ObjectiveTo investigate the effects of a two-week robot-assisted gait training (RAGT) program on walking performance and brain activation in children with spastic hemiplegic cerebral palsy (CP).DesignSingle-group, pre-post pilot study.MethodsEight children with CP were enrolled; six completed the protocol and provided usable gait and functional MRI (fMRI) data. Participants received 10 RAGT sessions over two weeks. Walking performance (6-min walk test [6MWT], 10-meter walk test [10MWT], GAITRite gait speed and cadence) was assessed at baseline, immediately after the intervention, and at one-month follow-up. Pre- and post-intervention fMRI during a lower-limb motor task quantified activated voxels in motor and cerebellar regions.Results6MWT distance, 10MWT speed, and GAITRite gait speed and cadence improved significantly (all p ≤ 0.009) at post-intervention and follow-up versus baseline. In children with isolated subcortical lesions (n = 4), activated voxels during the lower-limb task increased in the lesioned motor cortex (from 363 to 1,075; p = 0.02), with similar increases in ipsilesional cerebellar hemispheres (p = 0.02), whereas no significant changes were seen in children with additional hydrocephalus (n = 2). Change in cadence correlated positively with change in lesioned motor cortex activation (Spearman's ρ = 0.83, p = 0.03).ConclusionsIn this small cohort, a two-week RAGT program was associated with short-term improvements in walking performance and increased fMRI activation in motor-related regions, particularly in children with subcortical lesions. These preliminary, lesion-type-specific findings suggest neuroplastic responses to RAGT that warrant confirmation in larger controlled studies.

BackgroundBalance training on different surfaces is important in the rehabilitation of children with spastic cerebral palsy. However, the impact of balance training on different surfaces on ankle proprioception has not yet been investigated. This study aims to investigate the effects of balance exercises performed on rough and smooth unstable surfaces on ankle proprioception and dynamic balance in children with spastic cerebral palsy.MethodsThe study included 16 children aged 5–10 years with spastic hemiplegic and diplegic type cerebral palsy who were at the Gross Motor Function Classification System Level I and II. The children participating in the study were randomly assigned to two groups. One group performed balance exercises comprising six movements on a balance board for an average of 10 min following a 45-minute physical therapy session on a smooth surface, while the other group performed the same exercises on a rough surface. The intervention was conducted twice weekly for a duration of eight weeks. Balance was assessed using the Pediatric Balance Scale, the Functional Reach Test, and the Single Leg Stance Test. A digital goniometer was used to assess ankle joint proprioception.ResultsSignificant improvement was observed in balance test scores in both groups. However, in the joint position sense tests for 15° dorsiflexion and plantar flexion on both the dominant and non-dominant sides, significant improvement was observed only in children who performed exercises on the rough balance surface (p < 0.05).ConclusionsBalance training on unstable surfaces was found to be effective in improving balance parameters, with training on rough surfaces demonstrating greater efficacy than training on smooth surfaces in enhancing ankle proprioception.Trial registrationNCT05676983 (03/01/2023; retrospectively).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06346-5.

Constraint-induced movement therapy combined with Nogo-A downregulation enhances corticospinal tract remodeling and motor function in hemiplegic cerebral palsy mice.

Constraint-induced movement therapy (CIMT) is an intervention for hemiplegic cerebral palsy (CP) that has a strong evidence base. CIMT has been shown to be effective in improving functional use of the more impaired upper extremity, yet has not become standard practice. Toolkits have been effectively used in various settings to increase intervention implementation; however, no guide currently exists to support clinical decision-making related to CIMT. To provide an overview of the development of a practical guide for pediatric CIMT (pCIMT) that will aid therapists, other health care professionals, and families with children who may be eligible for pCIMT. Model development research. Virtual communication secured in accordance with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191). Content experts (N = 12) with expertise related to pCIMT, hemiplegic CP, and occupational therapy who were recruited via purposive sampling to develop the practical guide. Development of the practical guide followed a toolkit developmental model. Field notes were used to record all verbal and written feedback provided by content experts. The participants provided recommendations to include in the guide during the developmental phase. In two rounds of the expert review phase, they recommended revisions related to readability, content, and visuals. The final practical guide included six sections. A practical guide was developed to support occupational therapists, health care professionals, and caregivers in making an informed decision about whether pCIMT is the right intervention for a particular child. Plain-Language Summary: Hemiplegic cerebral palsy is the most common motor disability that affects children, and it often causes difficulty moving one side of the body. Pediatric constraint-induced movement therapy (pCIMT) is an evidence-based intervention to help children use their more affected side. However, pCIMT is not widely available. With guidance from key informants, we designed a practical guide to support health care professionals and families in determining whether pCIMT could be an appropriate intervention. A three-phase toolkit development model was followed to design the practical guide. In this article, we report on Stages 1 and 2 (the development and expert review phases). Twelve experts and caregivers informed the development of the six sections of the practical guide. Future research should proceed to Stage 3 (the evaluation phase) to evaluate the effectiveness of the practical guide and identify implementation strategies for the guide to support pCIMT usage.

Cortical development malformations result from disruptions in neuronal migration, leading to a spectrum of brain abnormalities with significant clinical implications. This case report presents a 1-year-old male with hemiplegic cerebral palsy, without a history of seizures—an atypical presentation for cortical migration disorders. Brain magnetic resonance imaging (MRI) revealed extensive cortical abnormalities, including features of focal cortical dysplasia (FCD), polymicrogyria, and subcortical heterotopia, along with asymmetric hemispheric changes suggestive of hemispheric dysplasia rather than classical hemimegalencephaly (HME). The imaging findings were crucial in differentiating between overlapping entities such as hemimegalencephaly, and hemispheric dysplasia. This case emphasizes the pivotal role of early neuroimaging in evaluating infants with neurological deficits, even when seizures are not present, and highlights the importance of a detailed and individualized approach to diagnosing intricate cortical malformations.

Background. Hemiplegic cerebral palsy presents with lateralized impairments that may influence developmental outcomes. While literature suggests lesion laterality affects domains such as language and spatial awareness, clinical consensus remains unclear. Purpose. To determine whether rehabilitation professionals observe differences in development or functional outcomes between right and left hemiplegia in children. Method. A cross-sectional survey of licensed pediatric rehabilitation professionals was conducted. Quantitative data were analyzed using descriptive statistics, Chi-square test and logistic regression. Qualitative responses were thematically analyzed. Results. 63.3% of total (n=49) pediatrics rehabilitation professionals report perceiving difference between hemiplegia types. Right hemiplegia was significantly associated with speech and language difficulties with a 61.3% of all participants. Motor deficits were the most commonly observed domain with 74.2% of participants. Cultural factors, such as religious emphasis on right-hand use, were noted to influence rehabilitation outcomes. Conclusion. The findings of this study, supported by previous literature, reinforce the hypothesis that developmental and functional differences are perceived between left and right hemiplegic cerebral palsy. Rehabilitation specialists should adopt a holistic approach that considers both lesion severity and cultural norms influencing perceptions of development and function. Integrating neurobiological and sociocultural factors is essential for individualized rehabilitation strategies.

The quest for effective treatments for cerebral palsy (CP) remains a significant challenge, crucial for improving outcomes in affected individuals. This study aimed to evaluate the therapeutic effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on lower limb function in children with hemiplegic cerebral palsy (HCP) through a controlled clinical trial. Forty children with HCP were randomly assigned to either a sham stimulation group or an rTMS treatment group, with 20 participants in each. The rTMS group received low-frequency rTMS in conjunction with conventional rehabilitation, while the sham group received sham stimulation paired with the same rehabilitation. Conventional rehabilitation included physical therapy, occupational therapy, orthopedic shoes, acupuncture, and other training modalities. Treatments were administered 5 days a week for 12 weeks. We assessed gross and fine motor skills, spasticity, and gait parameters before and after treatment using the modified Ashworth scale (MAS), dorsiflexion angle, gross motor function measure 88 (GMFM-88), Gesell developmental scale, and plantar pressure gait analysis. After 12 weeks, both groups exhibited improvements in MAS scores of the affected hamstring muscle, dorsiflexion angles, GMFM-88 D and E zone scores, Gesell developmental scale scores (gross motor), and gait parameters (P < .05). Notably, the rTMS group demonstrated significantly greater improvements (P < .05). Low-frequency rTMS combined with conventional rehabilitation therapy leads to better outcomes in gross and fine motor functions while reducing spasticity and improving gait parameters in children with HCP compared to sham stimulation.

Background. The hemiplegic form of cerebral palsy (CP) is the most prognostically promising in terms of the possibilities of correction and social adaptation of disabled children. However, the main limitation of successful rehabilitation is severe limb muscle spasticity, because so reducing muscle hypertonicity is a priority task in this disease. The aim. To evaluate the effectiveness of improved method for correcting of upper limb spasticity in children with the hemiplegic form of CP. Materials and methods. An open, non-randomized, prospective, comparative study was conducted involving two groups of patients with spastic hemiplegia with predominant damage to the upper limb, compared to the case-control type. The control group of children (n = 20) was treated using standard methods – drug therapy, exercise therapy, massage, physiotherapy; the main group (n = 20) was additionally prescribed exercises on the new medical simulator "Glove". The study participants in the groups were compared by gender, age and severity of motor impairment. The course in comprehensive rehabilitation lasted 10 days. The effectiveness of the improved method for correcting upper limb spasticity was assessed by studying the dynamics of motor function indices using scales for assessing muscle tone (modified Ashworth scale) and manual skills (Frenchai and ARAT tests, V.G. Bosykh and N.T. Pavlovskaya method). Results. The additional inclusion of training using the new medical simulator for correcting upper limb spasticity "Glove" in the rehabilitation program for children with hemiplegic CP allowed achieving a significantly better treatment result with a significant decrease in muscle tonus, an increase in the volume and accuracy of movements, including in the section of small differentiated acts, with the elimination of the phenomenon of the «learned non-use» phenomenon. Conclusions. The use of a new medical simulator in the complex therapy of children with spastic hemiplegia allows increasing its effectiveness relative to standard rehabilitation methods. However, the question of the long-term effect remains open and requires an assessment of longer-term use of the simulator in the interhospital period.

Correlation between arch height index, spatiotemporal gait parameters and plantar pressure in children with spastic hemiplegia cerebral palsy.

HighlightsWhat are the main findings?This is the first trial comparing Kinesio taping and rigid taping in children with hemiplegic cerebral palsy.Both taping types improved motor function, walking, balance, and functional capacity.What is the implication of the main finding?Taping can be used as an effective adjunct in pediatric neurorehabilitation to enhance functional outcomes.Background/Objectives: This randomized, single-blinded trial compared the effects of Kinesio taping (KT) and rigid taping (RT) on gross motor function, balance, and functional capacity in children with hemiplegic cerebral palsy (HCP). Methods: Fifty-two children (aged 7–16) were assessed using the Gross Motor Function Measure (GMFM), Pediatric Berg Balance Scale (PBBS), Time-Up-and-Go (TUG), and 2-Minute Walk Test (2-MWT). Results: Both KT and RT produced significant intra-group improvements in GMFM, PBBS, TUG, and 2-MWT scores (p ≤ 0.001). Although nonparametric analysis suggested greater changes for KT in TUG and 2-MWT (p < 0.001; p = 0.036), no significant inter-group differences were found when baseline scores were adjusted using the General Linear Model (GLM) (2-MWT: p = 0.29; TUG: p = 0.087). Conclusions: KT and RT are similarly effective adjuncts to physiotherapy, improving gross motor function, balance, and functional capacity in children with HCP. Therefore, the choice between KT and RT may be guided by clinical preference, child tolerance, and therapeutic goals rather than superiority of effect.

To find the effectiveness of Mirror therapy in improving arm functions in Hemiplegic cerebral Palsy child

Herein, we reported a case of right median nerve injury due to concurrent melorheostosis in an 11-year-old male patient followed for right hemiplegic cerebral palsy (CP). The patient was diagnosed with CP at 17 months of age due to weakness on the right side. During follow-up, melorheostosis, a bone dysplasia, was detected on radiographs taken due to the progressive contractures in the right hand. When the patient was four years old, electromyography was performed due to complaints of progressive weakness and pain in the right hand, and total axonal damage was detected in the median nerve. The patient's follow-ups were interrupted due to the coronavirus disease 2019 (COVID-19) pandemic. Although the pain decreased with splint and exercise treatments, functional progress could not be achieved. The patient was referred to hand surgery. However, the patient, who was not considered for surgery, continued to be managed with splint and exercise. Diagnosis of nerve injury due to melorheostosis can be difficult in an extremity affected by CP, as the motor deficits associated with CP can mask or complicate the recognition of additional nerve damage. Electrodiagnostic and ultrasonographic evaluations may be required in addition to physical examination. In cases of CP where new symptoms and motor skill loss develop, close monitoring and appropriate differential diagnosis are important.

Literature has identified disparities in reaching patterns between children with cerebral palsy and typically developing children. However, determining the spatiotemporal parameters that effectively quantify upper limb motor performance and examining the relationship between these parameters and spasticity level remains a challenge. This study aimed to investigate the relationship between the level of spasticity and the spatiotemporal parameters and detect which parameter is the most influenced by spasticity level. Fifty children with hemiplegic cerebral palsy participated and were asked to reach forward, at a self-selected pace, toward one target at a normalized distance under one level of accuracy. An optoelectronic system captured three-dimensional spatiotemporal parameters quantifying the movement time, velocity, strategy and smoothness of forward reaching. Spearman rank correlation coefficient was used to investigate the strength of the relationship between the level of spasticity and the spatiotemporal parameters (P˂0.05). Regression analysis was used to model the relationship between the studied variables and to investigate the impact of spasticity on the studied kinematic parameters. The level of spasticity was significantly correlated with normalized jerk score (NJS), number of movement units and peak velocity respectively (r = .0.7-0.8). The regression model was statistically significant (p < .001), and explained a significant proportion of the variances of the studied parameters especially NJS (R2 = 0.972) and NMU (R2 = 0.953). NJS is the most influenced parameter by the level of spasticity; therefore, it can be used as an index to quantify the impact of spasticity on reaching performance and to evaluate the effectiveness of treatment strategies on motor recovery.

IntroductionAdapted sports complement traditional rehabilitation for children with cerebral palsy (CP), who require continuous intervention to maintain motor function. This pilot study investigates the feasibility of using a climbing game combined with force sensors to quantify motor asymmetries in children with hemiplegic CP.MethodsEight children with hemiplegic CP participated in climbing games for three consecutive days. Force sensors embedded in the holds measured reaction forces, while marker-less motion capture linked these forces to specific limbs. Two indices, maximum force () and mean force (), were calculated for each limb as potential proxyes for motor asymmetry. Statistical analysis using repeated measures ANOVA assessed the ability of these indices to differentiate between the more and less affected limbs.ResultsThe maximum force index () successfully identified significant differences between the more affected and less affected arms in all activities (), with stronger results during structured tasks (). However, neither the maximum nor the mean force indices demonstrated significant discriminatory power for the legs, likely reflecting compensatory strategies or reduced asymmetry in the lower limbs.DiscussionThis pilot study supports the potential of as a robust index to quantify upper limb motor asymmetry. Such an index could be used by therapists to track the evolution of a child’s motor abilities through a game, rather than through less pleasant clinical evaluations. The findings highlight the need for further research to validate these indices in larger cohorts, investigate their longitudinal evolution during rehabilitation, and explore correlations with clinical motor assessments.ConclusionThe results confirm the feasibility of using climbing-based force indices to detect motor asymmetries in children with hemiplegic CP. Future studies could leverage this methodology to provide quantitative feedback on the efficacy of rehabilitation interventions, fostering personalized and engaging therapeutic approaches.

This case report describes the combined use of whole-body vibration (WBV), serial casting (SC), and physical therapy (PT) for a child with hemiplegic cerebral palsy (HCP). A 3-year 10-month-old male with HCP was followed for 10months. Treatment included 9weeks of SC due to ankle plantarflexion contracture, hypertonicity, poor orthotic tolerance, and gait limitations. WBV was introduced during week 4 to address hypertonicity and poor tolerance of manual therapy. PT sessions included stretching, gait training, and strengthening exercises, integrating SC and WBV into a comprehensive intervention. This is the first report to explore combining WBV and SC within a PT program. WBV was safe and effective, potentially serving as a preparatory activity for SC. Improved orthotic wear tolerance, dorsiflexion range of motion, and gait efficiency suggest potential benefits of this multimodal approach, warranting further research.

Effects of foot intrinsic muscle dynamic stretching intervention on static balance, gait parameters and gross motor ability with hemiplegic cerebral palsy: a randomized controlled pilot study.

Selective dorsal rhizotomy (SDR) is a proven surgical treatment of spastic diplegia to improve function in patients suffering from spasticity compared to physical therapy alone. Few studies have addressed the benefit for those with spastic hemiplegia. The aim of this study was to describe and evaluate the efficacy of SDR in patients with spastic hemiplegia. A retrospective chart review was performed on pediatric patients (< 18 years of age) who underwent SDR at Monroe Carell Jr. Children's Hospital from July 2013 through January 2024 with a diagnosis of spastic hemiplegic cerebral palsy. Patients underwent pre- and postoperative physical therapy testing at approximately 1 year. Any patients found to have spastic triplegia with asymmetrical hypertonia in the lower extremities, or those without postoperative evaluations, were excluded. Outcome measures included the modified Ashworth Scale (mAS), Gross Motor Function Measure-66 (GMFM-66), timed (10 m) walk test, Gross Motor Function Classification System (GMFCS), and the Pediatric Quality of Life Cerebral Palsy (PedsQL CP) module. Pre- versus postoperative comparisons were performed using a Wilcoxon signed-rank test and the differences were considered statistically significant when p values were < 0.05. Twenty-one patients underwent SDR for spastic hemiplegic cerebral palsy with pre- and postoperative physical therapy assessments. The patients were 52.4% male, 81.0% White, with a median age of 5 years at the time of surgery. The most common etiology for spastic hemiplegia was stroke (52.4%). All patients had a preoperative GMFCS level of I (85.7%) or II (14.3%). The median percentage of rootlets cut during the procedure was 60% on the affected side. The sum of the mAS extremity score was improved by 5 points (p < 0.001), the GMFM-66 score was improved by a median of 3.1 (p = 0.002), while the PedsQL CP module improved by a median of 12.3 percentage points (p = 0.003). Orthotic use was reduced from 90.5% preoperatively to 66.7% at follow-up. SDR is an effective treatment in patients with spastic hemiplegia resulting in significant improvement in motor function, quality of life, and tone.

Background: Hemiplegic cerebral palsy (HCP) is a motor dysfunction disorder resulting from perinatal developmental brain injury, predominantly impairing upper limb function in children. Nonetheless, there has been insufficient research on the brain activation patterns and inter-brain coordination mechanisms of HCP children when performing motor control tasks, especially in contrast to children with typical development(CD). Objective: This cross-sectional study employed functional near-infrared spectroscopy (fNIRS) to systematically compare the cerebral blood flow dynamics and brain network characteristics of HCP children and CD children while performing upper-limb mirror training tasks. Methods: The study ultimately included 14 HCP children and 28 CD children. fNIRS technology was utilized to record changes in oxygenated hemoglobin (HbO) signals in the bilateral prefrontal cortex (LPFC/RPFC) and motor cortex (LMC/RMC) of the subjects while they performed mirror training tasks. Generalized linear model (GLM) analysis was used to compare differences in activation intensity between HCP children and CD children in the prefrontal cortex and motor cortex. Finally, conditional Granger causality (GC) analysis was applied to construct a directed brain network model, enabling directional analysis of causal interactions between different brain regions. Results: Brain activation: HCP children showed weaker LPFC activation than CD children in the NMR task (t = −2.032, p = 0.049); enhanced LMC activation in the NML task (t = 2.202, p = 0.033); and reduced RMC activation in the MR task (t = −2.234, p = 0.031). Intragroup comparisons revealed significant differences in LMC activation between the NMR and NML tasks (M = −1.128 ± 2.764, t = −1.527, p = 0.025) and increased separation in RMC activation between the MR and ML tasks (M = −1.674 ± 2.584, t = −2.425, p = 0.031). Cortical effective connectivity: HCP group RPFC → RMC connectivity was weaker than that in CD children in the NMR/NML tasks (NMR: t = −2.491, p = 0.018; NML: t = −2.386, p = 0.023); RMC → LMC connectivity was weakened in the NMR task (t = −2.395, p = 0.022). Conclusions: This study reveals that children with HCP exhibit distinct abnormal characteristics in both cortical activation patterns and effective brain network connectivity during upper limb mirror training tasks, compared to children with CD. These characteristic alterations may reflect the neural mechanisms underlying motor control deficits in HCP children, involving deficits in prefrontal regulatory function and compensatory reorganization of the motor cortex. The identified fNIRS indicators provide new insights into understanding brain dysfunction in HCP and may offer objective evidence for research into personalized, precision-based neurorehabilitation intervention strategies.

Objectives: This review seeks to evaluate the effectiveness of electrical stimulation (ES) in improving upper limb function in children and young people (CYP) with hemiplegic cerebral palsy (HCP). Methods: A systematic literature search from inception until May 2025 was conducted. Various study designs comparing the effect of different ES techniques such as functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous spinal cord stimulation (TSCS), and transcranial direct current stimulation (tDCS) on upper limb function in CYP with HCP were included. Results: Eighteen studies were selected for review and quality assessment, comprising twelve randomised controlled trials (RCTs) and six non-RCTs. FES was shown to improve upper limb function, though more rigorous and controlled research is needed. Both TENS and NMES demonstrate potential to improve upper limb function, particularly when combined with other interventions. The analysis suggests that variability in reporting tDCS outcomes hinders assessment of its potential benefits for improving upper limb function. Conclusions: Current research suggests ES may support upper limb rehabilitation in CYP with HCP, though the overall evidence remains limited. Most studies are small, underpowered, and lack long-term follow-up, limiting confident conclusions. ES should therefore be applied cautiously and only as part of a comprehensive rehabilitation plan.

Introduction: Cerebral palsy is a group of disorders that affect the development of movement, balance, posture, and muscle tone. According to Charlotte Metz et al, it occurs in 2 out of 1000 live childbirths. Due to the unwillingness of children to be restrained in the method of application of Constrained-induced Movement Therapy (CIMT), mCIMT was developed. Studies suggest mCIMT is more effective than CIMT in improving motor function in hemiplegic cerebral palsy. Aim: The study aims to find a standard treatment protocol for mCIMT for treating hemiplegic cerebral palsy. Search engines like Google Scholar, Research Gate, Cochrane, SAGE Journals, and Academia, were electronically searched. An article was included if, the articles consisted of treating cerebral palsy children through mCIMT, or mCIMT combined with other treatments or comparative studies with bimanual therapy. Results: A total of studies accounted for the study, from which 9 studies were purely contingent on mCIMT, and 10 studies included comparative studies of bimanual therapy and mCIMT. Five articles had mCIMT as the treatment along with other conventional treatments. Nine studies were excluded as they did not meet the inclusion criteria. The studies included were mostly Randomised Controlled Trials (RCTs), pilot studies, multisite trials, systematic reviews, and meta-analyses. All 24 articles were read thoroughly to identify the particular time frame, length of the treatment, and specific tasks used by the therapists. They suggested that time varies from 1 to 3 hours a day of intensive treatment with up to 6 hours of constraint, 3 to 7 days a week, and a 2-10 weeks treatment period. The repetition of each activity may vary from 10 rep to 20 rep for 5 to 20 minutes. The tasks included catching and throwing a ball, using paint, clay, and manipulating sand. Puzzles, pegboards, card games, and functional activities are also included. Conclusion: In conclusion, the treatment protocol for mCIMT may vary in time, days, and weeks. More studies are needed for a specific time duration for a single activity.