ObjectivesComplex congenital heart disease (CHD), neonatal cardiac surgery, and perioperative extracorporeal membrane oxygenation (ECMO) are risk factors for increased perioperative mortality and morbidity, including impaired neurodevelopmental (ND) outcomes. We investigated perioperative mortality and the independent impact of ECMO on 1-year ND outcomes after cardiac surgery in infants younger than 6 weeks.MethodsUsing data from the Swiss Outcome Registry for Children with severe CHD (Swiss ORCHID), we assessed the impact of perioperative ECMO on 1-year mortality and ND outcomes using the Bayley Scales of Infant Development, Third Edition (BSID III) and language composite scores (LCSs), cognitive composite scores (CCSs), and motor composite scores (MCSs) while controlling for known risk factors.ResultsThe 1-year mortality rate among 240 patients who underwent surgery between 1 January 2020 and 30 May 2024 was 5.8%. Perioperative ECMO was used in 34 patients (14.2%). Mortality among patients with perioperative ECMO (ECMO group) was higher (29.4% in the ECMO group vs. 1.9% in the non-ECMO group, p < 0.001) and was more frequently associated with univentricular CHD (p = 0.005). The mean BSID III CCS (β=−13.942, SE = 3.736, p = <0.001) and MCS (β = −15.913, SE = 4.325, p=<0.001) were significantly lower in the ECMO group compared to the non-ECMO group in simple linear regression analyses. Multiple linear regression showed a negative impact of ECMO on CCS (p < 0.05); MCS was influenced by longer hospital stay (p < 0.01), and lower socioeconomic status (p < 0.05).ConclusionsPerioperative ECMO might be associated with higher perioperative mortality and morbidity, including lower BSID III ND scores in infants with CHD.Clinical trial registrationclinicaltrials.gov, NCT05996211.

BackgroundChildren with hemiparesis present with sensory and motor deficits, which negatively affect quality of life. Sensory Afferent Electrical Stimulation (SAES) triggers action potentials in afferent nerve fibers, leading to increased sensorimotor afferent input. While proven effective in adults after stroke and safe in children with cerebral palsy through small studies, a systematic and large-scale investigation in the pediatric population is still missing. This protocol describes a study designed to investigate the efficacy and mechanisms of SAES.MethodsWe will recruit 34 children and adolescents with spastic hemiparesis to participate in the prospective, single center, randomized controlled Bayesian phase II trial with a 5-week intervention period and a follow-up examination after 12 weeks. Participants will be randomly assigned to a 5-week SAES intervention or a control group consisting of treatment as usual. Before and after the SAES as well as at 12-week follow-up, clinical measures will be used to assess bimanual and unimanual hand functions (primary outcome: Assisting Hand Assessment AHA). Accelerometry and contactless motion tracking will be applied to evaluate everyday life upper limb functions. Neurophysiological methods such as structural and functional Magnetic Resonance Imaging and Transcranial Magnetic Stimulation will be performed to gain insight into neuroplastic mechanisms underlying SAES and are considered secondary outcomes.DiscussionPrevious studies were limited by small cohorts and narrow outcome measures. Our study addresses these gaps while additionally investigating underlying neurophysiological mechanisms in children using MRI and TMS, providing a scientific basis for implementing such stimulation in practice.Clinical Trial Registrationclinicaltrials.gov, identifier (NCT06536634); kofam.ch, identifier (SNCTP000005950).

Background:Diseases during childhood and adolescence such as cancer or attention-deficit/hyperactivity disorder (ADHD) can have an impact on brain development and place children and adolescents at increased risk for cognitive long-term problems. Most cognitive trainings currently available have limited efficacy and show limited transfer to nontrained tasks and everyday functioning. We developed a novel intervention (Mio-Training) aiming to increase metacognitive abilities at the intersection between exercise psychology and cognitive science to strengthen the cognitive development of pediatric patients with atypical brain development in the long term. Objective:The study assesses the efficacy of the Mio-Training on the primary (metacognitive abilities) and secondary outcomes (executive functions, processing speed, and memory) before the training, immediately after the training, and at a 3-month follow-up in patients with atypical development and healthy controls. Methods:The Mio-Training stimulates metacognition through 38 digital games, which playfully teach mnemonic strategies (ie, rehearsal, chaining, and associations), present intensive verbal and visual working memory training, and motor coordination tasks. The training group will train for 5 weeks, 3 times per week, for 20 minutes. The waiting control group will receive the training after completion of the study procedure. We will evaluate the efficacy of the Mio-Training on metacognitive abilities and cognitive performance in a randomized controlled clinical trial. We expect a long-term increase in metacognitive abilities associated with an increase in subjective and objective cognitive performance. The efficacy of the Mio-Training will be investigated in 3 subgroups (patients with cancer, ADHD, and healthy controls; each group n=40; all aged 8-16 years) using pre-intervention and post-intervention assessments. All participants will be randomly assigned to the Mio-Training or the waiting control group, stratified by age and sex. Results:This study protocol describes the study design of the randomized controlled trial evaluating the efficacy of the Mio-Training. The project is funded from October 2024 to December 2027. Recruitment for healthy controls has been completed (n=40; October 2024-August 2025), recruitment for childhood cancer survivors (n=10, 25% participants recruited) is scheduled from August 2025 to December 2027, and recruitment for participants with ADHD (n=39, 97.5% recruited) is scheduled from October 2025 to September 2026. Data analyses have not yet commenced; first results from the ADHD subgroup are expected in early 2027, with findings from the cancer survivor subgroup anticipated in early 2028 following completion of recruitment. Conclusions:To strengthen cognitive development in young patients with atypical development, it is necessary to address the current lack of effective treatment options. The combination of cognitive and motor training with metacognitive abilities may support patients' cognitive maturation trajectories and will enable transfer of the training effect to everyday and school situations.

Sibling relationships are central to family life, and siblings of children with disabilities often play major caregiving roles. Yet, it remains unknown how a child's cerebral palsy (CP) impacts siblings' everyday experiences. To describe how siblings of children with CP experience participation in everyday activities and their perceived support and challenges. We used a qualitative descriptive design, semi-structured interviews with 16 families (25 siblings, 16 children with CP, 29 parents) in Switzerland, and qualitative content analysis. Siblings' participation experiences encompass (a) different types of meaningful activities; (b) distinct support needs, challenges, and feelings of being overlooked; (c) hidden tensions and ambivalent feelings when doing activities. Siblings have diverse experiences including joyful and challenging everyday activities. Tensions arise when navigating roles, family dynamics, and societal expectations. This study underscores the need to prioritize siblings' perspectives in research and practice to enhance their agency, inclusion, and well-being.

BACKGROUND: Predicting the development of cerebral palsy after neonatal stroke remains challenging. This study aimed to identify novel acute brain functional connectome-based correlates of cerebral palsy after neonatal stroke. METHODS: Stroke lesions were segmented from routine clinical diffusion images of a cohort of term-born neonates with symptomatic arterial ischemic stroke, recruited to Swiss (from 2000 to 2013) and Australian (from 2003 to 2014) pediatric stroke registries. Lesions and 3-Tesla resting-state functional magnetic resonance imaging scans of term-born newborns from the developing Human Connectome Project were coregistered to a template. A neonatal stroke functional connectome was created by computing voxel-wise correlations between lesions and gray matter regions. Linear regressions compared functional connections to lesions between participants who did and did not develop cerebral palsy. RESULTS: From the total N=199 recruited participants, 85 newborns with stroke were included (65% male; median age at magnetic resonance imaging of 4 days), of which 33% developed cerebral palsy at a median age of 2.1 years. Multiple gray matter regions were more highly functionally correlated to lesions in participants who developed cerebral palsy (1721 voxels; t: 5.4-7.4; all P<0.05, family-wise error rate-corrected). These regions included the basal ganglia, thalamus, cerebellum, frontal regions (inferior and orbital frontal and superior frontal), temporal regions (pole, superior, and mesial temporal, including hippocampus and amygdala), and the insula. CONCLUSIONS:This study identified functional networks related to the development of cerebral palsy after neonatal stroke. Building on prior individual lesion-based studies, this work suggests that the development of cerebral palsy after neonatal stroke is related to disruptions of broader functional networks involving motor and extramotor regions, as opposed to only lesions in motor regions.

IntroductionThis scoping review aims to map the existing literature on sensory-level electrical stimulation (ES) interventions for children with cerebral palsy (CP).MethodsMEDLINE, Embase and PEDro were searched. Among 504 screened articles, 18 studies were included. ES forms utilized included transcutaneous electrical nerve stimulation (TENS), therapeutic electrical stimulation (TheES), threshold electrical stimulation (ThrES), Mesh-Glove Stimulation, and the Mollii suit. The reviewed ES modalities were used in upper extremities, lower extremities, and whole-body treatments.ResultsSome significant improvements were noted in motor control, spasticity, strength, and functional abilities.DiscussionWhile the findings suggest that sensory-level ES holds promise for enhancing motor function in children with CP with significant improvements shown in the relevant outcome measures in fourteen of eighteen papers, the existing literature is characterized by significant variability in stimulation parameters, study design, sample sizes, patient characteristics and outcome measures hindering the ability to generalize findings. Further research with larger, more homogeneous samples and standardized protocols are essential to validate these interventions and establish effective treatment guidelines.

Background: The Mio-Training is a novel multicomponent mobile serious game designed to strengthen cognitive development of children and adolescents. By combining intensive working memory training, mnemonic strategy training, coordinative challenges, and metacognitive reflection, the Mio-Training addresses the shortage of effective cognitive training programs for children and adolescents. This article reports on the development of the Mio-Training and presents results from a feasibility study with healthy children and adolescents. Methods: We included 21 healthy children and adolescents (aged 8-16 years) who underwent 5 weeks of Mio-Training and filled out a feasibility questionnaire (enjoyment, usability, level of autonomy, perceived impact, preferences and potential improvements) after using the Mio-Training. Within-training performance data was collected during the use of the multimodal Mio-Training. Results: The Mio-Training was perceived as feasible, with a high compliance rate of 95%. The usability, the enjoyment of the training, the level of autonomy and the perceived impact were rated as positive. The compliance and the socioeconomic status correlated significantly with enjoyment of the training, design, perceived flexibility, perceived difficulty, subjective duration of the training, motivation and self-efficacy ( r = .455 to .698, p <.001 to .044). Within-training performance improved significantly after acquiring a new mnemonic strategy ( p <.001 to .005, g = .327 to .881). Data from the intensive working memory training revealed strong variability in performance gains, with approximately half of the users showing improvement in their working memory performance. Conclusion: This study gives insight into the feasibility of a novel digital, game-based, multimodal training program focusing on metacognition. The combination of feasibility data and within-training performance essentially contributes to the development and revision of the Mio-Training. We conclude that the Mio-Training is feasible and users show high compliance. However, there is large inter-individual variance in within-training performance, and an evaluation of individual progress patterns is needed. With the insights of this feasibility study the Mio-Training will be evaluated in young patients with an increased risk for atypical cognitive development such as children after cancer or with AD(H)D and will hopefully lead to cognitive far transfer effects in everyday and school life. Trial registration: Clinicaltrials.gov (NCT06464237, date of registration: 12.06.2024)

BACKGROUND:In 2011, the Swiss Society of Neonatology issued new guidelines for the care of preterm infants at the limit of viability leading to higher survival of infants born <28 weeks of gestation. It is unclear whether and how these recommendations affected the prevalence and severity of cerebral palsy (CP). OBJECTIVE:To investigate whether the prevalence, severity, and subtypes of CP in extremely preterm infants differ in two successive birth cohorts. METHODS:Retrospective, population-based analysis of prospectively collected data on infants born <28 weeks of gestation. CP prevalence, subtypes (Surveillance of cerebral palsy in Europe - SCPE classification), and severity (Gross Motor Function Classification System - GMFCS) assessed at 2 years corrected were compared between the two birth cohorts (2006-2011 and 2012-2017). RESULTS:Of 3244 registered infants, 2090 survived, of whom 1764 were followed up (84 %). Mortality was 38 % for the first period and 33 % for the second (p = 0.003) and 112 were diagnosed with CP. CP prevalence was 34.5 per 1000 live births (37.0 for 2006-2011 and 32.4 for birth-years 2012-2017, p = 0.476). A trend towards more bilateral spastic CP (2006-2011: 32 % and 2012-2017: 50 %, p = 0.055) and more severe cases (2006-2011: 14.3 % and 2012-2017: 24.9 %, p = 0.154) was observed in the second period. CP severity was associated with cystic periventricular leukomalacia (PVL) (OR 3.4, 95 %-CI 1.1-10.3, p = 0.033) and necrotizing enterocolitis (NEC) (OR 5.5, 95 % CI 1.2-25.1, p = 0.028) but not with other neonatal morbidities. CONCLUSION:These results suggest that the greater number of bilateral forms and severe cases of CP could be due to the higher number of surviving infants in the 2011-2017 cohort. PVL and NEC are the factors mostly associated with severe cases of CP in Switzerland.

Aim This study aims to investigate the prevalence, intensity, and location of pain in children and adolescents with cerebral palsy (CP) and analyze pain-related symptoms and participation restrictions. Methods Children and adolescents aged 2 to 16 years diagnosed with CP were invited to participate in a pain survey. The questionnaire was based on the German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ). It was administered to children (2-11 years) by their caregivers, while adolescents (12-16 years) were asked to complete the questionnaire themselves or with the help of their caregivers. Results Fifty-seven of 133 children and adolescents with CP (43%) reported having pain in the past 12 months, of whom 17 (30%) reported chronic pain. Patients with Gross Motor Function Classification System (GMFCS) IV-V reported more frequent pain ( p = 0.003) and higher pain intensity ( p = 0.011). Lower extremity pain was the most common. Twenty-three percent of participants with pain did not receive any treatment. Pain often restricted participation, specifically by reducing sports activity in patients with GMFCS I-III, focusing attention on patients with GMFCS IV-V, and activities with the family in both GMFCS level categories. Interpretation Pain is common in children and adolescents with CP and frequently restricts their participation. Therefore, it must be consistently recorded and addressed during the consultation. The goal of treatment should be not only to reduce pain but above all to increase participation.

BACKGROUND: Inflammatory type focal cerebral arteriopathy (FCA-i) in the anterior circulation (AC) is well characterized, and the focal cerebral arteriopathy severity score (FCASS) reflects the severity of the disease. We identified cases of FCA-i in the posterior circulation (PC) and adapted the FCASS to describe these cases. METHODS: In this comparative cohort study, patients from the Swiss NeuroPaediatric Stroke Registry with ischemic stroke due to FCA-i between January 2000 and December 2018 were analyzed. A comparison between PC and AC cases regarding pediatric National Institutes of Health Stroke Scale score and pediatric stroke outcome measure and FCASS was performed. We estimated infarct size by the modified pediatric Alberta Stroke Program Early Computed Tomography Score in children with AC stroke and the adapted Bernese posterior diffusion–weighted imaging score in the PC. RESULTS: Thirty-five children with a median age of 6.3 (interquartile range, 2.7–8.2 [95% CI, 0.9–15.6]; 20 male; 57.1%) years with FCA-i were identified. The total incidence rate was 0.15/100 000/year (95% CI, 0.11–0.21). Six had PC-FCA-i. Time to final FCASS was longer in the PC compared with AC; the evolution of FCASS did not differ. Initial pediatric National Institutes of Health Stroke Scale score was higher in children with FCA-i in the PC with a median of 10.0 (interquartile range, 5.75–21.0) compared with 4.5 (interquartile range, 2.0–8.0) in those with AC-FCA-i. Different from the anterior cases, PC infarct volume did not correlate with higher discharge, maximum, or final FCASS scores (Pearson correlation coefficient [r], 0.25, 0.35, and 0.54). CONCLUSIONS: FCA-i also affects the PC. These cases should be included in future investigations into FCA-i. Although it did not correlate with clinical outcomes in our cohort, the modified FCASS may well serve as a marker for the evolution of the arteriopathy in posterior FCA-i.

Radical resection of spinal cord lipomas reduces the rate of re-tethering. Current conventional neurophysiological mapping techniques are not able to differentiate between crucial motor nerve roots and sensory roots. Enhanced differentiation could contribute to complete resection. We present our experience with a double-train paradigm to differentiate between motor and sensory roots. In children undergoing spinal cord lipoma resection, the double-train mapping paradigm was used with an inter-train interval of 60 ms. Given the longer recovery time due to the H-reflex, a single muscle response was presumed to be elicited from a sensory root, and a double muscle response from a motor root. The primary endpoint was postoperative neurological outcome and bladder function at discharge. We included 8 children undergoing 10 lipoma resections between 2016 and 2023. Double-train mapping was used in all cases. Motor and sensory roots were clearly differentiated in 6 cases and altered the course of surgery in 4 cases. Post-surgery, no sensory and motor function worsened within 3 months. Bladder function was stable in six and improved in two children. In two patients, bladder function worsened slightly at 3 months and 6 months, at which point one patient was re-operated on for re-tethering. Intraoperative mapping with the double-train paradigm reliably differentiated between motor and sensory nerve roots. Informing the surgeon on the specific function of a tethering root may help to maximize resection without risking major neurological deficits.

Introduction: Autism spectrum disorder (ASD) is characterized by deficits in social communication, repetitive behaviors, and can be accompanied by a spectrum of psychiatric symptoms, such as schizophrenia and catatonia. Rarely, these symptoms, if left untreated, can result in spinal deformities. Research question and case description: This case report details the treatment of a 16-year-old male ASD patient with catatonic schizophrenia and mutism, presenting with neck pain, left-rotated torticollis, and fever. MRI revealed atlantoaxial rotational instability and spinal cord compression from a dislocated dens axis. After inconclusive biopsies, empirical antibiotics, hard collar and halo fixation treatment, persistent instability necessitated C1/2 fusion. The ongoing catatonia was addressed with electroconvulsive therapy. Concurrently, he developed severe subaxial hyperkyphosis. The report examines the decision-making between conservative and surgical management for an adolescent with significant psychiatric comorbidity and progressive spinal symptoms against a backdrop of uncertain etiology. Materials and methods: A case report and review of the literature. Results: Posterior C1-C7 stabilization was successfully executed, effectively restoring cervical sagittal alignment, which was maintained throughout a two-year follow-up. Concurrently, the catatonia resolved. Discussion and conclusion: To our knowledge, this is the third reported case of severe cervical deformity associated with fixed posture in a psychiatric patient. This case report emphasizes the critical importance of multidisciplinary collaboration in managing the interplay between neuropsychiatric disorders and severe spinal deformities. It showcases the practicality and efficacy of surgical intervention for persistent cervical deformity in pediatric schizophrenia patients, highlighting the necessity for a comprehensive risk-benefit analysis.

Introduction: Prediction of adverse neurodevelopmental outcomes after neonatal arterial ischemic stroke (NAIS) is challenging. We identified brain regions functionally connected to stroke lesions (lesion networks), and investigated whether such lesion networks are related to the development of cerebral palsy (CP) after NAIS. Methods: We performed a novel lesion network mapping approach, involving: 1. Creation of a normative connectome using the developing Human Connectome Project (dHCP) dataset. Resting state functional magnetic resonance imaging (MRI) scans of 518 neonates born at term (>36 weeks) from the dHCP were aligned to a template, built from T 2 -weighted scans of the same neonates; 2. Manual segmentation of lesions using diffusion MRI scans of 85 term-born neonates with NAIS, who were identified from Australian and Swiss pediatric stroke registries. Lesion masks were aligned to the template; 3. Construction of lesion network maps, by computing functional correlations between lesion masks and other brain grey matter regions, making use of the normative connectome; 4. Investigation of relationships between lesion networks and CP, diagnosed by clinical examination at least 18 months after NAIS. Lesion network maps were compared between those who did (n=28) and did not (n=57) develop CP after NAIS, with two sample t-tests. Results: In participants who developed CP after NAIS, lesions were more strongly functionally connected to the following regions: frontal (inferior and orbital frontal), temporal (pole, superior, and mesial temporal), insula, basal ganglia, thalamus and cerebellum (Figure 1). Conclusions: Leveraging large-scale datasets and innovative connectomic methods, we uncovered brain networks related to adverse outcomes after NAIS. This provided novel findings compared to past methods such as voxel-based lesion-symptom mapping. Our results point to differences in network vulnerabilities after stroke in neonates compared to adults.

Cannabinoids are prescribed to children with cerebral palsy despite limited evidence. We aimed to assess cannabinoid prescribing practices in children with cerebral palsy, focusing on indications, types of preparations used, and tolerability. Furthermore, we investigated how physicians acquire knowledge about cannabinoid medication. We asked physicians with expertise in the care of children with cerebral palsy about their prescribing practices for cannabinoids. Data were collected through an online survey, which was distributed by email. In addition to the demographic information of participants, we also inquired about the indications for the prescription of cannabinoids, experiences regarding efficacy, and observed side effects of the therapy. Seventy physicians from Europe, North America, and Australia completed the survey. Forty-seven participants were experienced in treating of children with cerebral palsy with cannabinoids. The most common indication was epilepsy (69%), followed by spasticity (64%) and pain (63%). The preparations and doses prescribed varied considerably. Half of the participants evaluated the effect of the cannabinoids as moderate. Twenty-nine physicians reported side effects, most frequently, drowsiness (26%), somnolence (19%), fatigue (13%), and diarrhea (13%). Despite the lack of evidence to date, cannabinoids are used to treat children with cerebral palsy in a wide variety of indications. Randomized controlled trials in this vulnerable patient group are therefore of utmost importance.

Background: Major brain lesions, such as grade 3 intraventricular haemorrhage (G3-IVH) and periventricular haemorrhagic infarction (PVHI) are among the main predictors for poor neurodevelopment in preterm infants. In the last decades advancements in neonatal care have led to a general decrease in adverse outcomes. Aim: To assess trends of mortality and neurodevelopmental impairment (NDI) in a recent Swiss cohort of very preterm infants with grade 3 intraventricular haemorrhage (G3-IVH) and periventricular haemorrhagic infarction (PVHI). Methods: In this retrospective population-based cohort study, rates of mortality, and NDI at 2 years corrected age were reported in infants born at 24–29 weeks gestational age (GA) in Switzerland in 2002–2014, with G3-IVH and/or PVHI. Results: Out of 4956 eligible infants, 462 (9%) developed G3-IVH (n = 172) or PVHI (n = 290). The average mortality rates for the two pathologies were 33% (56/172) and 60% (175/290), respectively. In 2002–2014, no change in rates of mortality (G3-IVH, p = 0.845; PVHI, p = 0.386) or NDI in survivors (G3-IVH, p = 0.756; PVHI, p = 0.588) were observed, while mean GA decreased (G3-IVH, p = 0.020; PVHI, p = 0.004). Multivariable regression analysis showed a strong association of G3-IVH and PVHI for both mortality and NDI. Death occurred after withdrawal of care in 81% of cases. Conclusion: In 2002–2014, rates of mortality and NDI in very preterm born infants with major brain lesions did not change. The significant decrease in mean GA and changing hospital policies over this time span may factor into the interpretation of these results.

Background and ObjectivesResearch investigating neonatal arterial ischemic stroke (NAIS) outcomes have shown that combined cortical and basal ganglia infarction or involvement of the corticospinal tract predict cerebral palsy (CP). The research question was whether voxel-based lesion-symptom mapping (VLSM) on acute MRI can identify brain regions associated with CP and neurodevelopmental impairments in NAIS.MethodsNewborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language and cognitive-behavioral impairments were assessed using the Pediatric Stroke Outcome Measure, dichotomized to good (0-0.5) or poor (>= 1), at >= 18 months of age. Infarcts were manually segmented using diffusion-weighted imaging, registered to a neonatal-specific brain template. VLSM was conducted using MATLAB SPM12 toolbox. A general linear model was used to correlate lesion masks with motor, language, and cognitive-behavioral outcomes. Voxel-wise t-statistics were calculated, correcting for multiple comparisons using family-wise error (FWE) rate.ResultsEighty-five newborns met the inclusion criteria. Infarct lateralization was left hemisphere (62%), right (8%), and bilateral (30%). At a median age of 2.1 years (interquartile range 1.9-2.6), 33% developed CP and 42% had neurologic impairments. Fifty-four grey and white matter regions correlated with CP (t > 4.33; FWE < 0.05), including primary motor pathway regions, such as the precentral gyrus, and cerebral peduncle, and regions functionally connected to the primary motor pathway, such as the pallidum, and corpus callosum motor segment. No significant correlations were found for language or cognitive-behavioral outcomes.DiscussionCP after NAIS correlates with infarct regions directly involved in motor control and in functionally connected regions. Areas associated with language or cognitive-behavioral impairment are less clear.

Background There is little consensus on how lesion size impacts long-term cognitive outcome after pediatric arterial ischemic stroke (AIS). This study, therefore, compared two techniques to assessed lesion size in the chronic phase after AIS and determined their measurement agreement in relation to cognitive functions in patients after pediatric stroke. Methods Twenty-five patients after pediatric AIS were examined in the chronic phase (>2 years after stroke) in respect to intelligence, memory, executive functions, visuo-motor functions, motor abilities, and disease-specific outcome. Lesion size was measured using the ABC/2 formula and segmentation technique (3D Slicer). Correlation analysis determined the association between volumetry techniques and outcome measures in respect to long-term cognitive outcome. Results The measurements from the ABC/2 and segmentation technique were strongly correlated (r = 0.878, p < .001) and displayed agreement in particular for small lesions. Lesion size from both techniques was significantly correlated with disease-specific outcome (p < .001) and processing speed (p < .005) after controlling for age at stroke and multiple comparison. Conclusion The two techniques showed convergent validity and were both significantly correlated with long-term outcome after pediatric AIS. Compared to the time-consuming segmentation technique, ABC/2 facilitates clinical and research work as it requires relatively little time and is easy to apply.

In this study, the feasibility of Action Observation Training (AOT) in combination with sensor-based measurements in infants at high risk of Unilateral Spastic Cerebral Palsy (UCP) were evaluated. Over a four-week period, eight infants at high risk of UCP performed AOT at home while wearing sensors with assistance of caregivers. Sensor data were compared to clinical assessments of upper limb function, the Hand Assessment for Infants (HAI) and the Mini-Assisting Hand Assessment (Mini-AHA). AOT training time and acceptance by the caregivers were considered as indicators for feasibility. The excellent training adherence and positive feedback of the caregivers showed that the AOT was feasible in this patient group and setting. Sensor measurements were accepted and displayed significant correlations with hand function. These preliminary results indicate the potential of wearable sensors to record upper limb function over the course of AOT for infants at high risk of UCP. Thus, AOT in combination with sensor measurements are proposed as a feasible training tool to complement usual care.