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Children and youth with impairments in social skills and/or cognition face many barriers to community participation specifically physical activity (PA) (e.g., limited staff training). Inclusive PA settings may provide opportunities for children and youth with and without impairments to engage together and promote physical and social skill development. The purpose of this scoping review was to critically evaluate the literature on out-of-school PA programs (i.e., non-curriculum programming) that included children and/or youth with impairments in social skills and/or cognition. A keyword search of seven databases followed by eligibility screening led to ten articles for this scoping review. For each included study, two research team members independently extracted and synthesized the data, and appraised the study reporting quality using the published quality assessment tool (QATSDD). Experts' evaluation of the research literature was obtained. Ten studies, which varied from low to high reporting quality, collectively addressed the following outcomes, with all showing mixed impacts: anthropometrics and fitness; motor and sport skills; psychological well-being; and socialization. Experts suggested routes forward for research and practice including longitudinal designs and programming variety to meet individual needs. Out-of-school PA programs that include children and/or youth with impairments in social skills and/or cognition provide an opportunity to improve multiple areas of health and wellness. However, limited high-quality research has been conducted to-date. Further evaluation of program effectiveness is warranted.

Background: Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm. Methods: This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) prepost intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents. Discussion: This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention. [ABSTRACT FROM AUTHOR]

Aim: To estimate gross motor change in inpatient school‐aged children with subacute acquired brain injury (ABI), identify factors associated with gross motor change, and describe inpatient physiotherapy focus. Method: This retrospective chart review involved inpatient children (5–18 years) with subacute ABI who had either two Gross Motor Function Measure (GMFM‐88) assessments or one GMFM‐88 with another pre/post gross motor outcome measure. Outcome change scores and Goal Attainment Scaling (GAS) T scores were calculated. Regression analyses examined factors predicting gross motor change. GAS goal areas were analysed to determine physiotherapy focus. Results: Of the 546 charts screened, 266 (118 female) met study criteria. The GMFM‐88 was generally administered first, followed by other measures. GMFM‐88 (n = 202), Community Balance and Mobility Scale (n = 89), and Six‐Minute Walk Test (6MWT) (n = 98) mean change scores were 18.03% (SD 19.34), 17.85% (SD 10.77), and 142.3 m (SD 101.8) respectively. The mean GAS T score was 55.06 (SD 11.50). Lower baseline scores and increased time between assessments were most predictive of greater GMFM‐88 change (r ≥ 0.40). Twenty‐five percent of GAS goals were ambulation‐based. Interpretation: Appropriate outcome measure selection is integral to detecting gross motor change in pediatric inpatient ABI rehabilitation. Mean change score estimates can be used to compare standard inpatient rehabilitation with new treatment approaches. [ABSTRACT FROM AUTHOR]

Rehabilitation increasingly addresses the International Classification of Functioning, Disability and Health's (ICF) concepts of activity and participation, but little is known about associations between changes in body functions and structures, activity, and participation. We conducted a before-and-after study of 35 ambulatory children with spastic diplegia or hemiplegic cerebral palsy, mean age 5 years 6 months (SD 2y 2mo). Children were in Gross Motor Function Classification System (GMFCS) Levels I (n=11), II (n=12), or III (n=12). We assessed body functions and structures, activity, and participation at baseline and at 2 months and 6 months post-botulinum toxin type A (BoNT-A) injection. Repeated-measures analysis of variance evaluated change, and linear regression assessed relationships. Baseline score relationships were moderate to strong but, despite similar directions of change at 2 months, change score relationships between measures of body functions and structures (spasticity and timed walk), activity (Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory), and participation (Pediatric Outcomes Data Collection Instrument) at 2 months and 6 months were poor to fair (r less than 0.40). Predictor combinations accounted for less than 69% of variation in activity and participation change scores. Predictors often pertained to baseline score, GMFCS level, or age. Relationships between changes at different ICF levels are complex, and activity and participation gains post-BoNT-A are likely to be influenced by the child and environment factors.

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Since the mid-1990s, there has been considerable activity internationally on development and validation of pediatric prosthetic functional status measures for use with children with an upper extremity limb loss. In contrast, there are few prosthesis-specific functional status measures available specifically for use with adults with upper limb loss. The recent emphasis on outcome measurement across rehabilitation reflects the recognition that understanding of outcome results is an essential part of an effective health care system. From an outcomes perspective, the prosthetic community needs to systematically and prospectively gather information using validated functional status measures for both adult and pediatric groups. The purpose of this article is to provide measurement information to help clinicians and researchers in the identification and selection of ‘activity’ and ‘participation’ outcome measures that relate to upper extremity function and use of a prosthetic device. This review investigates: intended use of the measure, condition-specific (disease-specific) versus generic measures, age/life-stage considerations, observational measures versus client/parent-report questionnaires, psychometric properties of the measure, evaluation of change, use of individualized measures, choosing a measure or a core set of measures, and aspects of clinical utility. Three key recommendations were made by the author for future work: 1) Given the relative lack of prosthetic-specific measures available for adults, it is important to begin their development and validation. It may be possible to use existing pediatric prosthetic measures as a starting structural and content framework; 2) The building of a core set of outcome measures is recommended to provide a comprehensive picture of different aspects of hand function and prosthetic use. This core set should include an individualized measure of outcome; and 3) Because the numbers of upper limb amputees in any one center are often limited, formation of networks across rehabilitation facilities and use of the similar core sets of measures would facilitate capture of outcome data within large cooperative databases. There is a tremendous opportunity for the prosthetic service providers and researchers to make use of the recently validated functional measures and contribute ground-breaking knowledge on upper extremity outcomes. [ABSTRACT FROM AUTHOR]

This document discusses the refinement and evaluation of the Gross Motor Family Report (GM-FR), a tool used to assess gross motor function in children and adolescents with cerebral palsy. The study involved input from families to ensure the content validity of the measure. The GM-FR demonstrated high internal consistency and test-retest reliability. It also showed strong concurrent validity with other measures of gross motor function. The findings suggest that the GM-FR is a reliable and valid tool for assessing gross motor activity in children with cerebral palsy. [Extracted from the article]

Aim Method Results Interpretation To refine the Gross Motor Family Report (GM‐FR) using parents' input and to evaluate its psychometric properties.In this measurement study, 12 parents of children and adolescents with cerebral palsy (CP), aged 2 to 18 years, classified in all levels of the Gross Motor Function Classification System (GMFCS), were interviewed about their experience completing the GM‐FR (content validity). Parents' feedback was used to refine the measure which was then completed by 146 families to evaluate internal consistency, and discriminative and concurrent validity. Forty‐six parents completed the GM‐FR again, 7 to 30 days later, to evaluate test–retest reliability.GM‐FR scoring, pictures, descriptions, and the total number of items were revised based on parents' feedback. The GM‐FR version 2.0 demonstrated high internal consistency (Cronbach's α = 0.99), no floor/ceiling effects, and excellent test–retest reliability (intraclass correlation coefficient = 0.99). GM‐FR scores discriminated between GMFCS levels (p < 0.05) and were strongly negatively correlated with GMFCS level (r = −0.92; p < 0.001). GM‐FR scores correlated positively and strongly with the Gross Motor Function Measure‐66 (r = 0.94; p < 0.001) and the Pediatric Evaluation of Disability Inventory – Computer Adaptive Test mobility domain (r = 0.93; p < 0.001).Active participation of families in the GM‐FR's development facilitated creation of a family‐friendly instrument. This study provides strong evidence of reliability and validity to support GM‐FR use in clinical practice and research for assessing gross motor performance of children and adolescents with CP. [ABSTRACT FROM AUTHOR]

This commentary is on the original article by Schiariti et al. on pages 149–158 of this issue. [ABSTRACT FROM AUTHOR]

Introduction: This study explored the extent to which an interactive computer play system, Bootle Blast, supports motor learning in a clinical context and examined clinicians' perceptions of their therapeutic role in the system's use as an intervention tool., Methods: In this observational sequential explanatory mixed methods study, five children with cerebral palsy [mean age 9.4 years (SD, 0.5), Gross Motor Function Classification System Levels I-III] used Bootle Blast during a single video-recorded therapy session with their treating clinicians (physical therapists, occupational therapists, and therapy assistants). Children played one Bootle Blast mini game independently (without clinician involvement) before clinicians carried out therapy sessions with the game as per usual care. The type and extent of motor learning strategies (MLS) delivered by Bootle Blast and clinicians were rated from video recordings by a trained assessor using the 22-item Motor Learning Strategies Rating Instrument. Semi-structured interviews with clinicians were conducted to gain insights into MLS use and clinicians' perceived role during Bootle Blast use. Interviews were audio recorded, transcribed verbatim, and analyzed independently by two researchers using thematic analysis. Quantitative and qualitative data were merged and reported using narrative and joint display approaches., Results: Bootle Blast provided eight MLS, with clinicians adding or enhancing another eight. Four themes reflected clinicians' perspectives: (1) Bootle Blast disguises therapy as play, (2) clinicians give Bootle Blast the human touch; (3) home use of Bootle Blast is promising; and (4) Bootle Blast is not always the right fit but some shortcomings could be addressed. Agreement was found for nine MLS and disagreement for four MLS when quantitative and qualitative findings were merged., Discussion: Bootle Blast delivers several MLS as part of game play and clinicians can enhance and provide additional MLS to suit the child's needs/abilities. Further game refinements that were identified in this study may optimize its clinical use., Competing Interests: Holland Bloorview is supporting the creation of a company called Pearl Interactives to commercialize Bootle Blast so that it can be made widely available to those who can benefit from it. EB is a shareholder in Pearl Interactives and may financially benefit from this interest if Pearl Interactives is successful in marketing Bootle Blast. The terms of this arrangement have been reviewed and approved by Holland Bloorview Kids Rehabilitation Hospital and the University of Toronto in accordance with its policy on objectivity in research and will continue to be actively monitored to mitigate and manage any conflicts of interest. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Petrevska, Ryan, Sert, Munce, Wright and Biddiss.)

Introduction: Access to rehabilitation therapies is a salient and growing issue for children with cerebral palsy (CP) and their families, motivating interest in home-based interventions. Bootle Blast is a low-cost, movement-tracking videogame that can be used at home to encourage upper limb (UL) functional exercise tailored to each child's abilities and therapy goals. The study objectives were to: 1) Establish the extent to which children achieve their self-directed play-time goal over a 12-week intervention, 2) Measure changes in UL motor outcomes, and 3) Explore participants' experiences of using Bootle Blast at home., Methods: Mixed methods case series study of four children with hemiplegic cerebral palsy (HCP), each with a participating parent. Participants played Bootle Blast at home for 12 weeks. Study assessments occurred at baseline, post-intervention and four week follow up. A post-intervention interview explored participants' experiences. Game-logs provided play time and progress data., Results: Three of four participants (8-13 yrs., Manual Ability Classification Level I-II) completed the intervention. One dropped out at week 6. Play-time goals were achieved in most weeks, with two of four children surpassing their overall intervention goals. Outcomes varied across the three participants, however consistent improvements were observed on the Canadian Occupational Performance Measure and the Box and Blocks Test. Inductive analysis generated four main themes: 1) Intrinsic motivators fostered play engagement, 2) Virtual play for real-world gains, 3) Therapy on demand (at home), and 4) Shifting the onus from the parent to the game. Integration of qualitative and quantitative data was important for interpreting play patterns/usage and clinical outcomes., Discussion: This mixed methods study describes a novel videogaming intervention designed for home-rehabilitation for children with HCP and provides preliminary evidence to guide future study design and research., Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT04009031?recrs=h&cond=Cerebral+Palsy&cntry=CA&city=Toronto&draw=2&rank=1], identifier [NCT04009031]., Competing Interests: Holland Bloorview is supporting the creation of a company called Pearl Interactives to commercialize BB so that it can be made widely available to those who can benefit from it. EB and AK are shareholders in Pearl Interactives and may financially benefit from this interest if Pearl Interactives is successful in marketing BB. The terms of this arrangement have been reviewed and approved by Holland Bloorview Kids Rehabilitation Hospital and the University of Toronto in accordance with its policy on objectivity in research and will continue to be actively monitored to mitigate and manage any conflicts of interest. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Chan-Víquez, Khan, Munce, Fehlings, Wright and Biddiss.)