Elegast Monbaliu

Background: Digital technologies for rehabilitation (DT4R), such as robotics and treadmill systems (RobTS), virtual reality and active video gaming (VR-AVG), and telehealth and apps (T&Apps), are promising tools for pediatric motor rehabilitation. Identifying acceptance factors is essential for effective clinical adoption. Objective: This study aimed to analyze the use of 3 different technologies for rehabilitation—RobTS, VR-AVG, and T&Apps—through a causal model based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods: This study was part of RehaTech4child, a cross-sectional survey (2022) supported by the European Academy of Childhood-onset Disability, aimed at professionals working in pediatric motor rehabilitation across Europe. It assessed DT4R use, intention to use, and UTAUT concepts (performance expectancy, effort expectancy, social influence, and barriers). Structural equation modeling was performed to analyze the data and understand relationships between observed and latent variables. Results: A total of 1397 responses were received, and 635 fulfilled the eligibility criteria. The fitness indices suggested a satisfactory fit between the data and the model. The model explained 67% of the variance in the use of RobTS, 62% in VR-AVG, and 57% in T&Apps. Among all studied determinants, access had the strongest impact on use for all 3 categories of DT4R (RobTS: β=0.78, VR-AVG: β=0.73, and T&Apps: β=0.70; P <.001). Intention to use significantly impacted use behavior for all technologies; it was the second determinant after access for VR-AVG (β=0.18, P <.001) and T&Apps (β=0.21, P <.001), with a lower weight for RobTS (β=0.06, P=.007; P <.001). In the subgroup analysis of respondents reporting easy access, intention to use was the strongest determinant of use. The model explained 61% of the variance in intention to use for RobTS, 67% for VR-AVG, and 68% for T&Apps. Performance expectancy had the strongest effect on intention to use for the 3 technologies (RobTS: β=0.81, VR-AVG: β=0.84, and T&Apps: β=0.90; P <.001). For this concept, the items with the highest weights were significantly related to the effectiveness of DT4R on rehabilitation. Social influence and effort expectancy had a slight impact on intention to use. Conclusions: These results underscore the need to ensure easy access as a prerequisite for assessing relevant determinants of acceptance. Developing the evidence base for DT4R effectiveness and ensuring the availability of existing evidence may facilitate DT4R implementation. In our study, within the framework of the UTAUT model, no acceptance barrier was linked to the use of DT4R with children. Gathering families’ views may be useful for the implementation of RobTS. T&Apps may be useful for involving parents in their child’s rehabilitation. Further studies should focus on children’s and families’ points of view.

Aim: To map and summarize available clinical and instrumented assessment tools for evaluating trunk control in individuals with spastic or dyskinetic cerebral palsy (CP) across Gross Motor Function Classification System (GMFCS) levels, describing their current application, assessed features, and psychometric properties, to provide first practical guidance for tool use. Method: For this scoping review, eight databases were systematically searched. Studies were included if they evaluated reliability, validity, or responsiveness of tools assessing trunk control in spastic/dyskinetic CP. The review followed the methodology of the JBI and the guidelines of the Preferred Reporting Items for Systematic reviews and Meta‐Analyses for Scoping Reviews (PRISMA‐ScR). Results: The search yielded 27 332 publications, of which 110 met the inclusion criteria. Twenty‐two distinct assessment tools were identified, including 12 clinical and 10 instrumented. Instrumented assessment tools were most frequently investigated (65%). Validity was reported in 62% of studies; reliability and responsiveness in 30% and 0% respectively. Notably, 85% of studies focused exclusively on individuals with spastic CP, only 28% addressed individuals with CP classified in GMFCS levels IV or V. Interpretation: This review highlights critical gaps in research on trunk control assessment in CP, particularly for patients with severe disabilities, tool responsiveness, and coverage of key facets of trunk control. Future research should prioritize thorough psychometric evaluation of tools, across facets, accounting for the diverse applications and heterogenous clinical presentations in CP.

AIM: Executive functions (EF) are advanced cognitive processes that play an essential role in daily functioning and may be of increased importance in cerebral palsy (CP), given the complexity of primary and associated impairments. This study aims to synthesize existing evidence on the relation between EF and domains of the International Classification of Functioning, Disability and Health (ICF) in individuals with CP, and to quantify the magnitude of these associations through meta-analysis. METHOD: A systematic literature search was conducted in eight electronic databases up to 14 July 2025, examining associations between EF and ICF domains in CP. EF outcomes were classified into inhibitory control, working memory, cognitive flexibility, higher-order EF, and EF composite scores. Outcome measures were mapped onto ICF domains: Body Functions and Structures, Activity, Participation, and Contextual factors, using the CP Core Sets. Correlation coefficients were transformed to Fisher’s z and entered into three-level meta-analyses to estimate pooled effect sizes. Single moderator analyses examined CP subtype, EF domain, EF assessment type, and mean age. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. RESULTS: From 4637 identified records, 38 studies were included, comprising a total sample of 1633 participants with CP. There was substantial heterogeneity in CP subtype, participant age, and EF conceptualization, while the ICF Contextual factors domain was underrepresented. A medium-to-large association was found between EF and functioning across all ICF domains combined (r=0.26, p<0.001). Domain-specific analyses showed a medium association of EF with Body Functions and Structures (r=0.21, p<0.01), a medium-to-large association with Activity (r=0.38, p<0.001) and Participation (r=0.26, p<0.01). CP subtype and mean age significantly moderated the overall EF-functioning association, with mixed CP and younger age associated with stronger effects. INTERPRETATION: EF are meaningfully associated with multiple domains of functioning in individuals with CP. These findings support the relevance of routine EF assessment and suggest that EF are an important cognitive correlate to consider when addressing broader aspects of daily functioning. WHAT THIS PAPER ADDS: Executive functions (EF) showed medium-to-large associations with all ICF domains in people with cerebral palsy (CP) The strongest and most consistent associations were found between EF and ICF Activity Overall associations highlight the relevance of EF as a meaningful intervention target in CP

Interactive technology and games provide promising methods for wheelchair skills training. This paper introduces RollAbility, a rehabilitative game for powered wheelchair skills training aimed at children and teenagers with complex movement disorders. The game combines clinical best practices and standardized training protocols with player experience goals. Developed through an iterative process with rehabilitation experts and game designers, RollAbility utilizes the Wheelchair Skills Training Program [Kirby et al. '23] and integrates key insights from Aufheimer's [CHI '23] motivation studies in physical therapy to ensure both therapeutic and engaging gameplay. Evaluated through exploratory sessions with children, therapists, and clinical experts, results show that RollAbility effectively merges clinical protocols with an engaging game format. However, balancing player autonomy and therapist guidance remains a critical consideration. This work offers a blueprint for designing therapeutic games that align clinical protocols with engaging player experiences.

To explore the concurrent validity and responsiveness of the Wheelchair Skills Test-Questionnaire (WST-Q) caregiver proxy, and the inter- and intra-rater reliability of the Wheelchair Skills Test (WST) in children and young adults with cerebral palsy (CP). Concurrent validity and responsiveness of the WST-Q caregiver proxy were assessed in 12 participants with CP (mean age 15 years; SD: 3 years 6 months); power wheelchair users. Concurrent validity of the WST-Q was determined using Pearson's correlation coefficients, and responsiveness with linear regression. Inter- and intra-rater reliability of the WST were assessed with intraclass correlation coefficients (ICC) (n = 4). The WST-Q caregiver proxy showed good concurrent validity with WST total scores (r = 0.623, p < 0.001). No acceptable responsiveness was found for the WST-Q caregiver proxy (R² = 0.317, p = 0.071). Inter-rater reliability for the WST total scores was good (ICC = 0.864, p < 0.001); and intra-rater reliability ranged from good to excellent (Rater 1 ICC = 0.857; Rater 2 ICC = 0.904; Rater 3 ICC = 0.923, all p < 0.001). The WST-Q caregiver proxy appears to be valid for assessing levels of wheelchair skills in children and young adults with CP, however, it lacks suitability to measure intervention effects due to its poor responsiveness. The WST appears reliable for measuring wheelchair skills in young adults with CP.

Aim To synthesise existing evidence on the effectiveness of neurofeedback (NF) interventions in individuals with cerebral palsy (CP). Method A systematic search was conducted in nine databases in October 2023, December 2023, and November 2024, without language restrictions. Studies were eligible if they investigated NF interventions in individuals with CP, irrespective of intervention type, study design, or participant characteristics (e.g. diagnosis, sex, age). Study quality was appraised using the Downs and Black checklist and the Single-Case Experimental Design (SCED) Scale. Risk of bias was assessed with the revised Cochrane risk-of-bias tool (RoB 2), the Cochrane Risk of Bias in Non-randomised Studies of Intervention (ROBINS-I V2), and the Single-Case Design RoB tool. Results Eighteen studies (n=439, age range 4-47 years) were included: seven randomised controlled trials (RCTs), seven non-RCTs, and four SCED studies. All interventions used electroencephalography (EEG)-based NF, with some integrating brain–computer interfaces (BCIs) or external devices such as powered wheelchairs and robotic hands. Reported benefits included improvements in brain activity, motor outcomes, and cognitive functions. However, not all studies confirmed these effects, and findings were inconsistent across protocols. The use of multiple tools and external devices appeared to strengthen intervention effects in some cases. Interpretation NF interventions in CP show potential, but their effectiveness remains inconclusive, largely due to heterogeneity in intervention protocols (i.e., frequency bands targeted, electrode placement, feedback modalities, and intervention intensity) and limited follow-up data. Future studies should prioritise rigorously designed RCTs, incorporate personalised approaches, and consider multimodal NF interventions. What this paper adds Individuals with cerebral palsy are capable of learning to regulate their neural activity through neurofeedback. Neurofeedback interventions show potential to improve motor, cognitive, and functional outcomes, although findings remain inconsistent. The use of brain–computer interfaces and external devices may enhance the effectiveness of neurofeedback. Protocol heterogeneity and limited follow-up remain key barriers to establishing neurofeedback effectiveness.

Background Dyskinetic cerebral palsy (DCP) is dominated by dystonia and choreoathetosis, two movement disorders that are often simultaneously present and challenging to evaluate. Wearable technology shows potential for monitoring motor dysfunctions at high temporal resolution while expanding our understanding of DCP movement disorders. Objectives This study aimed (i) to develop a methodology for automatic classification of dystonia and choreoathetosis combining inertial measurement units (IMUs) and random forests (RFs) during powered wheelchair driving in participants with DCP, (ii) to determine signature features for dystonia and choreoathetosis, and (iii) to optimise placement of body-worn IMUs in function of dystonia and choreoathetosis classification performance. Methods Unconstrained movements of the arms and head during powered mobility (n = 5 DCP participants) were analysed to extract 111 time- and frequency-domain features in 5-second windows. RFs were then used to rank, select optimal features and classify dystonia and choreoathetosis, based on expert-annotated videos. Results Classification of dystonia and choreoathetosis for the neck, proximal and distal arm regions ranged within 67.8% - 80.7% accuracy. Reduced feature sets included between 19 - 73 features, as time-domain features were selected more prevalently in classifying both dystonia and choreoathetosis. IMUs on the distal arms predicted forehead dystonia and choreoathetosis with similar accuracy (74.5% - 81.2%) as using the forehead IMU. Conclusions This study increases insights into DCP by relating distinct IMU features to dystonia and choreoathetosis and by leveraging distal arm-placed IMUs to assess movement disorders in multiple body parts: distal arm, proximal arm and neck region.

This letter to the editor is on the Proposed updated description of cerebral palsy by Dan et al. To view this paper visit https://doi.org/10.1111/dmcn.16274 .

This study aimed to explore the effects of a four-week intensive eye-tracking intervention on children with dyskinetic cerebral palsy (DCP), focusing on goal attainment, communication competencies, stress levels, subjective workload, and caregivers' perception of psychosocial impact. A multiple case study design with non-concurrent, staggered multiple baselines was employed, involving three children aged 7, 12, and 13 years. The study included a randomized baseline period of two or three weeks, an intensive eye-tracking intervention, and a six-month follow-up. Two individual eye-tracking goals were identified and assessed using the Goal Attainment Scale, while communication competencies were evaluated with the Augmentative and Alternative Communication Profile: A Continuum of Learning. Stress levels were monitored through Heart Rate Variability measured by the Bittium Faros 360° ECG Holter during eye-tracking tasks. Subjective workload and psychosocial impact were assessed using pictograms and the Psychosocial Impact of Assistive Devices Scale, respectively. Descriptive statistics were applied for analysis. All participants attained and retained their eye-tracking goals, regardless of their initial functional profiles or prior experience with eye-tracking technology. Post-intervention improvements in communication competencies were maintained at the six-month follow-up. Variations in stress levels, subjective workload, and psychosocial impact were observed among participants across different phases of the study, aiding the interpretation of the results. The study concludes that a structured, tailored, four-week intensive eye-tracking intervention can yield successful results in children with DCP, irrespective of their baseline communication abilities or functional profile. Recommendations for future research, including more robust methodologies and reliable computerized tests, are provided.