cerebral palsy

Cerebral Palsy (CP) is a group of movement disorders. A recently proposed occupational therapy approach to reduce spasticity and improve balance and postural control is Hippotherapy Simulation (HS). The present study attempts to investigate how HS impacts balance, postural control, and spasticity of adductor muscles in children with spastic bilateral CP.

Thirty-one children with bilateral spastic CP, five to nine years old, were selected via availability sampling and divided into the intervention group (n=16) and the control (n=15) through stratified block randomization. Assessment tools, including Pediatric Balance Scale (PBS), Trunk Control Measurement Scale (TCMS), Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), and goniometry, were completed by an assessor unaware of the children’s grouping.

After the intervention, the average total scores of all variables in the HS group significantly exceeded those in the control group (P<0.01). However, no significant differences were observed between the groups at follow-up, underlining the necessity of providing long-term or recurrent interventions to maintain improvements in gross motor function. This approach also constructively influenced postural control and mitigated the spasticity of adductor thigh muscles.

This study showed the multimodal effect of simulated hippotherapy combined with occupational therapy routine exercises on the physical performance of children with bilateral spastic CP.

Hemiplegic Cerebral Palsy (HCP) causes significant motor impairments, due to disrupted Functional Connectivity (FC) between brain regions. Low-Frequency Repetitive Transcranial Magnetic Stimulation (LF-rTMS) has emerged as a potential therapeutic technique for restoring FC and motor recovery.
This study aimed to evaluate the effects of LF-rTMS on FC in children with spastic HCP.
This Randomized Controlled Trial (RCT) included ten children with spastic HCP, aged 4 to 13 years. Six children received 12 sessions of LF-rTMS, while four in the control group underwent 12 sessions of sham stimulation. Functional Magnetic Resonance Imaging (fMRI) was used to assess intra- and interhemispheric FC during passive knee movements of the affected limb.
LF-rTMS induced region-specific reductions in interhemispheric FC, particularly between the contralesional ventral premotor area (cPMv) and both the ipsilesional primary somatosensory cortex (iS1) (for effect size: T=-2.60, P-value=0.048, FDR-corrected) and the ipsilesional primary motor area (iM1) (T=-2.45, P-value=0.048, FDR-corrected). These findings suggest modulation of interhemispheric motor-sensory pathways. Concurrently, localized increases in FC were observed in contralesional regions, and FC decreased between the ipsilesional Supplementary Motor Area (SMA) and the secondary somatosensory cortex (S2) (T=-3.11, P-value=0.041, FDR-corrected). 
LF-rTMS may modulate FC and hold promise as a rehabilitative intervention for improving motor function in children with HCP.

Cerebral Palsy (CP) can lead to various impairments, activity limitations, and participation restriction. Mirror therapy is considered a useful treatment for improving the movement of lower and upper limbs in individuals with CP. This study examines current evidence on the effects of mirror therapy in children with hemiplegic CP. This study examines current evidence on the effects of mirror therapy in children with hemiplegic Cerebral Palsy (CP).

We performed this narrative review using the scientific databases (including PubMed, Scopus, Cochrane, springer, ProQuest, web of science, OT seeker, Magiran, SID and IranDoc) and included controlled trials, quasi-experimental, case reports, pilot studies, and case series. We identified 25 studies, from which, 3 were excluded after screening the full text. Totally 22 studies were included for deep reviewing the effect of mirror therapy on functional performance of children with hemiplegic CP.

Although studies on the effectiveness of mirror therapy in children with hemiplegic CP were limited and the available literatures have shown different results, it appears that mirror therapy as a complementary treatment may improve sensory and upper limb motor function in children with hemiplegic CP.

This study suggests that mirror therapy may be helpful for sensory and upper extremity motor performance of children with hemiplegic CP. However, more clinical trials are needed to use this intervention to determine the exact effect of this treatment on children with hemiplegic CP.

Cerebral palsy (CP) describes a group of permanent movement and posture disorders resulting from injury to the developing brain, affecting muscle movement and coordination. It causes lifelong physical and cognitive impairments.

This study examined the effects of a group psychoeducational intervention on anxiety, depression, and quality of life in mothers of children with CP.

This quasi-experimental study involved 50 mothers (25 in the intervention group and 25 in the control group) of children with CP aged 2 - 11 years. Mothers in both groups completed the Beck Depression Inventory, Beck Anxiety Inventory, and Short Form-36 health survey before and after the interventions. The intervention group received a 5-session (1 hour per session), weekly psychoeducational program that provided information about CP, stress management techniques, problem-solving skills, and social support. The control group received no intervention during this period. Follow-up assessments were conducted at 2 months post-intervention to evaluate outcomes.

Psychoeducation significantly reduced anxiety and depression and improved quality of life compared to the control group (P < 0.001). Also, group × time interactions were significant for all dependent variables (P < 0.001).

A brief group psychoeducational intervention effectively decreased anxiety and depression and enhanced the quality of life in mothers of children with cerebral palsy.

Cell-based therapy has shown promising outcomes in the treatment of cerebral palsy (CP). However, there is noconsensus on a standard therapeutic protocol regarding the source of cells, optimal cell dose, timing and frequencyof cell injections, route of administration, or the use of combination therapy. This lack of consensus necessitates acomprehensive investigation to clarify these crucial yet undefined factors in cell-based therapy for CP patients. In thiscommentary, we discuss and compare the trends in Gross Motor Function Measure-66 following intrathecal injectionof umbilical cord blood mononuclear cells (UCB-MNCs) and umbilical cord tissue mesenchymal stromal cells (UCTMSCs)in children with CP. Our study revealed that MNC injections led to earlier improvements in gross motor function,whereas MSC applications resulted in more sustainable changes. These findings provide key insights into the efficacyof different cell types, which will be beneficial for future studies and for refining cell-based therapy protocols for CPtreatment.

Cerebral palsy (CP) is a neurological motor disability, and children with CP should receive rehabilitation services to achieve their full potential.

The purpose of this study was to explore the quality of life (QOL) of children with CP across various domains and to assess the role of access to rehabilitation services on their QOL.

We conducted a cross-sectional study involving all 126 children aged 4 - 12 with CP and their parents in Saqqez county, Kurdistan province, Iran. The "Physical Rehabilitation Accessibility Assessment Questionnaire" and the "Parental Proxy CP QOL-Child questionnaire" were used to measure the main variables. The analysis performed separately for two subpopulations: 27 children aged 4 - 6 years and 99 children older than six, using SPSS version 23. After prforming Kolmogorov-Smirnov test, the Spearman correlation coefficient was employed to identify correlations.

The average age of the participants was 8 ± 2.36 years, with 51 (40.5%) being girls. Of the 126 children with CP, 45 (35.7%) had independent mobility function (GMFCS levels I and II). The mean CP QOL-Child domain scores ranged from 35.3 ± 25.1 in the 'access to services' domain to 74.5 ± 16.1 in the 'Emotional well-being and self-esteem' domain. The average accessibility score was 53.8 ± 22.1. Among children older than 6 years, access to rehabilitation services showed a significant correlation with all CP QOL-Child domain scores (P < 0.05), except for 'social well-being and acceptance.' In children aged 4 - 6 years, only the Family Health domain score was significantly correlated with access to rehabilitation services (r = 0.44, P = 0.021).

Access to rehabilitation services is a significant predictor of QOL in children older than 6 years. Further experimental research is needed to examine changes in various aspects of QOL in children with CP following improved access to rehabilitation services.

One of the most common movement disorders in children with cerebral palsy (CP) is upper limb function impairment. This limitation can lead to increased dependency in daily life activities and self-care. Recently, a new treatment method called transcranial direct current stimulation (tDCS) has been developed to improve hand function in neurological disorders involving upper limb impairments.

This study aimed to investigate the effectiveness of the tDCS technique, combined with occupational therapy exercises, on upper limb function in children with CP.

In this randomized clinical trial, 50 children aged 5 - 10 years with hemiplegic CP were randomly divided into two groups: An experimental group and a control group, with 25 children in each. The experimental group received 45 minutes of occupational therapy exercises along with 20 minutes of electrical stimulation via tDCS, while the control group received therapy exercises with the tDCS in off mode. The intervention lasted four weeks, with five sessions per week. Upper extremity motor function was assessed using the Fugl-Meyer test, and gross manual dexterity was evaluated with the Box and Block test. The Bruininks-Oseretsky test was employed to assess fine and gross motor skills across four motor areas: Fine manual control, manual coordination, body coordination, and strength and agility. Outcomes were measured in both groups before and after the 4-week interventions. An independent t-test or Mann-Whitney test was used for between-group comparisons.

The study results showed that all outcomes related to upper limb function improved in both groups after the 4-week intervention. However, the group that received tDCS alongside routine occupational therapy demonstrated significantly greater improvement compared to the group that received only routine occupational therapy (P < 0.001). Moreover, no significant side effects were observed during or after the use of tDCS.

The results suggest that although both therapy exercises and tDCS interventions individually enhance upper limb function in children with unilateral CP, the combined use of these two interventions led to significantly better outcomes compared to routine occupational therapy alone. This finding underscores the clinical applicability of incorporating both modalities into rehabilitation programs for children with CP. Therefore, combining occupational therapy exercises with tDCS is recommended for improved results in enhancing upper limb function in CP.

Cerebral palsy is a motor impairment syndrome that arises from a lesion in the developing brain. The condition varies based on the timing of the lesion, as well as differences in clinical presentation, location, and severity.

The aim of this study is to determine the clinical features of patients with cerebral palsy, identify the associated risk factors, and analyze cranial MRI findings in relation to the different types of cerebral palsy.

This study retrospectively evaluated the medical records of children diagnosed with cerebral palsy. Data collected included demographic information, details of potential relevant abnormalities during pregnancy, birth, and the neonatal period, comorbidities, types of cerebral palsy, cranial MRI findings, and classifications of motor impairments.

The mean age of the 202 patients with cerebral palsy in the study was 8.02 years, with a male predominance (60.4%). The most common type of cerebral palsy observed was spastic cerebral palsy, accounting for 81.6% of the cases. The most frequent cranial MRI finding was white matter damage of immaturity, present in 36.1% of the patients, while 8.4% of the cases had normal cranial MRI results. Epilepsy was the most common comorbidity, affecting 50.5% of the patients.White matter damage of immaturity was most commonly associated with spastic diparesis, and the identified risk factors for these patients included prematurity, low birth weight, oligohydramnios, multiple pregnancy, and neonatal sepsis/meningitis. Spastic tetraparesis was most frequently linked to miscellaneous MRI findings, with risk factors such as term birth, normal birth weight, polyhydramnios, asphyxia/resuscitation, and a history of neonatal convulsions. Focal infarction/hemorrhage was most often associated with spastic hemiparesis, while basal ganglia-thalamus damage was frequently seen in patients with choreoathetotic and dystonic cerebral palsy. In patients with dystonic cerebral palsy, vaginal delivery and a history of hyperbilirubinemia were identified as common risk factors. Cerebellar damage and malformations were most frequently associated with ataxic cerebral palsy.

In this study, it was determined that MRI findings can serve as a valuable guide for identifying different types of cerebral palsy. Additionally, the risk factors, disease severity, and accompanying comorbidities were found to vary according to the specific type of cerebral palsy.

Children with cerebral palsy (CP) are at a heightened risk of developing feeding and swallowing disorders, which are influenced by a variety of medical, cultural, psychosocial, and nutritional factors. The prevalence rates of these disorders vary widely across different studies, highlighting the complexity and multifaceted nature of these challenges.

This study aimed to determine the prevalence of feeding and swallowing disorders and to explore the factors associated with the severity of swallowing issues in Iranian children with CP.

A cross-sectional study was conducted with a convenience sample of 111 Iranian children with CP. The study assessed feeding and swallowing problems through clinical evaluations and parental reports. Data analysis was performed using IBM SPSS version 20, utilizing chi-square and Spearman's correlation coefficient tests.

The study found that feeding and swallowing problems are common among Iranian children with CP, with 79.2% of children having feeding disorders and 78.3% experiencing swallowing difficulties. Of particular concern, 40.5% of the children showed issues during the pharyngeal phase of swallowing, and 12.6% exhibited unsafe swallowing patterns. There were significant correlations between the severity of swallowing issues and several factors: Malnutrition (P ≤ 0.001), gastroesophageal reflux disease (GERD) (P = 0.007), motor impairment (P ≤ 0.001), and caregiver concern (P ≤ 0.001). Malnutrition was found in 60% of the children, yet only 23% were receiving dietary supplements, and a mere 2.7% were using tube feeding.

Feeding and swallowing disorders, along with malnutrition, are highly prevalent in Iranian children with CP. The positive correlation between the severity of swallowing issues and malnutrition underscores the critical need for early, multidisciplinary interventions to address these challenges.

Drooling, commonly observed in cerebral palsy children, negatively impacts different aspects of their lives. There are several treatment options for drooling, with no consensus on a single method as the most effective one. The current systematic review provides an overview of the evidence of the different non-medical intervention methods used by speech and language pathologists to reduce drooling in cerebral palsy children.

A comprehensive and systematic search was conducted in the following electronic databases for publications from 2010-22: PubMed, Scopus, Science Direct, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. The National Health and Medical Research Council (NHMRC)and the Physiotherapy Evidence Database (PEDro-P) scale were respectively used to determine the level of evidence and the methodological quality of articles.

Out of 2740 articles identified, 15 records met the inclusion criteria and were included in the study. The studies considered in this systematic review differed in the following criteria: design, participant characteristics, types of assessments and treatments, and follow-up periods. Non-medical interventions for drooling were found to be effective in alleviating the severity and decreasing the frequency of drooling.

The results showed the effectiveness of nonmedical interventions for drooling in cerebral palsy children. The treatments provided by SLPs can be classified into three categories: oromotor and sensory interventions, behavioral interventions, and the use of Kinesio-tape. Among these, the use of oromotor interventions and oral sensory interventions, alone or combined with other approaches, was the most widely used method.

There is uncertainty in identifying which aspects of functioning should be prioritized in the clinical brief assessment of children with cerebral palsy (CP). Brief ICF category sets specify the essential aspects of functioning that should be addressed in such assessments.

This study aimed to develop five brief ICF category sets based on the functional limitations of children with CP, as viewed by Iranian occupational therapists (OTs).

This cross-sectional, multi-method study was conducted from January to May 2022 in Iran. Nineteen OTs were recruited through purposive sampling for a Delphi process, and ten OTs through snowball sampling for an expert panel, all experienced in CP and ICF. The Delphi involved two rounds of electronic surveys, where participants identified categories that should be minimally addressed in brief assessments of children aged 6 - 12 with CP based on their functional limitations. The content validity of these sets was then quantitatively evaluated by the expert panel.

Most confirmed categories in the gross and fine motor brief sets pertained to body structure and function, while those in the eating-and-drinking and communication-function brief sets related to cognition and motor reflexes. Categories in the visual function brief set mostly pertained to activity, participation, and environmental factors. Content validity ratio (CVR) and item-content validity indexes (I-CVI) ranged from 0.80 to 1 across all categories/brief sets, with scale-content validity index/Average (S-CVI/Ave) ranging from 0.95 to 0.98.

These functional-based ICF brief sets are the first developed for children with CP in this age group and provide occupational therapists with tools to address crucial aspects of functioning, tailored to specific functional limitations. However, cultural biases and the generalizability of these brief sets remain limitations.

Cerebral palsy is one of the most prevalent physical disabilities in childhood. Children afflicted with this condition face a myriad of challenges and potential disabilities, which complicate treatment efforts. Integrating scales with other diagnostic instruments is increasingly crucial for accurately assessing these children and devising effective treatment strategies. This study primarily aims to review functional classification systems based on the International Classification of Functioning, Disability, and Health (ICF) for children with cerebral palsy and explore the relationships among these systems. This study was designed to review the ICF-based functional classification systems. A comprehensive search was conducted across multiple databases, including Google Scholar, PubMed, ERIC, OVID, ProQuest, Scopus, Web of Knowledge, and OTseeker. Search terms related to cerebral palsy and various aspects of body function, activity, and participation were utilized. The search was conducted until September 2022 to gather relevant literature for analysis. The analysis of the reviewed articles revealed the existence of five valid and reliable classification systems. In most studies, the correlation among these systems was moderate. Owing to their simplicity and comprehensiveness, these classification systems have significantly impacted the depiction of the functional status of children with cerebral palsy and the quality of their care. However, additional classification systems remain needed to address other overlooked functions and complete the overall description. The outcomes of this review indicated the development of classification systems for certain functions in children with cerebral palsy. In conjunction with the classifications above, creating additional new systems for overlooked functions could offer a comprehensive and integrated understanding of children with cerebral palsy's crucial functional capacities and performances.

This study examines the impacts of health-related quality of life (QoL) on children who suffer from cerebral palsy, in addition to sociodemographic characteristics and other aspects.

Children who suffer from cerebral palsy (CP) who were referred to a Rehabilitation and Rheumatology Clinic in Bagdad, Iraq, were the subjects of a cross-sectional research. The primary data were gathered from parents and kids via a questionnaire. The CP module for The pediatric QoL inventory 3.0 in Arabic was used. The period of August 2022 to February 2023 was used for gathering the data. Researchers evaluated participants using the body mass index (BMI) and the gross motor function classification system. Data analysis was done using SPSS software, version 26 and involved calculating Mean±SD, reporting descriptive statistics, and testing random distribution assumptions. Reliability was assessed via the Cronbach α coefficient and interference analysis, with a considerable level set at P≤0.05.

This research enrolled 139 children of which 55.7% were male and the mean age was 5.7 years. The greatest age group was 5 years (51.1%), 59.7% of children were categorized in levels (III, IV and V) and the majority had a low QoL. The domain of daily activity received the highest score out of the six existing domains (57.05%).

CP affects the QoL of children aged 5 to 7 years. The intensity of the gross motor function classification system, physiological and topographical classification, and health-related QoL were associated significantly.