appropriate education.

Vocal Characteristics of Children With Cerebral Palsy and Anarthria

PURPOSE

This study aimed to investigate the vocal characteristics of children with cerebral palsy (CP) and anarthria using the stage model of vocal development.

METHOD

Vocal characteristics of 39 children with CP and anarthria around 4 years of age were analyzed from laboratory-based caregiver-child interactions. Perceptual coding analysis was conducted using the Stark Assessment of Early Vocal Development-Revised to examine vocal complexity, volubility, and consonant diversity.

RESULTS

Children predominately produced vocalizations corresponding to the two earliest stages of vocal development characterized by vowel-like utterances. They showed a limited attainment of consonantal features with low consonant diversity and variably low vocal rates.

CONCLUSIONS

Our results demonstrate that underlying neurological impairments resulting in an anarthric status in children with CP affect the progression of speech motor development and their ability to advance beyond early vocal stages. These findings highlight the importance of considering alternative communication modalities for children demonstrating similar vocal characteristics beyond expected periods of development.

Developmental, Cognitive, Ocular Motor, and Neuroimaging Findings Related to SUFU Haploinsufficiency: Unraveling Subtle and Highly Variable Phenotypes

BACKGROUND

Biallelic SUFU variants have originally been linked to Joubert syndrome, comprising cerebellar abnormalities, dysmorphism, and polydactyly. In contrast, heterozygous truncating variants have recently been associated with developmental delay and ocular motor apraxia, but only a limited number of patients have been reported. Here, we aim to delineate further the mild end of the phenotypic spectrum related to SUFU haploinsufficiency.

METHODS

Nine individuals (from three unrelated families) harboring truncating SUFU variants were investigated, including two previously reported individuals (from one family). We provide results from a comprehensive assessment comprising neuroimaging, neuropsychology, video-oculography, and genetic testing.

RESULTS

We identified three inherited or de novo truncating variants in SUFU (NM_016169.4): c.895C>T p.(Arg299∗), c.71dup p.(Ala25Glyfs∗23), and c.71del p.(Pro24Argfs∗72). The phenotypic expression showed high variability both between and within families. Clinical features include motor developmental delay (seven of nine), axial hypotonia (five of nine), ocular motor apraxia (three of nine), and cerebellar signs (three of nine). Four of the six reported children had macrocephaly. Neuropsychological and developmental assessments revealed mildly delayed language development in the youngest children, whereas general cognition was normal in all variant carriers. Subtle but characteristic SUFU-related neuroimaging abnormalities (including superior cerebellar dysplasia, abnormalities of the superior cerebellar peduncles, rostrally displaced fastigium, and vermis hypoplasia) were observed in seven of nine individuals.

CONCLUSIONS

Our data shed further light on the mild but recognizable features of SUFU haploinsufficiency and underline its marked phenotypic variability, even within families. Notably, neurodevelopmental and behavioral abnormalities are mild compared with Joubert syndrome and seem to be well compensated over time.

Rehabilitation With Exergames in Individuals With Moderate to Severe Cognitive Impairment: A Case Report

A strong correlation exists between the severity of motor impairment and cognitive impairment in people with cerebral palsy. Moreover, severe cognitive impairment is associated with lower capacity for motor learning and hinders motor rehabilitation. In this report, we describe the effects of a therapeutic exercise protocol with exergames (TEP-Exergame) on postural control and spasticity of two young adults with spastic tetraplegia and moderate to severe cognitive impairment. Spasticity was measured in the elbow flexors using the Modified Ashworth Scale, and postural control was assessed through the following center of pressure (COP) variables: CoP sway area (CoPSway), mediolateral velocity (VML), anteroposterior velocity (VAP), mediolateral variability (SDML), and anteroposterior variability (SDAP). These variables were obtained during four postural tasks: eyes open (EO), eyes closed (EC), and weight-shifting (WS) in the mediolateral and anteroposterior directions (WSML and WSAP, respectively). We found that 18 sessions of TEP-exergame reduced muscle tone in the elbow flexors and improved postural control, as evidenced by a decrease in CoPSway in all conditions, SDAP, VML, and VAP in WSML; and SDAP, SDML, and VML in WSAP. For young adults with spastic tetraplegia and moderate to severe cognitive impairment, TEP-Exergame may enhance postural control and reduce spasticity.

Cerebral palsy in children: A clinical practice review

Cerebral palsy is a disorder characterized by abnormal tone, posture, and movement. In clinical practice, it is often useful to approach cerebral palsy based on the predominant motor system findings - spastic hemiplegia, spastic diplegia, spastic quadriplegia, extrapyramidal or dyskinetic, and ataxic. The prevalence of cerebral palsy is between 1.5 and 3 per 1,000 live births with higher percentage of cases in low to middle income countries and geographic regions. Pre-term birth and low birthweight are recognized as the most frequent risk factors for cerebral palsy; other risk factors include hypoxic-ischemic encephalopathy, maternal infections, and multiple gestation. In most cases of cerebral palsy, the initial injury to the brain occurs during early fetal brain development. Intracerebral hemorrhage and periventricular leukomalacia are the main pathologic findings found in preterm infants who develop spastic cerebral palsy. The diagnosis of cerebral palsy is primarily based on clinical findings. Early recognition of infants at risk for cerebral palsy as well as those with cerebral palsy is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging; however, in clinical practice, cerebral palsy is more reliably diagnosed by 2 years of age. Magnetic resonance imaging scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations. Genetic testing and tests for inborn errors of metabolism are indicated to identify specific disorders, especially treatable disorders. Because cerebral palsy is associated with multiple associated and secondary medical conditions, its management requires a sustained and consistent collaboration among multiple disciplines and specialties. With appropriate support, most children with cerebral palsy grow up to be adults with good functional abilities.

Motor and Cognitive Trajectories in Infants and Toddlers with and at Risk of Cerebral Palsy Following a Community-Based Intervention

BACKGROUND

Early motor development is fundamental in driving cognitive skill acquisition. Motor delays in children with cerebral palsy (CP) often limit exploratory behaviors, decreasing opportunities or the quality of cognitive development, emphasizing the importance of early intervention. This study aimed to assess immediate and 5-month motor and cognitive changes in infants and toddlers at risk of or with CP after participation in a community-based program.

METHODS

Twenty-two children (mean age: 22 ± 7 months) classified using the Gross Motor Function Classification System (GMFCS) and mini-Manual Ability Classification System (mini-MACS) participated in a 6-day community-based activity program, with outcomes assessed using the Developmental Assessment of Young Children (DAYC-2).

RESULTS

Participants who met their motor goals post-participation had significantly higher cognitive scores (p = 0.006) 5 months after the program. Participants with higher functional motor abilities (GMFCS levels I-II, p = 0.052; mini-MACS levels I-II, p = 0.004) demonstrated better cognitive scores at 5 months, adjusted for baseline scores, than those with lower functional motor abilities.

CONCLUSIONS

This study highlights the impact of motor improvements following an evidence-based community program on later cognitive development. Prospective studies investigating the mechanisms and mediation of cognitive progress in children with CP should investigate the effects of early motor interventions on long-term developmental trajectories.

Use of eye-gaze technology feedback by assistive technology professionals: findings from a thematic analysis

Purpose: Eye-gaze technology offers professionals a range of feedback tools, but it is not well understood how these are used to support decision-making or how professionals understand their purpose and function. This paper explores how professionals use a variety of feedback tools and provides commentary on their current use and ideas for future tool development.Methods and Materials: The study adopted a focus group methodology with two groups of professional participants: those involved in the assessment and provision of eye-gaze technology (n = 6) and those who interact with individuals using eye-gaze technology on an ongoing basis (n = 5). Template analysis was used to provide qualitative insight into the research questions.Results: Professionals highlighted several issues with existing tools and gave suggestions on how these could be made better. It is generally felt that existing tools highlight the existence of problems but offer little in the way of solutions or suggestions. Some differences of opinion related to professional perspective were highlighted. Questions about automating certain processes were raised by both groups.Conclusions: Discussion highlighted the need for different levels of feedback for users and professionals. Professionals agreed that current tools are useful to identify problems but do not offer insight into potential solutions. Some tools are being used to draw inferences about vision and cognition which are not supported by existing literature. New tools may be needed to better meet the needs of professionals and an increased understanding of how existing tools function may support such development.

Differential neuropsychological profiles in children and adolescents with motor disability in an inclusive educational setting

The aim of this study was to determine the potential cognitive impairment associated with motor disability in a group of children attending regular schools and to analyze whether there were different cognitive profiles according to the type of motor disability they presented. The study had 87 participants, 31 healthy and 56 with three types of motor disability: Neuromuscular Diseases (NMD Group), Cerebral Palsy-Hemiparesis (CP- HPx Group) and Cerebral Palsy-Diplegia (CP-DP). Ages ranged from 6 to 18 years and they had medium and medium-high socioeconomic and cultural levels. All participants attended regular state-funded and independent schools in an inclusive modality. The neuropsychological assessment included the following cognitive domains: processing speed, working memory, verbal and visual episodic memory, language, visuo-perception and constructive praxis and executive functioning. A second analysis was performed with the groups with CP: one based on the severity of gross motor impairment (GMFCS-E&R scale) and the other based on the levels of manual dexterity (MACS scale). ANCOVAs were performed controlling for age and processing speed in the three analyses. The group with CP-HPx was shown to be the most cognitively impaired of the three groups, with significant deficits in visuo-perception, verbal working memory, and visuo-spatial memory. Subjects with greater gross motor dysfunction (GMFCS-E&R) did not show the greatest cognitive impairment, while those with worse manual dexterity (MACS) exhibited greater cognitive impairment. Children and adolescents with motor disabilities, a priori cognitively normal, present different levels of cognitive impairment. This should be considered when planning educational adaptations for this infant-juvenile population.

Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

The RhoB p.S73F mutation leads to cerebral palsy through dysregulation of lipid homeostasis

Cerebral palsy (CP) is a prevalent neurological disorder that imposes a significant burden on children, families, and society worldwide. Recently, the RhoB p.S73F mutation was identified as a de novo mutation associated with CP. However, the mechanism by which the RhoB p.S73F mutation causes CP is currently unclear. In this study, rabbit models were generated to mimic the human RhoB p.S73F mutation using the SpG-BE4max system, and exhibited the typical symptoms of human CP, such as periventricular leukomalacia and spastic-dystonic diplegia. Further investigation revealed that the RhoB p.S73F mutation could activate ACAT1 through the LYN pathway, and the subsequently altered lipid levels may lead to neuronal and white matter damage resulting in the development of CP. This study presented the first mammalian model of genetic CP that accurately replicates the RhoB p.S73F mutation in humans, provided further insights between RhoB and lipid metabolism, and novel therapeutic targets for human CP.

Comprehensive evaluation of the child with global developmental delays or intellectual disability

Global developmental delay (GDD) and intellectual disability (ID) are relatively common neurodevelopmental disorders that significantly impact affected children, their families, and society. The etiology of GDD/ID is notably diverse, encompassing both genetic and acquired factors. Although the precise cause of most GDD/ID cases remains unclear, an estimated half of all cases can be attributed to genetic factors. Thus, a detailed medical history and comprehensive physical examination remain pivotal for guiding diagnostic investigations into the underlying causes of GDD/ID. Advancements in genetic testing have supplanted traditional methods such as karyotyping and fluorescence in situ hybridization with chromosomal micro arrays, which are now the primary genetic tests for children with idiopathic GDD/ID. Moreover, the evaluation of Fragile X and Rett syndrome should be an integral component of initial diagnostic assessments. In recent years, whole-exome sequencing and whole-genome sequ-encing have emerged as important diagnostic tools for evaluating children with GDD/ID and have substantially enhanced the diagnostic yield rates. Gene therapy has emerged as a promising avenue and is poised to become a cornerstone in addressing various genetic developmental and epilepsy disorders. Early intervention facilitated by a proficient multidisciplinary team can markedly enhance the prognosis and outcomes of GDD/ID, particularly when parents or caregivers are actively engaged in the interventional process. This review discusses risk factors and common underlying causes, explores recent evidence and recommendations for genetic evaluation, and offers management strategies for children with GDD/ID.

The Role of KDM2A and H3K36me2 Demethylation in Modulating MAPK Signaling During Neurodevelopment

Intellectual disability (ID) is a condition characterized by cognitive impairment and difficulties in adaptive functioning. In our research, we identified two de novo mutations (c.955C>T and c.732C>A) at the KDM2A locus in individuals with varying degrees of ID. In addition, by using the Gene4Denovo database, we discovered five additional cases of de novo mutations in KDM2A. The mutations we identified significantly decreased the expression of the KDM2A protein. To investigate the role of KDM2A in neural development, we used both 2D neural stem cell models and 3D cerebral organoids. Our findings demonstrated that the reduced expression of KDM2A impairs the proliferation of neural progenitor cells (NPCs), increases apoptosis, induces premature neuronal differentiation, and affects synapse maturation. Through ChIP-Seq analysis, we found that KDM2A exhibited binding to the transcription start site regions of genes involved in neurogenesis. In addition, the knockdown of KDM2A hindered H3K36me2 binding to the downstream regulatory elements of genes. By integrating ChIP-Seq and RNA-Seq data, we made a significant discovery of the core genes' remarkable enrichment in the MAPK signaling pathway. Importantly, this enrichment was specifically linked to the p38 MAPK pathway. Furthermore, disease enrichment analysis linked the differentially-expressed genes identified from RNA-Seq of NPCs and cerebral organoids to neurodevelopmental disorders such as ID, autism spectrum disorder, and schizophrenia. Overall, our findings suggest that KDM2A plays a crucial role in regulating the H3K36me2 modification of downstream genes, thereby modulating the MAPK signaling pathway and potentially impacting early brain development.

Development and validation of a nomogram for predicting intellectual disability in children with cerebral palsy

Objective

Intellectual disability (ID) is a prevalent comorbidity in children with cerebral palsy (CP), presenting significant challenges to individuals, families and society. This study aims to develop a predictive model to assess the risk of ID in children with CP.

Methods

We analyzed data from 885 children diagnosed with CP, among whom 377 had ID. Using least absolute shrinkage and selection operator regression, along with univariate and multivariate logistic regression, we identified key predictors for ID. Model performance was evaluated through receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA). Bootstrapping validation was also employed.

Results

The predictive nomogram included variables such as preterm birth, CP subtypes, Gross Motor Function Classification System level, MRI classification category, epilepsy status and hearing loss. The model demonstrated strong discrimination with an area under the receiver operating characteristic curve (AUC) of 0.781 (95% CI: 0.7504-0.8116) and a bootstrapped AUC of 0.7624 (95% CI: 0.7216-0.8032). Calibration plots and the Hosmer-Lemeshow test indicated a good fit (χ2= 7.9061, p = 0.4427). DCA confirmed the model's clinical utility. The cases were randomly divided into test group and validation group at a 7:3 ratio, demonstrating strong discrimination, good fit and clinical utility; similar results were found when stratified by sex.

Conclusions

This predictive model effectively identifies children with CP at a high risk for ID, facilitating early intervention strategies. Stratified risk categories provide precise guidance for clinical management, aiming to optimize outcomes for children with CP by leveraging neuroplasticity during early childhood.

Synergistic effect of functional strength training and cognitive intervention on gross motor function in children with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is a posture and movement disorder, however; it often includes disturbance of different aspects of cognitive function. This study aimed to investigate if combined functional strength training (FST) and cognitive intervention are more effective than either of them alone on gross motor function in children with spastic diplegic CP.

METHODS

Sixty-four children with spastic diplegic CP, with ages ranging from 8 to 12 years, were assigned randomly into four treatment groups; Group I; FST, group II; cognitive training, group III; combined FST and cognitive training, group IV; conventional physical therapy. The Gross Motor Function Measure (GMFM-88) was used to assess gross motor function at baseline, post-treatment, and 6 months follow-up.

RESULTS

Group III achieved a significant improvement in GMFM-88 when compared to other groups post-treatment and at follow-up.

CONCLUSION

This study suggests that combined lower limb FST and cognitive intervention had the potential to produce significantly more favorable effects than the single use of either of them on gross motor function in children with spastic diplegia.

Academic skills in children with cerebral palsy and specific learning disorders

AIM

To investigate the prevalence and clinical manifestations of reading, writing, and mathematics disorders in children with cerebral palsy (CP). We explored how the clinical profile of these children differed from those with specific learning disorders (SLDs), taking into account several factors, particularly IQ scores, neuropsychological aspects, and the presence of a visual impairment.

METHOD

A prospective cross-sectional study was conducted in 42 children with CP (mean age 9 years 8 months; SD = 2 years 2 months) and 60 children with SLDs (mean age 10 years; SD = 1 year 7 months). Clinical characteristics, neuromotor and cognitive profiles, neuropsychological aspects (speech performance, academic skills, visual attention, phonological awareness, working memory), and signs of visual impairment (visual acuity, contrast sensitivity, visual field, oculomotor functions) were assessed. A machine learning approach consisting of a random forest algorithm, where the outcome was the diagnosis and the covariates were the clinical variables collected in the sample, was used for the analyses.

RESULTS

About 59% of the children with CP had reading, writing, or mathematics disorders. Children with CP with learning disorders had a low performance IQ, normal phonological awareness, and working memory difficulties, whereas children with SLDs had normal performance IQ, impaired phonological awareness, and mild working memory difficulties. There were no differences in verbal IQ between the two groups.

INTERPRETATION

Learning disorders are frequently associated with CP, with different clinical characteristics, compared with SLDs. Assessment of academic skills is mandatory in these children, even if the IQ is normal. At school age, specific interventions to promote academic skills in children with CP could be a major rehabilitative goal.

WHAT THIS PAPER ADDS

Reading, writing, and mathematics disorders in cerebral palsy have specific clinical characteristics. Their underlying mechanisms differ from those described in specific learning disorders. Working memory impairment can be considered a hallmark of learning disorders in children with cerebral palsy.

The effects of postural control and upper extremity functional capacity on functional Independence in preschool-age children with spastic cerebral palsy: a path model

PURPOSE

To investigate the effects of postural control and upper extremity functional capacity on functional independence and identify whether quality of upper extremity skills mediates the effects of postural control on functional independence in preschool-age children with spastic cerebral palsy (CP).

METHODS

106 children with CP -mean age 43.4 ± 11.3 (24-71 months)- were included in this cross-sectional study. Postural control, upper extremity functional capacity, and functional independence in activities of daily living were evaluated using the Early Clinical Assessment of Balance (ECAB), Quality of Upper Extremity Skills Test (QUEST), and the Functional Independence Measure of Children (WeeFIM), respectively. A path model was used to evaluate the total, direct, and indirect effects.

RESULTS

According to the path model, ECAB (direct effect; r = 0.391, p < 0.01, indirect effect; r = 0.398) and QUEST (direct effect; r = 0.493, p < 0.01) had an impact on WeeFIM. In addition, QUEST had mediating effects on the relationship between ECAB and WeeFIM. The path model explained 71% of the variation in functional independence of the participants.

CONCLUSION

In the management of CP in preschool-age children, the focus should be on improving not only upper extremity capacity but also postural control to help improve functional independence in activities of daily living.

Fatigue in children using motor imagery and P300 brain-computer interfaces

BACKGROUND

Brain-computer interface (BCI) technology offers children with quadriplegic cerebral palsy unique opportunities for communication, environmental exploration, learning, and game play. Research in adults demonstrates a negative impact of fatigue on BCI enjoyment, while effects on BCI performance are variable. To date, there have been no pediatric studies of BCI fatigue. The purpose of this study was to assess the effects of two different BCI paradigms, motor imagery and visual P300, on the development of self-reported fatigue and an electroencephalography (EEG) biomarker of fatigue in typically developing children.

METHODS

Thirty-seven typically-developing school-aged children were recruited to a prospective, crossover study. Participants attended three sessions: (A) motor imagery-BCI, (B) visual P300-BCI, and (C) video viewing (control). The motor imagery task involved an imagined left- or right-hand squeeze. The P300 task involved attending to one square on a 3 × 3 grid during a random single flash sequence. Each paradigm had respective calibration periods and a similar visual counting game. Primary outcomes were self-reported fatigue and the power of the EEG alpha band both collected during resting-state periods pre- and post-task. Self-reported fatigue was measured using a 10-point visual analog scale. EEG alpha band power was calculated as the integrated power spectral density from 8 to 12 Hz of the EEG spectrum.

RESULTS

Thirty-two children completed the protocol (age range 7-16, 63% female). Self-reported fatigue and EEG alpha band power increased across all sessions (F(1,155) = 33.9, p < 0.001; F = 5.0(1,149), p = 0.027 respectively). No differences in fatigue development were observed between session types. There was no correlation between self-reported fatigue and EEG alpha band power change. BCI performance varied between participants and paradigms as expected but was not associated with self-reported fatigue or EEG alpha band power.

CONCLUSION

Short periods (30-mintues) of BCI use can increase self-reported fatigue and EEG alpha band power to a similar degree in children performing motor imagery and P300 BCI paradigms. Performance was not associated with our measures of fatigue; the impact of fatigue on useability and enjoyment is unclear. Our results reflect the variability of fatigue and the BCI experience more broadly in children and warrant further investigation.

Goal Contents, State Empathy and Instructional Goals in a Physical Disability Vignette

Setting and recommending instructional goals represents an important communication process in educational and health domains, which are intersected in many cases. However, little is known about the antecedents of instructional goals. The aim of the present study was to examine how the contents of participants' personal goals in life (i.e. goal contents) and state empathy during message processing affected the processes of prioritizing instructional goals in the case of an adolescent who presented physical disability and impaired cognitive functioning, as presented in a video vignette. Health and care practitioners who were members of the educational system, in-service teachers and university students of disciplines related to health, rehabilitation or education, participated in a cross-sectional study. The findings showed that the participants proposed instructional goals according to their current goal contents and state empathy. In particular, state empathy demonstrated both main effects and mediations in influencing intrinsic instructional goals. However, state empathy, in fact its associative component, influenced an extrinsic goal domain as well. Interpretations of this phenomenon are presented, and the limitations of some tools are demonstrated. In addition, suggestions are put forward regarding implications and future research for a proximal causation of the instructional goals.

Development of a New Scoring System in Higher Animals for Testing Cognitive Function in the Newborn Period: Effect of Prenatal Hypoxia-Ischemia

INTRODUCTION

Enhanced models for assessing cognitive function in the neonatal period are imperative in higher animals. Postnatal motor deficits, characteristic of cerebral palsy, emerge in newborn kits within our prenatal rabbit model of hypoxia-ischemia (HI). In humans, prenatal HI leads to intellectual disability and cerebral palsy. In a study examining cognitive function in newborn rabbits, we explored several questions. Is there a distinction between conditioned and unconditioned kits? Can the kits discern the human face or the laboratory coat? Do motorically normal kits, born after prenatal HI, exhibit cognitive deficits?

METHODS

The conditioning protocol was randomly assigned to kits from each litter. For conditioning, the same human, wearing a laboratory coat, fed the rabbit kits for 9 days before the cognitive test. The 6-arm radial maze was chosen for its simplicity and ease of use. Normally appearing kits, born after uterine ischemia at 79% or 92% term in New Zealand White rabbits, were compared to naïve kits. On postpartum day 22/23 or 29/30, the 6-arm maze helped determine if the kits recognized the original feeder from bystander (test 1) or the laboratory coat on bystander (test 2). The use of masks of feeder/bystander (test 3) assessed confounding cues. A weighted score was devised to address variability in entry to maze arms, time, and repeated-trial learning.

RESULTS

In conditioned kits, both naïve and HI kits exhibited a significant preference for the face of the feeder but not the laboratory coat. Cognitive deficits were minimal in normal-appearing HI kits.

CONCLUSION

The weighted score was amenable to statistical manipulation.

INTRODUCTION

Enhanced models for assessing cognitive function in the neonatal period are imperative in higher animals. Postnatal motor deficits, characteristic of cerebral palsy, emerge in newborn kits within our prenatal rabbit model of hypoxia-ischemia (HI). In humans, prenatal HI leads to intellectual disability and cerebral palsy. In a study examining cognitive function in newborn rabbits, we explored several questions. Is there a distinction between conditioned and unconditioned kits? Can the kits discern the human face or the laboratory coat? Do motorically normal kits, born after prenatal HI, exhibit cognitive deficits?

METHODS

The conditioning protocol was randomly assigned to kits from each litter. For conditioning, the same human, wearing a laboratory coat, fed the rabbit kits for 9 days before the cognitive test. The 6-arm radial maze was chosen for its simplicity and ease of use. Normally appearing kits, born after uterine ischemia at 79% or 92% term in New Zealand White rabbits, were compared to naïve kits. On postpartum day 22/23 or 29/30, the 6-arm maze helped determine if the kits recognized the original feeder from bystander (test 1) or the laboratory coat on bystander (test 2). The use of masks of feeder/bystander (test 3) assessed confounding cues. A weighted score was devised to address variability in entry to maze arms, time, and repeated-trial learning.

RESULTS

In conditioned kits, both naïve and HI kits exhibited a significant preference for the face of the feeder but not the laboratory coat. Cognitive deficits were minimal in normal-appearing HI kits.

CONCLUSION

The weighted score was amenable to statistical manipulation.

Functional difficulty among young children in Bangladesh: An analysis of nationally representative data

Functional difficulty in children is a crucial public health problem still undervalued in developing countries. This study explored the socio-demographic factors and anthropometry associated with children's functional difficulty in Bangladesh. Data for 2-4-year-old children, obtained from Multiple Indicator Cluster Survey 2019, were used in this study. The mixed-effects logistic regression model was used to analyse the data. Children whose mothers had functional difficulty were found to be 2.75 times more likely to have functional difficulty than children whose mothers had no functional difficulty (95% CI 1.63-4.63). Male children were more likely to experience functional difficulty than female children (OR = 1.48). Furthermore, stunting was found to be significantly associated with functional difficulty (OR = 1.50). The study also revealed that division and mother's education, specifically, children with mothers having higher secondary + education, had significant association with the outcome variable. The findings provided a vital overview of child disability in a developing country.

Associations between the aetiology of preterm birth and mortality and neurodevelopment up to 11 years

AIM

To investigate how the aetiology of very preterm birth/very low birth weight is associated with mortality and later neurodevelopmental outcomes.

METHODS

Very preterm/very low-birth weight singletons were categorised based on the aetiology of preterm birth: spontaneous preterm birth (n = 47, 28.1%), preterm premature rupture of membranes (n = 56, 33.5%) or placental vascular pathology (n = 64, 38.3%). Mortality, cerebral palsy, severe cognitive impairment by 11 years of age (<2SD) and mean full-scale intelligence quotient at 11 years were studied in association with birth aetiology.

RESULTS

There was no difference in mortality or rate of cerebral palsy according to birth aetiologies. The rate of severe cognitive impairment was lower (4.9% vs. 15.3%) in the preterm premature rupture of the membrane group in comparison to the placental vascular pathology group (OR 0.2, 95% CI 0.03-0.9, adjusted for gestational age). At 11 years, there was no statistically significant difference in the mean full-scale intelligence quotient.

CONCLUSION

Placental vascular pathology, as the aetiology of very preterm birth/very low birth weight, is associated with a higher rate of severe cognitive impairments in comparison to preterm premature rupture of membranes, although there was no difference in the mean full-scale intelligence quotient at 11 years. The aetiology of very preterm birth/very low birth weight was not associated with mortality or the rate of cerebral palsy.

Optimizing Epoch Length and Activity Count Threshold Parameters in Accelerometry: Enhancing Upper Extremity Use Quantification in Cerebral Palsy

Various accelerometry protocols have been used to quantify upper extremity (UE) activity, encompassing diverse epoch lengths and thresholding methods. However, there is no consensus on the most effective approach. The aim of this study was to delineate the optimal parameters for analyzing accelerometry data to quantify UE use in individuals with unilateral cerebral palsy (CP).

METHODS

A group of adults with CP (n = 15) participated in six activities of daily living, while a group of children with CP (n = 14) underwent the Assisting Hand Assessment. Both groups performed the activities while wearing ActiGraph GT9X-BT devices on each wrist, with concurrent video recording. Use ratio (UR) derived from accelerometry and video analysis and accelerometer data were compared for different epoch lengths (1, 1.5, and 2 s) and activity count (AC) thresholds (between 2 and 150).

RESULTS

In adults, results are comparable across epoch lengths, with the best AC thresholds being ≥ 100. In children, results are similar across epoch lengths of 1 and 1.5 (optimal AC threshold = 50), while the optimal threshold is higher with an epoch length of 2 (AC = 75).

CONCLUSIONS

The combination of epoch length and AC thresholds should be chosen carefully as both influence the validity of the quantification of UE use.

Increasing participation in computer activities using eye-gaze assistive technology for children with complex needs

PURPOSE

Eye-gaze assistive technology offers children with severe motor and communication difficulties the opportunity to access and control a computer through eye movements. The aim of this study was to examine the impact of eye-gaze assistive technology intervention on participation in computer activities and technology usability among children with complex needs in Taiwan.

MATERIALS AND METHODS

This study involved a multiple baseline design across individuals. The participants were four children aged three to six years with severe motor and communication difficulties and low eye-control skills. The six-month intervention consisted of two collaborative team meetings and 12 individual supports to facilitate the use of eye-gaze assistive technology at home or in educational environments. Participation in computer activities (diversity, frequency, and duration) was repeatedly measured through a computer use diary. Other outcomes included assessments of goal achievements and parents/teachers' ratings on children's performance in computer activities.

RESULTS

The young children increased the diversity of their computer activities and their frequency and duration of computer use from baseline to the intervention phase. The children attained six of eight predefined goals related to play, communication, and school learning. Parents and teachers perceived the children's changes in performance as meaningful.

CONCLUSION

This study strengthens the evidence that eye-gaze assistive technology is useful in everyday contexts for children with complex needs in Taiwan. The findings add knowledge that children with weak eye-control skills increased participation in computer activities as a result of the eye-gaze assistive technology. Implications for RehabilitationEye-gaze assistive technology (EGAT) as an access method to control a computer can provide opportunities for children with severe motor and communication difficulties to participate in computer activities.Children with severe motor and communication difficulties and low eye-control skills with sufficient practice can learn to use EGAT for communication and learning, with support from stakeholders and collaborative service.EGAT could be introduced for children with complex needs at early ages as a means of using computers for play, communication, and school learning, which could be helpful for later education and learning.Stakeholders in educational environments could include EGAT in educational computer systems so that pupils with severe motor and communication difficulties could interact with a computer, thereby enhancing their engagement and learning.

Accommodations to cognitive assessment for a child with dyskinetic cerebral palsy: case study

PURPOSE

Despite the importance of having knowledge about a child's cognitive functioning, less than one-third of children with cerebral palsy (CP) are formally assessed. Consequently, the cognitive strengths of many children with severe CP may be underestimated or go overlooked. This case study aimed to test accommodations to cognitive assessment administration procedures to enable switch access.

METHODS

A 9-year-old boy with dyskinetic CP tested a suite of cognitive assessments with accommodations for single switch access and measures of user experience. The cognitive assessment included: receptive vocabulary; non-verbal reasoning; sustained attention; executive functions of problem solving and shifting; and visual perception skills.

RESULTS

The participant's ability to independently undertake assessment on the receptive vocabulary, non-verbal reasoning and the sustained attention measures indicates that accommodations made for single switch access were appropriate. Assessment took 1-2 h longer than expected for a typically developing child via standardised administration procedures, but was considerably faster than expected if undertaken via low-tech partner assisted scanning. Accessibility barriers continued to be present for the executive function and visual perception measures. Overall, the user experience was positive, both in regards to usability and cognitive load.

CONCLUSIONS

This case study provides emerging data for usability and accessibility of accommodations to a battery of cognitive assessment tasks. Further research is needed to devise appropriate accommodations for executive function and visual perception measures and to determine whether the accommodations are accessible more generally for children with motor and/or speech impairments. Implications for rehabilitationAccommodations can be successfully made to receptive vocabulary, non-verbal reasoning and sustained attention assessment administration procedures for switch technologies.Cognitive assessment with switch accommodations takes considerably longer to complete than standardised administration estimates for a typically developing child. Assessment may need to be scheduled over more than one session.User experience, including usability and cognitive load, of accommodations was positive.

Satisfaction survey toward an innovative orthosis for children with cerebral palsy with pes planovalgus

BACKGROUND

Pes planovalgus (PPV) is common in children with cerebral palsy and can cause pain and gait alterations over time. Initial treatment of flexible PPV includes orthotics, despite a lack of consensus on the type of orthosis. We developed an innovative ankle-foot orthosis (RAFO). RAFO is a one-piece orthosis designed to correct both the valgus and the flat of the foot. Its conception situated above the malleolar enables a moderate anti equinus effect. Its precise description and fabrication's process is detailed.

OBJECTIVES

We wanted to assess user's satisfaction after several months of use and looked for clinical criteria of satisfaction.

STUDY DESIGN

Retrospective.

METHODS

We conducted a satisfaction study through a telephonic QUEST (Quebec User Evaluation of Satisfaction with Assistive Technology) survey analysing the device and the process in children and parents. 24 parents were contacted, whose child was wearing RAFO on a daily basis for at least 4 months. 20 parents answered the questionnaire. The results were then related to clinical data to research satisfaction' criteria.

RESULTS

Mean QUEST satisfaction was 4.25/5 (4.18/5 for device and 4.38/5 for process). Advantages reported concerned weight and dimensions (95%), although 20% reported the necessity to change to a shoe size above, ease of use (90%) and level of comfort (80%). Parent's satisfaction regarding perceived effectiveness was 80%. Children with equinus due to triceps surae spasticity were more susceptible to develop pain with our orthosis.

CONCLUSIONS

Parents were overall very satisfied with the orthosis. Its technical characteristics allowing both to be a corrector of flat foot and valgus and at the same time to be comfortable and discreet makes it innovative. The presence of spastic equinus is a limit for its utilization.

Pain coping and catastrophizing in youth with and without cerebral palsy

OBJECTIVES

The aim of this study is to compare the use of pain coping strategies and pain catastrophizing in youth with and without cerebral palsy (CP), and to examine how these two groups differ with respect to the associations between pain coping, catastrophizing, and measures of psychological function and sleep disturbance.

METHODS

Twenty-seven individuals with CP and 49 healthy controls aged 15-22 were included in this cross-sectional observational study. Pain was assessed using a semi-structured interviews and participants completed measures of pain coping, pain catastrophizing, psychological function, and sleep.

RESULTS

Youth with CP used information seeking and problem solving (p = 0.003, Cohen's d (d) = -0.80) and sought social support (p = 0.044, d = -0.51) less often, and used internalizing as a coping strategy more often (p = 0.045, d = 0.59) than healthy controls. The use of information seeking and problem solving correlated more strongly with measures of depression (p = 0.023, Cohen's f (f) = 0.08) and sleep disturbance (p = 0.022, f = 0.08), while behavioral distraction correlated more strongly with measures of anxiety (p = 0.006, f = 0.11) and sleep disturbance (p = 0.017, f = 0.09) in youth with CP, compared to healthy controls.

CONCLUSIONS

The study findings raise the possibility that youth with CP may benefit more in terms of psychological function and sleep quality from coping training interventions that focus on behavioral distraction, information seeking, and problem solving. Research to test these ideas in additional samples of youth with CP is warranted.

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.

Developmental trajectories of spoken language comprehension and functional communication in children with cerebral palsy: A prospective cohort study

AIM

To investigate spoken language comprehension (SLC), single-word comprehension (SWC), functional communication development, and their determinants, in children with cerebral palsy.

METHOD

This was a prospective cohort study in the Netherlands spanning 2 years 6 months. The main outcomes were SLC and SWC, assessed by the Computer-Based instrument for Low motor Language Testing (C-BiLLT) and the Peabody Picture Vocabulary Test-III-NL (PPVT-III-NL) respectively; and functional communication, measured by a subscale of the Focus on the Outcomes of Communication Under Six-34 (FOCUS-34). Linear mixed models were used to determine developmental trajectories, which were compared with norm and reference data. Potential determinants, for example intellectual functions, speech production, functional communication level (classified with the Communication Function Classification System, CFCS), and functional mobility, were added to assess their effects.

RESULTS

Children with cerebral palsy (n = 188; mean age 59 months, range 17-110) were monitored for 2 years 6 months. Developmental trajectories for SLC (C-BiLLT) and SWC (PPVT-III-NL) were nonlinear; those for functional communication (FOCUS-34) were linear. Compared with norm and reference groups, significantly delayed SLC, SWC, and functional communication development were found. Determinants for SLC and SWC were intellectual functions and functional communication level (CFCS); and for functional communication development (FOCUS-34), speech production and arm-hand functioning.

INTERPRETATION

Children with cerebral palsy showed delayed SLC, SWC, and functional communication development compared with norm and reference groups. Remarkably, functional mobility was not associated with the development of SLC, SWC, or functional communication.

WHAT THIS PAPER ADDS

Children with cerebral palsy have delayed spoken language comprehension (SLC), single-word comprehension (SWC), and functional communication development, compared to norm and reference data. Determinants for SLC and SWC development are intellectual functions and functional communication level. Determinants for functional communication development are speech production and arm-hand functioning. Functional mobility is not associated with SLC, SWC, or functional communication.

Provision of augmentative and alternative communication interventions to Norwegian preschool children with cerebral palsy: are the right children receiving interventions?

Preschool children with cerebral palsy (CP) with no or unintelligible speech need augmentative and alternative communication (AAC), but not all children needing AAC have access to it. This study describes the use and perceived benefit of AAC and explores factors associated with receiving AAC interventions. Using a cross-sectional design, we combined parent-reported data with data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Communication, speech and hand function was classified according to the Communication Function Classification System (CFCS), Viking Speech Scale (VSS), and Manual Ability Classification System (MACS), accordingly. The need for AAC was defined as Levels III-V on the CFCS, without simultaneous classification at VSS Level I, and/or Levels III-IV on VSS. Parents reported on child- and family-directed AAC interventions using the Habilitation Services Questionnaire. Of the 95 children (42 females) with CP (M = 39.4 months, SD = 10.3), 14 had communication aids. Of the 35 children (31.4%) defined as needing AAC, 11 had been provided with communication aids. Parents of children with a communication aid reported satisfaction with and frequent use of the aid. Children at MACS Level III-V (OR = 3.4, p = .02) or with epilepsy (OR = 8.9, p < .01) were most likely to have received an AAC intervention. The low proportion of children receiving communication aids indicates an unmet need for AAC interventions among preschool children with CP.

Managing Fatigue: Experiences From a 6-week Course for Adults With Cerebral Palsy

Objective

To explore experiences of a 6-week Fatigue Management course (FMC) in adults with cerebral palsy (CP).

Design

A qualitative study using semi-structured interviews. The study process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Setting

The study was conducted in southeastern Sweden in an out-patient setting.

Participants

Adults (N=8) with CP who had participated in FMC.

Interventions

Not applicable.

Main Outcome Measure

Qualitative content analysis of the transcribed interviews led to identification of a main category, categories, and subcategories, describing the participants' experiences of FMC.

Results

The analysis identified 2 categories: Awareness regarding fatigue, with the 2 subcategories: A better understanding, and The feeling of not being alone; and Perceive opportunities for changes, with the 3 subcategories: Understanding the need for changes, Demanding process, and Taking steps toward change. These categories were summed up in the main category describing the participants' experiences of FMC: A challenging and eye-opening course that gave deeper self-understanding and thoughts about making changes.

Conclusions

Overall, the participants described positive experiences of FMC, with increased awareness regarding fatigue and insight regarding the possibilities for change. Nevertheless, there were challenges in coping with the extensive information and with the home assignments. This study gives promising results regarding the applicability of FMC for adults with CP. However, there is a need for course modifications with more targeted and differentiated content that is manageable and does not overload the participants. The modifications should include extended time, the addition of individual support, and follow-up between sessions, to increase participants' opportunities to implement new strategies and initiate behavioral change.

Cognitive assessments among children with cerebral palsy in Sweden and the use of augmentative and alternative communication and interpreters: a cross-sectional registry study

PURPOSE

Children with cerebral palsy (CP) have an increased risk of cognitive difficulties and should be offered cognitive assessments. In Sweden, the CPCog protocol recommends children with CP undergo cognitive assessments at the start of primary and secondary school. To assess children with CP can be challenging, in particular when children are non-vocal or do not speak the local language. In such instances, augmentative and alternative communication (AAC) and qualified medical interpreters should be considered. The purpose of this study was to monitor the implementation and equitable delivery of the CPCog protocol in Sweden between the years 2017-2020.

MATERIALS AND METHODS

In this cross-sectional study, registry data were extracted from the combined follow-up program and national registry for individuals with CP (CPUP), and a convenience sample of psychologists responded to an online survey.

RESULTS AND CONCLUSIONS

Each year, less than 5% of eligible children had registered cognitive assessments in CPUP. There was underuse of AAC during assessments and a discrepancy between the registered versus reported use of interpreters. Psychologists perceived AAC as more reliable for cognitive assessments than interpreters. Greater availability of and capacity to offer cognitive assessments in other formats and languages could help increase test accessibility for all children with CP.Implications for RehabilitationThe cognitive assessment of children with cerebral palsy (CP) is a complex but important issue within disability and re/habilitation.Individualized cognitive assessments should be offered and carried out by psychologists.Rehabilitation centers should strive to be inclusive through reliable test adaptations for functional abilities, means of communication, and language.Greater availability of- and capacity to offer cognitive assessments in more formats and languages could help increase test accessibility for children with disabilities.

Children in Denmark with cerebral palsy rarely complete elementary school

AIM

To investigate how children with cerebral palsy (CP) perform in the Danish school system and which factors are associated with school performance.

METHOD

This was a population-based cohort study including 463 126 children born from 1997 to 2003. Data were extracted from seven national registries. The study encompassed 818 children with CP (483 [59.0%] males, 335 [41.0%] females) and 417 731 without CP (214 535 [51.4%] males, 203 196 [48.6%] females). We evaluated two primary outcomes: not completing 10 years of elementary school, defined as attending fewer than eight final mandatory exams; and grade point averages (GPAs). Mann-Whitney U tests were used to analyse differences in GPAs and logistic regressions were used to calculate odds ratios (ORs).

RESULTS

Among children with and without CP, 62.6% and 12.4% did not complete elementary school respectively (OR = 11.85 [10.28-13.66]). Additionally, children with CP who attended all final exams achieved lower overall GPAs than children without CP (6.6 vs 7.3, p = 0.001). In children with CP, comorbidities, maternal education, severity of motor impairments, and intellectual deficits were associated with increased odds of not completing elementary school. Notably, one-third of children with CP with apparent normal intelligence did not complete school, despite special educational measures.

INTERPRETATION

Danish children with CP rarely complete elementary school despite initiatives for a more supportive educational system. The complexity of individual needs in children with CP may be challenging for an inclusive school environment.

WHAT THIS PAPER ADDS

Children with cerebral palsy (CP) have a high risk of not completing elementary school. Children with CP achieve lower overall grades than children without CP. Motor impairment, comorbidities, and maternal education are associated with poor school performance. Intellectual impairment is the most important predictor of poor school performance.

Randomized clinical trial on the effects of a computerized cognitive training for pediatric patients with acquired brain injury or congenital malformation

Both acquired injuries and congenital malformations often cause lifelong disabilities in children, with a significant impact on cognitive abilities. Remote computerized cognitive training (CCT) may be delivered in ecological settings to favour rehabilitation continuity. This randomized clinical trial (RCT) evaluated the efficacy of an 8-week multi-domain, home-based CCT in a sample of patients aged 11-16 years with non-progressive acquired brain injury (ABI), brain tumor (BT) and congenital brain malformation (CBM). Following a stepped-wedge research design, patients were randomized into two groups: Training-first group, which started the CCT immediately after baseline assessment and Waiting-first group, which started the CCT after a period of time comparable to that required by the training (8 weeks). Post-training and long-term (6 months) changes were assessed. Both groups improved on visual-spatial working memory after the CCT, with benefits maintained after 6 months, while no other changes in cognitive or psychological measures were found. These findings suggest that a multi-domain CCT can generate benefits in visual-spatial working memory, in accordance with data from extant literature reporting that computer games heavily engage visuo-spatial abilities. We speculate that is tapping on the same cognitive ability with a prolonged training that may generate the greatest change after a CCT.

King-Devick Test in Wheelchair Sports: Identifying Normative Values and Effects of Exertion on Outcomes

OBJECTIVE

To establish normative baseline values on the King-Devick (KD) Test for contact wheelchair sport participants. The secondary purpose was to examine the effect of physical exertion on test score.

DESIGN

Quasiexperimental.

SETTING

Competitive disability sport venues before practices or games.

PARTICIPANTS

One-hundred 43 wheelchair rugby or wheelchair basketball (WBB) players completed the study. Participants were predominantly men (87.5%) and played WBB (84%).

INTERVENTION

30-m wheelchair sprint test to fatigue.

MAIN OUTCOME MEASURE

King-Devick Baseline Score.

RESULTS

Mean KD baseline score was 59.16 ± 15.56 seconds with significant differences ( P < 0.05) identified by sport and impairment type, but not sex. Athletes with spina bifida and cerebral palsy had significantly higher mean baseline KD times than athletes with spinal cord injury. KD scores improved by 3.5% in athletes who reported "light" to "somewhat hard" exertion (RPE = 13). In a subset of athletes who performed sprints until an RPE of 18 was reached, 8 of 12 players (66.7%) demonstrated an improvement in KD score; however, large increases by a few participants caused the noticeable change.

CONCLUSIONS

Normative values for wheelchair contact sport athletes are meaningfully slower than able-bodied sports participants. KD score improved with exertion with the greater improvement after moderate-intensity compared with vigorous-intensity exercise. These findings can be applied clinically to monitor athlete safety.

Remote cognitive training for children with congenital brain malformation or genetic syndrome: a scoping review

Increased attention is arising on the delivery of remote cognitive interventions, which allow performing exercises in everyday settings, favouring rehabilitation continuity. The present study offers an overview of remote cognitive training programs for children with congenital brain malformation or genetic syndrome affecting the central nervous system, included in papers published in the time period 2011-2021. A total of 13 records was found and discussed including efficacy studies, feasibility studies and study protocols. Many studies have focused on a specific diagnosis, such as cerebral palsy, Down Syndrome, Fragile X Syndrome, while no or little evidence has been gathered on more rare diseases or brain malformations. Interventions were found to generate benefits on some cognitive functions, but problems with adherence were highlighted, especially due to excessive cognitive load from the training or clinical comorbidities. Conclusions remain tentative due to heterogeneity in training, study and patients characteristics, and methodological limitations of studies.

Cognition and learning difficulties in a representative sample of school-aged children with cerebral palsy

BACKGROUND

Nearly half of all children with CP experience intellectual impairment, with impacts on academic achievement.

AIMS

To assess cognitive and academic functioning for primary-school aged children with CP METHODS AND PROCEDURES: This population-based cohort study assessed 93 participants (male n = 62; mean = 9 years 9 months, SD 1 y 1.8 months) on measures of fluid and crystallised intelligence (Raven's Coloured Progressive Matrices, Peabody Picture Vocabulary Test) and academic achievement (Wechsler Individual Achievement Test). Analyses included t-tests, Pearson's chi-square and regression.

OUTCOMES AND RESULTS

41 (44.1%) children met criteria consistent with intellectual developmental disorder. Academic skills were significantly below population means on word reading (M= 85.4, SD = 19.3), t(66) = -6.2, p < .001; spelling (M=83.3, SD=19.7) t(65) = -6.87, p < .001; and numerical operations (M=72.9, SD=21.7) Z = 66.0, p < .001. Cognitive ability was associated with GMFCS level (χ² (1, N = 93) = 16.15, p < .001) and diagnosis of epilepsy (χ² (2, N = 93) = 11.51 p = .003). Crystallised and fluid intelligence together accounted for 65% of the variance in word reading, 56% in spelling and 52% in numerical operations.

IMPLICATIONS

Many children with CP experience academic challenges. Screening is recommended for all children with CP and full psychoeducational assessment undertaken when children with CP experience academic difficulties.

Factors Related to Quality of Life in Children With Cerebral Palsy

BACKGROUND

We investigated the influence of relevant demographic, clinical, neuropsychological, and psychosocial variables on the proxy-reported quality of life (QOL) of children with cerebral palsy (CP).

METHODS

The proxy-reported Cerebral Palsy Quality of Life-Child questionnaire (CP QOL-Child) was completed by 58 children with CP (mean age 10.22 years, SD 1.67). Relationships between QOL scores and demographic, clinical, neuropsychological, and psychosocial variables were assessed. CP QOL scores and other variables that correlated significantly were introduced into a multiple linear regression model.

RESULTS

Executive functioning and motor functional status were explanatory variables for the CP QOL total score. Executive functions explained three specific QOL domains: Social Wellbeing and Acceptance, Feelings about Functioning, and Emotional Wellbeing and Self-esteem. Parental stress also explained Social Wellbeing and Acceptance. Motor functional status and visual perception were explanatory variables for the Access to Services domain. Finally, autism spectrum disorder (ASD) traits were an explanatory variable for the Participation and Physical Health domain.

CONCLUSION

Executive functioning and motor functional status importantly influence QOL of children with CP. Visual perception, ASD symptoms, and parental stress variables are related with specific QOL domains. These findings demonstrate that interventions targeting cognitive functions in children with CP may positively influence QOL.

Psychometric properties of the English language version of the C-BiLLT evaluated in typically developing Canadian children

PURPOSE

This study aimed to 1) investigate the convergent and discriminant validity, internal consistency, and test-retest reliability of the Canadian English version of the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), and 2) explore feasibility of the C-BiLLT assessment for children with cerebral palsy (CP) and complex communication needs in the Canadian health care context.

METHODS

Eighty typically developing children between 1.5 and 8.5 years of age completed the C-BiLLT-CAN, the Peabody Picture Vocabulary Test-IV (PPVT-4), the receptive language sub-test of the New Reynell Developmental Language Scales (NRDLS), and/or the Raven's 2. Correlations between raw scores were calculated for estimates of convergent and discriminant validity. Internal consistency was calculated for all items and separately for items pertaining to vocabulary and grammar. To calculate the standard error of measurement (SEM) and intraclass correlation coefficient (ICC), 33 participants were re-tested with the C-BiLLT within three weeks. Feasibility was explored with nine participants with CP.

RESULTS

C-BiLLT-CAN's convergent validity was good to excellent (Spearman's rho >  0.78) and discriminant validity was higher than hypothesized (Spearman's rho >  0.8). Internal consistency (Cronbach's alpha = 0.96), test-retest reliability (ICC >  0.9), and measurement error (SEM <  5%) were excellent. The feasibility study could not be fully completed due to the COVID-19 pandemic. Preliminary data demonstrated some technical and practical barriers for using the C-BiLLT in children with CP in Canada.

CONCLUSION

The C-BiLLT-CAN demonstrates good to excellent psychometric properties in a sample of typically developing children, indicating that it is an adequate test for measuring language comprehension in English-speaking Canadian children. Further research is needed to investigate the feasibility of the C-BiLLT-CAN in children with CP.

Exploring the Effects of Literacy Instruction for Children With Cerebral Palsy: A Systematic Review

PURPOSE

Some children with cerebral palsy (CP) have difficulty acquiring conventional reading and writing skills. This systematic review explores the different types of literacy instruction and their effects on the reading and writing skills of children with CP.

METHOD

Relevant studies published between 2000 and 2020 were identified using electronic databases and terms related to CP and literacy. Data on participant characteristics, instruction characteristics, and instruction outcomes were extracted. A standardized measure of effect size was used to quantify reported treatment effects.

RESULTS

The systematic search identified 2,970 potentially relevant studies, of which 24 met inclusion criteria. These studies included 66 children with CP aged 5-18 years. One of the included studies utilized a group research design, whereas the remaining used single-subject designs. Studies investigated literacy instruction methods designed to teach phonics, sight-word recognition, reading fluency, reading comprehension, spelling, or written expression skills, or multicomponent instruction (instruction methods encompassing three or more of these skills). Most instruction methods were associated with gains in reading and writing skills with medium to large effects; however, our analysis of methodological rigor suggests that these findings need to be interpreted with caution.

CONCLUSIONS

We propose that literacy instruction utilizing evidence-based principles can be effective for children with CP, provided instruction is accessible and allows children to demonstrate and receive feedback on their skills; however, further research is greatly needed. Clinical implications and priorities for future research are discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21357558.