Background Interest in patient involvement in research is growing. Research should rather be ‘with’ or ‘by’ patients, and not only be ‘about’ or ‘for’ patients. Patients’ active involvement in research is not self-evident and special efforts have to be made. If we make efforts towards patient involvement, it could contribute to even more relevant projects with an even greater impact. In this paper we describe the process of development of a tool to support patient involvement in research projects. Methods The tool development was done in a co-creation of experience experts (patients and their parents/relatives) together with researchers. We used a participatory method in an iterative process comprising three consecutive stages. First, the purpose for the tool was explored, using focus groups. Second, the main ingredients and conceptualization for the tool were determined, using a narrative review. Third, the so-called Involvement Matrix was formalized and finalized using various expert panels. Results A conversation tool was developed, through which researchers and patients could discuss and explain their roles of involvement in a research project. This tool was formalized and visualized as a ‘matrix’. The so-called Involvement Matrix describes five roles (i.e., Listener, Co-thinker, Advisor, Partner, and Decision-maker) and three phases (i.e., Preparation, Execution, and Implementation) and includes a user’s guide. Conclusion The Involvement Matrix can be used prospectively to discuss about possible roles of patients in different phases of projects, and retrospectively to discuss whether roles were carried out satisfactorily. Sharing experiences with the Involvement Matrix and evaluating its impact are the next steps in supporting patient involvement in research.

Background A good understanding of developmental trajectories is crucial for making prognoses, planning interventions, and monitoring progress in children and adolescents with cerebral palsy. Our study aimed to describe developmental trajectories of mobility and self-care capability in a large sample of children and adolescents with cerebral palsy from the Netherlands and Canada. Methods We did longitudinal data analyses of cohorts from the Netherlands (Pediatric Rehabilitation Research in the Netherlands; PERRIN) and Ontario, Canada (Adolescent Study of Quality of Life, Mobility, and Exercise; ASQME). All participants had a confirmed diagnosis of cerebral palsy and ranged in age from 1 year to 17 years at baseline, and were recruited from rehabilitation centres and university medical centres. Individuals diagnosed with additional conditions affecting motor function other than cerebral palsy (eg, spina bifida or muscle diseases) were excluded. After baseline assessment, up to three follow-up assessments were done at 1 year intervals. The whole spectrum of severity of cerebral palsy was represented in terms of motor function, using the Gross Motor Function Classification System (GMFCS). Mobility and self-care capability were assessed with the Pediatric Evaluation of Disability Inventory (PEDI). We applied non-linear mixed-effects modelling to estimate limits, rates, and variations of development. Findings For both projects, recruitment took place between 2002 and 2007. The combined dataset included 551 individuals with cerebral palsy (321 individuals from the PERRIN programme and 230 from ASQME), aged 1 year to 17 years at baseline, with longitudinal data available for up to 4 years. On the basis of a total of 1754 PEDI observations, we created developmental curves for ages 1-21 years. Both for mobility and self-care, limits and rates of development differed among individuals across GMFCS levels, resulting in distinct curves. For individuals classified as being in GMFCS level I, the estimated mean limit for mobility and self-care were both higher than 90 (95.6, 95% CI 94.5-96.7 for mobility and 91.8, 90.1-93.4 for self-care), indicating capability for most if not all items on the PEDI. By comparison, the estimated mean limits for children in levels II-V varied from 83.0 (80.3-85.7) to 23.6 (20.7-26.4), with increasing limitations in mobility and self-care capability for higher GMFCS levels. Individuals with lower GMFCS levels (ie, less severe cerebral palsy) showed higher developmental limits that were reached during a longer period of development. However, among individuals within the same GMFCS level, we found substantial interindividual variation in development for mobility, and even more so for self-care. Interpretation Prognosis for mobility and self-care capability can largely be based on developmental trajectories for children and adolescents with cerebral palsy grouped by GMFCS level. The interindividual variation in development within GMFCS levels indicates that, in addition to GMFCS level, other contextual factors need to be considered when discussing prognosis and management. Using the curves for individuals with cerebral palsy aged 1 year to 21 years, we illustrate how this new knowledge can be applied in paediatric practice. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

OBJECTIVE:To explore participation in social roles of adolescents (aged 12-18y) with cerebral palsy (CP), in terms of satisfaction compared with accomplishment.DESIGN:Cohort study as part of a prospective longitudinal research program.SETTING:Clinic.PARTICIPANTS:Participants were adolescents (N=45; 58% male, mean age 15y 6mo) with CP at levels I-II (88%) and III-IV-V (12%) of the Gross Motor Function Classification System.INTERVENTIONS:Not applicable.MAIN OUTCOME MEASURES:Accomplishment (0-9 scale; with score <8 "having difficulties") and satisfaction (1-5 scale; with score 3 "neutral") were assessed using the Life-Habits questionnaire, on 6 domains (Responsibilities, Interpersonal relationships, Community life, Education, Employment, Recreation). Per domain, we analyzed scatterplots of accomplishment vs satisfaction. Additionally, we compared determinant-models (including factors of CP, activity, person, and environment) using regression analysis.RESULTS:For accomplishment, mean scores were <8.00 except for Interpersonal relationships. For satisfaction, mean scores varied between 3.85 and 4.34. Overall, individuals with similar levels of accomplishment showed large ranges in their levels of satisfaction, which was expressed by low explained variances, especially on Education (6%). Furthermore, different sets of determinants were found for accomplishment (predominantly CP factors) compared with satisfaction (predominantly environment factors).CONCLUSIONS:This study revealed a dissociation between participation accomplishment and satisfaction with participation among adolescents with CP. For practice and research, we recommend not only to focus on accomplishment but also, if not mainly, on satisfaction.

BACKGROUND:Participation in society can be difficult for adolescents with cerebral palsy (CP). Information is often based on quantitative studies, and little is known about their personal participation experiences. OBJECTIVE:The aim of this study was to examine the participation experiences of adolescents (aged 12-17 years) with CP. METHODS:A qualitative participatory research method was used. Twenty-three semi-structured open interviews were conducted with 13 male and 10 female adolescents (mean age 15 years) with CP. An interview checklist was developed jointly with adolescents with CP. This checklist ensured that the adolescents reflected on various participation areas, that is school, sports, health care and work. The analysis was based on principles of grounded theory. FINDINGS:From the adolescents' experiences, 4 key categories were identified. One concerned participation, as such, expressed as "My participation experiences," including experiences, thoughts and feelings while participating in daily life. Three other categories concerned factors that influence participation experiences, expressed as "My disability," "Me as a person" and "My environment." These 4 categories together formed a model showing the interactions and dynamics of participation according to adolescents with CP. CONCLUSION:Adolescents with CP expressed their participation experiences, including various important influencing factors. This study conceptualized these experiences into a dynamic model. This experience-based participation model may provide new, personalized perspectives for practice, for instance in rehabilitation, but also for schools and sports (or sports clubs) attended by adolescents. Focusing on personal and environmental factors might be the key to successful participation.

Knowledge on long-term development can guide expectations of young individuals with cerebral palsy (CP) and their parents and inform treatment decisions. In children with CP, development of motor capacity has been described using development curves. The present study adds to this knowledge by describing development curves of motor and daily activity performance from childhood into adulthood of individuals with CP by functional severity level. Individuals with CP (n = 421) aged 1–20 years, with GMFCS I-V, 27% with intellectual disability (ID) were included. Participants were assessed up to four times at 1- or 2-year intervals and at a 13-year follow-up (n = 122). Gross and fine motor performance and personal, domestic and community daily activity performance were assessed using the Vineland Adaptive Behavior Scales. Non-linear mixed effects analyses were used to describe development curves, characterized by a limit (average maximum score) and age90 (age reaching 90% of the limit). Limits of gross and fine motor performance decreased significantly (P < 0.05) with each lower functional level. Children with GMFCS or MACS I-III reached age90s of gross and fine motor performance around 6–8 years. Individuals with lower functional levels reached age90s earlier (around 1–3 years). Individuals with GMFCS I-III without ID reach similar limits of daily activity performance. Their age90s for daily activity performance were around 11–14 years (personal), 26–32 years (domestic) and 22–26 years (community). Individuals with ID reached lower daily activity performance limits and approached their limits earlier. Children with CP approach motor performance limits between 6–8 years. Individuals with GMFCS I-III without ID develop performance of daily activities into adolescence and adulthood. Severely functionally affected individuals have the least favourable development of motor performance and those with ID of daily activity performance. Because of ongoing development of daily activities, we recommend routine monitoring of individuals with CP for activity limitations into adulthood.

OBJECTIVES: Describe development curves of motor and daily activity performance in individuals with cerebral palsy (CP). METHODS: Participants with CP aged 1 to 20 years at baseline (n = 421) and Gross Motor Functioning Classification System (GMFCS) levels I to V (27% of participants with intellectual disability [ID]) were longitudinally assessed up to a 13-year follow-up period. Motor and daily activity performance were assessed using the relevant subdomains of the Vineland Adaptive Behavior Scales survey. Nonlinear mixed effects analyses were used, estimating the limit (average maximal performance level) and the age by which individuals reached 90% of the limit (age90). RESULTS: Limits of motor performance decreased with each lower functional level. Age90 for motor performance was reached at ∼6 to 8 years of age in children with GMFCS levels I to III, and at younger ages in those with lower functional levels. Limits of daily activity performance did not differ between individuals without ID with GMFCS levels I to III. The age90s of daily activities were reached between 11 and 14 (personal), 26 and 32 (domestic), and 22 and 26 years of age (community). Individuals with ID reached lower daily activity performance limits earlier. CONCLUSIONS: Individuals with CP continue to develop motor performance after gross motor capacity limits are reached. For those without ID, daily activities continue to develop into their 20s. Individuals who are severely affected functionally have the least favorable development of motor performance, and those with ID have the least favorable development of daily activity performance.

This study examined the criterion validity of self-reported running-related injuries (RRI) by novice runners. Fifty-eight participants (41 females; age 4611yrs) of the Start-to-Run program provided self-reports on their RRIs using an online questionnaire. Subsequently, they attended injury consultations with sports medicine physicians who provided physician-reports (blinded for the self-reports) as a reference standard. Self-reports and physician-reports included information on injury location (i.e., hip/groin, upper leg, knee, lower leg, and ankle/foot) and injury type (i.e., muscle-tendon unit, joint, ligament, or bone). Sensitivity, specificity, and positive predictive values were 100% for all five injury locations. For injury type, sensitivity was low (66% for muscle-tendon unit, 50% for ligament, and 40% for bone) and lowest for joint injuries (17%). In conclusion, the validity of self-reported RRIs by novice runners is good for injury locations but not for injury types. In particular for joint injuries, the validity of novice runners' self-reports is low.Abbreviations: RRI: Running Related Injury; SMC: Sports Medicine Centre; MTU: Muscle Tendon Unit; PPV: Positive Predictive Value

Objective: To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP).Design: A prospective cohort study.Setting: Rehabilitation departments of university medical centers and rehabilitations centers.Participants: A sample (N=327) consisting of 148 children (aged 5-9y) and 179 youth (aged 11-20y) with CP, Gross Motor Function Classification System level I (n=180), level II (n=44), level III (n=36), level IV (n=34), and level V (n=33).Interventions: Not applicable.Main Outcome Measures: Gross motor capacity was assessed with the Gross Motor Function Measure-66 over a period of 2 to 4 years in different age cohorts. Neuromusculoskeletal function included selective motor control (SMC), muscle strength, spasticity, and range of motion (ROM) of the lower extremities.Results: Multilevel analyses showed that SMC was significantly associated with gross motor capacity in children and youth with CP, showing higher values and a more favorable course of gross motor capacity in those with better SMC. Strength was only associated with gross motor capacity in youth. Reduced ROM of hip (children) and knee extension (youth) and spasticity of the hip adductors (youth) were additionally but more weakly associated with lower values and a less favorable course of gross motor capacity.Conclusions: Results indicate that children and youth with more severely impaired SMC and youth with reduced muscle strength have a less favorable course of gross motor capacity, while spasticity and reduced ROM are less determinative. (C) 2016 by the American Congress of Rehabilitation Medicine

http://ajs.sagepub.com/content/early/2016/08/31/0363546516664162 The online version of this article can be found at: DOI: 10.1177/0363546516664162 published online August 31, 2016 Am J Sports Med Mitchell C.M. van Doormaal, Nick van der Horst, Frank J.G. Backx, Dirk-Wouter Smits and Bionka M.A. Huisstede Players: A Prospective Study No Relationship Between Hamstring Flexibility and Hamstring Injuries in Male Amateur Soccer

Objective:To describe absenteeism and health care utilization (HCU) within 6 weeks after occurrence of running-related injuries (RRIs) among novice runners and to explore differences relating to injury and personal characteristics. Design:Prospective cohort study. Setting:Primary care. Participants:One thousand six hundred ninety-six novice runners (18-65 years) participating in a 6-week running program (“Start-to-Run”). Main Outcome Measures:Injury characteristics were assessed by weekly training logs and personal characteristics by a baseline questionnaire. Data on absenteeism and HCU were collected using questionnaires at 2 and 6 weeks after the RRI occurred. Results:A total of 185 novice runners (11%) reported an RRI during the 6-week program. Of these injured novice runners, 78% reported absence from sports, whereas only 4% reported absence from work. Fifty-one percent of the injured novice runners visited a health care professional, mostly physical therapists (PTs) rather than physicians. Absenteeism was more common among women than men and was also more common with acute RRIs than gradual-onset RRIs. As regards HCU, both the variety of professionals visited and the number of PT visits were higher among runners with muscle–tendon injuries in the ankle/foot region than among those with other RRIs. Conclusions:Among novice runners sustaining an RRI during a 6-week running program, over three quarters reported short-term absence from sports, whereas absence from work was very limited, and over half used professional health care. Both absence and HCU are associated with injury characteristics. Clinical Relevance:In future running promotion programs (eg in Start-to-Run programs), specific attention should be paid to acute injuries and to muscle–tendon injuries in the ankle/foot region.

Background: In soccer, although hamstring flexibility is thought to play a major role in preventing hamstring injuries, the relationship between hamstring flexibility and hamstring injuries remains unclear. Purpose: To investigate the relationship between hamstring flexibility and hamstring injuries in male amateur soccer players. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 450 male first-class amateur soccer players (mean age, 24.5 years). Hamstring flexibility was measured by performing the sit-and-reach test (SRT). The relationship between hamstring flexibility and the occurrence of hamstring injuries in the following year, while adjusting for the possible confounding effects of age and previous hamstring injuries, was determined with a multivariate logistic regression analysis. Results: Of the 450 soccer players, 21.8% reported a hamstring injury in the previous year. The mean (±SD) baseline score for the SRT was 21.2 ± 9.2 cm. During the 1-year follow-up period, 23 participants (5.1%) suffered a hamstring injury. In the multivariate analysis, while adjusting for age and previous injuries, no significant relationship was found between hamstring flexibility and hamstring injuries ( P = .493). Conclusion: In this group of soccer players, hamstring flexibility (measured with the SRT) was not related to hamstring injuries. Age and previous hamstring injuries as possible confounders did not appear to influence this relationship. Other etiological factors need to be examined to further elucidate the mechanism of hamstring injuries.

Objective: This study investigated the hamstring-and-lower-back flexibility (HLBF) of male adult amateur soccer players, using the sit-and-reach test (SRT), with a view to obtaining population-based reference values and to determining whether SRT scores are associated with player characteristics. Design: Cross-sectional cohort study. Setting: Teams from high-level Dutch amateur soccer competitions were recruited for participation. Participants: Dutch male high-level amateur field soccer players (n = 449) of age 18 to 40 years. Players with a hamstring injury at the moment of SRT-measurement or any other injury that prevented them from following the SRT protocol were excluded. Main Outcome Measures: Sit-and-reach test scores were measured and then population-based reference values were calculated as follows: >2SD below mean (defining “very low” HLBF), 1SD-2SD below mean (“low” HLBF), 1SD below mean to 1SD above mean (“normal” HLBF), 1SD-2SD above mean (“high” HLBF), and >2SD above mean (“very high” HLBF). Whether SRT scores were correlated with player characteristics was determined using a Pearson correlation coefficient or Spearman rho. Results: Sit-and-reach test scores ranged from 0 to 43.5 cm (mean 22.0 cm, SD 9.2). The cutoff points for population-based reference values were <3.5 cm for “very low”, 3.5 to 13.0 cm for “low”, 13.0 to 31.0 cm for “normal”, 31.0 to 40.5 cm for “high”, and >40.5 cm for “very high”. Sit-and-reach test scores were significantly associated with players' height (&rgr; = −0.132, P = 0.005), body mass index (r = 0.114, P = 0.016), and history of anterior cruciate ligament surgery (P < 0.001). Conclusions: This study is the first to describe the HLBF of amateur soccer players. The SRT reference values with cutoff points may facilitate evidence-based decision making regarding HLBF, and the SRT might be a useful tool to assess injury risk, performance, or for diagnostic purposes.

Aims: We aimed to determine factors associated with the longitudinal development of social participation in a Dutch population of individuals with Cerebral Palsy (CP) aged 1-24 years.Methods and procedures: For this multicentre prospective longitudinal study, 424 individuals with CP aged 1-24 years were recruited from various rehabilitation centers in The Netherlands. Social participation was measured with the Vineland Adaptive Behavior Scales. We assessed associations with age, intellectual impairment, level of gross motor function, gender, type of CP, manual ability, epilepsy, hearing-, visual-, speech impairment and pain, internalizing- and externalizing behavioral problems, type of education and parental level of education. Each individual was measured 3 or 4 times. The time between measurements was 1 or 2 years.Outcomes and results: Epilepsy and speech impairment were each independently associated with the longitudinal development of social participation. The effects were rather small and did not change with age. Also, a trend was found that children attending special education develop less favorably in social participation.Conclusions and implications: Our results might provide parents and caregivers with starting points to further develop tailored support for individuals with epilepsy, with speech impairment and/or attending special education at risk for suboptimal social participation. (C) 2016 Published by Elsevier Ltd.

Objectives: To investigate the economic burden of running-related injuries (RRI) occurred during the 6-week 'Start-to-Run' program of the Dutch Athletics Federation in 2013.Design: Prospective cohort study.Methods: This was a monetary cost analysis using the data prospectively gathered alongside the RRI registration in the NLstart2run study. RRI data were collected weekly. Cost diaries were applied two and six weeks after the RRI registration to collect data regarding healthcare utilisation (direct costs) and absenteeism from paid and unpaid work (indirect costs). RRI was defined as running-related pain that hampered running ability for three consecutive training sessions.Results: From the 1696 participants included in the analysis, 185 reported a total of 272 RRIs. A total of 26.1% of the cost data (71 RRIs reported by 50 participants) were missing. Therefore, a multiple imputation procedure was performed. The economic burden (direct plus indirect costs) of RRIs was estimated at (sic)83.22 (95% CI(sic)50.42-(sic)116.02) per RRI, and (sic)13.35 (95% CI(sic)7.07-(sic)19.63) per participant. The direct cost per RRI was (sic)56.93 (95% CI (sic)42.05-(sic)71.81) and the indirect cost per RRI was (sic)26.29(95% CI (sic)0.00-(sic)54.79). The indirect cost was higher for sudden onset RRIs than for gradual onset RRIs, with a mean difference of (sic)33.92 (95% CI (sic)17.96-(sic)49.87).Conclusions: Direct costs of RRIs were 2-fold higher than the indirect costs, and sudden onset RRIs presented higher costs than gradual onset RRIs. The results of this study are important to provide information to public health agencies and policymakers about the economic burden of RRIs in novice runners. (C) 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Background: Individuals with cerebral palsy (CP) have impairments of musculoskeletal function causing activity limitations. Medical treatment and therapy is often targeted at the International Classification of Functioning, Disability and Health (ICF)-level of body function and structure, while the goal of treatment is at the ICF-level of activities and participation. Knowledge about the association between musculoskeletal function and gross motor development is therefore important for clinical management.

BACKGROUND:Hamstring injuries are the most common muscle injuries in soccer, and they have a high rate of recurrence. Eccentric hamstrings strength is recognized as an important modifiable risk factor. This led to the development of prevention exercises such as the nordic hamstring exercise (NHE). The effectiveness of the NHE on hamstring injury prevention has never been investigated in amateur soccer.PURPOSE:To investigate the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players.STUDY DESIGN:Randomized controlled trial; Level of evidence, 1.METHODS:Male amateur soccer players (age, mean ± SD, 24.5 ± 3.8 years) from 40 teams were randomly allocated to an intervention (n = 20 teams, 292 players) or control group (n = 20 teams, 287 players). The intervention group was instructed to perform 25 sessions of NHE in a 13-week period. Both the intervention and control groups performed regular soccer training and were followed for hamstring injury incidence and severity during the 2013 calendar year. At baseline, personal characteristics (eg, age, injury history, field position) were gathered from all participants via a questionnaire. Primary outcome was injury incidence. Secondary outcomes were injury severity and compliance with the intervention protocol.RESULTS:A total of 38 hamstring injuries were recorded, affecting 36 of 579 players (6.2%). The overall injury incidence rate was 0.7 (95% CI, 0.6-0.8) per 1000 player hours, 0.33 (95% CI, 0.25-0.46) in training, and 1.2 (95% CI, 0.82-1.94) in matches. Injury incidence rates were significantly different between the intervention (0.25; 95% CI, 0.19-0.35) and control groups (0.8; 95% CI, 0.61-1.15), χ(2)(1, n = 579) = 7.865; P = .005. The risk for hamstring injuries was reduced in the intervention group compared with the control group (odds ratio, 0.282; 95% CI, 0.110-0.721) and was statistically significant (P = .005). No statistically significant differences were identified between the intervention and control groups regarding injury severity. Compliance with the intervention protocol was 91%.CONCLUSION:Incorporating the NHE protocol in regular amateur training significantly reduces hamstring injury incidence, but it does not reduce hamstring injury severity. Compliance with the intervention was excellent.

http://ajs.sagepub.com/content/early/2015/03/20/0363546515574057 The online version of this article can be found at: DOI: 10.1177/0363546515574057 published online March 20, 2015 Am J Sports Med Nick van der Horst, Dirk-Wouter Smits, Jesper Petersen, Edwin A. Goedhart and Frank J.G. Backx Players: A Randomized Controlled Trial The Preventive Effect of the Nordic Hamstring Exercise on Hamstring Injuries in Amateur Soccer

Objective: To investigate the relations between changes in motor capacity (can do, in standardized environment), motor capability (can do, in daily environment), and motor performance (does do, in daily environment) among children with cerebral palsy (CP).Design: Prospective longitudinal study. After baseline measurements (at the age of 18mo, 30mo, 5y, 7y, 9y, 11y, or 13y), 2-year follow-up measurements were performed. Change scores were calculated, and Pearson correlations were used for change score relations.Setting: Outpatient clinic.Participants: Toddlers, school-age children, and adolescents with CP (N=321; 200 boys, 121 girls). Levels of severity according to the Gross Motor Function Classification System included level I (42%), level II (15%), level III (17%); level IV (13%), and level V (13%).Interventions: Not applicable.Main Outcome Measures: Change in motor capacity was assessed with the Gross Motor Function Measure-66. Changes in motor capability and motor performance were assessed with the Pediatric Evaluation of Disability Inventory using the Functional Skills Scale and Caregiver Assistance Scale, respectively.Results: Within the total group, change score correlations were moderate (.52-.67) and significant (P<.001). For age groups, correlations were significantly higher in toddlers than school-age children and adolescents. For severity levels, correlations were significantly higher in children at level III than level I, IV, and V.Conclusions: Results imply that change in motor capacity does not automatically translate to change in motor capability and change in motor capability does not automatically translate to change in motor performance. Results also show different relations for clinically relevant subgroups. These are important insights for clinical practice because they can guide evidence-based interventions with a focus on activities. (C) 2014 by the American Congress of Rehabilitation Medicine

The aim of this study was to examine which child and family characteristics at the child's age of 2 years are determinants of development of self-care and mobility activities over a period of 2 years in young children with cerebral palsy (CP). Longitudinal data of 92 children, representing all levels of the Gross Motor Function Classification System (GMFCS), were analyzed. Children's self-care and mobility activities were assessed with the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory. Development of self-care and mobility activities was related to several child determinants but no family determinants. GMFCS, type of CP, intellectual capacity, and epilepsy were related to the development of self-care and mobility activities, while manual ability and spasticity were related to development of mobility activities. Multivariate analysis indicated that GMFCS and intellectual capacity were the strongest determinants of development of self-care activities, and GMFCS was the strongest determinant of development of mobility activities. The change in self-care and mobility activities was less favorable in severely affected children with severe disability. Knowledge of GMFCS level and intellectual capacity is important in anticipating change over time and goal setting in young children with CP.