Gross Motor Function Research Articles

Multimodal intraoperative neurophysiological monitoring may better predict postoperative distal upper extremities’ complex-functional outcome than spinal and muscular motor evoked potentials alone in high-cervical intramedullary spinal cord tumor surgery

ObjectiveD-wave can safely monitor the corticospinal-tract (CST)-function regarding gross-motor outcome of lower extremities, but it is still unknown whether i)D-wave can also safely monitor the gross-motor outcome of distal upper extremities in those patients undergoing high-cervical intramedullary-spinal-cord-tumor (IMSCT)-resection (enabling epidural D-wave-placement below C5) and ii)multimodal IONM can also predict fine-motor/complex hand function. MethodsWe prospectively assessed 20 patients undergoing IMSCT-surgery above the C4/5-level with multimodal IONM (D-wave/mMEPs/EMG/SSEPs). Detailed gross-/fine-motor and complex hand function was assessed pre- and postoperatively and during long-term follow-up (mean:29.5 ± 18.8 months) and correlated with IONM-findings. ResultsD-wave monitoring was without intraoperative critical changes in all patients and none had any permanent postoperative gross-motor deficits. However, D-wave did not allow to predict the occurrence of mild permanent postoperative deficits affecting fine-motor function which was the case in 8% for distal upper extremities. The complex distal upper extremities’ function assessed by Nine-Hole-Peg-Test (reflecting the complex motor/sensory interaction for hand-usability) was permanently deteriorated in 15% postoperatively and only the combination of D-wave/mMEPs/EMG/SSEPs was able to provide a viable predictive power (specificity:79%/sensitivity:43%). ConclusionsIn high-cervical IMSCT-surgery, unimpaired D-wave reliably predicts preserved gross-motor function, but fails to sufficiently cover distal upper extremities’ fine-motor/complex function. SignificanceOur study underlines the importance of multimodal IONM for fine-motor/complex hand function.

Supported standing and stepping device use in young children with cerebral palsy, gross motor function classification system III, IV and V: A descriptive study

ABSTRACT This study described and compared use of supported-standing and stepping devices by young children with cerebral palsy, Gross-Motor Function Classification System (GMFCS) levels III-V following power mobility introduction. Data was collected at two time-points, 5–6 months apart, for 42 participants, aged 18–80 months, using the Home Use of Technology for CHildren (HUTCH). Supported-standing and stepping device choice and time in each device remained stable over 6 months. Associations between device use and three functional classifications were examined. Children with more impaired motor, postural and manual abilities were more likely to use a supine stander rather than a prone/upright stander or no stander. Children at GMFCS V tended to use hands-free stepping devices, while support-arms stepping devices were more common for children at GMFCS IV. Only children at GMFCS III used convertible stepping devices. Using power mobility, standers and supported-stepping devices was feasible and 19/34 classified at GMFCS IV/V used all three devices over 6 months. A key finding was that introduction of power mobility did not reduce use of supported-stepping devices at any GMFCS level. Use of multiple upright positioning and mobility devices may assist children with limited mobility to be actively engaged and participate in daily life.

BCKDK deficiency: a treatable neurodevelopmental disease amenable to newborn screening.

There are few causes of treatable neurodevelopmental diseases described to date. Branched-chain ketoacid dehydrogenase kinase (BCKDK) deficiency causes branched-chain amino acid (BCAA) depletion and is linked to a neurodevelopmental disorder characterized by autism, intellectual disability and microcephaly. We report the largest cohort of patients studied, broadening the phenotypic and genotypic spectrum. Moreover, this is the first study to present newborn screening findings and mid-term clinical outcome. In this cross-sectional study, patients with a diagnosis of BCKDK deficiency were recruited via investigators' practices through a MetabERN initiative. Clinical, biochemical and genetic data were collected. Dried blood spot (DBS) newborn screening (NBS) amino acid profiles were retrieved from collaborating centres and compared to a healthy newborn reference population. Twenty-one patients with BCKDK mutations were included from 13 families. Patients were diagnosed between 8 months and 16 years (mean: 5.8 years, 43% female). At diagnosis, BCAA levels (leucine, valine and isoleucine) were below reference values in plasma and in CSF. All patients had global neurodevelopmental delay; 18/21 had gross motor function (GMF) impairment with GMF III or worse in 5/18, 16/16 intellectual disability, 17/17 language impairment, 12/17 autism spectrum disorder, 9/21 epilepsy, 12/15 clumsiness, 3/21 had sensorineural hearing loss and 4/20 feeding difficulties. No microcephaly was observed at birth, but 17/20 developed microcephaly during follow-up. Regression was reported in six patients. Movement disorder was observed in 3/21 patients: hyperkinetic movements (1), truncal ataxia (1) and dystonia (2). After treatment with a high-protein diet (≥ 2 g/kg/day) and BCAA supplementation (100-250 mg/kg/day), plasma BCAA increased significantly (P < 0.001), motor functions and head circumference stabilized/improved in 13/13 and in 11/15 patients, respectively. Among cases with follow-up data, none of the three patients starting treatment before 2 years of age developed autism at follow-up. The patient with the earliest age of treatment initiation (8 months) showed normal development at 3 years of age. NBS in DBS identified BCAA levels significantly lower than those of the normal population. This work highlights the potential benefits of dietetic treatment, in particular early introduction of BCAA. Therefore, it is of utmost importance to increase awareness about this treatable disease and consider it as a candidate for early detection by NBS programmes.

Influence of malnutrition and body composition on the gross motor function of children with cerebral palsy in Kano, Nigeria: a cross-sectional study

BackgroundMalnutrition is common among children with cerebral palsy (CWCP); however, its impact on gross motor function (GMF) is not adequately reported. The study evaluated the influence of malnutrition and body composition on GMF.MethodsIn the cross-sectional survey, CWCP were recruited using purposive sampling from three selected secondary and tertiary hospitals in Kano, Nigeria. Sociodemographic variables were recorded on a data capture form. Anthropometric variables were measured using standard procedures. Percent (%) body fat, malnutrition, and GMF were assessed using skinfold thickness, screening tool for the assessment of malnutrition in pediatrics, and GMF classification system (GMFCS), respectively. The data was analyzed with one-way ANOVA, chi-square, and logistic regression using SPSS version 20 at p < 0.05.ResultsThe 146 CWCP have mean age of 4.70 ± 2.46 years. About 95 (65.1%) are malnourished. Those with GMFCS V had lower %body fat and higher malnutrition than children with GMFCS II and I, respectively (p < 0.05). Malnutrition has no significant influence on GMF (B = 0.984, OR = 2.676; 95% CI = 0.965–7.423, p > 0.05). %body fat (B = −0.192, OR = 0.826; 95% CI = 0.687–0.992, p < 0.05), type of CP (OR = 12.106; 95% CI = 3.771–38.866, p < 0.005), child’s position in the family (OR = 1.639; 95% CI = 1.162–2.312, p < 0.05), and mothers’ education (B = −2.815, OR = 0.060; 95% CI = 0.012–0.309, p < 0.005) all predicted GMF.ConclusionsMajority of the CWCP in this study are malnourished. But malnutrition did not however significantly predict GMF, meaning that though malnutrition could impair children’s physical growth and motor development, it however did not have significant influence on their motor function. Hence, CWCP undergoing rehabilitation may not likely experience significant decrease in their motor function due to inadequate nutrition. Decrease in body fat, type of CP, low level of mothers’ education, and child occupying 4th or more position in the family have negative influence on GMF. It was recommended that physiotherapists should routinely assess for malnutrition in CWCP. Prompt nutritional intervention may prevent considerable lose of body fat and augment the gains of physical rehabilitation by providing appropriate nutrition to support muscle growth and the supply of adequate energy for participation in physical exercise. Adequate caregiver education is important for ensuring satisfactory nutrition for CWCP.

Effectiveness of Dynamic Neuromuscular Stabilisation and Neurodevelopmental Therapy on Gross Motor Function and Trunk Control in Children with Spastic Diplegic Cerebral Palsy: A Protocol for a RCT

Introduction: The Dynamic Neuromuscular Stabilisation (DNS) technique uses feed forward feedback to involuntarily activate the diaphragm and deep abdominal muscles prior to purposeful movement in humans. It is an efficient approach for facilitating deep core muscle activation of the underactive muscle chain consisting of the Internal Oblique (IO), transverse abdominals and diaphragm, thereby enhancing age appropriate jumping, walking and standing, in participants with Spastic Diplegic Cerebral Palsy (SDCP), whereas the primary goal of Neurodevelopmental Therapy (NDT) is to facilitate more normal movement patterns for performing performance skills and rectifying abnormal postural tone. Need of the study: Even though studies have been done in the past, utilising DNS and NDT in children with diplegic CP, for improving core stability, balance, posture and diaphragmatic movement; however, Gross Motor Function (GMF) and trunk control are the aspects that have not been aimed with DNS. There is scarcity in the literature related to impact of DNS on GMF and trunk control in children with diplegic CP. As DNS has specific role on core strength it can be a valuable in the management of trunk control. Because no study comparing the impact of DNS and NDT on trunk control and functions of gross motor in diplegic children has been found; there is a strong need to perform a study to evaluate the same. Aim: To compare the impact of DNS to NDT on gross motor performance and trunk control in children with SDCP. Materials and Methods: It will be a Randomised Clinical Trial (RCT) with the assessor blinded, conducted in the Outpatient Department of Physiotherapy, AVBRH Sawangi, Meghe, Wardha, Maharashtra, India, from July 2022 to April 2023. Following the baseline assessments, children with SDCP (n=36) will be enlisted and randomly assigned into two groups, groups A and group B. Group A will be treated using conventional therapy along with NDT; group B will be given conventional therapy as well as DNS. Treatment will be given for four weeks, five days a week. On the first and the last day of the intervention, primary outcome measures Gross Motor Function Measure-88 (GMFM-88), Trunk Impairment Scale (TIS) and secondary outcome measure Modified Ashworth Scale (MAS) will be employed (on the first day and after the completion of four weeks). Mini-mental Scale Examination (MMSE) will be used as inclusion criteria for the children. Statistical analysis will be carried out using Statistical Package for the Social Sciences (SPSS) software version 27.0. Conclusion: The present study is expected to prove that DNS approach to be successful in enhancing the control of the trunk and gross motor abilities in children with SDCP.

Prevalence and determinants of hip pain in non-ambulatory cerebral palsy children: a retrospective cohort study.

Hip pain is common in cerebral palsy children, particularly at Gross-Motor Function Classification System level IV-V. It is associated to hip displacement and relates to the migration percentage. Recent literature suggested early reconstructive bone surgery, as the best approach to prevent hip luxation, then hip pain. Still, high rates of hip pain are reported. To investigate prevalence and determinants of hip pain in an Italian cerebral palsy sample. Single-center retrospective cohort study. Inpatient and outpatient. Patients with spastic or dyskinetic cerebral palsy, Gross-Motor Function Classification System level IV or V, age 0-18. A chart review was implemented to report hip pain, as a dichotomous variable (pain/no pain), age, sex, cerebral palsy subtype, Gross-Motor Function level, lumbar scoliosis, migration percentage, previous orthopedic surgery, or botulinum injections, oral or intrathecal baclofen, drug-resistant epilepsy, assistive devices for standing or walking. Descriptive statistics and a multivariate logistic stepwise regression were performed. A total of 504 subjects were included: 302 level V, 209 females, 432 spastics. The mean length of follow-up was 6 years. The overall prevalence of hip pain was 8.9% (6.3% were at level V) and of hip dislocation was 19% (15.9% were at level V). Just 39% of dislocated hips were painful. Children at spastic subtype and level V were predominantly affected. Botulinum and soft tissue surgery related to lower rates of hip pain, without statistical significance. Age (OR 1.19, 95%CI 1.14-1.25, P value 0.000), sex (OR 1.72, 95%CI 1.18-2.52, P value 0.005), migration percentage (OR 1.02, 95%CI 1.02-1.03, P value 0.000) and lumbar scoliosis (OR 1.32, 95%CI 0.86-2.01, P value 0.200) resulted significant independent determinants of hip pain. Hip pain relates with the migration percentage, but not all dislocated hips become painful. Hip pain may be transient and requires a targeted and individualized approach. Children at spastic subtype and level V were predominantly affected. Age and sex are confirmed as determinants. Specific validated measures are to be implemented to assess hip pain. Considering severe non-ambulatory cerebral palsy patients, pain and quality of life should be considered as outcomes, in the management of hip luxation.

The Economic Burden and Determinant Factors of Parents/Caregivers of Children with Cerebral Palsy in Malaysia: A Mixed Methods Study.

The economic burden is a major concern for parents/caregivers of children with cerebral palsy (CP). This study used the sequential explanatory mixed-method approach to explorethe economic burden on parents/caregivers with a CP child in Malaysia and the factors associated with the economic burden. The study period spanned April 2020 and December 2020. A total of 106 questionnaire respondents were selected for the quantitative part, and 15 were interviewed to obtain qualitative input. A retrospective costing analysis was conducted based on the cost data obtained from the questionnaire. The majority of the children were GrossMotor Function Classification System (GMFCS) Level 5 (71%), quadriplegic (63%), and aged >4 years (90%). The estimated annual median total economic burden on the parents/caregivers per child in 2020 was RM52,540.00 (~USD12,515.03), with indirect cost being the greatest cost (RM28,800.00, ~USD6860.16), followed by developmental cost (RM16,200.00, ~USD3858.84), direct healthcare cost (RM4540.00, ~USD1081.43) and direct non-healthcare cost (RM3000.00, ~USD714.60). The annual household income was identified as a significant determinant factor (p=0.019, 95% CI: 0.04, 0.40) of the economic burden. The participants’ responses during the in-depth interview in the qualitative part of the study supported the premise that socioeconomic factors play a substantial role in determining the total economic burden. Our findings may aid local policymakers when planning the greater provision of support to the affected families in the future, especially for the parents/caregivers of children with CP, who are facing socioeconomic challenges.

Prevalence, pattern and impact of sleep disturbance on quality of life and exercise participation among children with cerebral palsy in Kano city.

IntroductionSleep disturbance (SD) could have negative impact on the general well-being of children with cerebral palsy (CWCP).ObjectivesThe purpose of this study was to assess the prevalence of SD and its impact on quality of life and exercise participation among CWCP.Material and MethodsIn the cross-sectional study, CWCP and their siblings were recruited from secondary and tertiary hospitals in Kano City. SD, gross motor function (GMF), spasticity and quality of life were assessed with SD scale, GMF classification system, modified Ashworth scale and pediatric quality of life inventory, respectively. Data was analyzed with Mann-Whitney U and chi-square tests, linear and hierarchical regressions using SPSS version 20.0.ResultsThere were 200 CWCP (aged 4.35±8.03 years) and 200 siblings (aged 5.89±3.06 years). The prevalence of SD in CWCP was 31.5%. CWCP suffered more SD than their siblings (p<0.001). SD in CWCP is influenced by GMF level (ß=0.378, p<0.001) and gender (ß=0.16, p<0.05). SD has negative influence on quality of life (ß=-0.18, p<0.001), active participation in home-based (ß=-0.23, p<0.000), and clinic-based exercises (ß=-0.24, p<0.00). GMF levels (ß=-0.505, p<0.0001), hamstring spasticity (ß=-0.250, p<0.005), and age (ß=-0.207, p<0.001) also have influenced on quality of life.ConclusionOne-third of the CWCP suffered pathologic SD, which has negative impact on their quality of life and the ability to actively participate in both home and clinic-based exercises. Aside SD, other factors such as child’s age, spasticity level and severity of motor impairment also affected their quality of life negatively. Enhancing the motor abilities of CWCP may improve their quality of sleep and quality of life.

Factors for changes in self-care and mobility capabilities in young children with cerebral palsy involved in regular outpatient rehabilitation care

BackgroundAssessing prognosis of self-care and mobility capabilities in children with cerebral palsy (CP) is important for goal setting, treatment guidance and meaningful professional-caregiver conversations. AimsIdentifying factors associated with changes in self-care and mobility capabilities in regular outpatient multidisciplinary paediatric CP rehabilitation care. Methods and proceduresRoutinely monitored longitudinal data, assessed with the Paediatric Evaluation of Disability Inventory (PEDI-Functional-Skills-Scale, FSS 0–100) was retrospectively analysed. We determined contributions of age, gross-motor function, bimanual-arm function, intellectual function, education type, epilepsy, visual function, and psychiatric comorbidity to self-care and mobility capability changes (linear-mixed-models). Outcomes and resultsFor 90 children (53 boys), in all Gross-Motor-Function-Classification-System (GMFCS) levels, 272 PEDI's were completed. Mean PEDI–FSS–scores at first measurement (median age: 3,2 years) for self-care and mobility were 46.3 and 42.4, and mean final FSS-scores respectively were 55.1 and 53.1 (median age: 6,5 years). Self-care capability change was significantly associated with age (2.81, p < 0.001), GMFCS levels III-V (-9.12 to -46.66, p < 0.01), and intellectual impairment (-6.39, p < 0.01). Mobility capability change was significantly associated with age (3.25, p < 0.001) and GMFCS levels II-V (-6.58 to -47.12, p < 0.01). Conclusions and implicationsMost important prognostic factor for self-care and mobility capabilities is GMFCS level, plus intellectual impairment for self-care. Maximum capability levels are reached at different ages, which is important for individual goal setting and managing expectations.

The Effects of Aquatic Watsu Therapy on Gross Motor Performance and Quality of Life for Children with Cerebral Palsy

The purpose of this study was to compare the effects of Immersion and Watsu® therapy protocols on children with cerebral palsy. Gross motor function (GMF), spasticity (MAS), and Quality of Life (QoL) parameters of twenty-three children (age: 7.5±2.8, BMI: 17±3.7) were measured. Subjects received Watsu® therapy and Immersion protocols in Watsu-Immersion (W-I, n=12) and Immersion-Watsu (I-W n=11) groups in different periods based on a crossover design. The subjects received sessions for 30 minutes twice a week during 10-week experimental periods. The results were investigated with independent sample t-test and Wilcoxon rank-sum tests, which showed that there was no evidence of carryover effects in GMFM 88 and QoL. In contrast, Watsu® improved GMFM 88 (p&lt;0.05), Quality of Life (p&lt;0.05), and MAS-Upper spasticity (p&lt;0.05), scores significantly compared to immersion. The current results demonstrated the specific benefits of Watsu® therapy on children with CP, confirming the previous anecdotal reports. We recommend Watsu® as a safe and well-accepted complementary intervention for the management of CP.

Hippotherapy: benefits in children with cerebral palsy with application of the Rehabilitation Treatment Taxonomy / Equoterapia: benefícios em crianças com paralisia cerebral com a aplicação da taxonomia de tratamento em reabilitação

Purpose: To explore the effects of hippotherapy for children with cerebral palsy (CP) with different ages, topographies and severities. Method: Before-after study with three longitudinal measurements: (T1) initial, (T2) 3-months, (T3) 6-months after T1. CP children (n=31) stratified by age (4-7; 8-12 years), severity (mild, moderate, severe), topography (hemiplegia, diplegia, quadriplegia), previous hippotherapy time (3-6m, 6 months) undertook their individual weekly 30-minute hippotherapy sessions. Postural control and balance (PCB) was the primary outcome; gross-motor function (GMF) and quality of life (QL) were the secondary outcomes. Results: Changes in PCB associated with changes in GMF. Older children, with mild severity and diplegia had higher PCB and GMF scores between T1 and T3. Age groups’ initial differences in QL disappeared after 6 months. The Rehabilitation Treatment Taxonomy (RTT) guided interpretation of effects. Conclusion: The positive changes in motor and psychosocial outcomes depended on children’s age, time in rehabilitation and type of CP.

Development of a standards-based phenotype model for gross motor function to support learning health systems in pediatric rehabilitation.

IntroductionResearch and continuous quality improvement in pediatric rehabilitation settings require standardized data and a systematic approach to use these data.MethodsWe systematically examined pediatric data concepts from a pediatric learning network to determine capacity for capturing gross motor function (GMF) for children with Cerebral Palsy (CP) as a demonstration for enabling infrastructure for research and quality improvement activities of an LHS. We used an iterative approach to construct phenotype models of GMF from standardized data element concepts based on case definitions from the Gross Motor Function Classification System (GMFCS). Data concepts were selected using a theory and expert‐informed process and resulted in the construction of four phenotype models of GMF: an overall model and three classes corresponding to deviations in GMF for CP populations.ResultsSixty five data element concepts were identified for the overall GMF phenotype model. The 65 data elements correspond to 20 variables and logic statements that instantiate membership into one of three clinically meaningful classes of GMF. Data element concepts and variables are organized into five domains relevant to modeling GMF: Neurologic Function, Mobility Performance, Activity Performance, Motor Performance, and Device Use.ConclusionOur experience provides an approach for organizations to leverage existing data for care improvement and research in other conditions. This is the first consensus‐based and theory‐driven specification of data elements and logic to support identification and labeling of GMF in patients for measuring improvements in care or the impact of new treatments. More research is needed to validate this phenotype model and the extent that these data differentiate between classes of GMF to support various LHS activities.

Effect of Community-Based Functional Aerobic Training on Motor Performance and Quality of Life of Children with Spastic Cerebral Palsy.

Efficacies of community-based exercise programmes have been well reported but there is scarce information on the expediency of community-based rehabilitation in a society where many of children with disabilities live in poorly resourced settings with extremely limited rehabilitative services. The study investigated the effects of community-based functional aerobic exercise (CBFAE) on gross motor function, walking distance, and quality of life of children with cerebral palsy (CP). Quasi-experimental design was used. Children with gross motor function classification system (GMFCS) levels I - II participated in eight weeks CBFAE training four times/week, 50 minutes/day at 40-80% maximum heart rate. Gross motor function (GMF), walk distance and quality of life were assessed pre and post CBFAE training. Significant improvement observed in GMF (Dstanding) (8.2%, P=.000), GMF (E-walking+running+jumping (5.12%, P=.004), walking distance (6.09%, P=.009). Higher significant positive effects of CBFAE observed in Social wellbeing and acceptance (107.10%, P=.000), and participation and physical health (105.04%, P=.005) by children parent proxy. Self-reported results showed that for CBFAE, significant positive improvements were higher in Pain and impact of disability (67.93%, P=.049) and Participation and physical health (60.00%, P=.042). CBFAE training contributes majorly to improved standing, walking, jumping and running and selfesteem, quality of life of children with spastic CP. Clinicians and exercise therapists should essentially incorporate CBFAE training and activities into the management of children with CP for improved mobility and functional performances.

Plantar flexor voluntary activation capacity, strength and function in cerebral palsy.

Distal lower limb motor impairment impacts gait mechanics in individuals with cerebral palsy (CP), however, the contribution of impairments of muscle activation to reduced gross motor function (GMF) is not clear. This study aimed to investigate deficits in plantar flexion voluntary activation capacity in CP compared to typically developed (TD) peers, and evaluate relationships between voluntary activation capacity, strength and GMF. Fifteen ambulant individuals with spastic CP (23 ± 6 years, GMFCS I-III) and 14 TD (22 ± 2 years) people participated. Plantar- and dorsiflexion strength were assessed with a dynamometer. Voluntary activation capacity was assessed using the interpolated twitch technique via single twitch supramaximal tibial nerve stimulation. GMF was assessed using the timed upstairs test, 10m walk test, muscle power sprint test and six-minute walk test. Plantar- and dorsiflexion strength were 55.6% and 60.7% lower in CP than TD (p < 0.001). Although voluntary activation capacity was 17.9% lower on average for CP than TD (p = 0.039), 46.7% of individuals with CP achieved a sufficiently high activation to fall within one standard deviation of the TD mean. Plantar flexion voluntary activation capacity did not correlate with strength (R2 = 0.092, p = 0.314) or GMF measures in the high functioning CP group (GMFCS I-II). In contrast to previous research, plantar flexion activation capacity did not strongly predict weakness or reduced GMF. We propose that muscle size contributes more to weakness than voluntary activation capacity in high functioning individuals with CP and that relationships between muscle activation and functional capacity are complicated by effects at multiple joints.

Effect of Community-Based Functional Aerobic Training on Motor Performance and Quality of Life of Children with Spastic Cerebral Palsy.

Efficacies of community-based exercise programmes have been well reported, but there is scarce information on the expediency of community-based rehabilitation in a society where many children with disabilities live in poorly resourced settings with extremely limited rehabilitative services. This study investigated the effects of community-based functional aerobic exercise (CBFAE) on gross motor function, walking distance, and quality of life of children with cerebral palsy (CP). Quasi-experimental design was used. Children with gross motor function classification system (GMFCS) levels I - II participated in eight weeks CBFAE training four times/week, 50 minutes/day at 40-80% maximum heart rate. Gross motor function (GMF), walking distance and quality of life were assessed pre and post CBFAE training. Significant improvement was observed in GMF (Dstanding) (8.2%, P=.000), GMF (E-walking + running+ jumping (5.12%, P=.004), walking distance (6.09%, P=.009). Higher significant positive effects of CBFAE were observed in Social wellbeing and acceptance (107.10%, P=.000), and participation and physical health (105.04%, P=.005) by children parent proxy. Self-reported results showed that for CBFAE, significant positive improvements were higher in pain and impact of disability (67.93%, P=.049) and participation and physical health (60.00%, P=.042). CBFAE training contributes majorly to improved standing, walking, jumping and running and self-esteem, quality of life of children with spastic CP. Clinicians and exercise therapists should essentially incorporate CBFAE training and activities into the management of children with CP for improved mobility and functional performances.

Educational exercise program affects to physical fitness and gross motor function differently in the severity of autism spectrum disorder.

This study investigated the effects of participating in an educational exercise program on physical fitness and gross motor function (GMF) in adults with varying degrees of autistic spectrum disorder (ASD). The subjects consisted of 35 voluntary male participants between 20 and 29 years of age who were allocated to one of two groups: mild ASD (n=17) group and severe ASD (n=18) group. All selected tests for physical fitness, including body composition and GMF, have been used in previous studies. The results were as follows: first, with the exception of the basal metabolic rate, there were significant differences in the interaction of all other body composition variables. Second, there were significant differences in the interaction of almost all physical fitness variables, except for muscle strength. Finally, although there were significant differences in the interaction of all variables, except the locomotion skill for hopping, there were significant differences in the interaction of all variables of object control skill. Specifically, although the Δ% in the sum of locomotion skill in mild ASD group increased ~19.81%, that of severe ASD group decreased ~4.78%. The Δ% in the sum of object control skill in mild ASD group improved ~29.96%, while that of severe ASD group reduced ~15.2%. In conclusion, it is thought that these results are due to the better understanding of educational exercise and better performance of educational exercise in adults with mild ASD compared to adults with severe ASD.

Physical activity and motor skill outcomes of a 10-week intervention for children with intellectual and developmental disabilities ages 4–13: A pilot study

BackgroundChildren with intellectual and developmental disabilities (IDD) often experience increased barriers to engaging in physical activity (PA) which can stem from lack of gross motor function (GMF) development. Intervening on GMF at an early age can create better opportunities for children with IDD to engage in regular PA. In turn, increased PA can improve health outcomes and increase social skills. ObjectiveThe primary objective of this pilot study was to explore the effectiveness of a community-based GMF-focused PA intervention for improving overall motor skills and PA for children with IDD. MethodsAll study participants (n = 24) engaged in 10 weeks of programming for 1 h each week. A convenience sample was utilized. ResultsResults indicated no statistically significant changes pre to post for motor skill scores. However, a visual analysis of mean changes showed a consistent pattern of increased scores from pre to post on most skills. Additionally, we found that a change in participant locomotor skills significantly predicted change in Moderate to Vigorous Physical Activity (MVPA), F (1,11) = 5.16, Adj R2 = .26, p = .04. ConclusionsThese results suggest individualized attention on GMF may help to increase motor skills for children with IDD. This study adds to the small but growing amount of research examining the efficacy of community based adapted PA interventions. Further, study results should support continued exploration of effective approaches to address the motor delays experienced by children with IDD.

Spastik Serebral Palsili Çocuklarda Gövde Eğitiminin Gövde, Üst ve Alt Ekstremite Motor Fonksiyonları Üzerine Etkisi: Tabakalı Randomize Kontrollü Çalışma

Objective: The aim of this study was to investigate the effects of trunk training on the trunk, upper and lower limb motor functions of children with bilateral spastic Cerebral Palsy. Methods: 36 children were recruited for this study; 19 children were included in the trunk training group and 17 children were included in the control group. Motor functions of the children were assessed by the Trunk Control Measurement Scale, Gross Motor Function Measurement, Quality of Upper Extremity Skills Test, Pediatric Balance Scale, Gillette Functional Assessment Scale, Functional Independence Measure for Children and Impact on Family Scale at baseline and after an 8 week of intervention period. Wilcoxon Signed-Rank Test and Mann–Whitney U Test were used to assess the differences. Results: The Trunk Control Measurement Scale (p=0.008), Gross Motor Function Measurement (p=0.047), Quality of Upper Extremity Skills Test (p=0.032), Pediatric Balance Scale (p=0.006), Gillette Functional Assessment Scale (p=0.011) and Functional Independence Measure for Children (p=0.03) scores improved in favor of the trunk training group (p&amp;lt;0.05). Conclusion: Individually structured trunk training is a promising method to improve trunk, upper and lower extremity motor functions and activity levels of children with bilateral spastic Cerebral Palsy.

Longitudinal Association Between Human Parechovirus Central Nervous System Infection and Gross-Motor Neurodevelopment in Young Children.

A paucity of studies investigated the association between human parechovirus (HPeV) central nervous system (CNS) infection and motor and neurocognitive development of children. This study describes the gross-motor function (GMF) in young children during 24 months after HPeV-CNS infection compared with children in whom no pathogen was detected. GMF of children was assessed with Alberta Infant Motor Scale, Bayley Scales of Infant and Toddler Development or Movement Assessment Battery for Children. We conducted multivariate analyses and adjusted for age at onset, maternal education and time from infection. Of 91 included children, at onset <24 months of age, 11 had HPeV-CNS infection and in 47 no pathogen was detected. Nineteen children were excluded because of the presence of other infection, preterm birth or genetic disorder, and in 14 children, parents refused to consent for participation. We found no longitudinal association between HPeV-CNS infection and GMF (β = -0.53; 95% confidence interval: -1.18 to 0.07; P = 0.11). At 6 months, children with HPeV-CNS infection had suspect GMF delay compared with the nonpathogen group (mean difference = 1.12; 95% confidence interval: -1.96 to -0.30; P = 0.03). This difference disappeared during 24-month follow-up and, after adjustment for age at onset, both groups scored within the normal range for age. Maternal education and time from infection did not have any meaningful influence. We found no longitudinal association between HPeV-CNS infection and GMF during the first 24-month follow-up. Children with HPeV-CNS infection showed a suspect GMF delay at 6-month follow-up. This normalized during 24-month follow-up.

Human parechovirus meningitis and gross-motor neurodevelopment in young children.

This multicenter prospective cohort study describes the impact of human parechovirus meningitis on gross-motor neurodevelopment of young children. Gross-motor function was measured using Alberta Infant Motor Scale. Of a total of 38 eligible children < 10months of age at onset, nine cases had clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid; 11 had no meningitis and polymerase chain reaction positive for human parechovirus in nasopharyngeal aspirate, blood, urine, or feces; and in 18, no pathogen was identified (reference group).The children with human parechovirus meningitis showed more frequent albeit not statistically significant suspect gross-motor function delay (mean Z-score (standard deviation) - 1.69 (1.05)) than children with human parechovirus infection-elsewhere (- 1.38 (1.51)). The reference group did not fall in the range of suspect gross-motor function delay (- 0.96 (1.07)). Adjustment for age at onset and maternal education did not alter the results.Conclusion: Six months after infection, children with human parechovirus meningitis showed more frequent albeit not statistically significant suspect gross-motor function delay compared to the population norm and other two groups. Longitudinal studies in larger samples and longer follow-up periods are needed to confirm the impact and persistence of human parechovirus meningitis on neurodevelopment in young children. What is Known: • Human parechovirus is progressively becoming a major viral cause of meningitis in children. • There is keen interest in the development of affected infants with human parechovirus meningitis. What is New: • This study describes prospectively gross-motor functional delay in children with both clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid. • It shows the importance of screening young children for developmental delay in order to refer those with delay for early intervention to maximize their developmental potential.