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Aim Method Results Interpretation To describe what is known about hip problems in individuals with developmental central hypotonia.Searches were conducted in five databases to October 2023. Down syndrome was excluded from this analysis of less well‐known genetic diagnoses. At least two reviewers independently screened titles, abstracts, read full‐text articles, and extracted data.Of 89 full‐text articles, 79 met inclusion criteria. Studies included 544 individuals aged 1 month to 63 years with Kabuki, 49, XXXXY, Prader–Willi, PURA, Koolen de Vries, Emanuel, TRPM3, Wolf–Hirschhorn, and other rare syndromes. Most diagnoses may be associated with a combination of differences in hip structure or stability that are evident at birth, or develop in early infancy, with increasing hip dysplasia and subluxation over time. Joint or ligamentous laxity was most reported along with hypotonia and hypermobility as risk factors. Limited data were identified about conservative or surgical intervention and outcomes in these populations.Children with significant hypotonia, with or without a confirmed genetic diagnosis, are at increased risk of hip problems that may be missed with standard neonatal screening. Ultrasound is recommended between 6 weeks and 6 months, and annual orthopaedic review with regular radiographs for older children and adults with significant and persistent hypotonia. [ABSTRACT FROM AUTHOR]

This study described and compared use of supported-standing and stepping devices by young children with cerebral palsy, Gross-Motor Function Classification System (GMFCS) levels III-V following power mobility introduction. Data was collected at two time-points, 5–6 months apart, for 42 participants, aged 18–80 months, using the Home Use of Technology for CHildren (HUTCH). Supported-standing and stepping device choice and time in each device remained stable over 6 months. Associations between device use and three functional classifications were examined. Children with more impaired motor, postural and manual abilities were more likely to use a supine stander rather than a prone/upright stander or no stander. Children at GMFCS V tended to use hands-free stepping devices, while support-arms stepping devices were more common for children at GMFCS IV. Only children at GMFCS III used convertible stepping devices. Using power mobility, standers and supported-stepping devices was feasible and 19/34 classified at GMFCS IV/V used all three devices over 6 months. A key finding was that introduction of power mobility did not reduce use of supported-stepping devices at any GMFCS level. Use of multiple upright positioning and mobility devices may assist children with limited mobility to be actively engaged and participate in daily life. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate assessment and referral practices for the early detection and diagnosis of children at risk for or with cerebral palsy (CP) by health care and education providers in Maryland and Delaware. A secondary aim was to identify barriers for using early detection tools and identify opportunities for change to support early diagnosis and improve care. Seventy-two participants answered ≥ 50% of the survey questions. Most were occupational or physical therapists (86%) working in early intervention (61%). Eighty-eight percent indicated awareness that CP can be diagnosed by 12 months. Though 86% stated they typically suspect a diagnosis of CP between 0 and 12 months, only 19% reported that their patients received a CP diagnosis < 12 months. The Developmental Assessment of Young Children (73%) and the Peabody Developmental Motor Scales-2 (59%) were used most. Many respondents indicated never using magnetic resonance imaging (70%), the General Movements Assessment (87%), or the Hammersmith Infant Neurological Exam (69%). Participants identified clinical signs and symptoms prompting a referral for the diagnostic assessment of CP, most commonly stiffness in legs (95%), excessive head lag (93%), and persistent fisting (92%). Policy and organizational change, clinician education, and training are needed to support the implementation of CP early detection guidelines. [ABSTRACT FROM AUTHOR]

Standing power wheelchairs (PWSDs) expand positioning and mobility options for individuals with motor impairments. Although more available, little is known about how PWSDs are used in everyday life. to describe children's use of PWSDs in the first three months post-wheelchair delivery and the impacts on satisfaction with participation in daily life. An interrupted time series of purposefully sampled children aged 5–18 years who were receiving a PWSD. The Wheelchair Outcome Measure for Young People (WhOM-YP) documented satisfaction with patient-reported meaningful participation outcomes. Data loggers objectively measured wheelchair mobility outcomes including distance travelled, bouts of mobility, and duration. Data were measured over two sessions pre-wheelchair-delivery and at one week, one month and three months post-wheelchair-delivery. Six children aged 7–18 years participated, four diagnosed with cerebral palsy, two with spina bifida. Analyses of individual data illustrated positive change in overall WhOM-YP satisfaction scores after PWSD provision though change varied across time, as did, distance, bouts of mobility and duration of use. Participants identified 14 in-home and 16 out-of-home unique participation outcomes, although several commonalities existed. PWSDs hold promise for increasing children's satisfaction with participation in daily life, in addition to possibly increasing mobility outcomes. For children with mobility limitations, PWSDs may promote participation in daily life and increased mobility. Data logger technology provides valuable information about children's PWSD use and how this varies over time. Benefits and challenges exist with implementing PWSD and data logger technologies. When implementing PWSD use, it is critical to consider context, training and support needs of clients and caregivers. [ABSTRACT FROM AUTHOR]

Aim: To describe the evidence, outcomes, and lived experience of supported standing for children and young adults with cerebral palsy aged 25 years or younger, classified in Gross Motor Function Classification System levels IV and V. Method: This scoping review included searches in eight electronic databases and manual searching from database inception to May 2020 and updated on 21st February 2022. Two of three reviewers independently screened titles and abstracts and extracted and appraised data. Methodological quality and risk of bias were appraised using tools appropriate to study type. Content analysis and frequency effect sizes were calculated for qualitative and descriptive evidence. Results: From 126 full‐text references, 59 citations (one study was reported over two citations) were included: 16 systematic reviews, 17 intervention studies reporting over 18 citations, eight analytical cross‐sectional studies, five descriptive cross‐sectional/survey studies, five qualitative studies, and one mixed‐methods study were identified, along with six clinical guidelines. Maintenance of bone mineral density and contracture prevention outcomes were supported by the most experimental studies and evidence syntheses, while evidence supporting other outcomes was primarily quasi‐experimental or descriptive. Qualitative evidence suggests that programmes are influenced by attitudes, device, child, and environmental factors. Interpretation: Individualized assessment and prescription are essential to match personal and environmental needs. Although experimental evidence is limited due to many factors, lived‐experience and cohort data suggest that successful integration of standing programmes into age‐appropriate and meaningful activities may enhance function, participation, and overall health. What this paper adds: Supported‐standing interventions may provide an important psychosocial and physical change of position.Supported standing is not passive for those classified in Gross Motor Function Classification System level IV or V.Supported standing may enhance social participation, functional abilities, and fitness.Children need choice in where and when to stand. [ABSTRACT FROM AUTHOR]

Individuals with cerebral palsy functioning at Gross Motor Function Classification System (GMFCS) levels IV and V are unable to use hand-held walkers and require supported-stepping devices with trunk and pelvic support to allow overground stepping in natural environments. This scoping review explored what is known about the use of supported-stepping devices with individuals functioning at GMFCS IV or V. Comprehensive database and hand searches were completed in December 2022. Of 225 unique citations, 68 met the inclusion criteria: 10 syntheses and 58 primary studies including randomized, non-randomized, qualitative, observational and case study designs. Primary studies included 705 unique individuals functioning at GMFCS IV or V, aged 9 months to 47.7 years, while surveys and qualitative studies included 632 therapists. No new experimental studies have been published since previous reviews, however, lived experience and descriptive data suggest that upright positioning and mobility in supported-stepping devices have psycho-social significance with positive impacts on individual self-esteem and autonomy, as well as influencing the perception of others. Improved head and trunk control, use of hands, stepping and independent mobility may promote fitness, functioning, fun, friends, family and future, although environmental and physical challenges may limit use in adolescence and adulthood. Further research on all aspects of supported-stepping device use with individuals at GMFCS IV/V is warranted. [ABSTRACT FROM AUTHOR]

To measure and compare progression in children's power mobility skill among process and task-based measures following a loan of one of four early power mobility devices. Additionally, to explore different power mobility learner groups and skill development trajectories. In this pre-post study, children were purposefully sampled and power mobility skill was measured from video taken pre-post several months' experience (mean 192.40; SD 42.79 days) using the Assessment of Learning Powered mobility use (ALP) and two task-based measures. Associations among power mobility skill measures were examined. Child and environmental factors influencing ALP phase at loan-end were explored. Forty-six children aged 13 − 68 months (mean 40.40; SD 15.60) participated, with cerebral palsy being the most common condition (n = 33; 71.74%). ALP change scores ranged from −2 to +4 ALP phases (median 1.0). Wilcoxon signed rank test was significant for pre-post differences with a large effect size (z = 5.50, p < 0.001; r = 0.57). End-of-loan Spearman correlations between ALP and two task-based paediatric measures were excellent (rs = 0.92). Kruskal-Wallis test revealed significant effect of device, access method, diagnostic group and communication abilities on loan-end ALP phase. Positive change was demonstrated with most children (n = 39; 84.78%) changing at least one ALP phase during the study. Positive change was seen with children at all phases of tool-use, using all devices and access methods. Process and task-based measures were highly correlated, but differed in application for different learner groups. Different trajectories of skill development may be associated with different child profiles and access abilities. Children at all phases of tool-use can demonstrate positive change in power mobility skill using different devices and switch as well as joystick access methods The Assessment of Learning Powered mobility use (ALP) is useful for assessing tool-use and learning process skills for young children across the power mobility skill continuum. Task-based measures may also be helpful for guiding training and recording progress; The Power Mobility Training Tool (PMTT) is most useful for children exploring cause-effect and direction (ALP Phases 1–5), while the Power Mobility Program (PMP) is most useful for functional learners and those progressing from exploring direction to functional use (ALP Phases 5–8). Access method may influence power mobility learning trajectory and training [ABSTRACT FROM AUTHOR]

Introduction: This pre-post study explored the effect of children's 6 months' experience in one of four early power mobility devices. Method: Satisfaction with parent-selected goal achievement was measured using the wheelchair outcome measure for young people and compared with the assessment of learning powered mobility use, as well as device expectation fulfilment ratings. Results: Forty-six children with mobility limitations, aged 13–68 months (mean 40.40; SD 15.60) participated. The most common condition was cerebral palsy (n = 33; 71.74%). The Wilcoxon signed rank test measured the positive change in goal achievement (z = 4.90; P <0.001; r = 0.51). Fair to good statistically significant Spearman's correlations were observed between power mobility skill and goal achievement, as well as parent and therapist device expectation scores (r s = 0.48, 0.46 and 0.66, respectively; P <0.001). Parent and therapist ratings did not differ significantly. No statistically significant associations were found between goal achievement and child (age, diagnosis, abilities) or environmental factors (device, access method, loan length). Conclusion: Children at all phases of power mobility skill, using various devices and access methods, can demonstrate activity and participation change following power mobility experience. This study adds validity evidence supporting the use of the wheelchair outcome measure for young people with young children by parent-proxy rating. [ABSTRACT FROM AUTHOR]