Spared Primary Motor Cortex and The Presence of MEP in Cerebral Palsy Dictate the Responsiveness to tDCS during Gait Training Lycra(®) arm splints improve movement fluency in children with cerebral palsy. Lycra arm splints in conjunction with goal-directed training can improve movement in children with cerebral palsy. Effects on motor development of kicking and stepping exercise in preterm infants with periventricular brain injury: a pilot study. Action Observation Treatment Improves Upper Limb Motor Functions in Children with Cerebral Palsy: A Combined Clinical and Brain Imaging Study A Low-Cost Video Game Applied for Training of Upper Extremity Function in Children with Cerebral Palsy: A Pilot Study Muscle Strengthening in Children and Adolescents With Spastic Cerebral Palsy: Considerations for Future Resistance Training Protocols No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy Effect of Autologous Cord Blood Infusion on Motor Function and Brain Connectivity in Young Children with Cerebral Palsy: A Randomized, Placebo‐Controlled Trial Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: the impact on muscle morphology and strength Chorioamnionitis and cerebral palsy in term and near-term infants.
The current priority of investigations involving transcranial direct current stimulation ( tDCS ) and neurorehabilitation is to identify biomarkers associated with the positive results of the interventions such that respondent and non-respondent patients can be identified in the early phases of treatment . The aims were to determine whether : ( 1 ) present motor evoked potential ( MEP ) ; and ( 2 ) injuries involving the primary motor cortex , are associated with tDCS-enhancement in functional outcome following gait training in children with cerebral palsy ( CP ) . We review ed the data from our parallel , r and omized , sham-controlled , double-blind studies . Fifty-six children with spastic CP received gait training ( either treadmill training or virtual reality training ) and tDCS ( active or sham ) . Univariate and multivariate logistic regression analyses were employed to identify clinical , neurophysiologic and neuroanatomic predictors associated with the responsiveness to treatment with tDCS .  MEP presence during the initial evaluation and the subcortical injury were associated with positive effects in the functional results . The logistic regression revealed that present MEP was a significant predictor for the six-minute walk test ( 6MWT ; p = 0.003 ) and gait speed ( p = 0.028 ) , whereas the subcortical injury was a significant predictor of gait kinematics ( p = 0.013 ) and gross motor function ( p = 0.021 ) . In this preliminary study involving children with CP , two important prediction factors of good responses to anodal tDCS combined with gait training were identified . Apparently , MEP ( integrity of the corticospinal tract ) and subcortical location of the brain injury exerted different influences on aspects related to gait , such as velocity and kinematics AIMS To determine changes in upper limb movement substructures that denote fluency of movement in children with cerebral palsy ( CP ) following lycra ( ® ) splint wear  . Secondarily , to explore the efficacy of lycra ( ® ) splints for those with spastic and dystonic hypertonia . DESIGN R and omised clinical trial whereby participants were r and omised to parallel groups with waiting list control . METHOD Sixteen children ( mean age 11.5 years SD=2.2 ) with hypertonic upper limb involvement ( 13 hemiplegia , 4 quadriplegia ) were recruited . Children were r and omly allocated either to a control group or to wear the lycra ( ® ) splint for a period of three months . Three-dimensional ( 3D ) upper limb kinematics was used to assess four functional tasks at baseline , on initial lycra ( ® ) splint application , three months after lycra ( ® ) splint wear , and immediately after splint removal . Movement substructures of the motion of the wrist joint center were analysed . RESULTS A significant difference was observed between baseline and three months of lycra ( ® ) splint wear in the movement substructures ; movement time , percentage of time and distance in primary movement , jerk index , normalised jerk and percentage of jerk in primary and secondary movements . The magnitude of changes in normalised jerk and the percentage of jerk in the primary movement from baseline to three months was greatest in children with dystonic hypertonia . CONCLUSIONS The results indicate that lycra ( ® ) arm splinting induced significant changes in movement substructures and motor performance in children with CP . This research demonstrates that fluency of movement can be quantified and is amenable to change with intervention OBJECTIVES To investigate the effects of lycra ® arm splint wear on goal attainment and three dimensional ( 3D ) kinematics of the upper limb and trunk in children with cerebral palsy ( CP ) . DESIGN R and omised clinical trial whereby participants were r and omised to parallel groups with waiting list control . PARTICIPANTS Sixteen children with CP ( hypertonia ) aged 9 to 14 years . INTERVENTION Three months lycra arm splint wear combined with goal directed training . MAIN OUTCOME MEASURE Goal attainment scale , and 3D upper limb and trunk kinematics across four upper limb movement tasks . RESULTS 17/18 children achieved their movement goals following three months of splinting . Selected joint kinematics improved on immediate splint application . Further improvements in joint kinematics were demonstrated following 3 months of splint wear , particularly in elbow extension , shoulder flexion and abduction and in thorax flexion . Only improvements in movement compensations at the thorax remained following removal of the splint . CONCLUSIONS The lycra ® arm splint , made a quantifiable change to the attainment of movement goals of importance to the child . Furthermore , improvements were demonstrated in selected maximum range of movement and joint kinematics during functional tasks at the elbow and shoulder joints and thorax segment in children with CP BACKGROUND Preterm infants with periventricular brain injury ( PBI ) have a high incidence of atypical development and leg movements . OBJECTIVE Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age ( CA ) in children with PBI improves motor function at 12 months CA when compared with control subjects . METHOD In a multi-center pilot study for a controlled clinical trial , sixteen infants with PBI were r and omly assigned to home exercise consisting of kicking and treadmill stepping or a no-training control condition . Development was assessed at 2 , 4 , 6 , 10 , and 12 months CA with the Alberta Infant Motor Scale ( AIMS ) . At 12 months children were classified as normal , delayed , or with cerebral palsy ( CP ) . RESULTS At 12 months CA 3 of 7 ( 43 % ) of the exercise group children walked alone or with one h and held versus 1 of 9 ( 11 % ) in the control group ( p=0.262 ) , but no significant differences in AIMS scores were found at any age . Half of the subjects had CP or delay ; the outcomes of these infants were not improved by exercise . Compliance with the home program was lower than requested and may have affected results . CONCLUSION Although not statistically significant with a small sample size , self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI , but improvements of the protocol to increase and document compliance are needed before a larger study is implemented The aim of the present study was to assess the role of action observation treatment ( AOT ) in the rehabilitation of upper limb motor functions in children with cerebral palsy . We carried out a two-group , parallel r and omized controlled trial . Eighteen children ( aged 5–11 yr ) entered the study : 11 were treated children , and 7 served as controls . Outcome measures were scores on two functional scales : Melbourne Assessment of Unilateral Upper Limb Function Scale ( MUUL ) and the Assisting H and Assessment ( AHA ) . We collected functional scores before treatment ( T1 ) , at the end of treatment ( T2 ) , and at two months of follow-up ( T3 ) . As compared to controls , treated children improved significantly in both scales at T2 and this improvement persisted at T3 . AOT has therefore the potential to become a routine rehabilitation practice in children with CP . Twelve out of 18 enrolled children also underwent a functional magnetic resonance study at T1 and T2 . As compared to controls , at T2 , treated children showed stronger activation in a parieto-premotor circuit for h and -object interactions . These findings support the notion that AOT contributes to reorganize brain circuits subserving the impaired function rather than activating supplementary or vicariating ones The aim of the present study was to determine the user satisfaction of the EyeToy for the training of the upper limb in children with cerebral palsy ( CP ) .  User satisfaction was measured in 12 children with CP , using a postexperience question naire , primarily based on a presence question naire . In general , children with CP were satisfied with and motivated by the EyeToy training . In addition , a first evaluation study was performed to determine the effect of this training method on the upper limb function . Ten children with CP were r and omly assigned to the intervention ( mean age 11 years , 9 months ; SD 2,3 ) and the control group ( mean age 12 years , 3 months ; SD 3,2 ) . After a treatment period of 6 weeks , the intervention group completed a  user satisfaction question naire . Functional outcome was measured using the Melbourne Assessment scores . Percentage scores of the Melbourne Assessment of 7 of the 10 children were the same or changed only 1 % to 2 % from baseline to followup . However , in the experimental group , two children improved more , 9 % and 13 % respectively . In conclusion , it can be said that the EyeToy is a motivational training tool for the training of children with CP and has the potential to improve upper extremity function Resistance training of the lower limbs is now commonly used in clinical practice in children and adolescents with spastic cerebral palsy ( CP ) . However , the effectiveness of this type of training is still disputed . The most recently published systematic review with meta- analysis included interventions such as electrical stimulation and resistance training and found insufficient evidence to support or refute the efficacy of these exercises in children with CP . Thus , the aim of this article is to evaluate the extent to which training protocol s from the most recent r and omized controlled trials are in keeping with the evidence for effective resistance  training in children who are developing typically , as reflected in the training guidelines of the National Strength and Conditioning Association . Recommendations for resistance training protocol s , based on this evidence and appropriate to children with CP , are provided to help guide both future research and clinical practice for resistance training in children with CP Aim Stiffness and shortening of the calf muscle due to neural or mechanical factors can profoundly affect motor function . The aim of this study was to investigate non‐neurally mediated calf‐muscle tightness in children with cerebral palsy ( CP ) before and after botulinum toxin type A ( BoNT‐A ) injection Abstract Cerebral palsy ( CP ) is a condition affecting young children that causes lifelong disabilities . Umbilical cord blood cells improve motor function in experimental systems via paracrine signaling . After demonstrating safety , we conducted a phase II trial of autologous cord blood ( ACB ) infusion in children with CP to test whether ACB could improve function ( Clinical Trials.gov , NCT01147653 ; IND 14360 ) . In this double‐blind , placebo‐controlled , crossover study of a single intravenous infusion of 1–5 × 107 total nucleated cells per kilogram of ACB , children ages 1 to 6 years with CP were r and omly assigned to receive ACB or placebo at baseline , followed by the alternate infusion 1 year later . Motor function and magnetic resonance imaging brain connectivity studies were performed at baseline , 1 , and 2 years post‐treatment . The primary endpoint was change in motor function 1 year after baseline infusion . Additional analyses were performed at 2 years . Sixty‐three children ( median age 2.1 years ) were r and omized to treatment ( n = 32 ) or placebo ( n = 31 ) at baseline . Although there was no difference in mean change in Gross Motor Function Measure‐66 ( GMFM‐66 ) scores at 1 year between placebo and treated groups , a dosing effect was identified . In an analysis 1 year post‐ACB treatment , those who received doses ≥2 × 107/kg demonstrated significantly greater increases in GMFM‐66 scores above those predicted by age and severity , as well as in Peabody Developmental Motor Scales‐2 Gross Motor Quotient scores and normalized brain connectivity . Results of this study suggest that appropriately dosed ACB infusion improves brain connectivity and gross motor function in young children with CP . Stem Cells Translational Medicine Purpose : Investigate the combination effects of strength training and Botulinum Toxin Type-A ( BoNT-A ) on muscle strength and morphology in children with Cerebral Palsy ( CP ) . Methods : Fifteen children receiving BoNT-A , classified as Spastic Diplegic CP , GMFCS I-II , and aged 5–12 years were recruited for this study . R and omly allocated to 10 weeks of strength training either before or after BoNT-A , children were assessed over 6 months . Eight of the 15 children also completed a control period . The Modified Ashworth Scale measured spasticity . The Goal Attainment Scale ( GAS ) assessed achievement of functional goals . Magnetic Resonance Imaging assessed muscle volume ( MV ) . Instrumented dynamometry assessed strength . Results : Spasticity was significantly reduced following BoNT-A injection ( p = 0.033 ) . Children made significant isokinetic strength gains ( mean p = 0.022 , ES = 0.57 ) in the intervention period compared to the control period ( mean p = 0.15 , ES = 0.56 ) . Irrespective of timing , significant strength improvements were seen immediately ( 10 weeks ) and over 6 months for all children . This was also the case for improvements in the GAS ( immediately : mean p = 0.007 , ES = 4.17 , 6 months : mean p = 0.029 , ES = 0.99 ) , and improvements in MV in all assessed muscles . Conclusion : The simultaneous use of BoNT-A and strength training was successful in spasticity reduction , improving strength and achieving functional goals , over and above treatment with BoNT-A alone . Muscles targeted for BoNT-A injection should be included in strength training . Implication s for Rehabilitation Cerebral Palsy Botulinum toxin type-A ( BoNT-A ) and strength training are available interventions that , on their own have found success in managing spasticity and muscle weakness ( both significant motor impairments ) , respectively in children with Cerebral Palsy ( CP ) . This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength , spasticity and for the achievement of set functional goals . The results of this study show that the improved muscle strength can be associated with hypertrophy , which could indicate the potential role of strength training in altering the rate of muscle growth , in an aim to improve the failure of muscle growth associated with CP . Home based strength training , based on a child ’s individual goals is shown to be successful in improving strength and goal attainment for children with CP CONTEXT Half of all cases of cerebral palsy ( CP ) occur in term infants , for whom risk factors have not been clearly defined . Recent studies suggest a possible role of chorioamnionitis . OBJECTIVE To determine whether clinical chorioamnionitis increases the risk of CP in term and near-term infants . DESIGN , SETTING , AND PATIENTS Case-control study nested within a cohort of 231 582 singleton infants born at 36 or more weeks ' gestation between January 1 , 1991 , and December 31 , 1998 , in the Kaiser Permanente Medical Care Program , a managed care organization providing care for more than 3 million residents of northern California . Case patients were identified from electronic records and confirmed by chart review by a child neurologist , and comprised all children with moderate to severe spastic or dyskinetic CP not due to postnatal brain injury or developmental abnormalities ( n = 109 ) . Controls ( n = 218 ) were r and omly selected from the study population . MAIN OUTCOME MEASURE Association between clinical chorioamnionitis and increased risk of CP in term and near-term infants  . RESULTS Most CP cases had hemiparesis ( 40 % ) or quadriparesis ( 38 % ) ; 87 % had been diagnosed by a neurologist and 83 % had undergone neuroimaging .  Chorioamnionitis  , considered present if a treating physician made a diagnosis of chorioamnionitis or endometritis clinical ly , was noted in 14 % of cases and 4 % of controls ( odds ratio [ OR ] , 3.8 ; 95 % confidence interval [ CI ] , 1.5 - 10.1 ; P = .001 ) . Independent risk factors identified in multiple logistic regression included chorioamnionitis ( OR , 4.1 ; 95 % CI , 1.6 - 10.1 ) , intrauterine growth restriction ( OR , 4.0 ; 95 % CI , 1.3 - 12.0 ) , maternal black ethnicity ( OR , 3.6 ; 95 % CI , 1.4 - 9.3 ) , maternal age older than 25 years ( OR , 2.6 ; 95 % CI , 1.3 - 5.2 ) , and nulliparity ( OR , 1.8 ; 95 % CI , 1.0 - 3.0 ) . The population -attributable fraction of chorioamnionitis for CP is 11 % . CONCLUSION Our data suggest that chorioamnionitis is an independent risk factor for CP among term and near-term infants
INTERPRETATION In children with CP , h and splints may have a small benefit for upper limb skills .
However , results are diminished after splint wearing stops .
AIM The aim of this review was to determine the effectiveness of h and splinting for improving h and function in children with cerebral palsy ( CP ) and brain injury .