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Background: The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy.Methods: The sample will comprise 34 individuals with spastic hemiparetic cerebral palsy, 6 to 16 years old, classified at level I, II, or III of the Manual Ability Classification System. Participants will be randomly allocated to two groups: (1) functional training of the paretic upper limb combined with anodic transcranial stimulation; (2) functional training of the paretic upper limb combined with sham transcranial stimulation. Evaluation will involve three-dimensional movement analysis and electromyography using the SMART-D 140® system (BTS Engineering) and the FREEEMG® system (BTS Engineering), the Quality of Upper Extremity Skills Test, to assess functional mobility, the Portable Device and Ashworth Scale, to measure movement resistance and spasticity, and the Pediatric Evaluation of Disability Inventory, to evaluate performance. Functional reach training of the paretic upper limb will include a range of manual activities using educational toys associated with an induced constraint of the non-paretic limb during the training. Training will be performed in five weekly 20-minute sessions for two weeks. Transcranial stimulation over the primary motor cortex will be performed during the training sessions at an intensity of 1 mA. Findings will be analyzed statistically considering a 5 % significance level (P ≤ 0.05).Discussion: This paper presents a detailed description of a prospective, randomized, controlled, double-blind, clinical trial designed to demonstrate the effects of combining transcranial direct current stimulation over the primary motor cortex and functional training of the paretic limb in children with cerebral palsy classified at level I, II, or III of the Manual Ability Classification System. The results will be published and evidence found may contribute to the use of transcranial stimulation for this population.Trial Registration: ReBEC RBR-6V4Y3K . Registered on 11 February 2015. [ABSTRACT FROM AUTHOR]

Purpose: Children with cerebral palsy (CP) may present varied ophthalmological problems. Paradoxically, however, investigation of visual function and possible related disorders is not routinely conducted in this population during medical consultations. Method: This paper proposes a simple, practical guide for assessing vision and ocular motricity in children with CP. One-hundred and twenty-three patients (mean age: 8.4 years ± 2.3) from the Sarah Network of Rehabilitation Hospitals (Brasilia, Rio de Janeiro and São Luis units) were studied. Various parameters were investigated (smooth pursuit movements, strabismus, visual acuity, visual field, visuospatial neglect and nystagmus) using the following assessment tools: adapted smooth pursuit test for ocular motricity; Snellen test for visual acuity; confrontation method for visual field; cancellation test (star test) for visual neglect; and cover test for strabismus. Nystagmus was assessed based on patient observation. Results: Eighty-one children completed all the evaluations. Among these, 38 (47%) had no visual problems (hemiplegia 60.5%; diplegia 41.4%; triplegia 12.5%; mixed tetraplegic 33.3%); 23 had difficulties in one of the tested items; and 20 had problems in two or more areas of vision. Conclusions: Visual and oculomotor tests are of significant importance in children with CP and provide relevant information for creating a rehabilitation programme aimed at the individual as a whole. [ABSTRACT FROM AUTHOR]

Abstract: This paper proposes a simple method of hand skill assessment in children that can be useful in clinical practice. A reduced 5-hole version of Annett''s Peg Moving Task was used to quantify hand skill bilaterally in 435 normally developing preschool and school-children, and adolescents aged 3–18 years from Brazil. The cross-cultural validity of the normative data obtained in Brazil was verified in 157 school-children aged 6–11 years from France. An application in 76 children with cerebral palsy (hemiplegia 21, diplegia 34, triplegia 6, mixed type 15) showed very important variability of the deficits in hand function within each subtype of cerebral palsy (CP). Hand deficits were more severe in children in special schools than in children in regular schools within each CP subtype. A qualitative analysis showed which difficulties during the execution of the task were specific to children with CP and which were also observed in normally developing children. [Copyright &y& Elsevier]