AIM:To compare actual and ideal school-based physiotherapy practice in Israel and identify barriers to implementing preferred practices. METHODS:Two anonymous national online surveys were distributed to physiotherapists working in the Israeli education system: one asking respondents to report their actual school-based practice and a second, distributed two months later, asking respondents to report their perceived ideal practice. The surveys were completed by 202 and 152 physiotherapists, respectively. The adapted School-Based Practice survey included 30 parallel items addressing evaluation, individualized education program development, service delivery, team functioning, and administrative support. Item responses were compared between the two surveys using Mann-Whitney U tests with Bonferroni correction. Open-ended responses on barriers to ideal practice were analyzed using conventional content analysis. RESULTS:Significant differences between actual and ideal practice were found in 25 of the 30 survey items. Actual practice showed lower frequencies of collaborative, consultative, and participation-oriented activities. Open-ended responses from 91 respondents were organized into five barrier categories: team dynamics, resources, administrative support, students and parents, and professional "strangeness" within school settings. CONCLUSIONS:A substantial gap exists between ideal participation-oriented models of school-based physiotherapy and everyday practice. Addressing organizational conditions and strengthening collaboration may support implementation of participation-focused services.
AIMS:This study examined engagement during one-on-one motor program sessions for children with moderate and high support needs (MHS) autism by: (1) systematically coding child behaviors as on-task or off-task, and (2) exploring therapist-reported strategies to facilitate engagement. METHODS:Nine children (4-10 years) with MHS autism participated in a 13 week, twice-weekly motor program. All sessions were video recorded. A bespoke observational coding system was developed to measure gross motor skill practice, achieving interrater reliability (ICC = 0.927). A stratified sample of 27 sessions was coded. Eleven exercise physiologists completed semi-structured interviews at two timepoints, analyzed using reflexive thematic analysis. RESULTS:Children spent an average of 29.6% of session time in motor skill practice. Off-task periods involved sensory-seeking, co-regulation, avoidance, and exploratory or social behaviors. Interview analysis identified one overarching theme-attuning to the child-with subthemes describing the importance of the therapeutic relationship and prioritizing the child's needs. Sessions were adapted according to each child's cues, communication style, and regulatory needs. CONCLUSIONS:Findings highlight the central role of relational and regulatory processes in supporting engagement for children with MHS autism and emphasize the need for further research on mechanisms of change and therapists' moment-to-moment decision-making.
AIMS:People with autism spectrum disorder (ASD) may experience hypo- or hyperreactivity to sensory input. To date, sensory features of ASD have mostly been studied in children, with people over the age of 18 underrepresented in research. Therefore, this scoping review focuses on sensory factors affecting the everyday lives of adolescents and young adults with ASD. METHODS:The review followed the Joanna Briggs Institute guidelines and included peer-reviewed studies of people with ASD aged 15-29 years who have sensory challenges affecting their occupational engagement and participation. Literature was searched in five electronic bibliographic databases. Records identified from the initial database search (n = 2,959) were imported into Rayyan and screened blindly. RESULTS:Qualitative content analysis was performed on six qualitative studies that met the inclusion criteria using Atlas.ti. Three categories were developed: (1) interconnectedness of social and sensory experiences, (2) individual pursuit of balance, and (3) achieving and sustaining professional competence. CONCLUSIONS:This review suggests that sensory processing challenges profoundly influence occupational participation in young people with ASD, affecting not only their subjective experience but also their access to social, academic, and professional environments. Developing individualized sensory supports and environment adaptations are crucial for promoting meaningful occupational engagement and well-being.
AIMS:Acute care is essential for pediatric acquired brain injury (ABI), but finding precise guidelines for implementing and characterizing early neuromotor interventions is challenging. This scoping review explored the modalities and characteristics of neuromotor interventions, aligned with International Classification of Functioning, Disability and Health (ICF) and FITT (frequency, intensity, time, and type) criteria, for pediatric populations with ABI in acute care settings. METHODS:Following PRISMA-ScR framework, searches were conducted in PubMed, Embase, Scopus, Cochrane, and PEDro for English studies, limited to primary sources of evidence, published between 2000 and October 2025. Inclusion criteria focused on children aged one month to 18 years with ABI in acute care settings. Two reviewers screened and synthesized data on study characteristics, demographic data, clinical variables and types/characteristics of neuromotor interventions. RESULTS:Five of 3,497 screened articles were included. Primary interventions targeted mobilization/visual training (body structures and functions) and balance/gait training (activities). While "frequency" and "type" were consistently reported, "time" and "intensity" were frequently omitted. Outcomes were mixed for traumatic injuries but positive for inflammatory pathologies. CONCLUSIONS:Early neuromotor intervention for pediatric ABI is feasible and safe, but methodological heterogeneity and inconsistent parameter reporting underscore the need for standardized protocols and a core outcome set.
AIMS:To describe Manual Therapy (MT) practices, clinical reasoning, and perceived effectiveness among Greek physiotherapists working with children with neurological disorders. METHODS:A cross-sectional survey was conducted among 61 physiotherapists practicing in Greece, using a 34-item questionnaire assessing practice patterns, effectiveness, and safety. Data were analyzed using descriptive statistics and non-parametric tests. RESULTS:MT was used by 55.7% of participants, primarily as an adjunct intervention. It was rated most effective for joint mobility and range of motion. Formal MT training correlated with higher perceived effectiveness for pain reduction (p = .013) and sensory processing (p = .004). Conversely, specialized pediatric neurological training was negatively associated with perceived effectiveness for range of motion (p = .020) and joint mobility (p = .025). Frequent MT use was significantly associated with lower perceived safety (p <.001), indicating that clinical exposure increases risk awareness. No significant associations existed between years of experience and MT implementation. CONCLUSIONS:MT may have a role in managing selected biomechanical impairments when applied with clear clinical indications within a broader rehabilitation program. Training background, not years of experience, is the primary driver of clinical reasoning and risk perception. Findings emphasize the need for specialized pediatric education and longitudinal research.
AIMS:This study investigates whether synchronous telerehabilitation improves upper extremity function in children with hemiparetic cerebral palsy (CP). METHODS:Children aged 6-12 with Manual Ability Classification System (MACS) levels I-III were randomized into two groups. One group received Bilateral Activity-Based Exercise Training (BiActBET) in a clinic, while the other group received it via synchronous telerehabilitation (2 sessions/week for 12 weeks). The evaluations (the Quality of Upper Extremity Skills Test (QUEST), Shriners Hospital Upper Extremity Evaluation (SHUEE), ABILHAND-Kids Scale, Modified Tardieu Scale (MTS), Selective Control of the Upper Extremity Scale (SCUES), range of motion (ROM), Pediatric Evaluation of Disability Inventory (PEDI), and Cerebral Palsy Quality of Life Questionnaire for Children (CPQOL-Child)) were conducted face-to-face. Treatment efficacy, improvement, and satisfaction were also questioned. RESULTS:Both groups showed statistically significant improvements in all outcome measures (p < 0.001), with large effect sizes, with no comparison showing superiority (p > 0.05). Caregiver-rated effectiveness and improvement were similar between groups (both p = 0.183), but satisfaction was higher in the face-to-face group (p < 0.001). CONCLUSION:BiActBET enhances upper extremity function through both delivery methods. Synchronous telerehabilitation is a feasible, accessible option, associated with improvements in measured spasticity-related parameters (MTS outcomes), selective motor control, ROM, independence, and quality of life, though face-to-face therapy yields greater satisfaction.
AIM:Investigate the effect of an intervention for children with Generalized Joint Hypermobility (pgGJH) on running performance, participation, and kinesiophobia. METHODS:Single subject research design with baseline (usual care, 4-6 weeks), intervention (10 weeks), withdrawal (usual care, 6 weeks) and a six-month follow-up. Children with a Beighton score ≥6/9 undertook an individualized low-load plyometric program of 10 once/week group sessions, and a home program. The primary outcome measure was Goal Attainment Scaling (GAS). Secondary measures included Visual Analogue Scale (VAS) for pain and fatigue, leg stiffness, Muscle Power Sprint Test, Lower Extremity Grading System, Tampa Scale of Kinesiophobia, actigraphy and KIDSCREEN-10. Data were analyzed visually, Tau-u was calculated to confirm observed trends in GAS and VAS. RESULTS:Eight participants (mean age 11 years 6 months (standard deviation 2 years 2 months), male n = 6) were recruited. 5/24 goals for running-related performance, physical activity and participation had upward trends in the intervention phase (p = .04, p < .01, p = .03, p = .01 and p = .03) and one had a downward trend (p = .03). Six participants had clinically significant reductions in kinesiophobia at withdrawal. No trends were observed in pain or fatigue (pain p = .08-.94; fatigue p = .09-.71). Other results were variable. CONCLUSIONS:Outcomes for running performance, physical activity, and participation varied among children; 6 had reduced kinesiophobia.
AIMS:To examine the effects of exoskeleton-assisted rehabilitation in children with spastic cerebral palsy (CP) and explore whether outcomes differ by ambulatory status. METHODS:This exploratory longitudinal study included 20 children with spastic CP (aged 10-13 years; GMFCS I-IV) who completed a 10-week exoskeleton-assisted program (20 sessions, 30 min/session). Participants were classified as independent ambulators (GMFCS I-II, n = 11) or non-independent ambulators (GMFCS III-IV, n = 9). Outcomes were assessed at baseline and post-intervention, with 4-week follow-up in a subset. Measures included the Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), 10-Meter Walk Test, and 1-Minute Walk Test (1MWT). Longitudinal changes were analyzed using mixed-effects models. RESULTS:Main effects of time were observed for GMFM-88 (p = 0.001), PBS (p < 0.001), and 1MWT (p < 0.001). A time × group interaction was identified only for PBS (p = 0.034). The non-independent group showed baseline-to-post improvements in GMFM-88 and PBS, whereas the independent group showed an improvement in 10MWT. CONCLUSIONS:Exoskeleton-assisted rehabilitation may be associated with differential changes by ambulatory status in children with CP, particularly in balance outcomes, but subgroup and longer-term findings should be interpreted cautiously. Trial registration: Clinical Research Information Service (CRIS: KCT0010892).
AIM:This study investigated the perceived implications of caring on siblings and parents under COVID-19 lockdown in Australia. METHOD:Eighty parent/guardians participated. Dependent variables: care implications on siblings; and parent distress. Independent variables: sibling behavior; relationships; and family functioning. Correlation and multiple regression explored relationships. RESULTS:Sibling wellbeing was associated with emotional functioning (r = .41, p < .05), hyperactivity (r = .42, p < .01) and family functioning (r = .38, p < .01). Parental distress was associated with sibling's companionship (r = .50, p < .01), empathy (r = .33, p < .01), and behavioral difficulties. Parent distress was significantly predicted by both sibling's protective factors (sibling companionship and empathy and prosocial behavior) r = .51, F(3,76) =8.71, p < .001, accounting for 26% of the total variance, and risk factors (problem behaviors, impact of caring), R = .51, F(4,75) =6.58, p < .001, accounting for 26% of the total variance. The psychosocial impact on siblings was significantly predicted by sibling behavior problems, satisfaction with family functioning and parent distress, F(5,79) = 5.57, p < .001, and explained 22.5% of the variance. CONCLUSION:Implications for practitioners include consideration of the importance of protective factors such as emotional self-control and satisfaction with family functioning for siblings, and sibling companionship, empathy and the siblings' behavior on parental distress, among families raising children with disabilities.
AIMS:Spinal muscular atrophy (SMA) is a neurodegenerative disorder reducing independence in daily activities. The SMA Independence Scale Upper Extremity Module (SMAIS-ULM) evaluates upper limb independence in children with SMA. This study's aim is to assess the adaptation of the Turkish SMAIS-ULM caregiver form in children aged 2-12 years, examine its association with motor function, and compare independence with healthy peers. METHODS:Parents of children with SMA and healthy peers (n = 94) completed the SMAIS-ULM. Gross motor function was assessed using the Expanded Hammersmith Functional Motor Scale (HFMS-Expanded), upper extremity function with the Revised Upper Limb Module (RULM). Reliability was examined via test-retest ICC, Cronbach's α, and item-total correlations. Concurrent validity was assessed with Pearson correlations. Group differences were analyzed using Chi-square, Mann-Whitney U tests. RESULTS:The SMAIS-ULM demonstrated high reliability and a two-factor structure. Scores correlated strongly with RULM and moderately with HFMS-Expanded. Minimal ceiling effects were observed. Children with SMA scored significantly lower than healthy peers, indicating reduced upper limb independence. CONCLUSION:The Turkish SMAIS-ULM is a reliable, valid, and clinically applicable tool for assessing upper limb independence in children with SMA aged 2-12 years. It provides a standardized measure suitable for clinical practice and research.
AIMS:Cerebral palsy (CP) is a group of permanent disorders affecting movement and posture. In children, impaired walking limits daily activities and social participation. Robot-assisted gait training (RAGT), particularly with the Lokomat® is increasingly used in CP rehabilitation. However, evidence in children with CP remains limited. The objective of this review is to describe the extent of the effectiveness of the Lokomat® for CP children. METHODS:This systematic review followed PRISMA guidelines. Seven databases were consulted and the search strategy was conducted with related keywords: (1) CP, (2) pediatric, (3) RAGT - Lokomat®. Study quality was assessed using the Cochrane Collaboration's Tool and PEDro scale. RESULTS:Of 59 full-text articles reviewed, 33 were included. Seventeen reported improved mobility, two noted better balance with Lokomat®. Five studies have shown an impact on gait performance due to higher motivation and a feeling of pleasure during treatments. Finally, five studies reported improvement in gait parameters and one in motor function with Lokomat®. However, the studies showed a heterogeneity in the intervention protocols. CONCLUSIONS:While RAGT with Lokomat® appears to improve locomotion and motor function in children with CP, the heterogeneity of protocols and the limited methodological quality of several studies prevent clear clinical recommendations.
AIMS:To analyze the effectiveness of technology-based interventions utilizing non-immersive and immersive digital formats across cognitive, behavioral, and functional domains in children and adolescents with attention deficit hyperactivity disorder (ADHD). Meta-analysis evaluated executive function outcomes across immersion levels in randomized controlled trials (RCTs). METHODS:MEDLINE, Web of Science, and the Cochrane Library databases were searched for studies published between 2020 and 2025. Two reviewers independently screened studies and extracted data. Pooled standardized mean differences (SMDs) were calculated using a random-effects model, and heterogeneity was assessed. Subgroup analyses compared immersive and non-immersive interventions. RESULTS:Thirty-four studies met the inclusion criteria, including 14 randomized controlled trials (RCTs) included in the meta-analysis. Technology-based interventions demonstrated a small-to-moderate positive effect on executive functions overall (SMD = 0.24, 95% CI [-0.01, 0.48], p = 0.059), with substantial heterogeneity (I2=68.3%). Domain-specific analyses showed significant improvements in working memory (k = 10; SMD = 0.36, p = 0.008) and cognitive flexibility (k = 11; SMD = 0.30, p < 0.05), whereas improvements in inhibitory control were not statistically significant (k = 14; SMD = 0.18, p = 0.064). CONCLUSIONS:Technology-based interventions may enhance core executive functions in children and adolescents with ADHD. Non-immersive tools offer practical, implementable benefits, while immersive approaches may support complex learning despite limited evidence.
AIM:To examine the effects of Action Observation Therapy (AOT) and Mirror Therapy (MT) on occupational performance, occupational satisfaction, goal-oriented activities, bilateral hand skills, and upper extremity functions in children with unilateral cerebral palsy (CP). METHOD:This randomized controlled trial included 24 children with unilateral CP (12 AOT, 12 MT) aged 6-12 years. Both groups received 18 sessions over 6 wk (3 days/week), consisting of 30 min of Bilateral Activity Training (BAT) combined with 30 min of AOT or MT. Outcomes were assessed using the Canadian Occupational Performance Measure, Goal Attainment Scale, Shriners Hospital Upper Extremity Evaluation, and ABILHAND questionnaire at baseline, post-intervention, and 1-month follow-up. RESULTS:Both groups showed significant improvements in occupational performance, satisfaction, goal attainment, bilateral hand skills, and upper extremity function after treatment (all p < 0.001) and at follow-up (AOT: p = 0.02-0.09; MT: p = 0.02-0.05). Although some variation in effect size estimates was observed across outcomes, between-group differences were not statistically significant (all p > 0.05). INTERPRETATION:AOT and MT, when combined with BAT, appear to be effective complementary interventions for improving upper extremity-related outcomes in children with unilateral CP. TRIAL REGISTRATION:This study was registered as a Clinical Trial Number with the code NCT05951829.
AIM:Pretend play and executive functioning underpin developmental skills required for everyday functioning. Pediatric occupational therapists' practice often supports children in the development of these skills. Limited attention has been given to examine the association between these two concepts in school-aged children. This study investigated the association between executive functioning and pretend play skills in neurotypically developing children aged 9-12 years. METHODS:Twenty-nine (12 male, 17 female) participants aged 9-12 years old completed the Animated Movie Test (AMT), Affect in Play Scale-Brief Rating version (APS-BR), and the Behavior Rating Inventory of Executive Function, Second edition (BRIEF2). Spearman's rho correlations were used to examine the association between the factors. RESULTS:The BRIEF2 Emotional Regulation Index (ERI) was significantly correlated with the APS-BR Frequency of Affect (rs = .40., p = .033) while the BRIEF2 Cognitive Regulation Index (CRI) and Global Executive Composite (GEC) were both significantly associated with the APS-BR Tone of affect subscale (rs = -0.47, p = .011; rs = -0.39, p = .035). The AMT Generation of problems subscale was significantly correlated with the BRIEF2 CRI (rs = -0.49, p = .007) and GEC (rs = -0.40., p = .030). CONCLUSION:The findings provide evidence to suggest that aspects of executive functioning and pretend play are correlated for primary school aged children aged 9 to 12.
AIMS:To evaluate cognitive and executive function (EF) in children with obstetric brachial plexus injury (OBPI), and the potential effects of injury severity and surgical intervention. METHODS:Fifty-two children aged 6-12 years were assessed: 30 with OBPI (Type IIa: n = 10, Type IIb: n = 11, Type III-IV: n = 9) and 22 children with typical development. Cognitive function was measured using the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), and EF was assessed via parent-reported Childhood Executive Functioning Inventory (CHEXI). Non-parametric tests and subgroup analyses were conducted, with false discovery rate (FDR) correction applied for multiple comparisons. RESULTS:Children with OBPI scored significantly lower on total and domain-specific DOTCA-Ch measures (median [IQR]: 85 [72-95] vs. 125 [115-135]; q = 0.002), with large effect sizes (Cliff's δ = -0.82 to -0.90). No significant differences were found in CHEXI EF composites. Subgroup analyses showed no statistically significant effects of surgery or Narakas classification, although trends indicated potentially poorer cognitive outcomes in children with Narakas type III-IV. CONCLUSION:Children with OBPI had lower cognitive function than children with typical development but there was no difference in EF. Findings support integrating cognitive assessments into management of children with OBPI.
AIM:To identify caregiver-reported discriminative items for the early detection of children at risk for vestibular deficits. METHODS:Parents of children aged 6, 12, or 24 months completed a self-developed Vestibular Infant Screening Questionnaire and the motor subscale of the Bayley-III questionnaire. Participants were categorized into children with confirmed vestibular dysfunction (VD), children with vestibular risk factors but normal vestibular status (P), and typically developing children (N). Responses were compared across groups and age categories. RESULTS:A total of 390 questionnaires were analyzed (VD: 57, P: 255, N: 78). Parents in the VD group reported more motor difficulties than those in the P and N group. At 6 months, challenges included poor head control (p = .001), limited postural stability in prone position (p < .001), and delayed sitting (p < .001). At 12 months, children with VD ask more to be carried (p = .008). By 24 months, difficulties with walking (p = .016) and walking on uneven surfaces (p = .004) were more prevalent. Bayley-III motor subscale scores did not show significant differences between groups (p > .05). CONCLUSION:Parents consistently reported age-specific motor difficulties in children with VD. These findings highlight caregiver-reported red flags that could guide the development of a screening tool to identify children at risk for vestibular deficits.
AIMS:This study examined physical activity levels, video gaming habits, and interest in using exergames among adolescents with probable developmental coordination disorder (p-DCD). It also explored relationships between physical activity, sedentary video gaming time, and preferences between sedentary video games and exergames. METHODS:103 adolescents with p-DCD (17 girls, 86 boys; M = 12.48 years, SD = 1.25) from the Netherlands (n = 61) and Czech Republic (n = 42) completed a questionnaire. RESULTS:58.3% of participants reported low physical activity. On weekdays, 46.5% sat for 4-8 h; on weekends, 37.3% sat for 8-12 h. Motivations for sedentary video gaming included entertainment and social interaction. On weekdays, 39.8% played sedentary video games for 1-2 h; on weekends, 43.7% played for 3-5 h. While 43.7% believed exergames could increase their activity, 52.9% preferred sedentary video games. No significant relationship was found between physical activity levels and sedentary video gaming time or video game type preferences. CONCLUSION:Participants reported high sedentary behavior and sedentary video gaming engagement. Although many expressed interest in exergames, sedentary video games were preferred, suggesting the need to enhance exergames' entertainment value. Game choice may be influenced more by appeal and engagement than by physical activity levels.
AIMS:To gain consensus on the content and constructs of infant participation for infants with typical development. METHODS:An international three-round Delphi survey was conducted with primary caregivers of children aged <2 years and health professionals (HPs). In Round 1, all participants answered open-ended questions on Attendance (life situations between 0 and 12 months), Involvement (observable infant behaviors), and Caregiver role. HPs also addressed definitions of infant participation; Similarities/differences compared with older children; and Participation Assessments and Interventions. Items generated in Round 1 were rated for consensus in Rounds 2 and 3 using an agreement threshold of ≥85%. RESULTS:Sixteen maternal caregivers and 35 HPs participated. High agreement was achieved for caregiver roles in mediating infant participation, including providing access, support and a strong relationship. Participants agreed that infant Attendance diversity increases substantially between 0 and 12 months. Multiple observable indicators of Involvement reached consensus (7/10 HP-generated and 9/9 caregiver-generated items). HPs agreed that Attendance and Involvement underpin infant participation. Agreement was low for similarity and differences between age groups and for participation intervention approaches. No assessments reached consensus. CONCLUSION:Caregivers play a central role in co-constructing infant participation. Infants demonstrate increasing Attendance over time and observable signs of Involvement. Infant-specific participation assessments are urgently needed.
AIMS:Knowledge is limited on the weight-bearing load in standing frames, potentially leading to variability in therapeutic application and outcomes. This study investigated the inter-rater reliability and agreement of weight-bearing load during repeated standing-frame sessions in the education setting, measured by integrated force-plate devices, in children with cerebral palsy (CP). METHODS:Eighteen children with CP (aged 3-17 years, GMFCS levels III-V) each completed three 10-minute standing-frame sessions: one supervised by a physiotherapist, and two by different education staff. Weight-bearing load was continuously recorded using foot-plate integrated force-plate devices, with the device outputs blinded to the physiotherapist and education staff. Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), and agreement using a modified Bland-Altman approach for multiple observers (Limits of Agreement with the Mean, LOAM). RESULTS:Across all sessions, inter-rater reliability was moderate (ICC = 0.64 [95% CI, 0.39; 0.83]). The modified Bland-Altman analysis revealed wide LOAM (±14.2%), demonstrating substantial between-rater variability for the same child. CONCLUSIONS:Weight-bearing load during standing-frame use showed moderate inter-rater reliability but wide limits of agreement, indicating inconsistency in clinical practice. Incorporating objective feedback offers a feasible solution for real-time load monitoring and may support standardization; however further research is needed to determine whether such monitoring improves clinical outcomes.
