Background: In 2020, a multiprofessional panel was set up in collaboration with the Italian FightTheStroke Foundation family association to produce evidence-based recommendations for the management and neuromotor rehabilitation of persons with cerebral palsy aged 2–18 years to implement in clinical practice in Italy. Methods: The recommendations of these care pathways were developed according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for Care Pathways Development and the Grading of Recommendations Assessment Development and Evaluation working group for adoption, adaptation, or de novo development of recommendations from high-quality guidelines (GRADE-ADOLOPMENT). Results: Four strong positive recommendations were developed regarding comprehensive management, and twenty-four addressed neuromotor treatment. Conclusions: A holistic, individualized approach was affirmed in terms of both multidimensional patient profile and interdisciplinary management in a network with the school where children and adolescents are integrated. It was defined that all motor rehabilitation approaches must be individually tailored considering age and developmentally appropriate activities as interventions and goals, in light of the reference curves addressing prognosis for Gross Motor Function and Manual Ability Classification Systems. Intervention must be structured with adaptations of the task and/or of the context (objects and environment) based on the analysis of the child’s skills to support motivation and avoid frustration.

Background/Objectives: Physical activity is generally recommended, but youth with disabilities present increased sedentary behaviors. This is often due to limited or inaccessible exercise options. The aim of this systematic review was to report on the state of knowledge about the role of adapted physical activity (APA) in improving gross motor performance (query 1), participation and QoL (query 2) of children and adolescents with neurological motor disability. Methods: Pubmed, Scopus and Cinahl databases were enquired in October 2023 and updated in May 2025. Inclusion criteria were the following: any type of physical activity; pediatric subjects with any neuromotor disease; and any type of outcome measure regarding gross motor performance, participation or QoL. The risk of bias (RoB) was assessed by means of ROB 2, Robins-I and JBI tools. Results were synthetized focusing on the outcome measures and the type of activity proposed. Results: Thirteen and seven studies were included relative to queries 1 and 2, respectively. They all were RCTs, and some presented randomization RoB. Several types of APA (e.g., resistance, high-intensity circuit, running, cycling, aquatic and dance training) and of outcome measures were enquired, mostly focusing on subjects with cerebral palsy or Down syndrome. An increased time of moderate-to-vigorous physical activity, improvement in timed functional tests, muscle strength and stability were observed. Conclusions: APA may improve functioning, social participation and promote active lifestyle in pediatric persons with neuromotor disabilities, without adverse effects. In the future, more specific indications based on the functioning profile are advisable to orient professionals to define individualized safe training programs.