Gross Motor Function Measure Research Articles

Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Infants With Unilateral Cerebral Palsy

ImportanceEarlier detection of cerebral palsy (CP) and the high neuroplastic potential during the first years of life have motivated a search for early interventions to improve children’s long-term motor abilities.ObjectiveTo determine the effectiveness of baby Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) to improve motor function in infants with unilateral CP (UCP).Design, Setting, and ParticipantsThis parallel group, 1:1, randomized clinical trial was conducted between December 1, 2020, and September 9, 2022, in infants recruited through centers specializing in CP treatment and parents’ spontaneous applications. Therapy took place in Brussels, Belgium, from March 8, 2021, through June 17, 2022. Infants were matched in pairs by age and lesion type and randomized to either the treatment or control group. Infants were assessed at baseline (T0) and 1 (T1) and 3 months (T2) follow-up. Inclusion criteria were aged 6 to 18 months at T0 (corrected age if preterm birth), a diagnosis or being at risk of UCP, and the ability to comply with the testing and training procedures. Exclusion criteria were uncontrolled seizures, botulinum toxin injections, orthopedic surgery, or specific intensive therapy within 6 months before and until the end of the study.InterventionInfants in the treatment group received 50 hours of baby HABIT-ILE over 2 weeks, while those in the control group continued their usual motor activities.Main Outcomes and MeasuresThe primary outcome was use of the more affected hand as measured using the Mini-Assisting Hand Assessment (Mini-AHA). Secondary outcomes included Canadian Occupational Performance Measure (COPM) performance and satisfaction scores, Gross Motor Function Measure-66 (GMFM-66) scores, and other motor and functional outcomes. Between-group comparisons were calculated using repeated-measures analysis of variance (2 groups × 3 assessment times). Effect sizes were reported as partial η squared (ηp2) (small, 0.01; medium, 0.06; large, 0.14).ResultsOf the 48 infants entering the study, 46 (mean [SD] age, 13.3 [4.1] months; 27 boys [58%]) were included in the final analyses, with 24 in the treatment group and 22 in the control group. Group × assessment time interactions showed significant improvements that favored the treatment group for the Mini-AHA (mean [SE] difference from T0 to T2, 7.4 [1.4] Mini-AHA units in the treatment group vs 1.9 [1.5] Mini-AHA units in the control group; P = .008; ƞp2 = 0.11) and for both parts of the COPM (mean [SE] difference from T0 to T2, 5.0 [0.4] in the treatment group vs 2.9 [0.4] in the control group; P < .001; ƞp2 = 0.35 for the performance score and 4.4 [0.4] in the treatment group vs 2.1 [0.4] in the control group; P < .001; ƞp2 = 0.33 for the satisfaction score). Although both groups improved in the GMFM-66 (mean [SE] difference from T0 to T2, 6.6% [0.7%] logits in the treatment group vs 5.5% [0.7%] logits in the control group; P < .001; ηp2 = 0.68), there was no significant interaction (P = .43; ηp2 = 0.02).Conclusions and RelevanceThis randomized clinical trial demonstrates the feasibility of delivering 50 hours of HABIT-ILE over a 2-week period in infants with UCP. These findings show that the intervention is effective in improving motor abilities, as revealed by an increase in the use of the more affected hand in bimanual tasks and in enhanced reported functional goal outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT04698395

Equine assisted services - an intervention in the motor disorders of a child with cytomegalovirus sequelae

Cytomegalovirus infection (CMV) represents the most prevalent infection correlated with congenital neurological impairment. After infection occurs several factors contribute for the child to have motor development deficits and possibly present several neurological manifestations. Equine assisted services- therapeutic and educational method that uses the horse within an interdisciplinary approach has shown positive results in the intervention of neurological dysfunctions. The objective to analyze the effect of equine assisted services on the gross motor function of a participant with sequelae caused by CMV infection. A quantitative and descriptive case study. It consisted of assessments pre- and post-equine assisted services interventions using the Gross Motor Function Measure (GMFM). The child participating in the study is classified as level III according to the Gross Motor Function Classification System (GMFCS). The results indicate a percentage increase in the total average between the pre- and post-intervention assessments, with results of 31.9 and 50.3%, respectively, and evolution in three of the five dimensions assessed through the GMFM, which are: lying and rolling, sitting, crawling and kneeling. It is concluded that equine assisted services are an effective tool for improving gross motor function of a participant with sequelae caused by cytomegalovirus infection.

Effects of Treadmill Walking and Overground Walking in Young Children With Non-progressive Neurodevelopmental Disorders.

Introduction Neurodevelopmental disorders (NDDs) are responsible for childhood brain dysfunction and developmental disability. Physical therapists are important team members in providing a beneficial impact on the gross motor function of children with NDDs. Early intervention provides a beneficial effect on the improvement of gross motor function; however, most of the studies on treadmill training were in late age and the effect of early treadmill walking along with conventional physiotherapy was not studied. Hence, the objective of the present study was to compare the effect of overground walking with treadmill walking in young children aged 12-36 months with non-progressive NDDs. Methodology An experimental study was performed for one year on diagnosed cases of non-progressive NDD. A total of 36 children with non-progressive NDD were recruited for the study between the ages of 12 and 36 months of either gender and were allocated into treadmill walking and overground walking groups. The intervention was given for eight consecutive weeks, four days per week, and for 20-25 minutes per day. The children were assessed using Gross Motor Function Measure-66 (GMFM-66) and Peabody Developmental Motor Scale-2 (PDMS-2) for both stationary and locomotion components. Results The comparison of both the groups with PDMS-2 (stationary) at baseline, follow-up, and post intervention reported mean values of 25.56 ± 12.16, 27.22 ± 11.74, and 28.44 ± 11.72, respectively, in the overground walking group and 28.72 ± 8.96, 29.72 ± 9.46, and 31.33 ± 8.85 in the treadmill walking group, respectively, with statistically significant results (p = 0.0022). Additionally, the comparison of both the groups with PDMS-2 (locomotion) reported mean values of 35.78 ± 24.02, 39.11 ± 23.21, and 43.00 ± 23.58, respectively, in the overground walking group and 39.67 ± 22.28, 43.17 ± 22.94, and 46.61 ± 24.16 in the treadmill walking group, respectively, with statistically significant results (p = 0.020). Moreover, the comparison of both the groups with total GMFM-66 reported mean values of 16.97 ± 14.52, 18.35 ± 14.88, and 20.49 ± 16.86, respectively, in the overground walking group and 18.52 ± 14.28, 21.66 ± 15.76, and 25.92 ± 16.95 in the treadmill walking group with statistically significant results (p = 0.0118). Conclusion The present study concluded that between both the groups, a statistically significant difference was observed for PDMS-2 (stationary and locomotion)and GMFM-66 after a scheduled intervention of eight weeks. Hence, walking should be carried out as a part of therapy in early intervention and further studies can be performed to determine the long-term effect of these interventions and their role in the prevention of secondary complications.

Precision measurement of rehabilitation interventions-a secondary analysis of motor error in a clinical trial with young children with cerebral palsy.

The delivery of precision medicine in rehabilitation will require not only precise measurement of participant response, but also precise measurement of the "ingredients" of intervention and their dose. As an example, we report the measurement of motor error in two treatment groups from a randomized controlled trial in toddlers (mean age 26.3 months) with cerebral palsy (CP). Our objective was to measure the type and amount of motor error during physical therapy sessions in young children with CP. Participants were stratified by motor function and age and randomly allocated to "conventional" physical therapy that generally prevented falls or to an intervention that encouraged error experience by not preventing falls (experimental group). Baseline motor and cognitive function were measured using the Gross Motor Function Measure-66 (GMFM-66) and Bayley 3 cognitive subscale (B3-C) prior to randomization. Randomly selected video recorded therapy sessions were manually coded to identify losses of balance defined as falls (child contacted floor), rescues (therapist prevented fall) or saves (child recovered their balance independently). Average number of losses of balance per session were higher in the experimental group than the conventional group due to significantly greater falls. Saves were infrequent in both groups but were also significantly higher in the experimental group. Average number of rescues did not differ between groups. In the experimental group, greater frequency of falls was significantly related to GMFM-66. In both groups, greater frequency of saves was related to GMFM-66. Neither total losses of balance per session nor rescues were related to GMFM-66 in either group. There were no significant relationships between losses of balance and baseline cognition in either group, except greater frequency of saves was related to higher cognitive ability in the experimental group. Our observations suggest that motor error experience is lower in toddlers with CP compared to peers with typical development but can be manipulated to higher doses of error during therapy sessions. Future work should investigate the relationship between type and amount of error experience and rehabilitation outcomes, as well as other "ingredients" of rehabilitation therapy. Tools to automate the precise measurement of intervention content are necessary for broad scale implementation.

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.

Effectiveness of Task-Oriented Training in Improving Gait in a Child with Ataxic Cerebral Palsy: A Case Report

This case report examines the impact of task-oriented training on gait improvement in a child with Ataxic Cerebral Palsy (CP), a rare subtype characterized by balance and coordination difficulties. The goal was to determine the effectiveness of this intervention in enhancing gait stability, motor coordination, and overall mobility. A 6-year-old boy with Ataxic CP underwent task-oriented training for five days per week over a four-week period. Each session lasted one hour and included lower limb strengthening, coordination exercises, stretching, and walking practice. The Holden Gait Scale (HG) and Gross Motor Function Measure (GMFM) were used to evaluate changes in the child's gait and motor function pre- and post-intervention. After one week of therapy, the child demonstrated reduced tremors and attempted to climb stairs independently. By the end of the four-week period, the child was able to walk approximately 200 meters indoors without displaying a high-guard posture, although supervision was still required when navigating stairs. Improvements in gait stability and balance were observed, though the scissor gait persisted. Task-oriented training proved to be an effective approach in improving gait stability and motor coordination in a child with Ataxic CP. However, challenges such as upper limb high guarding and scissor gait remained, indicating the need for further personalized rehabilitation strategies. Future research should focus on integrated interventions to address these residual issues and enhance the long-term outcomes for children with Ataxic CP.

The Small Step Early Intervention Program for Infants at High Risk of Cerebral Palsy: A Single-Subject Research Design Study.

Background/Objectives: Early interventions for infants at high risk of cerebral palsy (CP) are recommended, but limited evidence exists. Our objective was, therefore, to evaluate the effects of the family-centered and interprofessional Small Step early intervention program on motor development in infants at high risk of CP (ClinicalTrials.gov: NCT03264339). Methods: A single-subject research design was employed to investigate participant characteristics (motor dysfunction severity measured using the Hammersmith Infant Neurological Examination (HINE) and Alberta Infant Motor Scale (AIMS) at three months of corrected age (3mCA) related to intervention response. The repeated measures Peabody Developmental Motor Scales-2 fine and gross motor composite (PDMS2-FMC and -GMC) and Hand Assessment for Infants (HAI) were analyzed visually by cumulative line graphs, while the Gross Motor Function Measure-66 (GMFM-66) was plotted against reference percentiles for various Gross Motor Function Classification System (GMFCS) levels. Results: All infants (n = 12) received the Small Step program, and eight completed all five training steps. At two years of corrected age (2yCA), nine children were diagnosed with CP. The children with the lowest HINE < 25 and/or AIMS ≤ 6 at 3mCA (n = 4) showed minor improvements during the program and were classified at GMFCS V 2yCA. Children with HINE = 25-40 (n = 5) improved their fine motor skills during the program, and four children had larger GMFM-66 improvements than expected according to the reference curves but that did not always happen during the mobility training steps. Three children with HINE = 41-50 and AIMS > 7 showed the largest improvements and were not diagnosed with CP 2yCA. Conclusions: Our results indicate that the Small Step program contributed to the children's motor development, with better results for those with an initial higher HINE (>25). The specificity of training could not be confirmed.

Acupuncture and Acupoints for Managing Pediatric Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials.

Acupuncture is frequently used to manage pediatric cerebral palsy (CP), yet updated evidence is needed to guide future research and clinical practice. Seven databases were searched from 1994 to 26 June 2023. Randomized controlled trials (RCTs) involving body, scalp, or ear acupuncture for managing CP, excluding acupoint injection, catgut embedding, electro-acupuncture, or laser acupuncture, were included. Twenty RCTs with 1797 participants were analyzed. Acupuncture groups had better improvements in gross motor function measure (GMFM) scores by 5% (mean difference: 5.93, 95% CI: 3.67-8.19, p < 0.001, I2 = 57%); a 16% higher probability to yield prominent improvement in effectiveness rate (ER) (risk ratio: 1.16, 95% CI: 1.08-1.25, p < 0.001, I2 = 0%); and better outcomes in the Modified Ashworth Scale (MAS) (standardized mean difference [SMD]: 0.3, 95%, CI: 0.11-0.49, p < 0.001, I2 = 0%), the Berg Balance Scale (BBS) (SMD: 2.48; 95% CI: 2.00-2.97, p < 0.001, I2 = 72%) and ADL (SMD: 1.66; 95% CI: 1.23-2.08, p < 0.001, I2 = 91%). Studies with eight core acupoints identified from all ninety-five acupoints had better ER. Acupuncture, especially using core acupoints, may be effective for managing symptoms in children with CP.

Quality of Life and Motor Function in Children with Spina Bifida and Hydrocephalus: Impact on Family Functioning in Indian Rural Population

Background &amp; Purpose: Spina Bifida means “open spine”, and refers to a common congenital birth defects involving a failure of the neural tube to close or to remain closed during early embryogenesis. A significant complication for infants born with myelomeningocele is the onset of hydrocephalus. In rural Indian populations, where socioeconomic constraints and healthcare accessibility are significant challenges, the correlation between motor function and QoL becomes a critical area of investigation. Thus, the purpose of this study is to explore quality of life and motor function in children with spina bifida and hydrocephalus… its impact on family functioning in Indian rural population. Methodology : 20 Subjects with spina bifida and hydrocephalus, age 6 –10 years, both male and female with mean age of 47.30 months were assessed for their demographic profile according to selection criteria. They were assessed for quality of Life by using PedsQL Infant scoring Scale, Family functioning by using PEDSQLFIS, Motor function by using Gross Motor Function Measure (GMFM), socioeconomic status using Modified Kuppuswamy Socioeconomic Scale. The data was collected and computed in a systematic way and then analysed by using SPSS 20. Results : Correlational analysis was done. Statistically significant correlation was found in duration of operation and GMFM, PedsQL Infant scoring Scale and GMFM. Conclusion : This study shows that children with spina bifida and hydrocephalus in rural India benefit from better quality of life when they have improved motor skills. However, the impact of family dynamics, socioeconomic status, and the length of surgery on their quality of life was less clear. Overall, while good motor function is strongly linked to a better quality of life, other factors also play a role.

Assessment and Prognostic Resources for Gross Motor Development in a Child with Cerebral Palsy Related to Congenital Zika Syndrome.

This article describes how the Gross Motor Ability Estimator (GMAE) software can provide important information based on the Gross Motor Function Measure (GMFM)-66 score of a child with congenital Zika syndrome.A child was assessed at 9, 17, and 25 months of age through the GMFM-66. At 2 years, the child's gross motor ability was estimated and classified according to the Gross Motor Function Classification System (GMFCS).At 2 years of age, the child in this case required assistance to roll and was unable to maintain antigravity trunk posture in sitting position, typical abilities of GMFCS level V.GMAE can be useful to guide health professionals that care for children with lifelong physical and developmental care needs. This is the first study that demonstrated how to use the GMAE in this specific population.

Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy

BackgroundCerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP.MethodsThe current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.ResultsThere was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.ConclusionsSDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.

Overground Gait Training With a Wearable Robot in Children With Cerebral Palsy: A Randomized Clinical Trial.

Cerebral palsy (CP) is the most common developmental motor disorder in children. Robot-assisted gait training (RAGT) using a wearable robot can provide intensive overground walking experience. To investigate the effectiveness of overground RAGT in children with CP using an untethered, torque-assisted, wearable exoskeletal robot. This multicenter, single-blind randomized clinical trial was conducted from September 1, 2021, to March 31, 2023, at 5 rehabilitation institutions in Korea. Ninety children with CP in Gross Motor Function Classification System levels II to IV were randomized. The RAGT group underwent 18 sessions of RAGT during 6 weeks, whereas the control group received standard physical therapy for the same number of sessions during the same period. The primary outcome measure was the Gross Motor Function Measure 88 (GMFM-88) score. Secondary outcome measures were the GMFM-66, Pediatric Balance Scale, selective control assessment of the lower extremity, Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), 6-minute walking test scores (distance and oxygen consumption), muscle and fat mass via bioelectrical impedance analysis, and gait parameters measured via 3-dimensional analysis. All assessments were performed for all patients at baseline, at the end of the 6-week intervention, and after the 4-week follow-up. Of the 90 children (mean [SD] age, 9.51 [2.48] years; 49 [54.4%] male and 41 [45.6%] female) in the study, 78 (86.7%) completed the intervention, with 37 participants (mean [SD] age, 9.57 [2.38] years; 19 [51.4%] male) and 41 participants (mean [SD] age, 9.32 [2.37] years; 26 [63.4%] male) randomly assigned to the RAGT and control groups, respectively. Changes in the RAGT group significantly exceeded changes in the control group in GMFM-88 total (mean difference, 2.64; 95% CI, 0.50-4.78), GMFM-E (mean difference, 2.70; 95% CI, 0.08-5.33), GMFM-66 (mean difference, 1.31; 95% CI, 0.01-2.60), and PEDI-CAT responsibility domain scores (mean difference, 2.52; 95% CI, 0.42-4.63), indicating independence in daily living at postintervention assessment. At the 4-week follow-up, the RAGT group showed significantly greater improvements in balance control (mean difference, 1.48; 95% CI, 0.03-2.94) and Gait Deviation Index (mean difference, 6.48; 95% CI, 2.77-10.19) compared with the control group. In this randomized clinical trial, overground RAGT using a wearable robot significantly improved gross motor function and gait pattern. This new torque-assisted wearable exoskeletal robot, based on assist-as-needed control, may complement standard rehabilitation by providing adequate assistance and therapeutic support to children with CP. CRIS Identifier: KCT0006273.

Combined effects of functional task training with electrical stimulation on motor abilities and balance in children with diplegia

BackgroundChildren with spastic diplegic cerebral palsy (CP) often demonstrate gluteus medius weakness that causes balance deficits and frequent falling during walking.PurposeThe aim of the study was to evaluate the combined effects of functional task training with electrical stimulation of bilateral hip abductor muscles on motor abilities (standing and walking) and balance in children with spastic diplegic CP.MethodsThirty children with diplegic CP of both sexes whose ages ranged from 7 to 10 years were assigned randomly into two equal groups. For both groups, motor abilities were assessed by gross motor function measure (GMFM), and balance (static and dynamic) was assessed by the humac balance system before and after the study. The control group received a functional training program focusing on standing walking and balance exercises. While children in the study group received the same functional training program with bilateral electrical stimulation of gluteus medius muscles for 50 min. The treatment program for both groups was conducted for 3 sessions/week for 8 weeks.ResultsThere were statistically significant differences between the control and study group post-treatment in GMFM as well as the center of pressure test and weight shift test in favor of the study group (p < 0.05).ConclusionUsing functional task training with electrical stimulation for treatment of children with spastic diplegic CP have significant effects on improving their motor abilities and balance that suggests using it in rehabilitation for these children.

The Relationship Between Postural Torticollis Abnormalities and Plagiocephaly on the Early Motor Development Milestones of Lying and Rolling Activities in Infants: A Retrospective Study

ABSTRACT The study examined how neck muscle imbalance and plagiocephaly affect the lying and rolling activities in 118 infants aged 4 to 6 months with postural torticollis. Outcome measures included age, sex, cervical movement, and plagiocephaly severity. Neck muscle function was assessed with the Muscle Function Scale (MFS), and infant motor abilities in lying and rolling were evaluated through the corresponding dimensions of the Gross Motor Function Measure (GMFM). Multiple regression analysis showed that a better MFS score of the affected neck was significantly associated with improved lying and rolling activities in the GMFM (p < .01), and importantly, the interaction between the plagiocephaly and the MFS scores of the affected neck muscle in these activities was found to be significant (p < .05). These results highlight the need for early intervention in infants with torticollis to address muscle imbalance and plagiocephaly, crucial for early motor development (KCT0008367).

Functioning and activity outcomes of the Akwenda Intervention Program for children and young adults with cerebral palsy in Uganda: A cluster-randomized trial.

To evaluate the efficacy of the Akwenda Intervention Program on motor, self-care, and social function of children and young people with cerebral palsy (CP). This was a cluster-randomized, controlled, single-blinded, intervention study of 100 participants with CP (2-23 years; 52 males) in rural eastern Uganda. Half were allocated to the intervention program, the remainder served as waitlist controls. Gross Motor Function Measure-66 (GMFM-66) and the Ugandan version of Pediatric Evaluation of Disability Inventory (PEDI-UG) were collected before group allocation and after intervention. General linear models and t-tests were used to compare changes within and between groups. Cohen's d estimated the effect size of group differences. Change scores were evaluated by age and mobility subgroups. Significant group by time interactions were found for GMFM-66 (p =0.003) and PEDI-UG outcomes (p <0.001), except mobility, with the intervention group demonstrating greater changes. Both groups increased their scores on the GMFM-66 and child PEDI-UG, while only the intervention group had significant increases in caregiver assistance scores and across all age and mobility subgroups. Cohen's d showed large effect sizes (d >0.8) of differences for PEDI-UG outcomes except mobility. The Akwenda Intervention Program had a large positive impact on functioning and activity across age and mobility levels.

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.

The Impact of Botulinum Toxin Combined with Robot-Assisted Gait Training on Spasticity and Gross Motor Function on Children with Spastic Cerebral Palsy

ABSTRACT Objective To evaluate the impact of combining botulinum toxin-A (BoNT-A) injection with robot-assisted gait training (RAGT) on lower limb spasticity and motor function in children with cerebral palsy. Methods A prospective study was conducted from January 2020 to January 2023, including 68 patients. Twenty patients received the combination of BoNT-A injection and RAGT, while 48 received BoNT-A injection alone. Assessments were performed before the intervention and at 1, 3, and 6 months post-injection using the Modified Tardieu Scale (MTS), sections D and E of the Gross Motor Function Measure-88 (GMFM-88), 6-minute walk test (6MWT), and 10-meter walk test (10MWT). Results Compared to the control group receiving BoNT-A alone, the combination of BoNT-A and RAGT did not significantly improve spasticity-related outcomes, including MTS scores, R1, and R2 angles (p > .05). However, the combination group demonstrated significantly improved gross motor function, particularly in walking, running (GMFM-E), short-term walking endurance (6MWT), and walking speed (10MWT) in children with cerebral palsy after the intervention (p < .05). Conclusion While the addition of RAGT did not enhance the anti-spasticity effects of BoNT-A, it significantly improved gross motor function and walking abilities in children with cerebral palsy.

White matter characteristics in children with cerebral palsy prior to selective dorsal rhizotomy: a multicenter diffusion tensor imaging study.

The aims of this study were to 1) assess and quantify white matter (WM) microstructural characteristics derived from diffusion tensor imaging (DTI) in children with cerebral palsy (CP) prior to selective dorsal rhizotomy (SDR), and 2) investigate potential associations between WM diffusion properties and gross motor function and spasticity in children with spastic CP who underwent SDR. This study is a multisite study based on DT images acquired prior to SDR as well as postoperative outcome data. DTI data collected from two sites were harmonized using the ComBat approach to minimize intersite scanner difference. The DTI abnormalities between children with spastic CP and controls were analyzed and correlated with the severity of impaired mobility based on the Gross Motor Function Classification System (GMFCS). The improvement in gross motor function and spasticity after SDR surgery was assessed utilizing the Gross Motor Function Measure-66 (GMFM-66), the Modified Tardieu Scale (MTS), and the modified Ashworth scale (MAS). Alterations in these outcome measures were quantified in association with DTI abnormalities. Significant DTI alterations, including lower fractional anisotropy (FA) in the genu of the corpus callosum (gCC) and higher mean diffusivity (MD) in the gCC and posterior limb of the internal capsule (PLIC), were found in children in the SDR group when compared with the age-matched control group (all p < 0.05). Greater DTI alterations (FA in gCC and MD in gCC and PLIC) were associated with lower mobility levels as determined based on GMFCS level (p < 0.05). The pre- to post-SDR improvement in motor function based on GMFM-66 was statistically significant (p = 0.006 and 0.002 at 6-month and 12-month follow-ups, respectively). The SDR efficacy was also identified as improving spasticity in lower-extremity muscle groups assessed with the MTS and MAS. Partial correlation analysis presented a significant association between pre- to post-SDR MTS alteration and DTI abnormalities. The findings in the present study provided initial quantitative evidence to establish the WM microstructural characteristics in children with spastic CP prior to SDR surgery. The study generated data for the association between baseline DTI characteristics and mobility in children with CP prior to SDR surgery. The study also demonstrated SDR efficacy in improving motor function and spasticity based on the GMFM-66, MTS, and MAS, respectively, in association with DTI data.

Effect of Physiotherapy on Preterm Neonates and its Results on Five-Year-Old Children, According to GMFM - GMPM Evaluation Scales.

The purpose of this study is to emphasize the necessity and possibilities of early intervention and physiotherapy rehabilitation of premature infants, as they are reflected in five-year olds according to the gross motor function measure (GMFM) and gross motor performance measure (GMPM) evaluation scales for gross function and quality of movement. In addition, the present study examined the importance of using assessment tools for children who have received or not therapeutic intervention, through which both the child's abilities and appropriateness of the help received by him/her are evaluated based on individual needs. Our specific exploratory process was carried out through a literature review as well as a process of primary research, in order to obtain and collect all necessary information and data which would finally lead us to the nearest and best conclusions. Our goal was to collect 20 complete and graded GMFM and 20 GMPM assessment tests, so that our research was based on a satisfactory sample of participants. In the next year, the scores received by participants were recorded and analyzed using the statistical software program SPSS (Superior Performance Software System). The analysis was performed through descriptive and inductive statistical analysis in the SPSS statistical program. Specifically, the SPSS version 20.0 and specifically the one-way ANOVA variance analysis and the Tukey's parametric test were used for the statistical analysis of the results. The use of physiotherapy care was found to be important for premature infants, as the level of statistical significance was set at p <0.05, while the data were reported as average. The final overall scores of the evaluations (on average) were higher in the group who received early intervention and specialized physiotherapy intervention from the first day after birth. The effect of physiotherapy on premature infants is positive in five-year-old children, who have completed almost all their developmental stages at that age. These benefits become apparent not only in a better handling of kinetic patterns and sequences but also in the ability to execute kinetic models, conquer developmental motor stages and perform them with quality in terms of alignment, sequence, synergy of movements, separation and stability.

Palliative single-level selective dorsal rhizotomy for children with spastic cerebral palsy Gross Motor Function Classification System level IV and V: a case series and systematic review of the literature.

Single-level selective dorsal rhizotomy (SDR), typically indicated for ambulatory patients, is a controversial topic for severe spastic cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level IV or V. The objective of this case series and systematic literature review was to outline the indication and outcome of palliative SDR for nonambulatory patients with CP and GMFCS level IV and V, focusing on improvement of spasticity and of patient and caregiver reported quality of life assessment. A retrospective case series of patients with CP and GMFCS level IV or V who underwent single-level SDR at the authors' institution is presented. Furthermore, two databases (PubMed and Embase) were searched and a systematic review with a search string based on the terms "selective dorsal rhizotomy," "cerebral palsy," and "outcome" was conducted. The primary outcome was the reduction of spasticity based on the modified Ashworth scale (MAS). Secondary outcomes were change on the Gross Motor Function Measure-66 (GMFM-66), evaluation of patient-reported outcome measures (PROMs), surgical morbidity, and mortality. Eleven consecutive children under the age of 25 years undergoing palliative single-level SDR were included. All patients showed a reduction in MAS score (mean 1.09 ± 0.66 points) and no surgical morbidity and mortality occurred. For the systematic review results from our case series, in addition to 4 reports, 274 total patients were included. Reduction of spasticity based on MAS score was noted in all studies (mean range 1.09-3.2 points). Furthermore, in 2 studies spasticity of the upper extremities showed a MAS score reduction as well (range 1.7-2.8 points). The GMFM-66 score improved in 72% of the patients, while bladder function improved in 78% of the patients. Based on the PROMs, 92% of the patients/caregivers were satisfied with the outcome and their quality of life after the procedure. Two wound infections (2.7%) and one CSF leak (1.3%) occurred, while no surgery-related deaths were described. This analysis showed an improvement in spasticity, daily care, and comfort for patients with CP and GMFCS levels IV and V. Larger cohorts analyzing the outcome of palliative single-level SDR, based on the MAS, GMFM-66, and PROMs, are still needed and should be the focus of future studies. Systematic review registration no.: CRD42024495762 (https://www.crd.york.ac.uk/prospero/).