Forms Of Cerebral Palsy Research Articles

Early differential diagnosis and restorative treatment of cerebral palsy

The article is devoted to an urgent problem of modern neurology - early diagnosis and complex restorative treatment of cerebral palsy (cerebral palsy). Etiological factors and pathogenetic aspects of the formation of various forms of cerebral palsy are considered in detail, as well as modern possibilities of differential diagnosis in children of the first years of life of cerebral palsy and a wide range of pathological conditions (somatic, endocrine, hereditary-conditioned, including hereditary-metabolic and neuromuscular diseases). The leading directions of complex rehabilitation of cerebral palsy are widely presented, taking into account modern standards and clinical recommendations. The high efficacy of the drug Cortexin has been shown, due to its positive multimodal action (stimulation of the processes of neuropreparation, neuroprotection, neuroplasticity) in the treatment of motor, cognitive and autonomic disorders in children with perinatal lesions of the central nervous system and cerebral palsy.

Comorbidity of cerebral palsy and epilepsy with autism in children

Background. Cerebral palsy is often combined with epilepsy (up to about 50 % of children). The treatment of epilepsy limits the rehabilitation of cerebral palsy, and the rehabilitation of cerebral palsy often provokes epileptic seizures. Epilepsy in children with cerebral palsy is often manifested in a form of developmental and epileptic encephalopathy with spike-and-wave activation in sleep, which is characterized by epileptiform activity according to the type of benign epileptiform patterns of childhood with a high index on the electroencephalogram (up to 100 %), severe epileptic seizures of a status course, and mental disorders by type autism-like behavior (the so-called atypical autism) and disorders of speech communication. The problem of comorbidity of cerebral palsy, epilepsy and autism remains relevant and needs further study.Aim. To study the features of autism spectrum disorder in a group of children with a combination of cerebral palsy and epilepsy.Materials and methods. We examined 100 patients aged 3–10 years with various forms of cerebral palsy, combined with epilepsy, to identify the clinical features of autism spectrum disorder. Criteria for inclusion in the study: age 3–10 years; verified diagnosis of epilepsy in combination with cerebral palsy and autism spectrum disorder; informed consent of the patient’s parents to participate in the study. Criteria for exclusion from the study: severe somatic diseases and disorders of the sense organs (in particular, kyphoscoliosis, gastrostomy and others, as well as deafness, blindness); age less than 3 or more than 10 years.Results. The average age of visiting a psychiatrist was 5.4 ± 0.5 years. The reasons for visit were: violation of the communication (76 %), decreased eye contact (75 %), lack of compassion for surrounding or adjacent animals (100 %), dysphoric disorders (77.1 %), aggression (55 %), autoaggression (40 %), phobias (90 %), impaired speech development (18 %). Perinatal brain damage was diagnosed in 100 % of cases. Epilepsy was manifested by focal motor seizures. Patients with complex treatment (drugs and pedagogical correction) have more pronounced positive dynamics compared with patients who received only drug therapy or only rehabilitation (p <0.05).Conclusion. In children with a combination of cerebral palsy and epilepsy, the cause of autism is perinatal lesions of the central nervous system, as well as the severity of motor pathology and the presence of continued epileptiform activity on the electroencephalogram. Autism in this group of children requires timely recognition and medical and pedagogical correction.

USING KINESIOTHERAPY IN THE REHABILITATION PROGRAM OF CHILDREN WITH CEREBRAL PALSY

The article presents the results of the use of decompression trainer and parter articular gymnastics exercises in rehabilitation of children with various forms of cerebral palsy (PTSD), formation and development of basic movement skills, physical fitness and endurance. The rehabilitation program for children diagnosed with PTSD was planned taking into account individual capabilities and needs. In order to increase the effectiveness of the rehabilitation program, the method of replacing training sessions was used. All treatment procedures are based on forms of play. The rehabilitation procedure is adapted to the level of personal development of the child, focusing on his strengths and needs. Passive, active and combined training methods were alternately used. Due to the introduction of the method of using the decompression trainer and parter articular gymnastics in the complex rehabilitation program, the volume of active movements and manipulative activity in patients increases, while the achieved results are preserved for a long time. KEY WORDS: children; cerebral palsy; rehabilitation; kinesiotherapy

Optical spectral diagnostics of the oxygenation level in periodontal tissues and photodynamic therapy using methylene blue in children with cerebral palsy.

To improve the effectiveness of phototheranostics methods using, namely PDT with simultaneous optical-spectral control, for the treatment of gingivitis in children with complex dental and somatic status (cerebral palsy). The study involved 15 children (6-18 y.o.) with various forms of cerebral palsy, in particular, spastic diplegia and atonic-astatic form and with gingivitis. The degree of hemoglobin oxygenation was measured in tissues before PDT and on the 12th day. PDT was performed using laser radiation (λ = 660 nm) with a power density of 150 mW/cm2 with a five-minute application of 0.01% MB. The total light dose was 45 ± 15 J/cm2. For statistical evaluation of the results, a paired Student's t-test was used. The paper presents the results of phototheranostics using methylene blue in children with cerebral palsy. An increase in the level of hemoglobin oxygenation from 50 to 67% (p < 0.001) and a decrease in blood volume in the microcirculatory bed of periodontal tissues were shown. Photodynamic therapy methods with application of methylene blue make it possible to assess the state of the gingival mucosa tissue diseases objectively in real time, and to provide effective targeted therapy for gingivitis in children with cerebral palsy. There is a prospect that they can become widely used clinical methods.

Hypothermia as a treatment option for hypoxic-ischemic encephalopathy in newborns – A literature review

Introduction and purpose: Neonatal asphyxia is a medical condition in which the neonate is not able to maintain sufficient respiratory function. The hypoxia may be caused by either an impaired respiratory activity of the neonate or an interruption of blood flow to the placenta in the period immediately before or during delivery, which resulted in inadequate oxygen perfusion to vital organs.&#x0D; Description of the state of knowledge: Hypoxic-ischaemic encephalopathy (HIE) is a form of perinatal hypoxia, occurring in newborns after the 35th week of gestation and presenting along with neurological disorders. In fact, it is a major cause of death and infant disability. The incidence of HIE is approximately 2-5 per 1000 live births. The standard recommended treatment for perinatal hypoxic-ischaemic encephalopathy is therapeutic hypothermia. There are two methods used: selective head cooling with moderate whole-body hypothermia (SHC) and whole-body hypothermia (WBC). In both cases, metabolism and neural tissue destruction are slowed down.&#x0D; Conclusions: Therapeutic hypothermia is a promising treatment option for neonatal encephalopathy. Thus, it decreases the risk of death and neurological deficits in the form of cerebral palsy, epilepsy and psychomotor retardation. Whole-body hypothermia appears to be a more successful method than selective head cooling, however more research is still needed.&#x0D;

Ultrasound and laser Doppler flowmetry assessment of jaw muscle hypertonia in children with cerebral palsy

Relevance. Spastic cerebral palsy is one of the most common forms of cerebral palsy, in which muscular hypertonia, including jaw muscles, is present. To date, there is no universal algorithm for muscle hypertonia. The diagnosis is made based on complaints and data from an electromyographic study. This paper describes and proves the rationale for including ultrasound and laser Doppler flowmetry (LDF) in additional diagnostic methods.Material and methods. We examined 84 children with cerebral palsy using ultrasound and LDF to study the state of the mastication muscles. The ultrasound examination determined the structure and thickness of the masseter and temporal muscles and detected trigger points and the infiltration site. LDF was performed both at rest and after an occlusal test, which allows assessing the reserve capacities of the mastication muscles. We compared the received data with a group of healthy subjects of the same age.Results. Ultrasound parameters and LDF data differed from the control group. The ultrasound examination revealed trigger points for the first time without patients’ complaints. Congestion caused by damage to muscle cells is characteristic of the local blood flow in children with cerebral palsy. The results of the occlusal test evidenced the mastication muscle compensation abilities, which clinicians should consider during treatment planning.Conclusion. The received data will help dentists diagnose and treat muscle hypertonia, which will prevent pathology deterioration.

Modern approaches to visual rehabilitation of patients with neuromotor disorde

Background. Approximately 50 % of children with cerebral palsy have vision problems, manifested in strabismus, impaired eye mobility, refractive errors, nystagmus development and partial atrophy of the optic nerve.The aim: to present a clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy (CP).Materials and methods. A clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy is presented. General anesthesia was used to perform a two-stage treatment under one anesthesia: the first stage – laser myopia correction by femtosecond extraction of the lenticule through a small access (SMILE) to both eyes, the second stage was the strabismus correction by performing tenoscleroplasty of the external rectus muscle and resection of the internal rectus muscle of both eyes. The sequence of stages is due to the relative traumatism of strabismus surgery, in some cases, accompanied by a reaction from the bulbar conjunctiva and the cornea in the form of edema, which, during subsequent femtosecond vision correction, can affect the refractive result and worsen visual acuity in the postoperative period.Results. The performed treatment let significantly increase uncorrected visual acuity, achieve a correct and stable eye position, which became the basis for changing the vision nature from monocular to binocular.Conclusion. Thus, modern laser and surgical technologies in combination with an adequate anesthesia allow rehabilitating patients as much as possible in a short time, even with severe forms of cerebral palsy, and significantly improving the quality of life.

Selective Dorsal Rhizotomy in Treatment of Spasticity in Patients with Cerebral Palsy

Selective dorsal rhizotomy (SDR) is effective and safe neurosurgical method for the treatment of patients with spastic forms of cerebral palsy (CP). The aim of the review is to introduce the opportunities of SDR in CP patients, to present indications, contraindications, and current inclusion criteria for the surgery for the broad audience of specialists. Authors have given recommendations on SDR implementation in complex rehabilitation of CP patients and have defined its effective combination with other methods of spasticity treatment according to the international experience of SDR, and its short-term and long-term results. The particular attention was paid to the application of SDR in cases of secondary orthopaedic deformities due to CP. The understanding of opportunities and limitations of SDR will allow us to give the patients relevant help and use the advantages of this method.

The Effect of Field Massage on Bilirubin Levels in Neonates with Hyperbilirubinemia

Hyperbilirubinemia is one of the most common clinical phenomena. It is found in 80% of premature infants and 60% of term infants in the first week of life. Most hyperbilirubinemia does not require special therapy, but because of the potential toxic effects, all neonates should be monitored to detect the possibility of severe hyperbilirubinemia. Based on data from the Directorate of Family Health, in 2019, out of 29,322 under-5 deaths, 69% of deaths occurred in the neonatal period. One of the causes of mortality in neonates is bilirubin encephalopathy/kernicterus. Bilirubin encephalopathy is the most severe complication of neonatal jaundice. In addition to encephalopathy, other risks include sequelae in the form of cerebral palsy, high-pitched deafness, paralysis and dental dysplasia, which greatly affect the quality of life. Several studies have been conducted to find alternative supporting therapies that can be used to effectively reduce bilirubin levels in addition to providing phototherapy, one of which is the provision of field massages. Field massage is thought to increase the excretion of bilirubin in infants during phototherapy. The purpose of this literature review was to determine the effect of field massage on reducing bilirubin levels in neonates with hyperbilirubinemia. This was a traditional narrative literature review which grouped similar extracted data according to the results measured to answer the objectives. According to the results, giving field massages two times a day for three days for 15 minutes each time was able to significantly reduce bilirubin levels.&#x0D; Keywords: field massage, hyperbilirubinemia, neonates

Використання кінезотерапії в реабілітації дітей із ДЦП

В роботі подані результати використання тренажерних пристроїв Гросса і МОТОmed gracile12 в реабілітації дітей із різними формами дитячого церебрального паралічу (ДЦП), формуванні й розвитку основних рухових навичок, підвищенні фізичної підготовленості та витривалості. Відновлювальне лікування дитини з ДЦП проводилось з урахуванням індивідуальних можливостей і потреб. У реабілітаційній програмі використовували метод чергування занять на тренажерах. Терапія базувалася на ігрових формах. Реабілітація адаптувалась до індивідуального рівня розвитку дитини, робився акцент на її сильні сторони та потреби. Використовувалися поєднані режими пасивного, активного й комбінованого тренування. Завдяки впровадженню методики використання тренажерних пристроїв Гросса і МОТОmed gracile12 в комплексну реабілітацію дітей із ДЦП збільшився загальний рівень рухової активності та маніпулятивної діяльності, досягнуті результати зберігалися тривалий час.

Лікування спастичних форм дитячого церебрального паралічу в дітей на етапах оперативного втручання

Проведено аналіз лікування 320 дітей віком від 3 до 18 років зі спастичними формами дитячого церебрального паралічу. Дітям було проведено оперативне лікування. До операціїї діти отримували препарат сирдалуд, після операції — сирдалуд, масаж, лікувальну фізкультуру. Препарат зменшує спастичний стан м'язів, чинить знеболювальну дію.

The problem of osteoporotic fractures of the femur in children with cerebral palsy

The problem of osteoporotic fractures of the femur in children with cerebral palsy

Comprehensive rehabilitation of patients with movement disorders with spastic forms of cerebral palsy

Until now, there is no radical method of treating children with cerebral palsy, which allows us to consider scientific research in this direction reasonable and promising.The aim of the research: to study the effect of exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback on the indicators of motor skills in children with spastic cerebral palsy.Materials and methods. We conducted an open, non-randomized, prospective, comparative, controlled study in pairs (each participant in the main group corresponds to a participant in the control group). The study involved 53 patients aged 4–12 years with cerebral palsy: the intervention group (group 1: n = 27 (13 boys, 14 girls)) and the control group (group 2: n = 26 (11 boys, 15 girls)), comparable in terms of gender, age and severity of movement disorders. Characteristics of the medical intervention: group 1 – botulinum toxin type A (BTA, for exercising against the background of relative muscular normotonus) + exercise therapy + exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback (BFB); group 2 – BTA + exercise therapy. Duration of the study: 2019–2020. The difference between groups in terms of motor skills on the day of hospitalization and after completion of the training program (10 sessions each) was determined. Motor skills were assessed according to the GMFM-66/88 (Gross Motor Function Measure) table using the “Scales for measuring global motor functions”.Results. The inclusion of additional exercises on the mini-simulator “Kinesioplatformswing” with biofeedback in the rehabilitation of patients with movement disorders with spastic cerebral palsy (BTA + exercise therapy) in comparison with the control group. However, the question of the long-term effects of such training remains open and requires further study.

Dose selection of Incobotulinumtoxin A for the treatment of spasticity and sialorrhea in cerebral palsy: results of a retrospective multicenter study

Introduction. In patients with infantile cerebral palsy (CP), botulinum therapy is used to treat both muscle tone disorders and sialorrhea. Therefore, it is logical to use one preparation of botulinum toxin type A to treat spasticity and sialorrhea in one injection procedure. The aim of the work is to conduct a retrospective analysis of data from 15 centres that treat patients with cerebral palsy and use the botulinum therapy method to determine the optimal doses of IncobotulinumtoxinA (IBTA) for the treatment of spasticity and chronic sialorrhea in real clinical practice. Materials and methods. The treatment results of 389 children with cerebral palsy (including 211 (54.2%) boys) with IBTA were analyzed. The majority were children with bilateral forms of cerebral palsy - 312 (80.2%). The average age of the patients was 5.27 ± 3.71 years, the average weight of the patients was 18.8 ± 10.9 kg. Results. The total dose of IBTA in the group of 389 patients with cerebral palsy for the treatment of spasticity was 163.74 ± 80.65 U (25-550; 95% CI 155.7-171.7) and 10.4 ± 5.4 U/kg body weight (1,25-29.7; 95% CI 9.8-10.9). The total dose of IBTA in the group of patients with cerebral palsy with simultaneous treatment of spasticity and chronic sialorrhea (n = 16) was significantly higher: 267.18 ± 124.57 U (115-570; 95% CI 200.8-333.6) and 13, 0 ± 7.1 U/kg (5.8-24.6; 95% CI 9.2-16.8). In the lower extremities, the most frequent target muscles were the gastrocnemius (55.0% of cases; 95% CI 49.9-60.0) and semitendinosus / semimembranous muscle (46.3% of cases; 95% CI 41.2-51.4 ), and in the upper limbs - pronator teres (48.6% of cases; 95% CI 43.5-53.7) and biceps brachii (28.8% of cases; 95% CI 24.3-33.6). Limitations of the study. The limitations of our work are the use of an open retrospective study format, a relatively small sample of patients with chronic sialorrhea, the absence of long-term follow-up of patients and the results of repeated IBTA injections. Conclusion. If it is necessary to use botulinum therapy for the treatment of spasticity and sialorrhea in a child with CP, it is optimal to use the product IncobotulinumtoxinA, which will allow correction of two pathological manifestations in one procedure and can shorten the intervals between repeated injection cycles.

Cost analysis of botulinum therapy of spastic forms of cerebral palsy in Ukraine

Cerebral palsy (CP) represents a group of disorders of the mechanisms of movement and body position, causing limitations of activity, which are caused by non-progressive damage to the developing brain, fetus or child. About 80% of cases are spastic forms of cerebral palsy. Along with motor rehabilitation, the use of botulinum toxin type A (BoNT-A) is considered one of the main methods of treatment of choice for focal spastic and dystonic syndromes, regardless of their etiology. At present, there are no studies in Ukraine on the analysis of the costs of using drugs based on BoNT-A, taking into account the recommended dose and frequency of administration.&#x0D; The aim of the work. Carrying out an analysis of minimizing the cost of botulinum therapy for spastic forms of cerebral palsy in patients aged two years and older.&#x0D; The annual dosage and frequency of administration of abobotulotoxin and onabotolutoxin for the treatment of dynamic equinus deformity of the foot caused by focal spasticity due to cerebral palsy in children over two years of age were obtained from the instructions for use. The cost of abobotulotoxin and onabotolutoxin was obtained from the Register of Wholesale Prices of the Ministry of Health of Ukraine.&#x0D; Cost analysis for a model cohort of children in different weight categories showed that abobotulotoxin 500 U will be the least expensive treatment technology in the weight category of 21–33 kg at a dosage of 15 U/kg in the treatment of diplegia. Abobotulotoxin 300 U is most rationally used in weight categories 10–20 kg and 34–40 kg with a dosage of 15 U/kg in the treatment of hemiplegia and in the weight category 17–20 kg with a dosage of 30 U/kg in the treatment of diplegia. Weight categories were identified in which the costs of using abobotulotoxin 300 U and abobotulotoxin 500 U were equal to and less than the costs of onabotolutoxin treatment.&#x0D; The study was the first to analyze the cost of botulinum therapy, which identified the benefits of abobotulotoxin in the symptomatic treatment of hemiplegia and diplegia in cerebral palsy in the focus of different weight groups of children. Possible variability in the dosage and frequency of administration of onabotolutoxin per year indicates the relevance of collecting additional information on the application in real clinical practice and further pharmacoeconomic studies.

Нейрофизиологические особенности спастического синдрома у детей с детским церебральным параличом в зависимости от выраженности моторных нарушений

Актуальность. Детский церебральный паралич (ДЦП) — собирательный термин, объединяющий многочисленные тяжелые заболевания нервной системы. 80 % детей с ДЦП страдают спастическими формами, основным симптомом которых является повышение мышечного тонуса — спастичность. Объективизацию состояния мышечного тонуса и контроль за динамикой спастичности можно проводить с помощью методов биомеханики и электронейромиографического (ЭНМГ) исследования, что дает возможность качественно и количественно изучить состояние нервно-мышечной системы. Цель: установить клинико-нейрофизиологические особенности спастического синдрома у детей с ДЦП в зависимости от выраженности моторных нарушений. Материалы и методы. Обследовано 122 ребенка с ДЦП (средний возраст 8,8 ± 3,7 года), которые были распределены на группы согласно шкале больших моторных функций, расширенной и дополненной (Gross Motor Function Classification (GMFCS E&amp;R)). Всем пациентам проведено тщательное неврологическое обследование и осуществлялось ЭНМГ-исследование. Для оценки надсегментарного (верхнего мотонейрона) и сегментарных (α-мотонейронов спинного мозга и периферических нервов) уровней поражения анализировали параметры Н-рефлекса и F-волны. Результаты. У большинства обследованных детей были диагностированы спастические формы ДЦП: у 40 (32,8 %) детей — спастическая диплегия, у 25 (20,5 %) — гемипаретическая форма, у 6 (4,9 %) — спастический трипарез, у 34 (27,9 %) — спастический тетрапарез. У детей с ДЦП с выраженными моторными нарушениями значительно чаще наблюдалась ортопедическая патология, а именно эквиновальгусная установка и плосковальгусные деформации стоп. По данным ЭНМГ у больных с ДЦП регистрировались нарушения надсегментарных влияний, проявлявшиеся повышением амплитуды М-ответа, особенно при тестировании большеберцового нерва, увеличением соотношения Нмах/Ммах, повышением амплитуды Н-рефлекса и F-волны. Выводы. С увеличением выраженности двигательных нарушений по шкале больших моторных функций (GMFCS E&amp;R) у детей с детским церебральным параличом достоверно усугублялись нейрофизиологические изменения.

Оценка уровня эндотелиального фактора роста сосудов и моноцитарного хемоаттрактанта при детском церебральном параличе

Objective. The aim of this article is to assess the role of vascular endothelial growth factor and monocytic chemoattractant in the development of cerebral palsy in children. Materials and methods. Examination of 77 children with different clinical forms of infantile cerebral palsy in the age group from 1 to 16 years was carried out. The content of monocyte chemoattractant (MCP) and vascular growth factor (VEGF) was determined in different forms of cerebral palsy. The obtained data were processed statistically. Results. The analysis of the obtained data revealed a significant increase in the indicators of monocytic chemoattractant and vascular growth factor in children with infantile cerebral palsy compared with healthy children. There were no significant differences between the indicators of MCP and VEGF in children with cerebral palsy and comorbid pathology and children with cerebral palsy without concomitant pathology. Conclusion. The authors of the presented analysis conclude that the determination of monocytic chemoattractant and vascular growth factor has a high diagnostic value for identifying a predisposition to the development of cerebral palsy. Timely detection of an increase in the level of these factors provides a broader prospective for early diagnosis of the disease and for the early implementation of rehabilitation measures accordingly.

Correlation of cognitive impairments with school performance depending on the form of cerebral palsy

Correlation of cognitive impairments with school performance depending on the form of cerebral palsy

ИЗМЕНЕНИЯ ФИЗИОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ ОРГАНИЗМА ДЕТЕЙ СО СПАСТИЧЕСКИМИ ФОРМАМИ ЦЕРЕБРАЛЬНОГО ПАРАЛИЧА ПОД ВОЗДЕЙСТВИЕМ ФИЗИЧЕСКОЙ НАГРУЗКИ

To assess the indicators of the cardiovascular system (CVS) affected by exercise in children with various forms of cerebral palsy (CP).

Can Children With Perinatal Stroke Use a Simple Brain Computer Interface?

Perinatal stroke is the leading cause of hemiparetic cerebral palsy resulting in lifelong disability for millions of people worldwide. Options for motor rehabilitation are limited, especially for the most severely affected children. Brain computer interfaces (BCIs) sample brain activity to allow users to control external devices. Functional electrical stimulation enhances motor recovery after stroke, and BCI-activated functional electrical stimulation was recently shown to improve upper extremity function in adult stroke. We aimed to determine the ability of children with perinatal stroke to operate a simple BCI. Twenty-one children with magnetic resonance imaging–confirmed perinatal stroke (57% male, mean [SD] 13.5 [2.6] years, range 9–18) were compared with 24 typically developing controls (71% male, mean age [SD] 13.7 [3.7] years, range 6–18). Participants trained on a simple EEG-based BCI over 2 sessions (10 trials each) utilizing 2 different mental imagery strategies: (1) motor imagery (imagine opening and closing of hands) and (2) goal oriented (imagine effector object moving toward target) to complete 2 tasks: (1) drive a remote controlled car to a target and (2) move a computer cursor to a target. Primary outcome was Cohen Kappa with a score >0.40 suggesting BCI competence. BCI performance was comparable between stroke and control participants. Mean scores were 0.39 (0.18) for stroke versus 0.42 (0.18) for controls (t[42]=0.478, P=0.94). No difference in performance between venous (M=0.45, SD=0.29) and arterial (M=0.34, SD=0.22) stroke (t[82]=1.89, P=0.090) was observed. No effect of task or strategy was observed in the stroke participants. Over 90% of stroke participants demonstrated competency on at least one of the 4 task-strategy combinations. Children with perinatal stroke can achieve proficiency in basic tasks using simple BCI systems. Future directions include exploration of BCI-functional electrical stimulation systems for rehabilitation for children with hemiparesis and other forms of cerebral palsy.