As the motor system relies heavily on deep sensory stimulation, recent studies have investigated the effect of vibration stimuli. Although research suggests a positive influence of vibration on motor performance in individuals with neurological disorders, there are very limited numbers of studies in children with cerebral palsy (CP). The objective of the present study was to evaluate the effects of sound wave vibration therapy on spasticity and motor function in children with CP. In this 3-month trial, 89 children with spastic CP were randomized to either continue their physiotherapy treatment (PT) or to receive vibration therapy twice a week in addition to their PT program. The randomization was stratified according to the Gross Motor Function Classification System (GMFCS) level to ensure similar functional ability. Children were assessed at baseline and after the 12-week intervention period. The outcomes measured were spasticity level as assessed by Modified Modified Ashworth Scale (MMAS) and gross motor function as assessed by Gross Motor Function Measurement (GMFM-88). Subgroup analysis was performed for the GMFCS. Significant differences between groups were detected for changes in spasticity level and gross motor function after the three months intervention. In conclusion, vibration therapy may decrease spasticity and improve motor performance in children with CP. The results of the present trial serve as valuable input for evidence-based treatments in paediatric neurorehabilitation.

One of the most remarkable observations in developmental neuroscience is the plasticity of the developing brain. Although recent findings suggest that the developing brain possesses substantial compensatory potential, the mechanisms of reorganization and its limitations remain largely unknown. This review includes studies elucidating the complexities of brain reorganization in response to early brain injury. It describes the factors influencing the pattern and degree of brain plasticity, provides insight into the patterns of reorganization in different brain systems and offers guidelines for clinicians in the field of neurorehabilitation. This knowledge is crucial in clinical work when designing the appropriate type and timing of interventions for children with early brain injuries

Spasticity has been considered as a major impairment in cerebral palsy (CP), but the relationship between this impairment and motor functions is still unclear, especially in the same group of patients with CP. The aim of this investigation is to determine the relationship between spasticity and gross motor capability in nonambulatory children with spastic CP. Seventy-one children (30 boys, 41 girls) with bilateral spastic cerebral palsy and with Gross Motor Function Classification System (GMFCS) levels IV (n=34) and V (n=37) were included in the study. The spasticity level in lower limbs was evaluated using the Modified Modified Ashworth Scale and the gross motor function with the Gross Motor Function Measure (GMFM-88). Spearman’s correlation analysis was used to determine the nature and the strength of the relationship. The results showed a moderate correlation between spasticity and gross motor skills (ρ=0.52 for the GMFCS level; ρ=0.57 for the GMFM-88), accounting for less than 30% of the explained variance. It seems that spasticity is just one factor among many others that could interfere with gross motor skills, even in children with severe forms of spastic CP. Knowledge of the impact of spasticity on motor skills may be useful in the setting of adequate rehabilitation strategies for nonambulatory children with spastic CP. Spastizität gilt als eine erhebliche gesundheitliche Schädigung bei Zerebralparese (CP), wobei die Beziehung zwischen dieser Schädigung und den motorischen Funktionen bisher noch ungeklärt ist, insbesondere in der gleichen Gruppe von Patienten mit CP. Ziel der vorliegenden Untersuchung war die Ermittlung der Beziehung zwischen Spastizität und körpermotorischen Fähigkeiten bei nicht gehfähigen Kindern mit spastischer CP. Insgesamt wurden 71 Kinder (30 Jungen, 41 Mädchen) mit bilateraler spastischer Zerebralparese und Graden IV (n=34) und V (n=37) laut Gross Motor Function Classification System (GMFCS) als Teilnehmer in die Studie aufgenommen. Das Ausmaß der Spastizität in den unteren Gliedmaßen wurde unter Zuhilfenahme der modifizierten Ashworth-Skala evaluiert, die körpermotorischen Fähigkeiten mit Hilfe des GMFM-Instruments (GMFM-88). Die Korrelationsanalyse nach Spearman wurde durchgeführt, um Art und Intensität der Beziehung genauer ermitteln zu können. Die Ergebnisse wiesen eine moderate Korrelation zwischen Spastizität und körpermotorischen Fähigkeiten nach (ρ=0.52 auf GMFCS-Ebene; ρ=0.57 bei GMFM-88), was weniger als 30% der erläuterten Varianz ausmacht. Spastizität scheint nur einer von vielen Faktoren zu sein, der selbst bei Kindern mit schwerer Form der spastischen Zerebralparese deren körpermotorische Fähigkeiten beeinträchtigen kann. Kenntnisse der Auswirkung von Spastizität auf die motorischen Fertigkeiten und Fähigkeiten sind bei der Konzipierung angemessener Rehabilitationsstrategien für nicht gehfähige Kinder mit spastischer CP möglicherweise hilfreich. La espasticidad es considerada como una discapacidad grave de la parálisis cerebral (PC), pero la relación entre dicha discapacidad y las funciones motoras todavía es incierta, especialmente dentro del grupo de pacientes con PC. El objetivo de esta investigación es determinar la relación entre la espasticidad y la capacidad motriz gruesa en niños con PC espástica que no pueden caminar. En este estudio participaron 71 niños (30 niños y 41 niñas) con parálisis cerebral espástica bilateral y con nivel IV (n=34) y V (n=37) del Sistema de Clasificación de la Función Motora Gruesa (GMFCS). El grado de espasticidad de las extremidades inferiores fue evaluado mediante la Escala modificada de Ashworth, mientras que la función motora gruesa fue examinada mediante la Medición de la Función Motora Gruesa (GMFM-88). Se utilizó el análisis de correlación de Spearman con el fin de determinar la naturaleza y la solidez de la relación. Los resultados mostraron una correlación moderada entre la espasticidad y la capacidad motora gruesa (ρ=0.52 para el nivel de GMFCS; ρ=0.57 para GMFM-88), lo que representa una cifra inferior al 30% de la varianza explicada. Parece ser que la espasticidad es solamente uno de los factores que podrían interferir en la capacidad motora gruesa, incluso en niños con PC espástica severa. Un mayor conocimiento sobre el efecto que tiene la espasticidad en la capacidad motora puede ser muy útil a la hora de establecer las estrategias de rehabilitación adecuadas en niños con PC espástica que no pueden caminar. La spasticité est considérée comme un handicap majeur dans la paralysie cérébrale (PC), mais la relation entre cette déficience et les fonctions motrices est encore incertaine, en particulier chez le même groupe de patients atteints de PC. Cette enquête avait pour objectif de déterminer la relation entre la spasticité et les capacités motrices globales chez les enfants atteints de paralysie cérébrale spastique non ambulatoires. Soixante et un enfants (30 garçons, 41 filles) souffrant de paralysie cérébrale spastique bilatérale avec des niveaux IV (n=34) et V (n=37) selon le système GMFCS de classification des fonctions motrices globales ont été inclus dans l'étude. Le niveau de la spasticité des membres inférieurs a été évalué à l'aide de l'échelle modifiée d’Ashworth modifiée et la fonction motrice globale avec la mesure des fonctions motrices globales (GMFM-88). L'analyse de corrélation de Spearman a été utilisée pour déterminer la nature et la force de la relation. Les résultats ont montré une corrélation modérée entre la spasticité et la motricité globale (ρ=0.52 pour le niveau GMFCS; ρ=0.57 pour la mesure GMFM-88), ce qui explique moins de 30% de la variance. Il semble que la spasticité ne soit qu'un facteur parmi d'autres qui pourraient interférer avec la motricité globale, même chez les enfants atteints de formes sévères de PC spastique. La connaissance de l'impact de la spasticité sur les capacités motrices pourrait être utile pour développer des stratégies de rééducation adéquates pour les enfants non ambulatoires atteints de paralysie cérébrale spastique.

Background: Children with perinatal brain damage have a high prevalence of visual impairment. Stimulation of vision at a critical period can encourage brain plasticity and the recovery of impaired function. Objective: The aim of our study was to investigate when is the critical period for visual stimulation in children with perinatal brain damage. Methods: We compared 35 children within the first eight months of life (median age = 4 months) to 35 children aged between eight and thirty months (median age = 15 months), all with perinatal brain damage. All the children were attending an early intervention program at Mali dom, Zagreb, a rehabilitation centre for children with visual impairment. We compared the results from baseline and follow-up assessments of visual functions (grating acuity and contrast sensitivity). We also compared differences in change scores between the two groups. Results: Our results have shown that children who commence a visual stimulation program within the first eight months of life had more improvement in both visual functions. This improvement is statistically significant in visual acuity (p = 0.048). Conclusions: These results indicate the importance of starting a visual stimulation program within the first eight months after birth.

In the field of developmental neuropsychology, interesting patterns of association between functional brain development at birth and neurodevelopmental outcomes during early childhood have been recently highlighted. In this work, we investigated a population of preterm neonates ( n = 32) and (1) derived perinatal functional connectivity (p-FC) markers of prematurity, through direct comparison with a group of at-term borns and (2) tested the role of these markers as predictors of cognitive (COG), language (LANG), and socioemotional (SE) outcomes measured at 6, 12, 24, and 36 months. We did this by means of regression models in which functional markers were tested as predictors, after accounting for variability captured by metrics derived from current clinical practice and which were previously reported to be associated with a higher risk for adverse neurodevelopmental outcomes (i.e., pregnancy, perinatal weight and physiological conditions, and structural brain development variability). Our results revealed that (1) p-FC between the bilateral cerebellar hemispheres predicted SE outcomes at 6 months; (2) p-FC between the bilateral visual cortices predicted COG outcomes at 12 months; (3) p-FC between cortices related to language and emotional control predicted SE outcomes at 12 months; (4 and 5) p-FC between somatosensory motor and higher-order control cortices predicted LANG outcomes at 24 months and COG outcomes at 36 months; and (6 and 7) p-FC between language-related cortices predicted SE and COG outcomes at 36 months. Linear mixed model analyses with pattern mixture modeling, performed to comprehensively explore the longitudinal impact of significant perinatal functional predictors, demonstrated the importance of specific perinatal functional predictors of global neurodevelopment over time. We discuss our results by suggesting that perinatal functional imaging of the brain at rest could represent a very valuable and unique addition to current preterm clinical care routines, to improve pediatric clinical practices of the near future.