Achievements

• Goal? Evaluate the effects of acute physical exercise on cognitive functioning in children with CP.
• How? To assess the effect of physical activity on attention capacity. 16 unassisted children, including 8 living with cerebral palsy, were followed by a pediatrician. Attention capacity of children before and after exercise was assessed using a pediatric version of the Stroop test.
• Results: The intensive exercise had:
  1) + effect on reaction time. Children with cerebral palsy are faster after an excercise.
  2) - effect on the Stroop test. Children with cerebral palsy make more erros after exercise.

In conclusion, this study demonstrates that intense exercise has an impact on cognitive function in children with cerebral palsy by increasing the speed of treatment and reducing the capacity of executive functions.

For more information
Acute Physical Exercise Affects Cognitive Functioning in Children With Cerebral Palsy.
Pediatr Exerc Sci. 2016 May;28(2):304-11. doi: 10.1123/pes.2015-0110. Epub 2015 Oct 23.
Maltais DB, Gane C, Dufour SK, Wyss D, Bouyer LJ, McFadyen BJ, Zabjek K, Andrysek J, Voisen JI. 

The low level of physical activity among all categories of children is a health issue that is increasingly observed around the world. This issue is even more important in children with cerebral palsy.

The latter have an even lower level of physical activity than their peers with a typical development, which affects their physical condition and increases the risk of developing certain chronic diseases.

Major points 

• It would be necessary and beneficial for all children with cerebral palsy who are able to walk to engage in aerobic-type physical activities, anaerobic and muscle building to the best of their ability.
• It is important to conduct more research to determine the best ways to assess the physical health of children with cerebral palsy who are unable to walk
• It would be important to measure the long-term effects of physical activity in this population.

For more information
Health-related physical fitness for children with cerebral palsy.
J Child Neurol. 2014 Aug;29(8):1091-100. doi: 10.1177/0883073814533152. Epub 2014 May 11.
Maltais DB, Wiart L, Fowler E, Verschuren O, Damiano DL. 

Many health professionals must measure the range of motion of their client’s joints daily. This practice is an integral part of a good physical assessment and is essential for the diagnosis and treatment of several pathologies.

• Goal: The goniometer is a proven instrument in terms of reliability and accuracy, although it may be difficult to use properly in a situation where the person being assessed suffers from cerebral palsy.
• How? Therefore, a team of researchers evaluated several measures of range of motion in 30 young people with cerebral palsy. They performed this exercise once using the goniometer and once using the inclinometer. Two physiotherapists took measurements during two different sessions using both instruments at each session.
• Results: The inclinometer proves to be as reliable as the goniometer for measuring the range of motion, both in the upper and lower limbs. In addition, the results are also reliable when two different people take the measurements.

For more information
Reliability of Inclinometer-Derived Passive Range of Motion Measures in Youth with Cerebral Palsy.
Phys Occup Ther Pediatr. 2019;39(6):655-668. doi: 10.1080/01942638.2019.1597822. Epub 2019 May 30.
Maltais DB, Ferland C, Perron M, Roy JS.

•  Goal: To explore what factors besides walking ability, e.g., additional health problems or complications, general health, and sociodemographic status, may be related to physical activity in adults with cerebral palsy.
• How? A questionnaire regarding sociodemographic and health-related factors of potential relevance to physical activity was administrated to 66 men (20-41 yrs) and 66 women (18-39 yrs) with various types of cerebral palsy.
• Results: For walkers, higher odds of being physically active was associated with:
  - Use of walking as the primary means of self-transport (walking ability) was associated with
  - Being younger and having a positive perception of health
• Conclusions: Among adults with cerebral palsy, the ability to walk is associated with being physically active.

For more information
Factors related to physical activity in adults with cerebral palsy may differ for walkers and nonwalkers.
Am J Phys Med Rehabil. 2010 Jul;89(7):584-97. doi: 10.1097/PHM.0b013e3181d89f32.
Maltais DB, Dumas F, Boucher N, Richards CL. 

• How? To answer this question, 145 adults with cerebral palsy (18 to 41 years) responded to a questionnaire on their socio-demographic and health factors, lifestyle and environment.
• Results: Most participants lived with their parents and recreation was their main occupation. It has been shown that the greater the mobility of one participant, the greater his participation in leisure activities. In addition, the environment including accompanying services, adapted transportation, community services and computers would facilitate the participation of people with an average level of participation to be raised. However, people with a low level of participation do not consider the environment to be influential.
• Conclusion: despite the influence of the environment and other factors, one of the key determinants of an adult’s participation with cerebral palsy would appear to be their ability to mobilize.

For more information
The influence of selected personal and environmental factors on leisure activities in adults with cerebral palsy.
Disabil Rehabil. 2010;32(16):1328-38. doi: 10.3109/09638280903514713.
Boucher N(1), Dumas F, Maltais DB, Richards CL.

• What is cerebral palsy? Cerebral palsy is now defined as a disorder of movement and posture development causing activity limitations for the person with the condition. This condition is generally attributed to brain damage that occurs before or after the birth of the child and does not worsen over time. Cerebral palsy can also affect the person’s sensations, perception, cognition, communication, and behaviour. Also, muscle weakness and loss of muscle flexibility will also be observed.
• How cerebral palsy is evaluated? In terms of evaluation, two methods are used:
  1) The General Movements Assesment and Test of Infant Motor Performance provide early detection of cerebral palsy.
  2) The Gross Motor Function Measure is used to assess changes in condition over time and the effects of clinical interventions.
• What about rehabilitation?
  Rehabilitation is now focused on improving functions in several areas with emphasis on fitness, participation and quality of life.

For more information
Cerebral palsy: definition, assessment and rehabilitation.
Handb Clin Neurol. 2013;111:183-95. doi: 10.1016/B978-0-444-52891-9.00018-X.
Richards CL, Malouin F. 

Ambulatory children and youth with cerebral palsy have limitations in locomotor capacities and in community mobility.

• Goal? Evaluate the ability of three locomotor tests to predict community mobility in 49 boys with CP between 6 and 16 years old.
• How?
  Step 1: 3 locomotor tests
  - 6-min-Walk-Test (6MWT) (level ground walking test)
  - 10-meter-Shuttle-Run-Test (10mSRT) (test of advanced locomotor capacities)
  - Timed-Up-and-Down-Stairs-Test (TUDS) (test of advanced locomotor capacities)
  Step 2: Measurement of community mobility with the Assessment of Life Habits mobility category.
• Results: Advanced locomotor capacity tests may be better predictors of community mobility in this population than level ground walking tests.

For more information
Locomotor tests predict community mobility in children and youth with cerebral palsy.
Adapt Phys Activ Q. 2012 Jul;29(3):266-77. doi: 10.1123/apaq.29.3.266.
Ferland C, Moffet H, Maltais DB. 

• Goal? Quantification of relationships between lower limb muscle strength and locomotor capacity in children with CP to identify key muscle groups for strength training.
• How? Muscle strength of different muscles were measured using dynamometry in 50 children with or without CP (6-16 years old). Locomotor capacity was evaluated by the 6-min walk test (6MWT), 10-meter Shuttle Run Test (10mSRT), and Timed Up and Down Stairs Test (TUDS).
• Results? The most important differences in term of strength were observed for hip flexor and ankle plantar flexor strength as well as hip abductor isometric.

For more information
Relationships between lower limb muscle strength and locomotor capacity in children and adolescents with cerebral palsy who walk independently.
Phys Occup Ther Pediatr. 2012 Aug;32(3):320-32. doi: 10.3109/01942638.2011.631102. Epub 2011 Nov 24.
Ferland C, Lepage C, Moffet H, Maltais DB. 

• Goal? Variability in hand function among children with unilateral cerebral palsy (UCP) might reflect the type of brain injury and resulting anatomical sequelae. The purpose of this study was to assess whether the type of brain injury could explain this diversity.
• How? The MRIs of 40 children living with one-sided PCs were analyzed using an anatomical atlas. Brain damage has been localized at two distinct locations: perivascular or medium cerebral artery. Dexterity and bimanual function were also evaluated in each child.
• Results: Children with perivascular lesions have better manual function.
• Conclusion: The location of the brain injury is characterized by an anatomical difference and can have a direct impact on manual function.

For more information
Anatomical and Functional Characterization in Children With Unilateral Cerebral Palsy: An Atlas-Based Analysis.
Neurorehabil Neural Repair. 2020 Feb;34(2):148-158. doi: 10.1177/1545968319899916. Epub 2020 Jan 26.
Ferre CL, Carmel JB, Flamand VH, Gordon AM, Friel KM. 

Each member, whether the right hand or the left foot, has a precise area corresponding to the level of the motor cortex, this area is called the motor representation.

• Goal? Measure the relationship between manual function and size, excitability and superimposition of motor representations of both hands at the level of the non-leased hemisphere of children living with unilateral spastic cerebral palsy (CPS).
• How? The size and excitability of the motor regions representing both hands were measured using a non-invasive and painless technique: transcranial magnetic stimulation. These measurements were performed in 50 children living with CPSU.
• Comments:
  - There is a significant superimposition of the motor regions of both hands on the non-leaded side
  - There is a link between the size and excitability of these overlay regions and the manual function
• Conclusion: The more motor regions corresponding to the two hands are superimposed, the better the manual function.

For more information
The Relationship Between Hand Function and Overlapping Motor Representations of the Hands in the Contralesional Hemisphere in Unilateral Spastic Cerebral Palsy.
Neurorehabil Neural Repair. 2018 Jan;32(1):62-72. doi: 10.1177/1545968317745991. Epub 2018 Jan 5.
Marneweck M, Kuo HC, Smorenburg ARP, Ferre CL, Flamand VH, Gupta D, Carmel JB, Bleyenheuft Y, Gordon AM, Friel KM.

• Goal? The Covid-19 pandemic has impacted many areas of daily living. The rehabilitation of children living with CP is unfortunately no exception. Finding solutions for rehabilitation was therefore essential.
• How? Assess whether active video games and virtual reality platforms can be used as a tool for home rehabilitation in the absence of a therapist in the physical environment.
• Results: video games and virtual reality
  - Allow motor training with challenges and immersive environments.
  - Are fun and motivating for children.
  - Can be a tool for rehabilitation.

For more information
Active Video Games and Low-Cost Virtual Reality: An Ideal Therapeutic Modality for Children With Physical Disabilities During a Global Pandemic.
Front Neurol. 2020 Dec 14;11:601898. doi: 10.3389/fneur.2020.601898. eCollection 2020.
Demers M, Martinie O, Winstein C, Robert MT. 

• Goal? Virtual reality is being more and more used for rehabilitation of patients living with CP. Is this approach effective?
• How? This article reviews 26 studies evaluating the effects of virtual reality video games as tools to improve arm motor learning in people living with PC. In these studies, both commercial games and tailor-made tasks for rehabilitation have been used.
• Results: Virtual reality has undeniable potential in the field of rehabilitation for people living with CP. However, it is still important to integrate more activities adapted to specific motor learnings in order to better understand its effects and maximize its beneficial effects.

For more information
Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review.
JMIR Serious Games. 2021 Apr 7;9(2):e23822. doi: 10.2196/23822.
Demers M, Fung K, Subramanian SK, Lemay M, Robert MT. 

• Goal? Develop and test a new device allowing the stabilization of a spoon to help people living with a motion disorder.
• How? The device used in this project was designed by engineers, in collaboration with occupational therapists and focus groups working with people living with movement disorders. The device is fixed on a table and is able to support a spoon. The prototype was tested with people living with cerebral palsy.
• Results: The device reduces the time required to perform the task and improves the fluidity of movements.

For more information
Preliminary Design of an Active Stabilization Assistive Eating Device for People Living with Movement Disorders.
IEEE Int Conf Rehabil Robot. 2019 Jun;2019:217-223. doi: 10.1109/ICORR.2019.8779388. 
Turgeon P, Laliberte T, Routhier F, Campeau-Lecours A. 

Mechanical design of a new device to assist eating in people with movement disorders.
Assist Technol. 2020 Mar 13:1-8. doi: 10.1080/10400435.2020.1734111.
Turgeon P, Dubé M, Laliberté T, Archambault PS, Flamand VH, Routhier F, Campeau-Lecours A.

Advances in maternal and perinatal care in developed countries have improved the health status of children. These changes affect at-risk populations and the profile of children developing with cerebral palsy.

• How? Based on data from the Canadian CP Registry, this study profiled 662 children living with CP born between 1999 and 2010 in Quebec.
• Results:
  - No change in profile or associated risk factors was observed
  - Prematurity remains a very high risk factor

For more information
Is Cerebral Palsy Changing in High Resource Settings? Data From the Quebec Cerebral Palsy Registry.
J Child Neurol. 2019 Sep;34(10):567-573. doi: 10.1177/0883073819845272. Epub 2019 May 10.
Hadjinicolaou A, Ng P, PhD XZ, Koclas L, Lamarre C, Malouin F, Pigeon N, Richards CL, Shevell M, Oskoui M.