Developmental neurorehabilitation最新文献

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Trial registration: ClinicalTrials.gov (NCT06831591).

Objective: To investigate the effects of combining aquatic therapy with a home exercise program on balance, functionality, and quality of life in children with DMD/BMD, compared with a home exercise program alone.

Methods: Sixteen patients aged 5-18 years with DMD/BMD were included. Those at the top of the waiting list were assigned to the intervention group (n = 8), and those further down to the control group (n = 8). The intervention group received 30-minute Halliwick-based aquatic therapy three times per week for five weeks in a 30°C pool, in addition to a home exercise program. The control group performed a home exercise program alone while awaiting aquatic therapy. The home exercise program consisted of joint range-of-motion and stretching exercises only (30 minutes/day, five days/week). Exercises were performed under caregiver supervision, and adherence was assessed by caregiver report and investigator questioning. Outcomes assessed at baseline and week 5 included weekly fall frequency, balance (Pediatric Berg Balance Scale; Functional Reach Test), activity (ACTIVLIM), physical performance (10-m walk; 4-step tests), quality of life (PedsQL Neuromuscular Module), and muscle strength (manual muscle testing) and joint range of motion.

Results: Significant improvements in balance, activity, physical performance, and quality of life were observed in the intervention group, alongside a reduction in weekly fall frequency (p < .05). In the control group, the only significant change was increased forward reach distance in the Functional Reach Test (p < .05). Between-group comparisons showed greater gains in balance, functionality, and quality-of-life scores in the intervention group (p < .01). Hip extensor strength increased significantly only in the intervention group. No adverse events occurred.

Conclusion: Combining aquatic therapy with a home exercise program was safe and well tolerated and was associated with greater short-term improvements in balance, functionality, and quality of life than a home exercise program alone, with reduced fall frequency over five weeks. These findings support integrating aquatic therapy into DMD/BMD management and justify larger randomized controlled trials to confirm efficacy and guide optimal regimens.

Clinical trial registration number: NCT06186310.

Background: Autism spectrum disorder (ASD) is characterized by aberrant functional brain connectivity and deficits in network dynamics. Transcranial direct current stimulation (tDCS) has emerged as a promising intervention with potential therapeutic effects; however, its effects on both static and dynamic functional brain network organization remained insufficiently understood.

Methods: A total of 42 children with ASD aged 4-6 years were enrolled and randomly assigned to either active tDCS or sham stimulation groups. Resting-state electroencephalography (EEG) data were acquired before and after the intervention. Low-order functional connectivity (LOFC) and high-order functional connectivity (HOFC) networks were constructed, followed by graph-theoretical analyses to assess clustering coefficient, characteristic path length, global efficiency, and local efficiency. Furthermore, state entropy was employed to evaluate dynamic network transitions between integrated and segregated states.

Results: Active tDCS was associated with increased LOFC strength in the delta, alpha, and beta bands, and more widespread increases in HOFC across all examined frequency bands. Changes in network topology were primarily observed in HOFC, with reductions in characteristic path length and increases in global and local efficiency, particularly in the delta and theta bands. Dynamic network analysis indicated that tDCS modulated state entropy at specific time scales in both LOFC and HOFC networks. These findings suggest shifts in functional coordination and temporal variability among the recorded regions. Behavioral measures exhibited a trend toward improvement in the active group; however, these changes were not the focus of the present analysis, and their relationship to neural modulation remains to be clarified in future work.

Conclusions: tDCS modulated functional interaction patterns and dynamic state characteristics among the recorded brain regions in children with ASD. These results provide preliminary neurophysiological evidence regarding the influence of tDCS on both static and dynamic network organization and highlight potential network-based markers to guide future individualized neuromodulation research. Further studies with larger samples and longitudinal follow-ups are needed to clarify the functional and clinical significance of these network-level changes.

Objective: To evaluate the effectiveness and application value of moderate to high intensity badminton activities on the sleep quality of children with autism.

Methods: Forty-eight children with autism were randomly divided into experimental and control group (42 were included for data analysis). The experimental group underwent 8 weeks of moderate to high intensity badminton intervention (3 times/week, 80 min/time, 60 ~ 80% HRmax), the control group maintained daily routines. Sleep quality was assessed both objectively Children's Sleep Habits Questionnaire (CSHQ) and subjectively (ActigraPh wGT3X-BT triaxial accelerometer).

Results: After 8 weeks of moderate to high intensity badminton intervention, children in the experimental group showed decreased bedtime resistance, night wakings and total CSHQ scores, sleep latency, and wake after sleep onset were reduced. Conclusions: Eight weeks of moderate to high intensity badminton has significant effects on improving sleep quality in children with autism.

Background and objective: Children with Down syndrome (DS) experience delays across multiple developmental domains, including communication and motor coordination. While prior studies have investigated these domains separately, few have examined their interrelation using population-level data. This study aimed to evaluate (1) differences between young children with DS and typically developing (TD) peers in early communication skills and motor-coordination difficulties, and (2) whether the relationship between these domains is similar across groups.

Methods: This brief report used data from the 2021-2022 National Survey of Children's Health, a nationally representative U.S. dataset including children aged 0-5 years. Children were categorized as having DS (parent-reported diagnosis) or typical development (no developmental delays). Early communication skills were assessed using 11 parent-report items (five receptive, six expressive). Motor coordination was assessed using two items reflecting chronic difficulty using hands or moving around. Chi-square tests were used to compare group differences and to examine associations between motor coordination and communication milestones within each group.

Results: The sample included 90 children with DS and 24,988 TD children. Compared with TD peers, children with DS were less likely to achieve all early communication milestones and more likely to experience motor-coordination difficulties (p < .001). Within the DS group, those with motor-coordination difficulties were less likely to say one word (57.1% vs 80.6%), follow verbal directions (45.2% vs 72.2%), point to things (38.1% vs 69.4%), understand "in," "on," "under" (31.0% vs 58.3%), or use two words (19.0% vs 44.4%) compared to TD children (p < .05). The TD group showed significant associations between the acquisition of early communication skills and motor coordination difficulties for all the early communication skills recorded (p < .01).

Discussion: Findings indicate a dynamic, bidirectional relationship between early motor coordination and communication skill acquisition in young children with DS, mirroring patterns observed in TD peers. Population-level evidence underscores the need for early interventions targeting both domains concurrently. Future prospective studies using standardized developmental assessments are warranted to clarify temporal relationships and inform early intervention strategies.

Purpose: The utility of the Coma Recovery Scale for Pediatrics (CRS-P) was evaluated as a measure for assessing responsiveness in young children in states of disorders of consciousness (DoC) after brain injury.

Methods: Retrospective demographic and CRS-P data were abstracted from medical records of patients between 6 months and <7 years of age at admission to a paediatric inpatient brain injury rehabilitation program before September 2023 if administered the CRS-P at least once during admission.

Results: The sample included children aged 8 months to 6 years and 10 months (N = 18) admitted for inpatient rehabilitation following a new brain injury. CRS-P total score was significantly higher at discharge compared to admission (p < .001). CRS-P auditory, visual, and motor subscales were sensitive to change (i.e. significant improvement in responsiveness) between admission and discharge (p's < 0.02). Just over one-third of patients (n = 7) emerged from a minimally conscious state (MCS), and functional object use was the first sign of emergence for all. Age at assessment was not significantly correlated with CRS-P scores. Conclusions: Results highlight the utility of the CRS-P for classifying states of DoC, as well as emergence, in young children with severe brain injury.

Purpose: The aim of this study was to conduct a scoping review of the health benefits of adapted physical activity (APA) programs for children and adolescents with autism based on the ICF-CY.

Methods: Retrieving experimental studies related to APA in children and adolescents (0-18 years) with autism in the PubMed, Web of Science, EBSCO, PsycINFO, and CNKI databases, January 2014-December 2023.

Results: A total of 34 studies were included (involving 13 countries and 997 subjects). Coding of health effects according to ICF-CY categories, 52% of the 210 outcome items focused on body functions, 48% on activities and participation.

Conclusions: With its individualized, diversified and structured characteristics, APA not only serves as an effective non-pharmacological treatment strategy, but also an important way to promote the health of children and adolescents with autism in all-round way. However, the complexity of environmental factors makes it challenging to design an APA program based on the concept of ICF-CY.

This scoping review aimed to identify participation assessment measures, focusing on everyday functioning or social interactions in children aged 2 to 5. Following the PRISMA guidelines, relevant studies published over a 5-year period were identified and selected, using a transdiagnostic approach. Four hundred and eighty publications from 37 countries were analyzed. Among the 651 mentions, 186 different measures were identified, of which only 34 were cited more than three times. To assess participation in young children, the alignment of concepts and their operationalization seems a challenge across the early childhood professions. Results highlight the difficulty of transitioning from unidisciplinary, diagnosis-focused approaches to child-and-family-centered practices.

This feasibility randomized controlled trial (RCT) evaluated "Children and Teens in Charge of Their Health" (CATCH), a solution-focused coaching intervention promoting physical activity and healthy eating in children with spina bifida or cerebral palsy. All participants received standard care and printed materials; the intervention group also received up to eight coaching sessions over six months. Quantitative analyses examined whether a priori feasibility criteria were met and the responsiveness of measures assessing goal attainment, functional mobility, dietary intake and physical activity at four timepoints over 12 months. Nineteen participants were randomized. While stratification and fidelity criteria were met, recruitment and retention were not, likely impacted by Covid-19. CATCH participants showed significant improvements in two of three goal attainment scores, along with positive trends in functional mobility, active hours, and some dietary measures compared to controls. Most outcome measures were responsive, although protocol adaptations are needed for a full-scale RCT.