Cerebral palsy (CP) causes permanent motor impairments, limiting postural control and mobility. The Dubousset Functional Test (DFT) was developed to assess daily activity performance, but its reliability and validity in pediatric CP are unclear. This study aimed to evaluate its reliability, convergent and discriminative validity, and clinical utility in children with spastic CP at GMFCS Levels I - II. Thirty-three children aged 6-15 years with spastic CP (GMFCS I - II) participated in this cross-sectional methodological study. The DFT (Rise-and-Walk, Step, Sit-to-Stand, and Dual Task subtests) was administered along with the Timed Up and Go (TUG), Dual-task TUG, 3-Meter Backward Walk Test (3MBWT), Functional Reach Test (FRT), and Pediatric Balance Scale (PBS). All assessments were conducted twice, seven days apart, by a single experienced physiotherapist. The DFT demonstrated excellent reliability, with ICC(3,2) values ranging from 0.91 to 0.95 and minimal measurement bias (-0.61 to 0.36 s). The smallest detectable change (SDC) ranged from 2.1 to 13.0 s, confirming high measurement precision. Strong correlations were observed between the DFT Dual Task and both TUG (r = 0.95, p < .001) and Dual-task TUG (r = 0.95, p < .001), supporting convergent validity. ROC analysis indicated excellent discriminative accuracy for identifying children with balance limitations (PBS < 45) (AUC = 0.82, sensitivity = 0.81, specificity = 0.78). The DFT is a reliable, valid, and clinically feasible tool for assessing balance and mobility in ambulatory children with spastic CP at GMFCS I - II, supporting routine rehabilitation use. ClinicalTrials.gov (NCT06831591).

The calcaneo-cuboid-cuneiform (triple-C) osteotomy is indicated for the correction of symptomatic flexible planovalgus foot deformity. This procedure allows correction of all of the varied components of the planovalgus foot deformity in a single operation1,2. The patient is positioned in a floppy lateral position2. The calcaneus is exposed via an oblique lateral incision along the peroneal tendons. The osteotomy is performed in an extra-articular fashion beginning posterior to the posterior articular facet and extending distally and anteriorly to the inferior surface of the calcaneus. The posterior calcaneal fragment is displaced medially to allow correction of heel valgus. A separate lateral incision is made over the cuboid in order to expose it. An osteotomy is performed in the middle third of the cuboid without violating the adjacent joints and opened with a lamina spreader to allow correction of the forefoot abduction. The medial cuneiform is exposed via a medial incision. A medial and plantar-based wedge of bone is removed in toto from the middle third of the cuneiform. Closing this wedge corrects forefoot supination and recreates the medial longitudinal arch. The wedge of bone harvested from the cuneiform is inserted into the cuboid and all of the osteotomies are fixed with Kirschner wires of sizes between 1.8 and 2.5 mm or cannulated cancellous screws. If the feet are supple enough to allow passive correction, an in-socket ankle-foot orthosis with a medial arch support can be utilized to maintain the shape of the foot and to delay deterioration and the need for surgery3. Various other surgical treatment methods are described in the literature and can be categorized as joint-sparing procedures, arthroereises, and arthrodeses. Joint-preserving procedures include the popular calcaneal-lengthening osteotomy (CLO)4 and the double calcaneal osteotomy5. Arthroereisis, a non-fusion motion-limiting technique, is minimally invasive and recently gaining popularity3. The literature has described promising results with use of this procedure6. Extra-articular and intra-articular arthrodesis typically have been employed for the treatment of severe and rigid planovalgus feet and in children who have limited ambulatory potential. On the basis of the currently available literature, no procedure can be labeled superior to another3. The triple-C osteotomy is straightforward and has a short learning curve. There is no need for bone-graft harvesting and the associated morbidity thereof. Studies have shown minimal complications and low long-term recurrence with use of the triple-C osteotomy in patients with spastic cerebral palsy3. We have reported on the short-term outcomes of this procedure2. The patient would be informed regarding the ability of the surgery to correct even severe deformities7. The procedure is not associated with notable complications, and the primarily reported complications are related to wound healing2,8. Although delayed healing of an osteotomy has been described by the originators of this technique1, we have not encountered this complication. We reported good clinical and radiographic outcomes in our series of 12 feet2. Moraleda et al.8 compared the outcomes of the triple-C osteotomy and CLO and reported similar outcomes in terms of clinical and radiographic correction, but with more frequent and more severe complications following CLO. Protect the sural nerve during calcaneal exposure.Osteotomize the medial cortex of the calcaneus with use of an osteotome in order to avoid injuring the medial neurovascular structures.Avoid violating the adjacent joints when performing the cuboid and cuneiform osteotomies.The wedge of bone harvested from the medial cuneiform should be excised in toto to effectively lengthen the cuboid.If utilized, cannulated cancellous screws should be countersunk in the posterior cortex of the calcaneus to prevent irritation. AFO = ankle-foot orthosisUCBL = University of California Biomechanics LaboratoryCP = cerebral palsyAP = anteroposteriorVAS = visual analog scoreCC screws = cannulated cancellous screws.

Coordination index - A method for the assessment of the inter-joint coordination during gait.

BackgroundOur aim was to investigate change over time of passive range of motion (pROM) in the upper limbs of children with cerebral palsy (CP), treated or not treated with botulinum neurotoxin-A (BoNT-A).MethodsData from 2000 to 2017 were collected from the Cerebral Palsy follow-up program and registry in Sweden (CPUP) for children with spastic or dyskinetic CP. Mixed models were used to analyse changes in pROM from the first, until the last measurement for five upper limb movements.ResultsThe study involved 496 children with CP, aged 1–15 years (median 2 years, Interquartile range = 4). Of these, 22% had received at least one BoNT-A treatment. Contractures were classified as red (severe) or yellow (moderate) based on the Traffic Light system within CPUP. About 36% developed upper limb contractures before age 15. Early BoNT-A treatment (< 4 years) implied better pROM outcomes over time compared with later treatment, after adjusting for pROM category, CP subtype and level of manual ability.ConclusionsUpper limb contractures can develop during growth in children with CP affecting one third of this population. Early monitoring of pROM can detect the first signs of muscle shortening before contractures are established. Our findings suggest that early BoNT-A treatment may help maintain pROM in children with CP.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-026-09528-z.

HighlightsWhat are the main findings?•Individual trajectories in adulthood diverge by cerebral palsy (CP) type, with those with bilateral CP GMFCS II and III showing a higher frequency of functional decline from early adulthood to adulthood life stages.•Normalized walking speed declines significantly for all individuals with CP.What are the implications of the main findings?•The findings challenge the assumption that gait improvements in childhood are sustained, revealing more frequent functional decline in adulthood, especially for individuals with bCP GMFCS II and III.•This study underscores the necessity for lifelong, regular monitoring and potential intervention for adults with CP, particularly those with greater motor impairments.Background/Objectives: Cerebral palsy (CP) is the most common cause of physical disability in childhood. While gait improvements are often observed during childhood, it remains unclear whether these gains are sustained into adulthood. This study aimed to evaluate the long-term evolution of gait outcomes from childhood to adulthood in individuals with CP who received orthopedic care early in life. Methods: This retrospective study included 83 adults with cerebral palsy (44 unilateral/uCP, 39 bilateral/bCP; GMFCS I–III) who underwent clinical gait analysis in childhood and again as adults (minimum 4 years between visits, n = 249 CGA). Gait was assessed using the modified Gait Profile Score (mGPS) and normalized walking speed (NWS). The effects of life stage (childhood, adolescence, early adulthood, and adulthood) were analyzed using Kruskal–Wallis tests with post hoc comparisons. Individual clinical transitions were quantified from early adulthood to adulthood, with a minimal clinically important difference (MCID) change in mGPS (1.6°) and NWS (0.20 s−1) for improvement or decline. Results: Longitudinal analysis revealed that while group-average mGPS improved from childhood to adulthood, NWS declined significantly for all patients (p < 0.01). However, individual trajectories from early adulthood to adulthood diverged by CP type. Those with bCP GMFCS II and III had a more frequent clinical decline in mGPS (4/14, 29%), with minimal potential for improvement (1/14, 17%). In contrast, individuals with uCP had less frequent decline (1/17, 6%) and a greater improvement (3/17, 18%). Conclusions: While significant improvements in gait quality are achieved by early adulthood, substantial clinical decline occurs during adulthood in bCP (GMFCS II–III) patients. These findings highlight the need for lifelong monitoring, with re-evaluation regarding the need for surgical interventions from early adulthood to adulthood in bCP patients with greater motor impairments.

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.

Postural control is often impaired in children with spastic cerebral palsy (sCP), with inter-individual differences not fully explained by CP topography or functional level. While brain lesion characteristics are known determinants of upper limb function, their predictive value for postural control remains underexplored. In this cross-sectional study, 43 children with uni- or bilateral sCP (GMFCS I-III), aged 5-12 years, underwent standardized postural control assessment using the Kids-BESTest-2 (in percent scores). Lesion type was classified using theMRI classification scale (MRICS), and lesion extent and location were retrospectively scored on clinical MRI using the semi-quantitative MRI (sqMRI) scale. Associations between lesion characteristics and postural control domains were analyzed using stepwise regression models. Children with predominant white or grey matter lesions performed similarly across all postural control domains. Greater lesion extent was significantly associated with poorer postural control in all domains (β = -0.8 to -1.8% per sqMRI point increase, p ≤ 0.02) except 'Sensory Orientation'. Lesions in the frontal lobe, anterior corpus callosum, PLIC, thalamus, and brainstem were the strongest predictors of domain-specific deficits, explaining up to 53% of variance. Lesion extent and location, rather than type, determine the severity and domain-specificity of postural control deficits in sCP. Lesion-specific MRI scoring may support patient-tailored rehabilitation and prognosis. This study demonstrates that semi-quantitative MRI-based scoring of brain lesion extent and location, rather than lesion type, is key to understanding domain-specific postural control deficits in children with spastic cerebral palsy. It provides novel evidence that damage to specific brain regions, including the frontal lobe, anterior corpus callosum, PLIC, thalamus, and brainstem, most strongly predicts impairments in distinct postural control domains. Lesion-specific MRI profiling has clinical value for identifying postural control deficits and guiding individualized rehabilitation in children with spastic cerebral palsy. Further longitudinal and multimodal research is needed to validate these findings and optimize intervention strategies.

HighlightsWhat are the main findings?•The Portuguese version of the Selective Control Assessment of the Lower Extremity (SCALE-BR) was successfully translated, cross-culturally adapted, and validated, proving to be a reproducible and reliable tool.•SCALE-BR showed excellent internal consistency, intra- and interobserver reliability, and a strong, significant inverse correlation with the Gross Motor Function Classification System (GMFCS).What are the implications of the main findings?•SCALE-BR provides a standardized and clinically useful tool for the quantitative assessment of selective motor control in Brazilian patients with spastic cerebral palsy, supporting clinical decision-making and progress monitoring.•This validation confirms selective motor control as a key factor in functional severity and mobility in cerebral palsy patients, which can refine therapeutic intervention selection and enhance understanding of gait.Background/Objectives: This study aims to translate and validate the Selective Control Assessment of the Lower Extremity (SCALE) tool from English into Portuguese. Methods: SCALE was translated into Portuguese independently by two native Portuguese translators and synthesized into a single manuscript: SCALE-BR. Using this test in patients with spastic cerebral palsy, the internal consistency (Cronbach’s α), reliability by intra-class correlation (ICC), and validity compared with the Gross Motor Function Classification System (GMFCS) scores were evaluated. Results: 30 patients diagnosed with spastic cerebral palsy were assessed, with a predominance of males (66.7%), a mean age of 12.9 ± 7.9 (4–38 years) and a majority of diparetic patients (73.3%) and GMFCS I (53.3%). Spearman’s correlation coefficient, R2 = −0.84, p < 0.001, revealed an inverse relationship between the SCALE instrument and the GMFCS, corroborating the findings in the literature. There was an excellent intra- and interobserver agreement (ICC > 0.75). Conclusions: The Portuguese version of the questionnaire was effective, proving to be reproducible and reliable among different evaluators and patients, with an inverse correlation with the GMFCS as expected in the literature.

Person-level engagement, though well studied in counseling, mental health, and adult rehabilitation, is also critical in pediatric rehabilitation, yet it remains underexplored in motor learning interventions for children with unilateral spastic cerebral palsy (USCP). This study investigated how individual characteristics, including age and mastery motivation, influenced person-level engagement and examined how engagement affected motor outcomes. A retrospective analysis was conducted involving 49 children with USCP aged 6-17 years who participated in either constraint-induced movement therapy (CIMT) or hand-arm bimanual intensive therapy (HABIT). Engagement was assessed through video coding and behavioral questionnaires, while hand function was evaluated using three standardized tests. Findings indicated that age was significantly related to engagement. Engagement measures correlated with improvements in hand capacity as measured by the Jebsen-Taylor Hand Function Test, but not with performance on the Assisting Hand Assessment. The results highlighted the relationship between age and engagement, emphasizing the importance of age-appropriate intervention strategies. Engagement played a role in improvements observed on capacity-based hand function tests, suggesting that engagement during therapeutic camps may be more critical for capacity-based than for performance-based motor activities. These insights support the design of targeted, age-appropriate interventions that optimize therapeutic outcomes for children with USCP.

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.

This article analyzes the relationship between inflammatory biomarkers and functional status as well as rehabilitation outcomes in children with spastic cerebral palsy. The study included children aged 2–18 years who underwent comprehensive clinical and functional assessment using international classification systems. Serum levels of key pro-inflammatory and anti-inflammatory cytokines and acute-phase proteins were measured and analyzed in relation to the severity of functional impairment. The results demonstrated that elevated inflammatory biomarkers were associated with more severe motor limitations and reduced rehabilitation response. These findings support the relevance of a biomarker-based approach for personalized rehabilitation planning and outcome prediction in pediatric cerebral palsy.

Free-living physical activity levels in children with cerebral palsy.

Spastic diplegic cerebral palsy is commonly associated with lower limb muscle weakness, impaired mobility, and increased spasticity, which significantly limit functional independence in children. Progressive Resistance Training (PRT) has emerged as a targeted therapeutic approach to enhance muscle strength and functional outcomes without exacerbating spasticity. This study aimed to investigate the impact of PRT on lower limb strength, mobility, and spasticity in children with spastic diplegic cerebral palsy. Children with spastic diplegia participated in a structured PRT program focusing on major lower limb muscle groups, with training intensity gradually increased according to individual capacity. Outcome measures included assessment of lower limb muscle strength,mobility-related functional performance, and spasticity using standardized clinical scales, recorded before and after the intervention period. The findings demonstrated significant improvements in lower limb strength and mobility, accompanied by a reduction or no adverse increase in spasticity levels following the PRT program. These results suggest that Progressive Resistance Training is a safe and effective intervention for improving muscular strength and functional mobility in children with spastic diplegic cerebral palsy, thereby supporting its inclusion in comprehensive pediatric neurorehabilitation programs.

BackgroundBilateral spastic cerebral palsy (BSCP) is frequently associated with communication impairments, with magnetic resonance imaging (MRI) revealing morphological and connectivity changes. We develop an individual diagnostic model for communication impairment using multivariate lesion and connectome-based approaches in BSCP children.MethodsA total of 28 children aged from 4 to 16 years diagnosed with BSCP and 31 matched typically developing children were recruited. All children received three-dimensional T1-weighted imaging (3D-T1WI) and diffusion tensor imaging (DTI) scans. Communication impairments were evaluated using the verbal comprehension index (VCI) and Communication Function Classification System (CFCS). The correlation between the MRI morphological and diffusion parameters and VCI and CFCS was analyzed, and support vector classification (SVC) algorithm was used to construct a diagnostic model of communication impairment in children with BSCP.ResultsChildren with BSCP showed reduced mean cortical surface areas and gray matter volumes mainly in the frontal and temporal lobes, along with widespread decreases in white matter connectivity [false discovery rate (FDR) correction, P<0.05]. The morphological alterations and white matter fiber of bilateral frontal lobes, sensory motor areas, and part of temporal occipital lobes were associated with communication impairment of BSCP children (P<0.05). The combined SVC model, based on gray matter morphology and white matter fiber index, can be utilized for diagnosing communication impairments in children with BSCP, achieving an accuracy of 80.77% and an area under the curve of 0.88. The cortex features that distinguished communication impairment in children with BSCP were predominantly found in the bilateral middle frontal gyrus, left middle temporal gyrus, and the white matter fiber features were primarily located within and between the bilateral frontal lobes, sensorimotor areas, and partial temporo-occipital lobes.ConclusionsThe brain morphological and white matter connectivity changes are associated with communication impairment in BSCP children. The multi-parametric MRI can be used to establish an individualized diagnosis model of communication impairment in children with BSCP.

BackgroundTo classify MRI patterns in children with cerebral palsy (CP) using the MRI Classification System (MRICS) and examine their associations with perinatal risk factors and clinical outcomes.MethodsThis retrospective cohort study included 1,403 children with CP who underwent post-neonatal cranial MRI between 2011 and 2020. MRI patterns were categorized using MRICS. We analyzed the associations between MRI findings and perinatal risk factors (e.g., gestational age, birth weight, sex, perinatal adversity, plurality) using univariate and multivariable multinomial logistic regression. Clinical outcomes—including CP subtype, gross motor function, intellectual disability, epilepsy, and composite impairment index—were assessed using chi-square, Kruskal–Wallis tests, and correspondence analysis.ResultsMRI abnormalities were observed in 86.5% of children, with predominant white matter injury (PWMI) being most common (46.5%). Preterm birth and perinatal adversity significantly increased the risk of PWMI and PGMI. PWMI was linked with spastic CP, better motor outcomes, and lower rates of intellectual disability. In contrast, PGMI and maldevelopments were associated with epilepsy, hearing loss, and severe impairment. Importantly, a subset of children with normal MRI findings still exhibited substantial functional impairments, emphasizing the limitations of structural imaging alone.ConclusionsMRI patterns, as classified by MRICS, provide critical insight into the neurodevelopmental heterogeneity of CP. Normal MRI findings do not preclude significant clinical impairment, underscoring the need for integrated neuroimaging and clinical-genetic assessment in CP management.

Cerebral palsy (CP) remains a leading cause of childhood disability, with varying clinical presentations and comorbidity patterns. This study explored the clinical spectrum, functional severity, and perinatal risk factors of CP among children aged 4–14 years in eastern India to identify priority areas for early intervention and support. A cross-sectional study was conducted over one year at a tertiary care centre. Data were collected through structured caregiver interviews and clinical assessments using standardized tools—the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS). Associations between demographic, perinatal, and clinical variables and CP severity were analysed using likelihood ratio tests and partial correlation analyses. Among 127 children with CP (median age: 5.9 years; 74.0% male), spastic CP was the predominant subtype (75.6%), followed by dyskinetic (9.4%), ataxic (7.9%), and mixed (7.1%) forms. Severe motor impairments (GMFCS IV–V) were present in 63.8% of participants, and manual ability severity increased proportionally with GMFCS levels (ρ = 0.702; p < 0.001). Significant correlates of severe impairment included younger age, parental age (20–29 years), high birth weight (> 4000 g), home delivery, absence of crying at birth, neonatal seizures, hypoxic–ischemic encephalopathy, and jaundice. Comorbidities were common—language (78.7%), cognitive (62.2%), and personal–social (58.3%) impairments were most frequent. Only 12.6% of children attended school; attendance was positively associated with older age, male gender, lower GMFCS and MACS levels, and absence of cognitive, language, fine-motor, personal–social impairments, and seizure history. Spastic CP was the most frequent subtype, commonly associated with severe motor limitations and multiple comorbidities that significantly restricted educational participation. Strengthening perinatal care, early screening, and multidisciplinary rehabilitation are essential to improve functional outcomes and inclusion for children with CP in resource-limited settings.

The aim is to examine the effect of gross motor function on mental health and quality of life in individuals with spastic diplegic Cerebral Palsy (CP). This study is a cross-sectional study including 37 individuals with spastic diplegic CP aged 13-18 years. The severity of gross motor functional impairment was assessed using the Gross Motor Function Classification System scale (GMFCS), mental health using the Revised Child Anxiety and Depression Scale (RCADS), and quality of life using the Cerebral Palsy Quality of Life Questionnaire (CPQOL)-teen. It was observed that there was no statistically significant difference between the results of Social phobia, Panic disorder, Major depressive disorder, Separation anxiety disorder, Obsessive-compulsive disorder, Total Internalizing Scale (p&gt;0.05) except for the Generalized anxiety disorder and Total Anxiety Scale scores of individuals at GMFCS levels I, II and III (p0.05). It was concluded that gross motor function had no effect on mental health outcomes and quality of life, except anxiety, in individuals with diplegic CP.

To give a comprehensive overview of genetic findings in children with cerebral palsy, including a description of subtype, comorbidities and neuroimaging, providing insight into the clinical utility of genetics. A systematic review of previous literature using Embase and Medline as databases. All studies were published between 2000 and 2022, each including at least 10 individuals with cerebral palsy. A total of 19 studies were included, comprising a total of 3707 individuals with cerebral palsy. The overall diagnostic yield was 22.2%, with the highest yield (up to 55%) in cryptogenic cerebral palsy. Variants in a total of 377 unique genes were identified, most frequently CTNNB1, SPAST and ATL1. In addition, 59 different CNVs were identified, of which 32 were in known (micro)duplication/-deletion syndromes such as 22q11.2 microdeletion/-duplication and 14q12 microdeletion. Spastic and dyskinetic cerebral palsy were the most common phenotypes among genetically diagnosed cases. Findings also included variants in genes linked to epilepsy, specific neuroimaging patterns and potentially treatable conditions. These results highlight the importance of genetic evaluation for diagnostic clarification, targeted treatment, monitoring of comorbidities and genetic counseling. We recommend offering genetic testing to individuals with cryptogenic cerebral palsy to optimize management and prevention.

Impaired fundamental movement skills are prevalent among children with developmental coordination disorder (DCD) and mild cerebral palsy (CP). Although postural control is a prerequisite for gross motor skills, its role in fundamental movement skills is understudied. This study aims to determine the extent to which postural control contributes to fundamental movement skill performance in children with DCD, mild CP, and with typical development (TD). This was a case-control study. Participants were 127 children aged 5.0 to 10.9 years (DCD [N = 48], TD [N = 59)], mild spastic CP [N = 20]). Children with CP were classified as Gross Motor Function Classification System (GMFCS) I (N=11) or II (N=9), and as having either unilateral (N=11 or bilateral CP(N= 9). The Test of Gross Motor Development-3 (TGMD-3) evaluated fundamental movement skills, and the Kids-Balance Evaluation Systems Test-2 (Kids-BESTest-2) assessed postural control. The domain and total scores of both tests were used for analysis. Children with TD significantly outperformed those with DCD and mild CP, while DCD and mild CP performed similarly. Across groups the Kids-BESTest-2 and TGMD-3 correlated significantly (r = 0.42 - r = 0.77). The total Kids-BESTest-2 score and group (TD-DCD-mild CP) explained 69% of locomotor skill variance but did not significantly explain ball skill performance (R2 = 0.40). Among postural control domains, only anticipatory postural adjustments contributed to fundamental movement skills. Group effects were larger (ⴄp2 = 0.15-0.31) than the effects of Kids-BESTest-2 scores (ⴄp2 = 0.01-0.12). The findings suggest that postural control plays a role in locomotor performance but that unique group-specific factors influence this relationship. Further research should investigate the impact of postural control task-oriented training on fundamental movement skills, and should examine the influence of additional factors, such as body functions and environmental influences on fundamental movement skill development.

Cerebral palsy (CP) is a group of non-progressive neurological disorders affecting posture and movement, mostly resulting from perinatal intrauterine disorders to the developing infant brain. A 6-years old, male patient with spastic cerebral palsy (CP), which predominantly affected the right extremities more than the left ones, required dental surgical treatment of multiple tooth extractions and restorations, under general anesthesia. He received allogenic umbilical cord derived mesenchymal stem cells treatment one time, 6 months before the dental intervention. The intervention under general anesthesia lasted approximately one hour and concluded successfully. Muscle relaxants were purposely avoided. The anesthesia was reversed and the patient was extubated successfully without complications and there was no sign of any adverse reactions postoperatively.