In recent years, artificial intelligence-based language models have emerged as a means of rapid access to health-related information. This study aimed to evaluate the quality, reliability, understandability, and readability of ChatGPT’s responses to frequently asked questions by families of children with cerebral palsy (CP). Responses generated by the free version of ChatGPT to the ten most frequently asked questions posed by families of children with CP were obtained. These responses were evaluated across four dimensions: quality, reliability, understandability, and readability. Content quality was evaluated using the DISCERN instrument. Reliability was assessed by 20 physiotherapists holding MSc or PhD degrees using a 5-point Likert scale. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), while readability was analyzed using the Flesch–Kincaid Grade Level (FKGL). The median DISCERN score was 45, reflecting average content quality. The median Likert scale score across all questions was 4 out of 5, indicating reliable responses. No significant differences were observed between PhD and MSc expert raters in their Likert scale ratings. The median PEMAT-P was 69.23; however, only 40

IntroductionThe aim of the study was to evaluate the intra- and inter-rater reliability, and validity of the Trunk Control Measurement Scale (TCMS) for tele-assessment in children with cerebral palsy (CP).MethodA cross-sectional study was conducted with 36 children aged 4-18 years, diagnosed with hemiplegic CP. Participants underwent four TCMS assessments: in-person assessment, tele-assessment via videoconferencing, and two video-based tele-assessments scored by same rater and by a second rater. Reliability was analyzed using intraclass correlation coefficients (ICC). Discriminant validity was assessed by comparing TCMS tele-assessment scores between children with Gross Motor Function Classification System (GMFCS) levels I and II, while criterion validity was evaluated by examining the correlation between face-to-face and tele-assessment TCMS scores.ResultsExcellent reliability was observed between face-to-face and tele-assessment (ICC: 0.91; 95%CI: 0.83-0.95). TCMS tele-assessment also demonstrated excellent intra-rater reliability (ICC: 0.90, 95%CI: 0.80-0.94) and high inter-rater reliability (ICC: 0.82, 95%CI: 0.66-0.90). Criterion validity was confirmed by strong correlations between face-to-face and tele-assessment scores (r = 0.925, and r = 0.892, p < 0.001 for rater-1 and rater-2, respectively). The TCMS successfully discriminated children by functional levels, demonstrating discriminative validity (p = 0.002). Bland-Altman analysis revealed minimal systematic error, with internal consistency remaining high across all assessments (>0.88).DiscussionTCMS is a valid and reliable tool for teleassessing trunk control in children with hemiplegic CP. These results may pave the way for developing child-specific, targeted telerehabilitation programs, bringing telerehabilitation closer to its primary aim of ensuring equal opportunities.This study was registered as a clinical trial (NCT06707831). https://clinicaltrials.gov/study/NCT06707831.

Aim: The aim of the study was to describe the distribution of the impairment index across Cerebral Palsy (CP) subtypes and Gross Motor Function Classification System (GMFCS) levels and investigate the relationship between CP subtypes, birth weight, gestational age, and the impairment index. Method: This retrospective study was conducted with 423 children with CP aged between 0-18 years. Data were gathered from the medical records of children. Birth weight and week, functional classification levels, intellectual impairment, presence of vision, hearing problems, epilepsy recorded. All children were classified according to the GMFCS, Manual Abilities Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Abilities Classification System (EDACS), and CP subtypes. Participants were categorized according to Impairment Index (II) that consist of gross motor, intellectual, vision and hearing impairments and epilepsy. Multivariate backward modelling linear regression model was used to explain relations between impairment index and functional classification systems, birth weight and birth week. Results: Amongst the 423 children (mean age 6.38±4.57 years) analyzed, 130 (30.7) of the children had low impairment, 159 (31.7%) of them had moderate impairment, and 134 (31.7%) of them had high impairment according to the II. In unilateral spastic type CP, 61.5% had a low impairment index (p<0.05), in bilateral spastic CP, 44.2% of children had a moderate impairment index (p<0.05), in dyskinetic CP 67.9% of children had a high impairment index (p<0.05). In ataxic type there were not any difference significantly between impairment index levels (p=0.06). As a result of regression analysis gross motor function level (Beta=0.85, p<0.01) and birth weight (Beta=-0.05, p=0.04) were predictors of the Impairment Index, and explained 73% of the variance. Conclusion: Nearly one third of the children had high II; birth weight and gross motor functional level are the predictors of II. These results can help improve rehabilitation and social services.

This commentary is on the original article by Magalhães et al. on pages 254–262 of this issue.

We investigated the psychometric properties of a Turkish version of the Young Children's Participation and Environment Measure (YC-PEM-T). Our participants were 367 children (212 children with disabilities and 155 children without disabilities; M age = 40.76 months, SD = 20.33; range 0-71 months) and their parents, who were selected by a convenience sampling method. We translated and cross-culturally adapted the original YC-PEM from English to Turkish (YC-PEM-T). We found the internal consistency and test-retest reliability of the YC-PEM-T to be good with a Croanbach's alpha ranging from .68 to .94, and intraclass correlation coefficients ranging from .69 to .89 after the YC-PEM-T was administered twice to 100 parents within a three week period. In a two-way analysis of variance (ANOVA) we compared YC-PEM-T scores between children with and without the presence of a disability and found significant differences (p < .05). While we found significant differences between three different age groups, they did not follow consistently. To evaluate discriminant validity, we followed up these ANOVAs with post-hoc analyses when results were statistically significant. Regarding concurrent validity, there were strong to very strong relationships between scores on the participation part of the YC-PEM-T and both the Pediatric Evaluation of Disability Inventory (PEDI; .701 < r < .854, p < .001), and the European Child Environment Questionnaire (ECEQ; - .632 < r < - .690, p < .001). We concluded that the YC-PEM-T is a valid, reliable, and culturally adapted tool for evaluating daily life participation and adaptation to environmental factors in young Turkish children. We can recommend the YC-PEM-T for use in clinical settings and for epidemiological research to assess young children's participation in activities in the home, preschool and community. We also recommend that future investigators examine other psychometric properties of this scale, including its interpretation and capacity to differentiate varied diagnostic and disability groups.

Background: Manual functions affect more than a half of children with Cerebral palsy (CP). Asymmetric involvement of hands may also affect unilateral and bilateral activities of daily life. The Bimanual Fine Motor Function version 2.0 (BFMF-2.0) is a unique functional classification that categorizes the capacity of each hand (what the child can do) during bimanual functions. Purpose: The aim of this study was to investigate the validity and reliability of the Turkish version of the BFMF-2.0 in children with CP. Study Design: Clinical measurement and cross-sectional study. Methods: The study included 91 children with CP (56 girls, mean age; 7.41 +/- 4.23 years [4-18 years]) and their parents. The Manual Ability Classification System (MACS), the Quality of Upper Extremity Skills Test (QUEST), and the Box and Block Test (BBT) were used for construct and concurrent validity. Experienced/ inexperienced therapists and parents classified fine motor capacities of the children via live or video-based observation to assess inter-rater reliability. Three weeks later, the children were reclassified for intra-rater reliability. Results: The Turkish version of the BFMF-2.0 classification was strongly correlated with the MACS (rho = -0.88, p < 0.001), the QUEST (rho = 0.80, p < 0.001), and the BBT (rho = -0.77, p < 0.001). The interrater reliability scores were weak to excellent between the parents and the therapists (via live observation, kappa(w) = 0.57) and also between experienced/inexperienced therapists (via live or video-based observation, kappa(w) = 0.66-0.79). Intra-rater reliability scores were good to excellent (Intraclass Correlation Coefficient [ICC] = 0.87-0.95). Conclusions: The Turkish version of the BFMF-2.0 classification is valid and reliable and could be applied by experienced and inexperienced therapists via live or video-based observation and by parents via live observation. (c) 2023 Elsevier Inc. All rights reserved.

The modified Mallet classification is widely used to measure motor function in brachial plexus birth injuries. The aim of the study was to investigate agreement and reliability of this classification under three different evaluation conditions: face-to-face; live tele-assessment; and delayed video-based assessment. A total of 100 children aged 4-15 years were included. Children were assessed by two raters except for live tele-assessment, which was performed by four raters. Agreement between the three different assessment conditions for the same rater were between strong and excellent for both raters 1 and 2. The interrater reliability for raters 1 and 2 under different assessment conditions was strong to excellent. Interrater reliability among the four raters was moderate to strong in tele-assessment. The modified Mallet classification may have appropriate reliability to be used in remote medical follow-up.Level of evidence: III.

Epilepsi, serebral palsili (SP) çocuklarda yaygın görülen bir semptomdur. Bu çalışmanın amacı epilepsinin SP’li çocukların fiziksel, bilişsel, görme, işitme, konuşma, iletişim ve beslenme fonksiyonlarına etkisini incelemekti. Çalışmaya 297 SP’li çocuk dahil edildi. Avrupa Serebral Palsi Surveyans (SCPE) sistemi değerlendirme formu ile kaydedilen çocukların epilepsi ve fonksiyonel durumları retrospektif olarak tarandı. Fiziksel, iletişim, konuşma ve beslenme fonksiyonları Kaba Motor Fonksiyon Sınıflandırma Sistemi, El Becerileri Sınıflandırma Sistemi, İletişim Fonksiyonları Sınıflandırma Sistemi, Viking Konuşma Ölçeği ve Yeme-içme Becerisi Sınıflandırma Sistemine göre belirlendi. Epilepsinin fonksiyonlar üzerine etkisi Chi Square testi ve Cramer’s V ile incelendi. Epilepsi, SP’li çocuklarda kaba motor (p

BACKGROUND:The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words. METHODS:Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future'). RESULTS:The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y. CONCLUSIONS:Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.

Purpose This study aims to translate the Selective Control Assessment of the Lower Extremity (SCALE) into Turkish language, assess its reliability and validity in children with spastic cerebral palsy. Materials and methods Fifty-two children with CP (mean age 9 years 8 months, range 4-18 years) included in this cross-sectional study. Intra- and interrater reliability was assessed by intraclass correlation coefficient (ICC). The SCALE was correlated with the Gross Motor Function Classification System (GMFCS), the Physician's Rating Scale (PRS), and Gross Motor Function Measurement (GMFM) to assess validity. Results Intra- and interrater reliability of the SCALE were excellent (ICC > 0.75). SCALE and GMFCS (r = -0.786, p < 0.001), SCALE and PRS (r = 0.761, p < 0.001), SCALE and GMFM (r = 0.863, p < 0.001) were highly correlated. SCALE scores differed significantly between GMFCS levels and between types of spastic CP. Conclusions The Turkish version of the SCALE appears to be a valid and reliable tool to assess selective voluntary motor control of the lower limbs in children with spastic CP.

Purpose: The Gross Motor Function Measure (GMFM) is commonly used to assess gross motor functions in children with cerebral palsy (CP). Our aim was to investigate the relationship between gross motor function and health status in children with CP based on clinical types and functional levels. Methods: This cross-sectional study included 75 children with CP (mean age +/- SD 7.59 +/- 3.86 years). The 66-item Gross Motor Function Measure (GMFM-66) was used to measure the gross motor functions of children. The International Classification of Functioning, Disability and Health (ICF) CP Core Set was used to assess the general health status of children including body functions and structures, activity and participation, and environmental factors for obtaining a holistic framework. Results: Of the children, 61 (81.3%) were spastic and 14 (18.7%) were dyskinetic. Children were divided into 3 groups based on the Gross Motor Function Classification System (GMFCS) level as mild (levels 1-2, n=28), moderate (level 3, n=16), and severe (levels 4-5, n=31). The GMFM-66 had moderate to strong correlations with body functions and structures (r=-0.811, p<0.001) and activity and participation (r=-0.862, p<0.001) domains of the ICF in severely affected children with CP although it had no strong correlation in any of the ICF domains in mildly or moderately affected children. Conclusion: Although gross motor functions may reflect the health status holistically in severely affected children with CP, it seems not sufficient to reflect the health status in mildly or moderately affected children with CP.

Purpose: The Gross Motor Function Measure (GMFM) is commonly used to assess gross motor functions in children with cerebral palsy (CP). Our aim was to investigate the relationship between gross motor function and health status in children with CP based on clinical types and functional levels. Methods: This cross-sectional study included 75 children with CP (mean age ± SD 7.59 ±3.86 years). The 66-item Gross Motor Function Measure (GMFM-66) was used to measure the gross motor functions of children. The International Classification of Functioning, Disability and Health (ICF) CP Core Set was used to assess the general health status of children including body functions and structures, activity and participation, and environmental factors for obtaining a holistic framework. Results: Of the children, 61 (81.3%) were spastic and 14 (18.7%) were dyskinetic. Children were divided into 3 groups based on the Gross Motor Function Classification System (GMFCS) level as mild (levels 1-2, n=28), moderate (level 3, n=16), and severe (levels 4-5, n=31). The GMFM-66 had moderate to strong correlations with body functions and structures (r=-0.811, p

Objective: To investigate the effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy (CP) from a parental perspective. Methods: The study included 209 children with CP aged between 5 and 13 years (mean age, 8.06 +/- 2.41 years; girls, 45.5%) and their parents. Fatigue, gross motor function, and participation status were evaluated with the Pediatric Quality of Life (PedsQL), Gross Motor Function Classification System (GMFCS), and the Assessment of Life Habits (Life-H) questionnaire, respectively. The effects of fatigue, gross motor function, and gender on participation were investigated with linear regression analysis. Results: According to parental reports, 79.9% of the children had fatigue. Children in all GMFCS levels experienced fatigue. Fatigue and GMFCS levels were dependent variables, and therefore only simple linear regression analyses were performed. Fatigue explained 38-43% of the variances in daily activities, social roles, and total Life-H scores, while gross motor function explained 48-65% of the variances in scores (p < 0.001). Gender had no effect on participation scores (p > 0.05). Conclusion: More than two thirds of the school-aged children with CP had fatigue. Fatigue and poor gross motor function had a negative effect on participation in daily activities and social roles. (c) 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

To investigate the relationships between four functional classification systems in children with cerebral palsy (CP) and parent-interpredicted intelligence level, and the functional status in clinical types of CP.Two hundred and twenty-five children with CP ages between 2 and 18 (mean age 6.5 ± 4.4) years included using the Surveillance of CP in Europe (SCPE) database in Turkey. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Classification System (EDACS) levels were classified by clinical observation, and intelligence quotient (IQ) was determined by parent reports.Correlations were found between all functional levels; the strongest were between GMFCS-MACS (r = 0.784, p < .001), CFCS-EDACS (r = 0.772, p < .001). Strong correlations were found for the IQ-CFCS (r = 0.762, p < .001) and IQ-EDACS (r = 0.634, p < .001). Correlations were stronger in children with bilateral CP and IQ level <70.Taken together, these four classification systems and reported IQ levels can adequately describe overall functioning for children with CP. Our results can guide clinicians in the rehabilitation of children with CP.

The purpose of the study was to investigate families' concerns and service requirements during the Covid-19 lockdown. In case of tele-consultation, we also aimed to assess the effects of this service on coping and the family's worries. At end of lockdown, we contacted the parents of 67 obstetric brachial plexus palsy patients (0-10 years age) by e-mail. During lockdown, 42 of the families had had a teleconsultation with our team, while 25 reported that not receiving any service. A questionnaire consisting of 6 questions was sent to the families, and data were analyzed according to 4 age-groups. Parents' concerns varied according to the children's age group (p = 0.001). All families replied that their children should receive remote services during Covid-19-like situations (p = 0.173). Parents of the 42 children who had tele-consultations reported that this had alleviated their worries, independently of age-group (p = 0.160). The usefulness of tele-consultation to manage the lockdown situation differed according to age-group (p = 0.002). The parents of under-3-year-olds experienced more worry during lockdown, but all respondents reported needing remote services. Although the tele-consultation alleviated the worries of almost all families, it was most useful in managing lockdown in families with under-3-year-olds. (C) 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.

Background: Ankle foot orthoses (AFOs) are usually recommended to prevent deformities and to increase the standing and walking performance in children with spastic cerebral palsy (CP). Objective: To compare the body functions and structures, activity and participation levels, and environmental factors according to AFO-wearing time in children with spastic CP. Study design: Prospective, cross-sectional-observational-clinical study. Methods: Eighty children with spastic CP (Gross Motor Function Classification System I–III; mean age 7.3 ± 3.9 years) were divided into two groups with equal ages and duration of AFO usage, which is provided as a part of routine clinical care: 6–12 hours per day group (n = 40) and 12–24 hours per day group (n = 40). The outcomes measured were calf muscle's spasticity with the modified Ashworth Scale (MAS), passive ankle dorsiflexion angle (DA), 66-item Gross Motor Function Measurement, Pediatric Berg Balance Scale, and Pediatric Quality of Life Inventory (PedsQL). Parental satisfaction was measured with a Visual Analog Scale. Multifactorial ANOVA was used to compare the groups, corrected for 66-item Gross Motor Function Measurement. Results: No significant differences for the Pediatric Berg Balance Scale, MAS, and DA were found between the groups. Significant differences for the PedsQL (76.99 vs. 57.63; mean difference [MD], 15.60; 95% confidence interval [CI], 10.99∼20.22), daily living activities (65.30 vs. 35.92; MD, 25.72; 95% CI, 17.58∼33.86), fatigue (76.9 vs. 56.85; MD, 23.11; 95% CI, 16.87∼29.35), and satisfaction (8.08 vs. 5.21; MD, 2.46; 95% CI, 1.64∼3.27) were found between the groups; 6–12 hour group had superiority for each outcome (P < 0.001). Wearing time was significantly correlated with PedsQL (r = −0.524, P < 0.001) and satisfaction (r = −0.521, P < 0.001) but not with MAS or DA. Conclusions: AFO-wearing time seems to depend on the child's activity and participation levels rather than body functions and structures in children with spastic CP. Prolonged AFO-wearing time was negatively correlated with both the activity-participation level and parental satisfaction.

Background and Purpose: This case report investigated the benefits of a 12-week physical therapy program for a child with ataxia-telangiectasia (AT). Case Description: A 9-year-old girl with a diagnosis of AT participated. The physical therapy program consisted of balance and strength exercise and Wii Fit Balance-based video games training with a pediatric physical therapist for 12 weeks. Measurements: The motor performance, Gross Motor Function Measurement (GMFM), Pediatric Berg Balance Scale (PBBS), Trunk Control Measurement Scale (TCMS), participation as measured by the Life Habits Questionnaire (LIFE-H), and the Pediatric Quality of Life Inventory (PedsQL). Outcomes: Positive changes were observed in the TCMS, PBBS, GMFM, and motor performance, participation, and quality of life. Conclusions: Notable improvements were observed in both body structure and function, and activities and participation level. What This Adds to Evidence: This case report is the first to support the effectiveness of physical therapy in a child with AT.

Objectives: The Assessment of Life Habits (LIFE-H) is a well-known questionnaire used to evaluate participation. The aim of this study was to determine the reliability and validity of the Turkish version of the LIFE-H in children with Cerebral Palsy (CP). Patients and Methods: The study included 450 children with CP between the ages of 2-18 years old. The internal consistency and testretest reliability of the LIFE-H were calculated. The construct validity of the LIFE-H was determined with the Pediatric Evaluation of Disability Inventory (PEDI) domains and Pediatric Outcome Data Collection Instrument (PODCI) subscales. Results: The mean age of the children was 8.37±5.13 years (42.4% female, 57.6% male). The internal consistency of the LIFE-H was determined to be acceptable for all categories (Cronbach alpha:0.794-0.999). The test-retest reliability values were found to be of good to excellent reliability (ICC:0.804-0.999). The correlation between the LIFE-H total scores, PODCI subscales and PEDI domains was determined as acceptable (rho between 0.538-0.894) except for the Pain/Comfort, Happiness subscales of the PODCI (rho:0.240 – 0.479). Conclusions: It was determined that the Turkish LIFE-H had acceptable internal consistency, good test-retest reliability and satisfactory construct validity. Turkish LIFE-H is an appropriate tool to assess the participation of children and adolescents with CP.