Background: Upper limb (UL) function in children with unilateral cerebral palsy (CP) may vary largely depending on presumed timing, location and extent of brain lesions. These factors might exhibit a complex interaction and the combined prognostic value warrants further investigation. This study aimed to map lesion location and extent and assess whether these differ according to presumed lesion timing and to determine the impact of structural brain damage on UL function within different lesion timing groups. Materials and methods:Seventy-three children with unilateral CP (mean age 10 years 2 months) were classified according to lesion timing: malformations (N=2), periventricular white matter (PWM, N=42) and cortical and deep grey matter (CDGM, N=29) lesions.Neuroanatomical damage was scored using a semi-quantitative MRI scale. UL function was assessed at the level of body function and activity level.Results: CDGM lesions were more pronounced compared to PWM lesions (p=0.0003).Neuroanatomical scores were correlated with a higher degree to UL function in the CDGM group (r s =-0.39 to r s =-0.84) compared to the PWM group (r rb =-0.42 to r s =-0.61). Regression analysis found lesion location and extent to explain 75% and 65% (p<0.02) respectively, of the variance in AHA performance in the CDGM group, but only 24% and 12% (p<0.03) in the PWM group. Conclusions:In the CDGM group, lesion location and extent seems to impact more on UL function compared to the PWM group. In children with PWM lesions, other factors like cortical reorganization and structural connectivity may play an additional role.

Background and Purpose Regaining functional independence and independent living is challenging in hospitalized geriatric patients. Different from community dwelling and institutionalized older people, geriatric patients on rehabilitation wards generally receive more frequent and structured physiotherapy with the primary aim to discharge them to their home or place of residence. There is a paucity of evidence concerning the structure and components of physiotherapy programs to improve functional performance in this particular group. In this paper, we describe how we developed the Geriatric Activation Program Pellenberg (GAPP) based on patients' needs and available literature. Methods We searched the literature on physiotherapy interventions focusing on the core components for improvement of functional performance: strength, balance, function, (gait)speed, coordination, and endurance training. Based on physiotherapist staffing and physiotherapy time allocated to each patient, we organized the practical, daily delivery of the program. Results GAPP is a 5‐day program, repeated weekly, delivered by physiotherapists and physiotherapy students. Each day, one or a combination of two to three different core components of functional performance is trained intensively in 45‐min sessions. A set of standard exercises is constantly adjusted to each patients' capacity. On day 5, there is a mix of these core elements in a group session (e.g., chair‐dance, table tennis, karate) and the Berg Balance Scale is completed to evaluate progress. Conclusion GAPP is a multicomponent physiotherapy program for hospitalized patients on a geriatric rehabilitation ward, aimed at improving functional performance.

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