Gross Motor Function Measure Scores Research Articles

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

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

The Impact of Umbilical Cord Mesenchymal Stem Cells on Motor Function in Children with Cerebral Palsy: Results of a Real-world, Compassionate use Study.

The aim of this study was to analyze the impact of human umbilical cord-derived MSCs (hUC-MSCs) on motor function in children with cerebral palsy (CP). The study enrolled 152 children with CP who received up to two courses of five hUC-MSCs injections. Children's motor functions were assessed with the Gross Motor Function Measure (GMFM), 6-Minute Walk Test (6-MWT), Timed Up and Go test (Up&Go test), and Lovett's test, and mental abilities were assessed with the Clinical Global Impression (CGI) scale. Data collected at visit 1 (baseline) and visit 5 (after four injections) were analyzed retrospectively. After four hUC-MSCs administrations, all evaluated parameters improved. The change in GMFM score, by a median of 1.9 points (IQR: 0.0-8.0), correlated with age. This change was observed in all GFMCS groups and was noticed in all assessed GMFM areas. A median increase of 75m (IQR: 20.0-115.0) was noted on the 6-MWT, and this correlated with GMFM score change. Time on the Up&Go test was reduced by a median of 2s (IQR: -3 to - 1) and the change correlated with age, GMFM score at baseline, and the difference observed on the 6-MWT. Results of Lovett's test indicated slight changes in muscle strength. According to the CGI, 75.5% (96/151) of children were seriously (level VI) or significantly ill (level V) at the 1st visit, with any improvement observed in 63.6% (96/151) of patients at the 5th visit, 23.8% (36/151) with improvement (level II) or great improvement (level I). In conclusion, the application of hUC-MSCs generally enhanced functional performance, but individual responses varied. The therapy also benefited children with high level of disability but not to the same extent as the initially less disabled children. Although younger patients responded better to the treatment, older children can also benefit. Trial Registration152/2018/KB/VII and 119/2021/KB/VIII. Retrospective registration in ClinicalTrials: ongoing.

Assessing the Efficacy of Intermittent Intensive Physical Therapy in Pediatric Cerebral Palsy

Background: Cerebral palsy (CP) is a prevalent neurological disorder affecting children worldwide, particularly boys, with spastic CP being the most common form. Despite its prevalence, effective rehabilitation strategies for severely disabled children with CP remain limited. Objective: This study aimed to evaluate the feasibility and effectiveness of a 6-month rehabilitation program for severely disabled children with CP, utilizing alternating intense therapy sessions and rest periods, to enhance gross motor function. Methods: Employing a multiple-baseline design, the study assessed changes in motor performance using the Gross Motor Function Measure (GMFM). Visual and statistical analyses, including descriptive statistics and paired t-tests, were conducted to evaluate outcomes. Results: Participants received an average of 60 treatments over the 20-week trial, exceeding expectations. Seven out of ten children exhibited significant increases in GMFM scores, with a mean improvement of 9.2% (range 3 to 15%; p < 0.05). Importantly, all participants maintained motor function during rest periods, with a high compliance rate of 93.1% during intense therapy. Conclusion: The study highlights the potential of the proposed rehabilitation program to improve gross motor function in severely disabled children with CP. These findings provide valuable insights for developing more effective and sustainable rehabilitation strategies for this population

Effects of additional functional strength training on mobility in children with hemiplegic cerebral palsy

Background: Cerebral palsy (CP) affects the mobility and functional strength of children which leads to a decline in the quality of life of children. Functional strength training may considered objective-oriented to achieve some specific activity level and improve the overall performance of children. Objective: To determine the effects of additional functional strength training on mobility in Children with Hemiplegic Cerebral Palsy (HCP). Method: A single-blind randomized control trial (NCT05878756) was conducted on (n=40) children with hemiplegic cerebral palsy (HCP) at the National Institute of Rehabilitation Science, Islamabad. Children who can follow commands, not using assistive devices, and are not being treated in any other rehabilitation services were included. Children aged 4-12 years were recruited through a non-probability convenient sampling technique and a total of n=40 participants were randomly divided into Group A (n=20) which received conventional therapy along with functional strength training for 4 weeks, while Group B (n=20) only received conventional physical therapy. Both groups received intervention for 4weeks. The tools, Gross Motor Function Measure (GMFM) used for the severity of mobility and, five times sit to stand (FTSST) to assess functional lower extremity strength, transitional movement balance, and fall risk in older adults, were used at baseline and post-treatment assessment. Results: Both groups had improvements in strength and mobility but there was significant improvement in strength and mobility in Group A after 4th week (p≤ 0.05). However, no significant increase in the dimension of lying and kneeling was observed. Comparison between both groups (pre and post-treatment) for dimensions of walking, running, and jumping in both groups showed significant improvement (p=0.045). According to the result of GMFM scoring, a significant improvement in the interventional group (A) as compared to Group B (p=0.003). So, there is a considerable increase in GMFM score for Group A than Group B group. Conclusion: It is concluded that additional functional therapy has a better outcome as compared to conventional therapy on mobility and strength of children with CP. Keywords Cerebral palsy; functional strength training; mobility; Gross Motor Function Measure; Gross Motor Function Classification System

Agreement Between the Gross Motor Ability Estimator-2 and the Gross Motor Ability Estimator-3 in Young Children With Cerebral Palsy.

The purpose of this study was to determine the agreement between Gross Motor Ability Estimator-2 (GMAE-2) and Gross Motor Ability Estimator-3 (GMAE-3) calculations of Gross Motor Function Measure-66 (GMFM-66) scores in infants and young children with cerebral palsy. Data from 53 children 5 to 53 months of age were analyzed. Agreement between GMFM-66 scores using the GMAE-2 and the GMAE-3 was calculated using Bland-Altman plots and interclass correlation coefficients (ICCs). Eleven participants who had at least 1 GMFM-66 score of less than 25 using either method were identified for further analysis. The average difference between GMFM-66 scores was 0.27 for all participants and 0.63 for the subset of lower-scoring participants. Good agreement was found for GMFM-66 scores for all participants (ICC = 0.998) and for subset of lower-scoring participants (ICC = 0.879). High levels of agreement exist between the GMAE-2 and the GMAE-3, which suggests that scores are comparable using either algorithm.

Effect of Translatoric Joint Mobilization on Knee Joint Range of Motion in Spastic Diplegic Children– A Clinical Trial

Background Cerebral palsy ( CP) is a non progressive but often changing, motor impairements due lesions of the Central Nervous System (CNS). Knee flexion contractures are a common secondary complication experienced by spastic children. The purpose of this study was to examine the effects of Translatoric Joint Mobilization (TJM) program to address bilateral knee flexion contractures in diplegic Cerebral Palsy (CP) children. The use of translatoric joint mobilization along with other common Physical Therapy (PT) interventions in this population remains controversial. Objectives 1. To establish the effectiveness of Kaltenborn’s Translatoric Joint Mobilization in improving knee joint range of motion in spastic diplegia and 2. To see improvement in functional mobility as measured by GMFM (88) scoring. Methodology Examination of function and impairment of 30 children with spastic diplegia included Popliteal Angle, Gross Motor Function Measure (GMFM)1 total score and dimension D and E of GMFM. Physiotherapy intervention consisted of Kaltenborn’s Translatoric knee joint mobilization and NDT for group A (experimental), and for group B (control) only NDT. The treatment was given for 6 days a week for 3 weeks. Results After 3 weeks of mobilization, there was significant improvement in popliteal angle and GMFM scoring seen in group A as compared to group B. Conclusion Translatoric joint mobilization proved to be a safe and effective addition to standard PT interventions for knee flexion contractures for the children in this study. The functional impact of improved knee extension was seen as an improvement in GMFM scores.

Abstract 5 Umbilical Cord Blood Treatment to Improve Gross Motor Function in Individuals with Cerebral Palsy: Results from an Individual Participant Data Meta-Analysis

Abstract Introduction Umbilical cord blood (UCB) is a novel treatment for cerebral palsy (CP) with clinical trials indicating UCB is safe and can improve gross motor function. However, heterogeneity across research design, participant selection and treatment protocols has limited the ability to interpret overall treatment effect, identify best responders and dosing thresholds. Objectives We sought to conduct a systematic review and individual participant data meta-analysis (IPDMA) to 1) determine the effect of UCB treatment measured by Gross Motor Function Measure (GMFM) in individuals with CP, and 2) determine the effect of UCB cell dose on clinical improvement. Methods CENTRAL, Embase and Medline were systematically searched for clinical studies administering UCB to individuals with CP with or without a control group/comparator, collecting GMFM scores at baseline and 1, 3, 6 and/or 12 months. Individual de-identified participant data were obtained before being cleaned and coded. A one-stage IPDMA was conducted in R to obtain the pooled effect of UCB and the pooled cell dose effect via linear mixed models, including random effects terms to investigate between-study heterogeneity. Results Individual participant data from nine published and two unpublished studies (seven RCTs and four single-arm studies) were obtained, comprising 285 UCB (+/- erythropoietin, EPO)- treated participants and 171 controls for analysis. Median baseline age was 43 months (range 8-227). Most UCB infusions were allogeneic (80%), and 10/11 studies applied UCB intravenously. The median pre-thaw dose of intravenous-infused UCB was 46.7x10^6 total nucleated cells/kg (range 7.7-210.3). The pooled effect at 6 months post-intravenous UCB was an average change from baseline GMFM-66 of 0.93 (95% CI: 0.12, 1.75; p=0.027) points greater among UCB-treated participants (+/- EPO) compared to controls. There was also a statistically significant positive pooled cell dose effect at 6 months post-intervention (p=0.005), indicating that higher cell doses were associated with greater GMFM-66 increases. There was negligible between-study heterogeneity in both the treatment effect and the cell dose effect at 6 months. Discussion UCB improves gross motor function, and higher dose is beneficial. Future exploration of additional timepoints in addition to co-variates including age at infusion, severity, and etiology is underway and may elucidate responder subgroups and reveal increased efficacy.

Sitting Capacity and Performance in Infants with Typical Development and Infants with Motor Delay

Aims Infants with neuromotor disorders demonstrate delays in sitting skills (decreased capacity) and are less likely to maintain independent sitting during play than their peers with typical development (decreased performance). This study aimed to quantify developmental trajectories of sitting capacity and sitting performance in infants with typical development and infants with significant motor delay and to assess whether the relationship between capacity and performance differs between the groups. Methods Typically developing infants (n = 35) and infants with significant motor delay (n = 31) were assessed longitudinally over a year following early sitting readiness. The Gross Motor Function Measure (GMFM) Sitting Dimension was used to assess sitting capacity, and a 5-min free play observation was used to assess sitting performance. Results Both capacity and performance increased at a faster rate initially, with more deceleration across time, in infants with typical development compared to infants with motor delay. At lower GMFM scores, changes in GMFM sitting were associated with larger changes in independent sitting for infants with typical development, and the association between GMFM sitting and independent sitting varied more across GMFM scores for typically developing infants. Conclusions Intervention and assessment for infants with motor delay should target both sitting capacity and sitting performance.

The Effects of Neurodevelopmental Treatment-Based Trunk Control Exercise on Gross Motor Function and Trunk Control in Children with Developmental Disabilities.

Good trunk control is essential for higher developmental stages as the trunk is activated first when movement occurs, providing stability for the head and extremities. To determine if neurodevelopmental treatment-based trunk control exercise (NDT-TCE) is effective in improving gross motor function and trunk control in children with developmental disabilities (DD). Twenty children with developmental disabilities were randomly assigned to the NDT-TCE (12 children) and control (8 children) groups. After the intervention; the NDT-TCE group showed improvement in GMFM (Gross Motor Function Measure; except for the GMFM-E dimension) and SATCo scores. The control group showed improvement in GMFM-A; B; C; and total scores; as well as static and active control of SATCo. The NDT-TCE group had a significant improvement in the GMFM B dimension and total score compared to the control group. The NDT-TCE group showed a significant improvement in static and active control of SATCo compared to the control group, but there was no significant difference in reactive control. The NDT-TCE intervention specifically improved GMFM-B and trunk control scores. Therefore, NDT-TCE can be applied as a trunk-focused intervention for children with DD who have difficulty controlling their trunk.

Gross motor function profile of children with cerebral palsy in a low-resource setting: A call for reflection on the model of care.

The current study aimed to explore Gross Motor Function Measure (GMFM) profiles among children with cerebral palsy (CP) at various Gross Motor Function Classification System (GMFCS) levels in a low-resource setting. Ambulatory capacity of children with CP was classified using GMFCS levels. Functional ability of all participants was measured using GMFM-88. Seventy-one ambulatory children with CP (61% males), were studied after signed informed consent was obtained from parents and assent from children older than 12 years. Children with CP in a low-resource setting had 12-44% lower GMFM scores in dimensions of standing, walking, running, and jumping with reference to children from high-resource settings with similar ambulatory capacity reported previously. The most affected components across various GMFCS levels were 'sitting on a large and small bench from floor,' 'arm-free squatting,' 'half-kneeling,' 'kneel-walking,' and 'single-limb hop'. Knowledge of GMFM profiles can guide clinicians and policymakers in low-resource settings for strategic rehabilitation planning and extend the focus of rehabilitation from restoration of body structure and function to the wider domain of social participation in leisure, sport, work, and the community at large. Additionally, providing tailored rehabilitation based on a profile of motor function can ensure an economically, environmentally, and socially sustainable future.

Trihexyphenidyl in young children with dystonic cerebral palsy: A single arm study.

The incidence of dystonic cerebral palsy causing significant morbidity is on the rise. There is a paucity of evidence for the management of dystonia in children. Forty-one children aged 6 months-5 years with predominantly dystonic cerebral palsy were started on a predetermined protocol of trihexyphenidyl (0.25-0.52 mg/kg) and followed up at 3, 6 and 12 weeks. Dystonia severity, motor function and developmental age at baseline and 12 weeks were compared using the Global Dystonia Scale (GDS), the Gross Motor Function Measure (GMFM), and Fine Motor/Perceptual Subscale of the Early Developmental Profile-2. Thirty-four children completed the entire 12 weeks of intervention. The mean age of participants was 25±11 months. A significant decrease in median total dystonia scores on the GDS was observed post-intervention (74.5 to 59, p < 0.0001), and 64% of participants gained motor milestones. GMFM scores increased significantly from a median of 19.8% pre-intervention to 26.5% post-intervention (p < 0.0001). There was improvement in the fine motor domain as compared to the baseline (p < 0.0001). The number of children classified at Gross Motor Function Classification System levels 1 and 2 increased to 47.05% from 5.88% in the pre-intervention group. Trihexyphenidyl significantly improved dystonia, motor function and development in children with dystonic cerebral palsy in this study. Additional studies are needed to clarify its role in larger numbers of children with this condition.

Effects of Telerehabilitation-Based Structured Home Program on Activity, Participation and Goal Achievement in Preschool Children with Cerebral Palsy: A Triple-Blinded Randomized Controlled Trial

A home program is implemented as an evidence-based mode of delivering services for physiotherapy and rehabilitation. Telerehabilitation is a method applied in physiotherapy modalities for children. This study aims to determine the effectiveness of usual care plus a Telerehabilitation-Based Structured Home Program on preschool children with cerebral palsy (CP) compared to usual care. Forty-three children aged 3-6 years (mean age 4.66 ± 1.08 years) with CP were randomly assigned to the Telerehabilitation-Based Structured Home Program and usual care groups. Their motor function was assessed with the Gross Motor Function Measure (GMFM); performance and satisfaction were evaluated with the Canadian Occupational Performance Measure (COPM); goal achievement was assessed with the Goal Attainment Scale (GAS); and activity and participation were evaluated with Pediatric Evaluation of Disability Inventory (PEDI). Participants were evaluated at baseline, immediately post-intervention (12 weeks) and at follow-up (24 weeks). There was a statistically significant difference between pre- and post-test GMFM, COPM, GAS and PEDI scores in the intervention and control groups (p < 0.001). The Telerehabilitation-Based Structured Home Program showed statistically significant changes in activity, participation and goal achievement after 12 weeks of intervention (p < 0.001). However, significant results were not obtained in the usual care group. The Telerehabilitation-Based Structured Home Program may be an effective method for preschool children with CP. (Registration number: NCT04807790; no = KA-20124/26.01.2021).

The Effect of Kinesio Taping Over the Gluteal Muscles on Activity and Participation in Children with Unilateral Cerebral Palsy: A Preliminary Randomized Controlled Study

Background: Insufficiencies of gluteus medius and maximus muscles in children with unilateral cerebral palsy (CP) may restrict activity and participation by affecting gait, gross motor functions, and balance. Objectives: The present study aimed to elucidate the effect of Kinesio taping (KT) applied to the gluteus medius and maximus muscles on activity and participation in children with CP. Methods: The study was completed with 20 children with unilateral CP who were randomly divided into 2 groups: The KT group received KT and physiotherapy (n = 11), and the control group received only physiotherapy (n = 9). The KT application was administered for 4 weeks. The activity was evaluated with a BTS G-Walk Spatiotemporal Gait Analysis System, Timed Up and Go test (TUG), Functional Mobility Scale (FMS), Gross Motor Function Measure (GMFM), and Pediatric Balance Scale (PBS); in addition, participation was evaluated using the Canadian Occupational Performance Measure (COPM). Results: The KT group showed significant improvements in the gait parameter (cadence; P = 0.009), pelvic tilt symmetry (P = 0.017), pelvic rotation symmetry (P = 0.018), gait symmetry (P &lt; 0.001), FMS (P = 0.07), TUG, GMFM, PBS, and COPM scores (P &lt; 0.001) in the medium-term compared to the control group. It was also found that gait (cadence; P = 0.004) and functional mobility (P &lt; 0.001) improved in the immediate term than in the KT group. Conclusions: KT combined with conventional physiotherapy can improve cadence and functional mobility in the immediate term, as well as gait and pelvic symmetry, functional mobility, gross motor function, balance, and participation in the medium term in children with unilateral CP. Further randomized controlled studies addressing large samples and long-term effects are warranted.

The Effect of Kinesio Taping Over the Gluteal Muscles on Activity and Participation in Children with Unilateral Cerebral Palsy: A Preliminary Randomized Controlled Study

Background: Insufficiencies of gluteus medius and maximus muscles in children with unilateral cerebral palsy (CP) may restrict activity and participation by affecting gait, gross motor functions, and balance. Objectives: The present study aimed to elucidate the effect of Kinesio taping (KT) applied to the gluteus medius and maximus muscles on activity and participation in children with CP. Methods: The study was completed with 20 children with unilateral CP who were randomly divided into 2 groups: The KT group received KT and physiotherapy (n = 11), and the control group received only physiotherapy (n = 9). The KT application was administered for 4 weeks. The activity was evaluated with a BTS G-Walk Spatiotemporal Gait Analysis System, Timed Up and Go test (TUG), Functional Mobility Scale (FMS), Gross Motor Function Measure (GMFM), and Pediatric Balance Scale (PBS); in addition, participation was evaluated using the Canadian Occupational Performance Measure (COPM). Results: The KT group showed significant improvements in the gait parameter (cadence; P = 0.009), pelvic tilt symmetry (P = 0.017), pelvic rotation symmetry (P = 0.018), gait symmetry (P &lt; 0.001), FMS (P = 0.07), TUG, GMFM, PBS, and COPM scores (P &lt; 0.001) in the medium-term compared to the control group. It was also found that gait (cadence; P = 0.004) and functional mobility (P &lt; 0.001) improved in the immediate term than in the KT group. Conclusions: KT combined with conventional physiotherapy can improve cadence and functional mobility in the immediate term, as well as gait and pelvic symmetry, functional mobility, gross motor function, balance, and participation in the medium term in children with unilateral CP. Further randomized controlled studies addressing large samples and long-term effects are warranted.

AFOs Improve Stride Length and Gait Velocity but Not Motor Function for Most with Mild Cerebral Palsy

Ankle-foot orthoses (AFOs) are prescribed to children with cerebral palsy (CP) in hopes of improving their gait and gross motor activities. The purpose of this retrospective study was to examine if clinically significant changes in gross motor function occur with the use of AFOs in children and adolescents diagnosed with CP (Gross Motor Function Classification System levels I and II). Data from 124 clinical assessments were analyzed. Based on minimum clinically important difference (MCID), 77% of subjects demonstrated an increase in stride length, 45% of subjects demonstrated an increase in walking velocity, and 30% demonstrated a decrease in cadence. Additionally, 27% of the subjects demonstrated increase in gait deviation index (GDI). Deterioration in gait was evident by decreases in walking speed (5% of subjects), increases in cadence (11% of subjects), and 15% of subjects demonstrated decreases in gait deviation index. Twenty-two percent of subjects demonstrated no change in stride lengths and one participant demonstrated a decrease in stride length. However, AFOs improved Gross Motor Function Measure (GMFM) scores for a minority (10%) of children with mild CP (GMFCS level I and II), with 82-85% of subjects demonstrating no change in GMFM scores and 5-7% demonstrating decrease in GMFM scores.

The Effect of Combination of Core Stability Training and Lower Extremity Strength Training on Static Standing Balance Ability in a Child with Down Syndrome

Balance is the ability to stay in one position with good control. Children with a diagnosis of Down syndrome usually have decreased muscle tone (hypotonia) or muscle weakness, so that their balance is disturbed and they are more prone to falling when standing. Core stability and lower extremity strength exercise are expected to improve the ability of static standing balance in children with a diagnosis of Down syndrome. The aim of the study is to determine the effect of giving a combination of core stability and lower extremity strength exercises on the static standing balance ability in children with Down syndrome. This study uses a single subject research on a child with a diagnosis of Down syndrome who is given core stability and lower extremity strength exercise for 4 weeks to improve the ability of static standing balance. The ability of static standing balance in this study was measured using Gross Motor Function Measure (GMFM). Measurements were taken before exercise was given (A1), follow-up (B) and final evaluation (A2). After being given exercise twice for four weeks, there was no increase in the GMFM score, so it was concluded that there was no increase in the ability of static standing balance in children with Down syndrome in this study. In conclusions, giving core stability exercise and lower extremity strength exercise twice for four weeks is considered not to be able to improve the ability of static standing balance in children with Down syndrome.

The Effect of a Horse-Riding Simulator with Virtual Reality on Gross Motor Function and Body Composition of Children with Cerebral Palsy: Preliminary Study.

This study aimed to evaluate the effect of a horse-riding simulator (HRS) with virtual reality (VR) on gross motor function, balance control, and body composition in children with spastic cerebral palsy (CP). Seventeen preschool and school-aged children with spastic CP were included; 10 children in the intervention group (HRS group) received 30 min of HRS with VR training twice a week for a total of 16 sessions in addition to conventional physiotherapy. Seven children in the control group were instructed to perform home-based aerobic exercises twice a week for 8 weeks in addition to conventional physiotherapy. Gross motor function measure (GMFM) and body composition were evaluated before the first session and after the last session. Before and after the 2-month intervention, Pediatric Balance Scale and Timed Up and Go test were evaluated for the HRS group. GMFM scores and body composition changed significantly in the HRS group (p < 0.05). However, no significant differences were observed in the control group. Changes in the GMFM total scores, GMFM dimension D scores, and skeletal muscle mass significantly differed between the HRS and control groups (p < 0.05). HRS with VR may be an effective adjunctive therapeutic approach for the rehabilitation of children with CP.

Estimation of Gross Motor Functions in Children with Cerebral Palsy Using Zebris FDM-T Treadmill.

A standardized observational instrument designed to measure change in gross motor function over time in children with cerebral palsy is the Gross Motor Function Measure (GMFM). The process of evaluating a value for the GMFM index can be time consuming. It typically takes 45 to 60 min for the patient to complete all tasks, sometimes in two or more sessions. The diagnostic procedure requires trained and specialized therapists. The paper presents the estimation of the GMFM measure for patients with cerebral palsy based on the results of the Zebris FDM-T treadmill. For this purpose, the regression analysis was used. Estimations based on the Generalized Linear Regression were assessed using different error metrics. The results obtained showed that the GMFM score can be estimated with acceptable accuracy. Because the Zebris FDM-T is a widely used device in gait rehabilitation, our method has the potential to be widely adopted for objective diagnostics of children with cerebral palsy.

Effect of Electromyographic Biofeedback Therapy on Muscle Strength Recovery in Children with Guillain-Barré Syndrome.

GBS, as an immune-mediated acute inflammatory peripheral neuropathy (Tan and Halpin et al.), with the characteristics of acute onset and rapid progression, is mainly manifested with damages in nerve root and peripheral nerve. The purpose of the study was to investigate the effect of electromyographic biofeedback therapy on muscle strength recovery in children with Guillain–Barré syndrome (GBS). A total of 62 GBS children patients admitted to our hospital from June 2014 to December 2018 were selected and divided into control group (n = 30) and experimental group (n = 32) according to the order of admission. The children patients in the control group received physical therapy combined with occupational therapy (PT + OT), while based on the treatment in the control group, the experimental group children patients were treated with electromyographic biofeedback therapy. After that, the recovery of nerve and muscle at different time points, muscle strength score, gross motor function measure (GMFM) score, and Barthel index (BI) score of the children patients before and after treatment were compared between the two groups. There were no significant differences in the recovery of nerve and muscle of the children patients between the two groups at T0 and T1 (P > 0.05), and the recovery of nerve and muscle of the children patients in the experimental group was significantly better than that in the control group at T2, T3, and T4 (P < 0.001); the muscle strength score, GMFM score, and BI score of the children patients in the experimental group were significantly better than those in the control group after treatment (P < 0.001). The application of electromyographic biofeedback therapy for the treatment of GBS can effectively relieve clinical symptoms, promote rapid recovery, and improve treatment efficacy in children patients, which is worthy of application and promotion.

Gross motor function in children with Congenital Zika Syndrome from Rio de Janeiro, Brazil

Congenital Zika Syndrome (CZS) is characterized by many impairments especially in the central nervous system, potentially compromising neurodevelopment and causing significant morbidity in affected children. The aim was to assess gross motor function in children with CZS. This was a cross-sectional investigation nested within a prospective cohort study of children with CZS based in a Brazilian referral hospital in Rio de Janeiro. Between March/2017 and February/2018, we performed gross motor function assessments using the Gross Motor Function Classification (GMFCS) and the Gross Motor Function Measure (GMFM), estimating the mean and standard deviation of GMFM scores among GMFCS groups. The study sample included 72 children, with a median age of 13 months (7–25). Of these, 63 (87.5%) had severe motor impairment, 3 (4%) had moderate impairment, and 6 (8%) had mild impairment. The mean GMFM score for each group was respectively 11.6, 26.1, and 81.6, with statistically significant differences (p-value < 0.001). Severely affected children only achieved head control in the sitting posture when supported. Children with milder forms were able to develop walking skills.Conclusion: Most children with CZS have major motor disabilities and a poor prognosis. Better understanding of limitations and functionality in children with CZS can serve as a prognostic guide in their management.What is Known:• Severe motor impairment was present in 63 (87.5%) children with CZS.• The degree of neurological impairment was inversely associated with motor performance.What is New:• Microcephaly was more frequent among children with severe gross motor function impairment.• Children with CZS have major motor disabilities and a poor prognosis.