Visual impairment during early childhood can hinder motor, language, and social development, yet data on its developmental impact across common pediatric ocular diseases remain limited. To investigate the developmental impact of low vision and blindness on children under six with common ocular diseases. This retrospective study reviewed records of new patients under six with visual impairment at Siriraj Hospital's low vision rehabilitation center (January 2017-October 2022). We collected ocular, systemic, and developmental data; recorded visual acuity in the better-seeing eye after refractive correction; and assessed developmental domains with the Denver II. Univariable and multivariable logistic regression identified factors associated with developmental delay. A total of 161 pediatric patients (mean age 24.9 ± 18.9 months) were enrolled and evaluated based on their ability to fix on and follow an object or light source. Some were further assessed using the Allen picture chart and all had visual acuity worse than 1.07 ± 0.58 LogMAR, and 83.2% were identified as having global developmental delay (GDD). The three most common ocular causes were cortical visual impairment (CVI), optic neuropathy/atrophy, and optic nerve hypoplasia. Extremely poor visual acuity (inability to fixate and follow) was significantly associated with GDD [adjusted odds ratio (AOR) 41.0] and delays in all developmental domains: Gross motor (AOR 10.0), fine motor (AOR 12.8), language (AOR 5.3), and personal-social skills (AOR 13.4) (P ≤ 0.002). Multiple disabilities, most often visual impairment with cerebral palsy, were also significantly associated with gross motor delays (AOR 7.7) and fine motor delays (AOR 4.0) (P < 0.05). CVI was also related to delays in language and personal-social skills (AOR 9.1 each) (P < 0.05). This study underscores the developmental issues in children with visual impairment, especially those with poorer acuity, CVI, and multiple disabilities. Significant delays were observed in all domains, including GDD. A timely referral to specialists is strongly recommended.

Reduced toe clearance during the swing phase of gait, often referred to as foot drop, is a common cause of walking disability in clinical populations like stroke, cerebral palsy, or multiple sclerosis. Individuals with foot drop often wear an ankle-foot orthosis (AFO) to prevent excessive plantarflexion, but many commercially available AFOs overly restrict ankle mobility or make the wearer feel unstable/uncomfortable. Soft AFOs-AFOs with soft attachment points and elastic assistance-are designed to retain ankle mobility and comfort. However, their effect on gait biomechanics, as compared to traditional AFOs, is not well understood. Therefore, the objective of the current study was to perform a comprehensive biomechanical and neurophysiological comparison of soft AFOs with traditional AFOs. Sagittal plane kinematics, ground reaction forces, and lower extremity muscle activation were measured in 23 neurologically intact individuals while walking on a treadmill without assistance from an AFO (No AFO) and then with unilateral assistance from four commercially available AFOs (rigid anterior, flexible posterior leaf spring, and two soft AFOs). We found that soft AFOs allowed for greater ankle dorsiflexion velocity, plantarflexion velocity, and plantarflexion angle while retaining or increasing dorsiflexion during the swing phase. We also found that the traditional AFOs reduced propulsive ground reaction forces compared to the soft AFOs, and the rigid anterior AFO reduced plantarflexor muscle activity compared to the soft AFOs. These results highlight the differences between different commercially available AFOs and present soft AFOs as an exciting alternative to traditional AFOs when ankle mobility is desired.

BackgroundEffective engagement and motivation during balance training can be achieved through using technology such as virtual reality and promotes positive adaptation and neural plasticity.ObjectiveThe aim of the study was to explore the effect of gamified balance training using virtual reality on postural control in children with spastic diplegic cerebral palsy.MethodsFifty children with spastic diplegic cerebral palsy from both genders with ages ranged from six to twelve years old participated in this study. The participants were allocated randomly into two groups (n = 25). The control group (A); received conventional physical therapy programs based on neurodevelopmental technique including balance and gait training exercises, while the study group (B); received conventional physical therapy programs based on neurodevelopmental technique including balance and gait training exercises in addition to virtual reality balance training. All children were examined clinically pre- and post-treatment using HUMAC balance and tilt system to asses Limit of Stability (LOS), Center of Pressure (COP), and the Modified Clinical Test of Sensory Integration of Balance (mCTSIB).ResultsThere were significant improvements of all measured variables in both control and study groups with significant difference between groups in favor to the study group (p < 0.05).ConclusionGamified balance training using virtual reality has a beneficial effect on improving postural control in children with spastic diplegic cerebral palsy.

Children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) level III-V are at risk of reduced bone strength and low-trauma fractures. This systematic literature review aimed to identify fracture rates, locations, and risk factors in this population. Five databases (MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO) were searched up until November 2024. Studies were included if they involved children younger than 18years with CP (GMFCS III-V). Included study designs were cross-sectional, cohort, case-control, or experimental, including both randomized control trials and quasi-experimental, which reported baseline data separately. The Newcastle Ottawa Scale was used to assess methodological quality. Study characteristics, population characteristics, fracture rate, location, and risk factors identified were extracted. Out of 2220 studies, 30 were included. The fracture rate ranged from 2.2 to 4.8 per 100 child-years, and lifetime prevalence estimates were between 9.4% and 15.5%. The most frequently reported fracture location was in the lower extremities, particularly the femur (54.1%). Risk factors for fracture supported by high-quality evidence were low bone mineral density, epilepsy, and weight imbalance; factors with mixed-quality evidence were anticonvulsant use, feeding difficulties, reduced weight bearing, history of fracture, and increasing age. Variability in methodological quality across studies and inconsistent reporting limited the generalizability of findings. Children with CP functioning at GMFCS III-V are prone to fragility fractures in the lower extremities with several modifiable risk factors identified, including poor nutrition, weight imbalance, uncontrolled seizures, and limited weight-bearing activity.

This exploratory study investigated relationships between three proprioceptive modalities - joint movement sense (JMS), joint position sense (JPS), and dynamic position sense (DPS) - assessed with the sensor-based Proprioception Measurement Tool (ProMeTo) and motor outcomes in children with upper motor neuron (UMN) lesions. In a cross-sectional study, 48 children with UMN lesions (mean age 11.0±3.5; 27 girls) were recruited. Diagnoses included cerebral palsy, acquired brain injury, and other UMN-related conditions. Proprioception at the hip, knee, and ankle was assessed for JMS, JPS, and DPS. Motor outcomes included selective motor control, gait and balance, gross motor function, movement quality, and functional mobility. Statistical analyses comprised Mann-Whitney U-test, Wilcoxon's signed-rank, and Spearman's correlations (rho=ρ) tests. Children who correctly identified all JMS directions across joints showed significantly better motor outcomes. Negligible to moderate correlations (ρ=0.01-0.55) emerged between proprioceptive modalities and motor outcomes, with the strongest relationships found between JPS at the hip (ρ=0.431-0.46) and ankle (ρ=0.36-0.55) and outcomes related to motor function, movement quality, and mobility. Proprioceptive function, particularly JPS, shows moderate relationships with motor capacity and movement quality in children with UMN lesions. Further research is needed to confirm these associations and determine their clinical implications.

To describe individuals with cerebral palsy (CP) followed at the SARAH Network of Rehabilitation Hospitals in Brazil. This was a multicentre, cross-sectional, descriptive study. Individuals diagnosed analysis (n=17 771). The mean age at the first visit was 3 years 5 months (SD=3 years 1 month), with 55.3% participants being male. At birth, 52.0% had normal weight and 50.3% were born at term. Perinatal risk factors were the most prevalent: preterm birth (48.4%); low birthweight (48.0%); and hypoxic-ischaemic encephalopathy (40.1%). Spastic CP (75.5%), bilateral involvement (75.9%), and Gross Motor Function Classification System levels III to V (57.8%) were predominant. Demographic and clinical data are comparable with previous reports from low- and middle-income countries (LMICs). Despite clinical advances in prenatal and perinatal care, most individuals with CP had severely affected motor function. As the prevalence of CP is higher in LMICs, and considering the direct influence of psychosocial factors on children with CP, it is essential to support multicentre and national registries in LMICs to adapt family-centred rehabilitation planning guidelines.

Background/Objectives: Cerebral palsy (CP) is a non-progressive, permanent syndrome of childhood, with approximately 80% of patients exhibiting spasticity. Untreated spasticity can cause pain, structural changes in bones, muscles, and nerves negatively impacting quality of life and functionality. Photobiomodulation (PBM) has demonstrated biological effects such as tissue regeneration, muscle relaxation, inflammation reduction, and pain relief. The objective of this pilot study is to evaluate the action of PBM on the spasticity of the medial and lateral right gastrocnemius muscles of children and adolescents with spastic cerebral palsy. Methods: This single-blinded, randomized, controlled trial evaluated PBM’s effect on gastrocnemius spasticity in children and adolescents with CP. The study presents pilot preliminary results from twelve children and adolescents (7–16 years) with spastic CP who were randomized into two groups: active PBM (850 nm, 100 mW, 1.5 J/point, 2 points, weekly for 8 weeks) or placebo (same protocol, device off). Both groups received standard rehabilitation exercises. Outcomes were assessed using the Modified Ashworth Scale (MAS), Pediatric Evaluation of Disability Inventory (PEDI), Gross Motor Function Classification System (GMFCS), and ankle range of motion before and after the intervention (8 weeks). Results: MAS and all outcomes improved significantly over time in both groups. No significant differences were found between groups for all outcomes. The PBM effect size on MAS improvement (ANOVA, Analysis of Vari, η2 = 0.171) suggests modest but positive benefits. PBM did not worsen spasticity, and no adverse effects were reported. Conclusion: This study represents a pioneering effort in evaluating a safe PBM protocol for the spastics gastrocnemius in children and adolescents with CP. This protocol, used as an adjunct to physiotherapy, demonstrated no short-term adverse effects and no participant dropouts. Future studies should explore this PBM protocol in patients with less severe GMFCS levels, those with minimally preserved functionality, or those with contraindications to physiotherapeutic exercises.

Children with chronic diseases are at a significant risk of radiation exposure. This cohort study evaluates the effectiveness and reliability of ultrasonography (US) for detecting femoral head decentration in children with cerebral palsy (CP) and developmental dysplasia of the hip (DDH), comparing it with traditional radiographic techniques to reduce radiation exposure. A total of 169 patients were enrolled in the study. Both hips were evaluated in 158 patients, resulting in a total of 327 hips. Patients underwent clinical and radiological assessments, including standardized US. Parameters measured included the ventral and lateral bony and cartilaginous ultrasonographic migration indices (bUMI and cUMI), which were compared with standardized radiographic indices (Reimers index (RI) and extrusion index (EI)). The lateral bUMI (17.4%) was significantly lower than the lateral cUMI (25.9%). RI values were lower than EI values (16.8% vs. 27.7%). No significant differences were observed between the bUMI and RI, or between the cUMI and EI, indicating the reliability of US. All lateral parameters correlated well with the lateral centre-edge angle (LCE). Positive correlations were found between the lateral cUMI and the radiological indices, with high inter- and intra-rater reliability (ICC). Significant differences in lateral and ventral UMIs were noted when comparing DDH and CP patients. US is a reliable alternative to radiography for hip surveillance in detecting hip decentration in children with CP and DDH. It reduces radiation exposure while maintaining diagnostic accuracy. The findings support the adoption of US in clinical practice to improve early diagnosis and intervention.

This study aimed to explore parent-reported perceptions of the usability and functional impact of wheelchair headrests among children with severe physical disabilities. Participants included children and youth with severe physical disabilities who assessed either retrospectively (49 children, ages 2-25 years) or prospectively (30 children, ages 2-18 years). Parents completed structured questionnaires evaluating user experience, satisfaction, and perceived changes in daily function following a two-week trial with a borrowed headrest. Data from 79 participants were analysed together as the groups did not differ significantly (gender, mean age). Most participants were male (64%) with cerebral palsy (55%). Three types of headrests were most commonly used: the Headaloft (30%), headrests with posterior support only (24%), and the 360 system by Headovations (16.5%). Overall usability, as reported by a parent from the prospective group, was high (System Usability Scale = 82.4 ± 11.3) for all headrests. Most parents reported improvements in their child's communication (73%), eye contact (68%) and position in transportation (68%). There were also improvements (mean = 4/5) in feeding, breathing and decreased fatigue. No statistically significant differences were found between headrest types. Parents perceived high usability and functional value across headrest designs, particularly when devices were selected through individualised fitting by experienced therapists. The findings highlight the importance of incorporating parent feedback when evaluating head support systems for children with severe disabilities.

Mapping the Comparative Effectiveness of Modified Constraint-Induced Movement Therapy, Hand-Arm Bimanual Intensive Training, and Mirror Therapy for Upper Extremity Rehabilitation in Children With Hemiplegic Cerebral Palsy: A Scoping Review

BackgroundChildren with cerebral palsy experience regular falls, but their lived experiences of falls in the real-world are unknown. Understanding the perspectives of children and parents is important to gain deeper insight into how falls happen in real-world environments, especially since typical walking analyses are carried out over level-ground and may overlook everyday challenges to balance (e.g., uneven pavements when walking to school). Walk-along interviews can generate rich insights into children’s everyday life by discussing experiences while walking.AimThe Walk-Along Project aimed to explore lived experiences of ambulatory children with cerebral palsy to determine challenging walking environments that increase fall risk day-to-day, using walk-along interviews.MethodsTwelve ambulatory children with cerebral palsy (12 ± 3 years old, 6 hemiplegia, 6 diplegia) and their parents took part in an outdoor walk-along interview. Previous fall experiences and everyday challenging environments that may increase fall risk were discussed. Action cameras and microphones captured walking environments and conversations, which were later synchronised, transcribed and analysed in NVivo using interpretive description.ResultsTwo themes were generated (‘places where trips and falls occur’ and ‘things children do to control falls and manage consequences’) plus five subthemes (‘walking on bumpy and unstable ground’, ‘taking care, walking slower and avoiding places’, ‘distracting environments are dangerous environments’, ‘close calls and falls’, and ‘managing consequences and concerns’). The most common environment suggested to increase fall risk was uneven surfaces (e.g., grass potholes) with distractions (e.g., dogs barking).ConclusionsThe Walk-Along Project reveals novel insights about places that increase fall risk in ambulatory children with cerebral palsy, beyond what is currently known. The importance of considering both environmental challenges (e.g., uneven surfaces) and sensory challenges (e.g., distractions) is highlighted through children’s lived experiences. Future work should consider how interacting factors (e.g., distractions in uneven environments) increase fall-risk in ambulatory children with cerebral palsy, in order to understand mechanisms of falls for potential fall prevention programmes.

Hip displacement in cerebral palsy (CP) is common, with incidence linked to ambulatory status. In the past, children 6 years of age or younger were treated with adductor releases alone, but a high failure rate was reported. Proximal femoral guided growth (PFGG) has had modest improvements in hip migration (∼10%) for older children (6y of age or older). The purpose of this study was to evaluate the effects of age and preoperative migration percentage (MP) severity on treatment success for young children (6y of age or younger) with CP. Children with CP 6 years of age or younger, all Gross Motor Function Classification System (GMFCS) levels and motor types, undergoing PFGG ±adductor tenotomies, were identified. Children were stratified by age (younger than 4, 4 to 6y), motor type, and preoperative MP. The primary outcome was the MP. A successful outcome was defined as a ∆MP ≥10% (definitive improvement) or ∆MP <5% (no progression) at final follow-up. Changes in MP and differences in success rates between age groups were determined. Forty-four patients (78 hips) were included; follow-up was 1.9 (range: 0.8 to 4) years (22 [50%] ≥2 years follow-up). Concurrent adductor tenotomies were performed in 33 hips. All GMFCS levels showed improvement (GMFCS I-III: MP 37% to 29%, P=0.007, GMFCS IV to V: MP 43% to 37%, P<0.001). Greater MP improvements were seen for hips with preoperative MP ≥40% and for patients <4 vs 4 to 6 years old [41% to 28% (P<0.001) vs. 37% to 37% (P=0.44), respectively]. Definitive improvement was seen in younger children (younger 4 vs. 4 to 6y: 62% vs. 13%, respectively; P=0.003), and both age groups had high success with no progression (100% vs. 81%, respectively; P=0.07). PFGG was associated with improved hip migration for patients 4 years of age or younger, with high rates of success (no progression) for both age groups. Greater MP improvement was seen with MP ≥40%, possibly secondary to concomitant femoral neck shortening. Although PFGG offers a promising minimally invasive treatment for younger children with CP, further studies with longer follow-up duration, increased sample size, and comparison to an adductor-only group are necessary to determine its true efficacy. Level III.

IntroductionCerebral palsy (CP) is the most common motor disability in children, with higher prevalence in low-income and middle-income countries (LMICs) compared with high-income countries (HICs). Children with CP (CwCP) often face significant challenges in achieving toileting independence due to motor, sensory and cognitive impairments. Parents play a pivotal role in managing these challenges, often encountering significant emotional, physical and social burdens. Despite the importance of toileting for autonomy and dignity, limited evidence exists on tailored toilet training programmes for CwCP, especially in LMICs. Understanding parental perspectives is essential to addressing these gaps and informing family-centred interventions.Methods and analysisThis scoping review aims to explore parents’ perspectives on toileting management for CwCP, focusing on strategies, challenges and unmet needs, to inform future research and the development of supportive interventions. This scoping review will be conducted in accordance with the guidelines of the Joanna Briggs Institute and summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework. The English language full-text articles, published between January 2014 and December 2024, addressing the parental perspectives, challenges and strategies related to the task of toileting in CwCP below 18 years of age will be included. Systematic searches will be conducted through PubMed, EMBASE, CINAHL, Scopus, Web of Science and grey literature. The data will be extracted and analysed thematically using Microsoft Excel.Ethics and disseminationThe present protocol has been registered in the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/73YQZ). Ethical approval is not required, as this review uses secondary data from published studies and does not involve direct participant recruitment. The findings will synthesise themes related to parents’ strategies, challenges and expectations in toileting management for CwCP. They will help address existing literature gaps and inform the development of practical, evidence-informed toileting education programmes for parents.

Introduction: Cerebral palsy is an early-onset, lifelong condition that requires comprehensive care. Occupational therapy contributes to the care of individuals with Cerebral Palsy through various intervention methods which aim to promote independence and well-being in all areas of life. This rapid review aimed to describe the intervention methods used globally by occupational therapists for Cerebral Palsy to inform policymakers on integrating occupational therapy into the healthcare system for effective management of Cerebral Palsy within the care team. Method: Searches were conducted of the Cochrane and Medline databases. Systematic reviews published in peer-reviewed journals from January 2014 to December 2023 were included for screening if the search terms "occupational therapy/therapist" and "cerebral palsy" were included in the title or abstract by two reviewers, and then by full text. A third reviewer resolved conflicts. The included reviews were analysed and data plotted on a custom excel worksheet. All studies were assessed for bias and quality using the CASP appraisal tool. Results: Eleven articles were included in the review. Seven themes were identified from the included systematic reviews through thematic analysis: gaming, early intervention, cognitive approaches, interventions that impact cognitive function, constraint-induced movement therapy, interventions that improve motor performance, and a general overview of treatment methods for cerebral palsy among children. Nine approaches with 24 intervention methods were identified from the individual systematic reviews, with varied evidence. Intervention venues and duration also varied widely. A multi-model approach using more than one intervention method was the preferred intervention approach, yielding better outcomes. Conclusion: High-quality evidence from eleven systematic reviews support the role of occupational therapy intervention for Cerebral Palsy. Implications for practice: Occupational therapy plays an integral part in supporting individuals with Cerebral Palsy by providing varied interventions aiming to optimise functional abilities, promote independence and enhance overall quality of life. A multi-model occupational therapy approach for Cerebral Palsy is supported by research evidence. Intervention settings and duration vary widely according to intervention aims and approaches. High-quality systematic reviews guide policy development in Africa. However, research in the form of scoping reviews is recommended to include lower-level evidence studies and information to plot current practices and gaps in therapy service delivery in Africa.

Deep learning has become an influential tool in the machine learning domain, enabling artificial intelligence systems to identify complex patterns in two-dimensional (2D) images and present precise predictions from massive datasets. One of the deep learning’s promising uses is human disabilities detection, a diagnostic field for enhancing the identification and classification of people with physical and sensory limitations. In this research, a deep learning framework is proposed for identifying and transferring six primary human disabilities, namely, blindness, Down syndrome, dwarfism, cerebral palsy, prosthetic arms, and prosthetic legs in a secure medical imaging system. The proposed framework is evaluated based on broadly accepted performance metrics to accurately measure human disability detection in images with complex interfering objects where various visual elements are partially blocking or overlapping the person of interest, which makes it challenging for the deep learning models to determine relevant human disability features. The performance of the proposed approach is evaluated by implementing the current state-of-the-art object detection models, RetinaNet, Single Shot MultiBox Detector (SSD), Faster Region Convolutional Neural Network (FR-CNN), YOLOv11, and EfficientNet. A robust security technique is developed to verify the privacy, security, and integrity of human disabilities in medical imaging systems. The experimental results demonstrated that the proposed framework enables human multi-disabilities detection accuracy exceeding 97% and proves potential image transmission in secure medical imaging systems.

Cerebral palsy (CP) is a heterogeneous, neurodevelopmental disorder arising from a static brain lesion and leading to progressive muscle degeneration. Quantitative understanding of 3D muscle morphology and fibre architecture effects of CP are lacking. Here, we present a novel imaging and computational method to investigate morphology and 3D fibre orientations of skeletal muscles in adolescents with CP. Principal component analysis was performed on data derived from conventional MRI and diffusion tensor MRI; principal components (PCs) described dominant variations in each cohort. We applied this method to the medial gastrocnemius muscles of seven young people with CP and eight typically developing controls to quantitatively assess deviations in muscle structure associated with CP. Morphology and architecture models in each cohort had similar variance of dominant features, with size being the predominant mode of variation in both cohorts. The first three PCs accounted for a cumulative variance of CP and TD cohort of 96 and 97%, and 95 and 97% for shape models and shape and fibre orientation models, respectively. Size differences were greatest in the proximal and distal regions, rather than middle, of the muscle. Models revealed localised variation in 3D fibre orientations between the two cohorts in medial-distal region of the muscle. Local variations were observed in the medial- distal regions of the mean muscle of about 10° in the TD model compared to the CP model. PCs of architecture models indicated that greater localised angular differences in the 3D fibre orientations were associated with larger-than-average muscles. This work offers insights into both muscle morphology and architecture of the medial gastrocnemius in individuals with CP, including variations of overall size and localised muscle fibre orientations. The quantitative descriptions of muscle architecture we present here may contribute to greater understanding of muscle function and dysfunction and may motivate imaging-informed perspectives on therapeutic interventions for CP.

Effect of Pilates exercise on balance in adults with cerebral palsy.

The Visual Function Classification System (VFCS) provides a standardised framework for grading visual functioning in children with cerebral palsy (CP). This study evaluated the reliability and construct validity of the Croatian VFCS, and its ability to distinguish visual functioning across CP subtypes and functional classifications. Ninety-five children with CP (mean age: 11.8 years, range: 4-18) were assessed using VFCS, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). Reliability was tested using quadratic weighted kappa and intraclass correlation coefficients (ICCs); differences across CP types with the Kruskal-Wallis, and construct validity with Spearman correlations. The Croatian VFCS showed excellent interrater ( κ = 0.87) and intrarater reliability ( κ = 0.92), with ICCs greater than 0.90. VFCS levels differed significantly by CP subtype ( χ ² = 8.30, P = 0.016), with preliminary evidence suggesting that unilateral spastic CP may be associated with better visual function than bilateral spastic or dyskinetic CP. Moderate correlations with CFCS ( ρ = 0.557), MACS ( ρ = 0.392), and GMFCS ( ρ = 0.308) revealed clinically relevant divergences between visual and motor abilities. The Croatian VFCS is a reliable, valid, and clinically sensitive tool. This study provides preliminary evidence of its discriminative utility across CP subtypes and supports integrating VFCS into multidisciplinary assessment and individualised rehabilitation planning.

Reasons for hospital admissions in children with chronic diseases during the COVID-19 pandemic: A retrospective study.

Effects of therapeutic instrumental music performance on upper limb motor function of children with cerebral palsy: A systematic review.