As this study was powered to test for large differences between groups, future investigations on larger samples will be needed to compare differences at the two dosage levels.

HighlightsFour models of therapeutic suits have had their effects tested empirically in pediatric rehabilitation.The Dynamic Elastomeric Fabric Orthoses and TheraTogs improve postural alignment and gait in children with diplegic CP.The isolated effects of TheraSuit and AdeliSuit were not tested. Both suits were investigated within the context of intensive training programs.No additional benefits could be attributed to TheraSuit wearing during intensive training programs.Low quality of evidence suggests caution in recommending therapeutic suits.

Aim To examine the efficacy of Hand–Arm Bimanual Intensive Therapy (HABIT) on daily functioning, unimanual dexterity, and bimanual performance of children with bilateral cerebral palsy (CP) compared with customary care. Method Forty‐one children with bilateral CP, aged 4 to 16 years, classified in levels I to III of the Manual Ability Classification System, were randomly assigned to HABIT (90h) (n=21) or to customary care (4.5h) (n=20). Participants’ daily functioning (Pediatric Evaluation of Disability Inventory [PEDI], Canadian Occupational Performance Measure [COPM]), unimanual dexterity (Jebsen–Taylor Test of Hand Function, Box and Blocks Test [BBT]), and bimanual performance (Both Hands Assessment) were assessed pre‐, post‐, and 6 months after the intervention. Linear mixed‐effects models were used for inferential analysis. Results Children participating in HABIT showed greater improvements in daily functioning (COPMperformance: χ12=9.50, p<0.01; COPMsatisfaction: χ12=5.07, p<0.05; PEDIfunctional skills: χ12=6.81, p<0.01; PEDIcaregiver assistance: χ12=6.23, p<0.05) and in the dexterity of the dominant hand (BBT: χ12=3.99, p<0.05) compared with children maintaining customary care. Group or time effects did not explain any variance in bimanual performance or in the dexterity of the non‐dominant hand. Interpretation HABIT may be beneficial for children with bilateral CP, with benefits evidenced for daily functioning outcomes. What this paper adds Hand–Arm Bimanual Intensive Therapy (HABIT) improved daily functioning of children with bilateral cerebral palsy (CP). Bimanual performance, measured by the Both Hands Assessment, did not change after HABIT in children with bilateral CP. Children with asymmetric and symmetric hand use exhibited similar improvements after HABIT.

Functional mobility of children with cerebral palsy (CP) is influenced by personal and environmental factors, serving as barriers and/or facilitators and impacting on children's strategies and functional outcome. OBJECTIVES: To describe typical mobility methods used by children with CP at home, school and community and to compare them across family's socioeconomic levels (SES). METHODS: The Functional Mobility Scale was used to assess mobility of 113 children with CP of high and low SES at home, school, and community. RESULTS: Differences in mobility methods of participants classified as Gross Motor Function Classification System levels II, III and IV were found between home and community. For levels III and IV, differences were also found between home and school. At home, participants from higher SES used wheelchairs more frequently while those from lower SES used floor mobility (crawling). CONCLUSIONS: Environmental settings and families' socioeconomic status influence mobility and use of mobility devices by children with CP.

| Background: The optimization of gait performance is an important goal in the rehabilitation of children with cerebral palsy (CP) who present a prognosis associated with locomotion. Gait analysis using videos captured by digital cameras requires validation. Objective: To evaluate the validity of a method that involves the analysis of videos captured using a digital camera for quantifying the temporal parameters of gait in toddlers with normal motor development and children with CP. Method: Eleven toddlers with normal motor development and eight children with spastic hemiplegia who were able to walk without assistive devices were asked to walk through a space contained in the visual field of two instruments: a digital camera and a three-dimensional motion analysis system, Qualisys Pro-Reflex. The duration of the stance and swing phases of gait and of the entire gait cycle were calculated by analyzing videos captured by a digital camera and compared to those obtained by Qualisys Pro-Reflex, which is considered a highly accurate system. Results: The Intraclass Correlation Coefficient (ICC) demonstrated excellent agreement (ICC>0.90) between the two procedures for all measurements, except for the swing phase of the normal toddlers (ICC=0.35). The standard error of measurement was less than 0.02 seconds for all measures. Conclusions: The results reveal similarities between the two instruments, suggesting that digital cameras can be valid instruments for quantifying two temporal parameters of gait. This congruence is of clinical and scientific relevance and validates the use of digital cameras as a resource for helping the assessment and documentation of the therapeutic effects of interventions targeted at the gait of children with CP.Keywords: gait; toddlers; cerebral palsy; image processing; computer-assisted; rehabilitation. HOW TO CITE THIS ARTICLEFigueiredo PRP, Silva PLP, Avelar BS, Chagas PSC, Oliveira LCP, Mancini MC. Assessment of gait in toddlers with normal motor development and in hemiplegic children with mild motor impairment: a validity study. Braz J Phys Ther. 2013 July-Aug; 17(4):359-366. http://dx

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O objetivo do estudo foi compreender fatores que influenciam a participação de adolescentes com paralisia cerebral (PC) na Educação Física Escolar. Dez adolescentes com PC foram entrevistados utilizando roteiro de entrevista semiestruturado, cujo conteúdo foi gravado, transcrito e submetido à Análise de Conteúdo. Três categorias e sete subcategorias emergiram dessa análise. Verificou-se que fatores ambientais (atitudinais e físicos) e pessoais influenciaram a participação. Especificamente, as atitudes de colegas, professores e monitores, bem como a disponibilidade de dispositivos de auxílio para marcha e a acessibilidade física da escola foram elementos importantes que impactaram, negativamente ou positivamente, a participação na Educação Física. Características pessoais, como medo de realizar as atividades e baixa ou alta percepção de autoeficácia, também influenciaram o engajamento dos adolescentes na Educação Física e devem ser consideradas por profissionais da Educação Física e reabilitação.

Individuals with unilateral cerebral palsy (CP) demonstrate reduced performance in upper limb tasks compared to typically developing (TD) peers. We examined whether task conditions modify differences between teenagers with and without CP during a reciprocal aiming task. Twenty teenagers (nine CP and 11 TD) moved a pointer between two targets as fast as possible without missing a target. Task conditions were manipulated by changing the targets' size, by modifying the inertial properties of the pointer and by varying the upper limb used to perform the task (preferred/non-affected and non-preferred/affected upper limbs). While compared to TD peers, CP teenagers exhibited lower performance (longer movement times). Such differences were attenuated when the task was performed with the preferred upper limb and when accuracy requirements were less stringent. CP teenagers were not differentially affected by the pointer inertia manipulation. Task conditions not only affected performance but also joint kinematics. CP teenagers revealed less movement at the elbow and more movement at the shoulder when performing the task with their less skilled upper limb. However, both CP and TD teenagers demonstrated a larger contribution of trunk movement when facing more challenging task conditions. The overall pattern of results indicated that the joint kinematics employed by individuals with unilateral CP constituted adaptive responses to task requirements. Thus, the explanation of the effects of unilateral CP on upper limb behavior needs to go beyond a context-indifferent manifestation of the brain injury to include the interaction between task demands and action capabilities.