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Background: Children with cerebral palsy are considered to be a population at risk for the occurrence of sleep difficulties. However, existing literature has been limited by subjective measures of sleep and has failed to examine contributing factors. Methods: Forty-five youth with cerebral palsy participated. Both youth and caregivers completed sleep-related questionnaires, while youth completed daily actigraphy for objective sleep assessments. Results: Sleep patterns, including sleep duration, wake after sleep onset, and sleep efficiency, are generally aligned with existing sleep recommendations. However, the number of awakenings was significantly higher in youth with cerebral palsy compared to these recommendations. Most youth experienced poor sleep quality, and approximately a quarter experienced insomnia. Being a boy and having a preexisting mental health diagnosis was associated with poor sleep quality and greater insomnia symptoms. Conclusions: Most youth with cerebral palsy experience a range of sleep difficulties. This study provides new information on sleep patterns in youth with cerebral palsy, highlighting the importance of addressing sleep issues in this population to improve their well-being and ultimately limit the negative impacts on overall health and quality of life. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed physical activity (PA) and body composition of ambulatory children and adolescents with cerebral palsy (CP) and their typically developing peers. Methods: Participants included youth with CP (ages 8–18 y and Gross Motor Function Classification System [GMFCS] levels I–III) and their typically developing peers. Outcomes included PA (actigraphy) and fat/lean mass index (FMI/LMI; dual-energy X-ray absorptiometry). Statistical analyses included linear mixed effects models with Bonferroni adjustment. Fixed effects were study group (CP and typically developing); random effects were participant clusters (sex and age). Exploratory analyses included association of body composition and PA, GMFCS level, and CP involvement (unilateral and bilateral). Results: Seventy-eight participants (CP: n = 40, girls: n = 29; GMFCS I: n = 20; GMFCS II: n = 14; GMFCS III: n = 6) met inclusion criteria. Individuals with CP had lower moderate to vigorous PA (MVPA; β = −12.5; 98.3% confidence interval, −22.6 to −2.5 min; P =.004) and lower LMI (β = −1.1; 97.5% confidence interval, −2.1 to −0.0 kg/m2; P =.020). Exploratory analyses indicated increased LMI with greater MVPA (P =.001), reduced MVPA for GMFCS II (P =.005) and III (P =.001), increased sedentary time for GMFCS III (P =.006), and greater fat mass index with unilateral motor impairment (P =.026). Conclusions: The findings contribute to the knowledge base of increasing MVPA and LMI deficits with the greater functional impact of CP. Associations of increasing LMI with greater MVPA support efforts targeting enhanced PA participation to promote independent mobility. [ABSTRACT FROM AUTHOR]

To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention. Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries. Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, 'e-helpers') were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement. This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions. The COVID-19 pandemic has increased the need for effective, evidence-based virtual interventions. This study summarizes the available literature to support preschool rehabilitation clinicians in making decisions about virtual interventions. Data presented can inform clinical decisions about technology to use, session length and frequency for various disorders, and activities used to engage preschoolers in the virtual environment. [ABSTRACT FROM AUTHOR]

Lockdown measures during COVID-19 have presented increased challenges in the home and family responsibilities. Single mothers may face unique challenges as they may be isolated from external family supports. Changes on a 19-item home and family work role survey pre- and post-COVID were tested with a paired t-test and sign test; the impact of age and people in the home was assessed using linear regression. There was a significant increase (p < 0.05) in 6/19 post-COVID-19 family responsibilities. In comparison to pre-COVID-19, post-COVID-19 single mothers reported a statistically significant median increase in family responsibilities (Mdn =.0000), p <.041. Each additional person living in the home was associated with a decrease in family responsibilities (B = -13.1, 95% CI [-21.943, -4.247]). Changes in the home and family responsibilities confirm that COVID-19 led to increased unpaid work to fulfill home and family responsibilities among single mothers. [ABSTRACT FROM AUTHOR]

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Aim: To explore relationships between category classifications for children's rehabilitation goals, outcomes, and participant characteristics. Method: Children with hemiparetic cerebral palsy due to perinatal stroke rated self‐selected goals with the Canadian Occupational Performance Measure (COPM) and completed the Assisting Hand Assessment (AHA) and Box and Block Test (BBT), at baseline and 6 months, in a randomized, controlled 10‐day neuromodulation rehabilitation trial using repetitive transcranial magnetic stimulation. Goals were classified with the Canadian Model of Occupational Performance and Engagement and the International Classification of Functioning, Disability and Health. Analysis included standard linear regression. Results: Data for 45 participants (mean age 11y 7mo, SD 3y 10mo, range 6–19y, 29 males, 16 females) on 186 goals were included. Self‐care goal percentage corresponded with baseline BBT by age (standardized ß=–0.561, p=0.004). Leisure goal percentage corresponded with baseline BBT (standardized ß=0.419, p=0.010). AHA change corresponded with productivity goals (standardized ß=0.327, p=0.029) and age (standardized ß=0.481, p=0.002). COPM change corresponded with baseline COPM and age by AHA change (p<0.05). Interpretation: Younger children with lower motor function were more likely to select self‐care goals while those with better function tended to select leisure goals. Functional improvement corresponded with older age and productivity goals. COPM change scores reflected functional improvement among older children. Children chose functionally and developmentally appropriate goals. Consequently, children should be free to set goals that matter to them. What this paper adds: Children in a brain stimulation trial chose divergent upper extremity functional goals.Younger children with lower ability chose more self‐care goals.Children with higher ability chose more leisure goals.Older children's goal ratings reflected objective functional motor gains.Children chose goals appropriate to their function and level of development. What this paper adds: Children in a brain stimulation trial chose divergent upper extremity functional goals.Younger children with lower ability chose more self‐care goals.Children with higher ability chose more leisure goals.Older children's goal ratings reflected objective functional motor gains.Children chose goals appropriate to their function and level of development. [ABSTRACT FROM AUTHOR]

To explore the self-reported factors that generate fatigue and to describe fatigue self-management strategies from the perspectives of adolescents and adults with cerebral palsy (CP). Text responses to open-ended questions of the Fatigue Impact and Severity Self-Assessment from 160 participants (mean age 22.4 years) across all GMFCS levels were coded using inductive line-by-line coding and then grouped together to generate larger categories for each question. Frequency counts associated with each category were then summarized descriptively by Gross Motor Function Classification System level. The most commonly reported contributors to fatigue included the following: activity-related factors, general demands of life, sleep/rest, general health concerns, CP-related factors, mental health concerns, and environmental factors. The top five strategies participants reported to manage fatigue included rest or relaxation, sleeping or napping, changing or limiting their activities, being physically active, or using specific adaptations or assistive devices. Results from this study suggest that there are potentially modifiable factors, including activity level and sleep, that significantly contribute to fatigue for persons with CP; these could form the basis of interventions targeted at the prevention and management of fatigue. As individuals with cerebral palsy who are physically active experience significant fatigue, clinicians need to address fatigue to enable these individuals to reap the health benefits of physical activity. Providing education and support to integrate self-management techniques, such as planning and pacing, may be an effective long-term strategy to support individuals to complete highly valued tasks. Interventions targeting modifiable fatigue-generating factors such as activity level, sleep, and mental health concerns are needed. [ABSTRACT FROM AUTHOR]

Ten prepubertal girls and 15 young women were tested for maximal torque, peak rate of torque development, electro-mechanical delay (EMD), and time to peak rate of torque development during isometric elbow flexion. Absolute peak torque (17.0 ± 7.7 vs. 40.5 ± 8.3 Nm) and peak rate of torque development (105.9 ± 58.6 vs. 297.2 ± 113.0 Nm·s-1) were lower in the girls (p < .05). Normalized to muscle cross sectional area, torque was similar (8.27 ± 2.74 vs. 8.44 ± 1.65 Nm·s-2), as was peak rate of torque development, normalized to peak torque (6.21 ± 1.94 vs. 7.30 ± 2.26 Nm·s-1/Nm). Both, time to peak rate of torque development (123.8 ± 36.0 vs. 110.5 ± 52.6 ms) and EMD (73.2 ± 28.6 vs. 51.9 ± 25.6 ms), were longer in the girls, although EMD's difference only approached statistical significance (p = .06). Age-related isometric strength differences in females appear to be mainly muscle-size dependent. However, the time to peak torque and EMD findings suggest differential motor-unit activation which may functionally manifest itself in fast dynamic contractions. [ABSTRACT FROM AUTHOR]

Aims: This study investigated the experiences and perceptions of parents of children with cerebral palsy (CP) when classifying their children using the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). The second aim was to collate parents’ recommendations for service providers on how to interact and communicate with families.Methods: A purposive sample of seven parents participating in the On Track study was recruited. Semi-structured interviews were conducted orally and were audiotaped, transcribed, and coded openly. A descriptive interpretive approach within a pragmatic perspective was used during analysis.Results: Seven themes encompassing parents’ experiences and perspectives reflect a process of increased understanding when classifying their children, with perceptions of utility evident throughout this process. Six recommendations for service providers emerged, including making the child a priority and being a dependable resource.Conclusions: Knowledge of parents’ experiences when using the GMFCS, MACS, and CFCS can provide useful insight for service providers collaborating with parents to classify function in children with CP. Using the recommendations from these parents can facilitate family–provider collaboration for goal setting and intervention planning. [ABSTRACT FROM PUBLISHER]

Purpose: The Fatigue Impact and Severity Self-Assessment (FISSA) was created to assess the impact, severity, and self-management of fatigue for individuals with cerebral palsy (CP) aged 14–31 years.Methods: Items were generated from a review of measures and interviews with individuals with CP. Focus groups with health-care professionals were used for item reduction. A mailed survey was conducted (n=163/367) to assess the factor structure, known-groups validity, and test–retest reliability.Results: The final measure contained 31 items in two factors and discriminated between individuals expected to have different levels of fatigue. Individuals with more functional abilities reported less fatigue (p< 0.002) and those with higher pain reported higher fatigue (p< 0.001). The FISSA was shown to have adequate test–retest reliability, intraclass correlation coefficient (ICC)(3,1)=0.74 (95% confidence interval [CI] 0.53–0.87).Conclusions: The FISSA valid and reliable for individuals with CP. It allows for identification of the activities that may be compromised by fatigue to enhance collaborative goal setting and intervention planning. [ABSTRACT FROM AUTHOR]

Aim: The objectives of this exploratory study were (1) to describe the experience of fatigue in adults with cerebral palsy (CP) inclusive of all levels of the Gross Motor Function Classification System (GMFCS); and (2) to determine if physical activity level, sedentary time, age, or body composition can predict fatigue in adults with CP.Method: An observational study was conducted in an outpatient setting in Ontario, Canada. Participants included adults with CP (n=41; GMFCS levels I-V; mean age 33.7y, standard deviation [SD] 12.3y). Fatigue was measured using the Fatigue Impact and Severity Self-Assessment (FISSA) questionnaire. Habitual physical activity and sedentary time were measured using accelerometry. Body mass index (BMI) and waist circumference were reported as measures of body composition.Results: The mean (SD) FISSA score for all participants was 84.5 (30.6), ranging from 54.0 (18.3) (GMFCS level I) to 93.6 (21.9) (GMFCS level V). Significant positive relationships (regression coefficient β [95% confidence intervals]) were observed between BMI and FISSA scores (1.9 [0.73-3.1]), waist circumference and FISSA scores (0.71 [0.19-1.2]), and age and FISSA scores (0.99 [0.26-1.7]). A significant negative relationship was observed between moderate-to-vigorous physical activity (MVPA) per hour and FISSA scores -6.4 [-12 to -0.83]). Backwards stepwise regression analysis revealed BMI (1.8 [0.61-2.9]) and MVPA per hour (-5.4 [-10 to -0.30]) were significant predictors of FISSA scores.Interpretation: Health care providers should consider the importance of weight management and physical activity to prevent and treat fatigue in this population. [ABSTRACT FROM AUTHOR]