IMPORTANCECerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.OBJECTIVES To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.

This review outlines a conceptual approach to inform research and practice aimed at supporting children whose lives are complicated by impairment and/or chronic medical conditions, and their families. ‘Participation’ in meaningful life activities should be an essential intervention goal, to meet the challenges of healthy growth and development, and to provide opportunities to help ensure that young people with impairments reach their full potential across their lifespan. Intervention activities and research can focus on participation as either an independent or dependent variable. The proposed framework and associated hypotheses are applicable to children and young people with a wide variety of conditions, and to their families. In taking a fresh ‘non‐categorical’ perspective to health for children and young people, asking new questions, and exploring issues in innovative ways, we expect to learn lessons and to develop creative solutions that will ultimately benefit children with a wide variety of impairments and challenges, and their families, everywhere.

Both CIMT and bimanual training lead to similar improvements in hand function. A potential benefit of bimanual training is that participants may improve more on self-determined goals.

Children with hemiplegic cerebral palsy (CP) have impairments in bimanual coordination above and beyond their unilateral impairments. Recently we developed hand‐arm bimanual intensive therapy (HABIT), using the principles of motor learning, and neuroplasticity, to address these bimanual impairments. A single‐blinded randomized control study of HABIT was performed to examine its efficacy in children with hemiplegic CP with mild to moderate hand involvement. Twenty children (age range 3y 6mo‐15y 6mo) were randomized to either an intervention (n=10: seven males, three females; mean age 8y 7mo, SD 4y) or a delayed treatment control group (n=10: seven males, three females; mean age 6y 10mo, SD 2y 4mo). Children were engaged in play and functional activities that provided structured bimanual practice 6 hours per day for 10 days. Each child was evaluated immediately before and after the intervention, and again at 1‐month post‐intervention. Children in the intervention group demonstrated improved scores on the Assisting Hand Assessment, increased involved extremity use measured using accelerometry and a caregiver survey, bimanual items of the Bruininks–Oseretsky Test of Motor Proficiency, and the simultaneity of completing a draw‐opening task with two hands (p<0.05 in all cases). The results suggest that for this carefully selected subgroup of children with hemiplegic CP, HABIT appears to be efficacious in improving bimanual hand use.

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1. While subjects lifted a variety of commonly handled objects of different shapes, weights, and densities, the isometric vertical lifting force opposing the object's weight was recorded from an analog weight scale, which was instrumented with high-stiffness strain gauge transducers. 2. The force output was scaled differently for the various objects from the first lift, before sensory information related to the object's weight was available. The force output was successfully specified from information in memory related to the weight of common objects, because only small changes in the force-rate profiles occurred across 10 consecutive lifts. This information was retrieved during a process related to visual identification of the target object. 3. The amount of practice necessary to appropriately scale the vertical lifting and grip (pinch) force was also studied when novel objects (equipped with force transducers at the grip surfaces) of different densities were encountered. The mass of a test object that subjects had not seen previously was adjusted to either 300 or 1,000 g by inserting an appropriate mass in the object's base without altering its appearance. This resulted in either a density that was in the range of most common objects (1.2 kg/l) or a density that was unusually high (4.0 kg/l). 4. Low vertical-lifting and grip-force rates were used initially with the high-density object, as if a lighter object had been expected. However, within the first few trials, the duration of the loading phase (period of isometric force increase before lift-off) was reduced by nearly 50% and the employed force-rate profiles were targeted for the weight of the object.(ABSTRACT TRUNCATED AT 250 WORDS)

Aim To systematically review the evidence on the effectiveness of motor interventions for infants from birth to 2 years with a diagnosis of cerebral palsy or at high risk of it. Method Relevant literature was identified by searching journal article databases (PubMed, Embase, CINAHL, Cochrane, Web of Knowledge, and PEDro). Selection criteria included infants between the ages of birth and 2 years diagnosed with, or at risk of, cerebral palsy who received early motor intervention. Results Thirty‐four studies met the inclusion criteria, including 10 randomized controlled trials. Studies varied in quality, interventions, and participant inclusion criteria. Neurodevelopmental therapy was the most common intervention investigated either as the experimental or control assignment. The two interventions that had a moderate to large effect on motor outcomes (Cohen's effect size>0.7) had the common themes of child‐initiated movement, environment modification/enrichment, and task‐specific training. Interpretation The published evidence for early motor intervention is limited by the lack of high‐quality trials. There is some promising evidence that early intervention incorporating child‐initiated movement (based on motor‐learning principles and task specificity), parental education, and environment modification have a positive effect on motor development. Further research is crucial.

Constraint-induced (CI) movement therapy is a promising therapy for improving upper limb function in adults after stroke. It involves restraint of the non-involved limb and extensive movement practice with the involved limb. In this study, a single-blinded, randomized, control study was performed to examine the efficacy of CI therapy, modified to be child friendly, in children with hemiplegic cerebral palsy (CP). Twenty-two children (8 females, 14 males; mean age 6 y 8 mo [SD 1 y 4 mo]; range 4-8 y) were randomized to either an intervention group (n=11) or a delayed treatment control group (n=11). Children wore a sling on their non-involved upper limb for 6 hours per day for 10 out of 12 consecutive days and were engaged in play and functional activities. Children in the treatment group demonstrated improved movement efficiency and dexterity of the involved upper extremity, which were sustained through the 6-month evaluation period, as measured by the Jebsen-Taylor Test of Hand Function and fine motor-subtests of the Bruininks-Oseretsky Test of Motor Proficiency (p<0.05 in both cases). Initial severity of hand impairment and testing compliance were strong predictors of improvement. Caregivers reported significant increases in involved limb frequency of use and quality of movement. However, there was no change in strength, sensibility, or muscle tone (p>0.05 in all cases). Results suggest that for a carefully selected subgroup of children with hemiplegic CP, CI therapy modified to be child-friendly, appears to be efficacious in improving movement efficiency of the involved upper extremity.