Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy

Dear Colleagues,

Cerebral palsy (CP), resulting from brain damage during fetal or infant development, is the most common childhood motor disorder and associated impairments have consequences for development and participation. Cerebral palsy is a clinical description rather than a distinct diagnosis and, historically, the clinical diagnosis is made around two years of age. Recent advances in early diagnositcs suggest, however, that diagnosing infants at risk of cerebral palsy should be followed by early and specific intervention. The challenges concern whether the children’s abilities can be improved by intervention and whether we can understand more about the factors influencing development after an early brain lesion. Coherent and flexible services are required to meet the needs of the families, necessitating the inclusion of the parent/carer voice and expectations. The aim of this Special Issue is to provide an overview of recent advances in the early diagnosis and treatment of pediatric cerebral palsy, as well as early detection and treatment of associated comorbidities and complications. Researchers in the field of cerebral palsy are encouraged to submit original articles or reviews to this Special Issue, so that we can build an evidence base to guide decision making.

Dr. Ann Kristin G. Elvrum
Prof. Dr. Ann-Christin Eliasson
Guest Editors

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• cerebral palsy
• early diagnosis
• family factors
• associated impairments
• outcome measures
• intervention
• mental health

Title: Feasibility of an early-Infant-Hybrid Therapy in children with unilateral cerebral palsy into the natural context.
Authors: Rocío Palomo-Carrión; Helena Romay-Barrero; Elena Pinero-Pinto; Rita Pilar Romero-Galisteo; María Coello-Villalón; Asunción Ferri-Morales; Purificación López-Muñoz; Cristina Lirio-Romero
Affiliation: Faculty of Physiotherapy and Nursing of Toledo. University of Castilla-La Mancha. Avenida Carlos III, s/n. Toledo
Abstract: Background: The first stage of childhood, before the age of two, is made up of great neuronal plasticity, which favors the acquisition of brain changes after an injury, increasing the child's functioning. For this reason, it is essential to carry out early treatment, with the involvement of the family and within the natural context. The objective was to assess the bimanual functional performance increase into the affected upper limb and the feasibility of Infant-Hybrid Therapy (mCIMT-BIT) applied at home with family involvement in children with UCP aged 9-18 months. Methods: A single-group of 10 children (12.8 months, SD: 3.4), performed the Infant-Hybrid Therapy (50 hours of modified Constraint Induced Movement Therapy and Bimanual Intensive Therapy, 5 h per week, 10 weeks). The main outcome was Bimanual Functional Performance (BFP) measure with mini-Assisting Hand Assessment scale (mini-AHA), Functional Goals measure with Goal Attainment Scale (GAS) and Satisfaction-expectations on intensive therapy from parents measured through a specific questionnaire. Three measures were performed (week0, week10 and 6-months). Results: Ten children completed the study with an average of 48-hours (97%), the participants did not drop out of the study during the follow-up process, and the parents’ expectations were fulfilled, indicating high caregiver compliance, achieving a great adherence into the treatment. Clinically relevant changes were observed between pre-post intervention in BFP with an increasement of 9 units (p < 0.001), and it was kept for 6 months. Families achieved their functional objectives and showed a great satisfaction with interest to repeat the therapy after treatment. Conclusions: Infant-hybrid is feasible to be performed at home with the family’s involvement, obtaining improvements in the affected upper limb at early age unilateral cerebral palsy.

Title: Upper limb therapy for infants and young children with unilateral cerebral palsy: what, when and why?
Authors: Sue Greaves
Affiliation: Royal Children's Hospital, Melbourne, Melbourne, Australia
Abstract: Aim: The aim of this paper is to outline the required knowledge underpinning the provision of upper limb therapy for infants with unilateral cerebral palsy, describe the key ingredients for Constraint-Induced Movement Therapy (CIMT) and Bimanual therapy, and to provide a clinical rationale for when and why to implement these models of therapy in clinical practice.

Title: Independent wheeled mobility for children with cerebral palsy – a Norwegian registry study of 1780 children
Authors: /
Affiliation: /
Abstract: Background: About one third of children with cerebral palsy (CP) use a wheelchair for mobility. Independent mobility strongly influences children’s cognitive and social development. Children without independent mobility have less opportunities to play, explore their environment and participate in everyday life. The aim of the study was to explore independent wheeled mobility in children with CP relative to their sex, age, CP subtype, levels of gross motor function (GMFCS) and manual abilities (MACS), and furthermore whether age for independent mobility differed between birth cohorts. Methods: Cross-sectional data on children’s use of wheelchair and their independent mobility, together with selected demographic data and GMFCS and MACS levels, were retrieved from the Norwegian quality and surveillance registry for CP (NorCP). All children in the registry born 2002-2019 were included, and data were analysed with logistic regression models. Longitudinal data based on 11565 assessments from 20XX to 20XX were used to estimate age for independent wheeled mobility using Kaplan-Maier survival analysis. Results: Of 1780 included children, 640 (36%) used a wheelchair. Of these, 284 children used the wheelchair independently, yet only 20% were less than 7 years old. Most children with independent wheeled mobility used a power wheelchair. Poor hand function was negatively associated with independent wheeled mobility. Over the last 20 years, the age for first time registration of independent wheeled mobility decreased. Conclusions: Power mobility should be introduced early to promote independent mobility for children with CP with limited or delayed walking ability. Interventions focusing on improved hand function may be important for achieving independent wheeled mobility.