Sarah Elizabeth Reedman

Background and aims: Cord blood infusion is an emerging treatment for cerebral palsy (CP) currently offered in the United States through clinical trials and an expanded access pathway. This study aimed to understand the barriers and facilitators influencing implementation of cord blood treatment for CP, to help inform future implementation efforts. Methods: Semi-structured interviews were conducted with US professionals involved in the cord blood treatment program for CP at Duke University and a collaborator site. Data were analyzed using reflexive thematic analysis. Results: From 16 interviews, 5 themes were identified capturing patterned barriers and enablers. Key facilitators included boundary-spanning clinical leadership, interprofessional coordination, dedicated resourcing, responsiveness to community demand, an established safety profile, and a strong research culture. Barriers included the need for cross-disciplinary expertise, uncertainty regarding efficacy evidence, funding and regulatory constraints, and system-level challenges. Participants described that many barriers were overcome to establish the program, while acknowledging that others may persist and are context dependent. Conclusions: Findings highlight that implementation of cord blood treatment for CP is feasible within specialized settings but contingent on local infrastructure, governance, and workforce capacity. Identified facilitators align with established implementation strategies and offer transferable insights, while underscoring the need for regulatory approval, ethical oversight, and system-level supports to enable equitable and sustainable access to emerging regenerative therapies for CP.

Aim: To identify intervention ingredients used to address the F‐words for childhood development in community‐based physical activity programmes for children with physical disabilities, the programme outcomes, and the strength of available evidence. Method: A scoping review was conducted guided by the JBI Manual for Evidence Synthesis. Electronic database and hand searches of international literature identified studies that evaluated community‐based physical activity programmes for children with a physical disability with impaired gross motor skills (e.g. sitting, walking) ranging from mild limitations in speed, balance, and coordination to severe impairment requiring the use of a wheelchair for mobility. Intervention ingredients were mapped to the six F‐words: functioning, fitness, friends, family, fun, and future. Primary study outcomes were tallied and themed. Evidence strength was assessed using the Australian National Health and Medical Research Council guidelines and the Risk of Bias in Non‐randomised Studies ‐ of Interventions (ROBINS‐I) tool. Results: Twenty‐four primary research articles were included. Most studies addressed the concept of functioning, fitness, fun, and friends, and few studies addressed family and future. Thirty common intervention ingredients were identified to deliver the F‐words. Eight key outcome areas were identified. Most studies were level IV evidence and possessed a serious level of bias. Interpretation: Despite identifying numerous intervention ingredients mapped to the F‐words, the overall evidence base remains weak. Strengthening the quality and scope of research is essential to ensure the F‐words framework is applied inclusively for physical activities across diverse populations of children with physical disabilities in community contexts.

Aim: To describe how movement behaviours (sedentary time, light‐intensity physical activity, moderate‐to‐vigorous physical activity [MVPA]) and parent‐reported community physical activity participation vary across levels of environmental supportiveness (home, school, community) in children with cerebral palsy (CP). Method: This was a secondary cross‐sectional observational study using pooled data ( n = 141) from four studies of children with CP aged 6 to 16 years (mean = 10 years 1 month [SD = 2 years 5 months]; Gross Motor Function Classification System level I = 71, level II = 41, levels III–IV = 29). Children wore hip‐mounted triaxial accelerometers; validated machine‐learning models classified sedentary time, light physical activity, and MVPA. Parents reported community physical activity participation and environmental supportiveness using the Participation and Environment Measure for Children and Youth. Linear models were adjusted for wear time and study. We estimated marginal mean differences (MMDs) in time spent in movement behaviours between the 25th and 75th centiles of supportiveness scores. Results: Greater community (MMD = −30.1 minutes, 95% confidence interval [CI] = −53.4 to −8.1), home (−31.4 min, 95% CI = −51.5 to −11.3), and school (MMD = −54.1 min, 95% CI = −76.0 to −32.2) supportiveness were associated with less sedentary time. Higher home supportiveness was associated with more time in light physical activity (MMD = 23.7 minutes, 95% CI = 11.0 to 36.3), whereas school and community supportiveness were not associated with light physical activity. No environmental supportiveness measures were associated with time in MVPA. Interpretation: Greater environmental supportiveness across all contexts was associated with lower sedentary time, while greater home supportiveness was associated with more time in light physical activity. Other factors may have stronger associations with MVPA time.

Aim: To compare active upper‐limb therapies for children with cerebral palsy using a network meta‐analysis. Method: For this systematic review, five electronic databases were searched up to 2nd September 2024. Outcomes pertaining to improved hand use (Assisting Hand Assessment, AHA), goal attainment (Canadian Occupational Performance Measure, COPM), and self‐care were analysed with therapies classified into 15 discrete categories. Results: Quantitative analysis of 48 randomized controlled trials ( n = 1629) was performed. Compared with control, treatment effect on hand function (AHA mean difference, standard error) was greater for bimanual therapy (BiM: 4.6, 1.0), modified constraint‐induced movement therapy (mCIMT; 4.0, 1.0), goal‐directed therapy (GDT; 3.8, 1.6), action observation (4.9, 1.1), and mCIMT + intensive (7.4, 2.5). For COPM performance, treatment effect was greater for cognitive orientation to occupational performance (CO‐OP; 5.9, 1.4), BiM (3.3, 0.4), mCIMT (2.5, 0.5), GDT (2.3, 0.7), mirror therapy (2.6, 1.2), and mCIMT + GDT (4.2, 1.1). For self‐care, treatment effect (standardized mean difference, standard error) was greater for BiM (0.39, 0.10), mCIMT (0.37, 0.08), and mCIMT + GDT (0.43, 0.32). Interpretation: BiM and mCIMT were confirmed as effective interventions for hand function, self‐care, and individual goal achievement. Mirror therapy, CO‐OP, and four different combination approaches feature single studies, small sample sizes, and high risk of bias, requiring further clinical trials to confirm efficacy.

Children with cerebral palsy (CP) have low physical activity (PA) and high sedentary behavior. The aim was to trial a participation-focused behavior-change intervention to increase PA and decrease sedentary behavior. Twelve children with CP were recruited (mean age 5 years 6 months ± 1 year 2 months, Gross Motor Function Classification System [GMFCS] levels I = 1, II = 1, III = 1, IV = 4, V = 5); eight with complete post-intervention data (mean 5 years 10 months ± 1 year 4 months, GMFCS I = 1, III = 1, IV = 4, V = 2). Children received 8 weekly sessions targeting individualized PA participation goals in a pre-post feasibility trial. Outcomes included: implementation, effectiveness (Canadian Occupational Performance Measure [COPM]), device-measured PA, goal confidence, quality of life, and barriers to PA participation. Semi-structured interviews explored acceptability and were analyzed thematically. Implementation was feasible with ≥90% sessions attended and high enjoyment (89.5%). After 8 wk, COPM goal performance (mean difference [MD] = 2.9, 95% CI 0.7, 5.0; p = 0.02), satisfaction with performance (MD = 3.0, 95% CI 1.6, 4.4; p = 0.002), and confidence (MD = 1.4, 95% CI 0.4, 2.5; p = 0.02) significantly increased with no change in other outcomes. All six caregivers interviewed reported the intervention to be acceptable. Active Start Active Future was feasible to conduct, acceptable and showed preliminary evidence to improve PA in young children with CP.

Introduction The benefits of physical activity (PA) are compelling for all ages and abilities. For children with cerebral palsy (CP), two distinct health behaviours, being physically active and reducing sedentary time, are critical to target as an early intervention to reduce long-term morbidity. One approach may be to increase PA participation by empowering parents who are key to making family lifestyle changes. This study will compare Active Start Active Future, a participation-focused intervention, to usual care in a mixed-methods randomised waitlist-controlled trial. Methods and analysis A total of 40 children with CP (3–7 years), classified in Gross Motor Function Classification System (GMFCS) levels II–V, will be stratified (GMFCS II vs III, IV vs V) and randomised to receive either (1) Active Start Active Future, an 8-week intervention for 1 hour per week in any setting or (2) usual care followed by delayed intervention. Active Start Active Future aims to increase PA and reduce sedentary behaviour of young children with CP by providing participatory opportunities to promote PA behaviour change. Outcomes will be measured at baseline (T1), immediately postintervention at 8 weeks (T2) and at 26 weeks postbaseline (T3). The primary outcomes are the Canadian Occupational Performance Measure for both child and parent participation goals and child physical performance goal. Secondary outcomes include daily time spent in moderate to vigorous PA and sedentary time, gross motor function, quality of life, barriers to participation for the children and parents’ PA and sedentary time. Intervention acceptability and experiences of PA participation will be explored using a qualitative descriptive approach. Ethics and dissemination The Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/23/QCHQ/100850) and The University of Queensland Human Research Ethics Committee (2024/HE000054) have approved this study. The results of the study will be disseminated to families and community agencies as guided by our advisory group and as conference abstracts and presentations, peer-reviewed articles in scientific journals and institution newsletters and media releases. Trial registration number ACTRN12624000042549, Universal Trial Number: U1111-1300-7421; Australian New Zealand Clinical Trials Registry.

Aim: To explore the clinical utility and psychometric properties of standardized tools for the early detection of developmental concerns or disability in young children.Method: Systematic reviews and clinical practice guidelines containing psychometric data on tools appropriate for use with children from birth to 5 years 11 months were searched for in MEDLINE, CINAHL, Embase, and PsycINFO for the years 2000 to 2023, with no language restrictions.Results: Eighty‐six systematic reviews and six clinical practice guidelines guided identification of tools. A total of 246 tools were identified across domains of neurological, motor, cognition, communication/language, social–emotional, sensory processing, and/or specific diagnostic conditions of attention‐deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, developmental coordination disorder, and fetal alcohol spectrum disorder. After critical evaluation, 67 tools were included in the recommendations. Recommendations for screening and diagnostic assessment tools were based on best available evidence for predictive and discriminative validity, diagnostic accuracy, together with consideration of resource use and accessibility.Interpretation: This comprehensive scoping review provides recommendations on the best tools for primary care, medical, allied health professionals, nursing, and other health workers to detect and identify developmental concerns or disability in young children using evidence‐based tools.

Introduction Children with cerebral palsy (CP) participate less in physical activities and have increased sedentary behaviour compared with typically developing peers. Participate CP is a participation-focused therapy intervention for children with CP with demonstrated efficacy in a phase II randomised controlled trial (RCT) to increase perceived performance of physical activity participation goals. This study will test the effectiveness of Participate CP in a multisite phase III RCT. Methods and analysis One hundred children with CP, aged 8–14 years, classified Gross Motor Function Classification System levels I–IV will be randomised to either (1) receive Participate CP once/week for 1 hour for 12 weeks, or (2) waitlist control, usual care group. The waitlist group will then receive Participate CP following the 26-week retention time point. Outcomes will be assessed at baseline, 12 weeks and then 26 weeks post baseline. The primary outcomes are (1) self-reported participation goal performance on the Canadian Occupational Performance Measure at 12 weeks and (2) daily time in moderate-to-vigorous physical activity. Secondary outcomes include home and community participation frequency, involvement and environmental supportiveness, contextual barriers to participation, quality of life, intrinsic motivation for physical activities, child perception of an autonomy-supportive climate for physical activities and physical literacy at 12 and 26 weeks post study entry. Ethics and dissemination The Children’s Health Queensland Hospital and Health Service, The University of Queensland and the New Zealand Health and Disability Ethics Committees have approved this study. Findings will be disseminated in peer-reviewed journals and conference presentations. Trial registration number ACTRN12618000206224.

Introduction It is well established that young people with moderate-severe (Gross Motor Function Classification System [GMFCS] levels II-V) cerebral palsy (CP) participate in less physical activity compared to typically developed peers, and children with CP who can walk without limitations (GMFCS level I). Frame Running (formerly RaceRunning) is a World Para Athletics sanctioned sport that allows people with moderate-severe CP to access, experience and compete in running using a specialised three-wheeled frame with low rolling resistance. The Run4Health pilot randomised controlled trial (protocol published elsewhere) was designed to investigate the cardiorespiratory benefits of a 12-week frame running training program in young people with CP (aged 8-21 years, GMFCS II-V). Following enrolment of 12 participants in the pilot study, additional funding was secured to expand the Run4Health study to include additional training/study sites, new research questions and outcome measures, based on feedback from consumers. Such changes necessitate an expanded and updated study protocol. This expanded Run4Health study will investigate the effects of a 12- week Frame Running training program on cardiorespiratory health, bone mineral density, gross motor function and capacity, physical activity participation, sleep, pain and quality of life in children and youth (aged 8-21 years) with moderate-severe CP (GMFCS levels II-V). Methods and Analysis One hundred and two children and youth with CP (age 8-21 years) classified in GMFCS levels II-V will be recruited across three sites (six training locations) and randomised to receive either 12 weeks of Frame Running training twice weekly for 60 minutes, or 12 weeks of usual care (waitlist control group). Outcomes will be measured at baseline, immediately post-intervention, and 12 weeks post-intervention. The control group will receive the intervention following T3, and have an additional assessment session following 12 weeks of training (T4). Outcomes include cardiorespiratory fitness, bone mineral density, blood pressure, habitual physical activity, body mass index, waist circumference, percentage body fat, gross motor function and capacity, community participation, sleep, pain, quality of life and mood, health utility, feasibility, tolerability, and safety. Adverse events will be monitored, and participants, caregivers and coaches will be interviewed to explore barriers and facilitators to ongoing, sustainable participation in Frame Running. Ethics and Dissemination Ethical approval for this study was granted by The Children’s Health Queensland Hospital and Health Service (HREC/21/QCHQ/69281) and the University of Queensland Human Research Ethics Committees (2021/HE000725). Research outcomes will be disseminated via scientific conferences and publications in peer reviewed journals; to therapists and coaches through professional and athletic organisations; and to people with CP and their families. Registration Australian New Zealand Clinical Trials Registry number: ACTRN12621000317897