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Where’s the Evidence? Challenging Therapists to Stop Legitimizing Dynamic Movement Intervention and Cuevas Medek Exercises.

Paleg, Ginny PT, MPT, DScPT; Pool, Dayna PT, PhD; Hidalgo-Robles, Álvaro PT, MSc; Frumberg, David MD; Livingstone, Roslyn OT, MSc(RS); Damiano, Diane PT, PhD

Open Access!
https://journals.lww.com/pedpt/fulltext/9900/where_s_the_evidence__challenging_therapists_to.204.aspx

Dynamic Movement Intervention (DMI) and Cuevas Medek Exercises (CME) are promoted as innovative neurorehabilitation methods for children with neurological disabilities, yet both rely on outdated reflex-hierarchical models rather than contemporary motor learning principles. 

A review of the literature reveals that CME, despite 5 decades of use, is supported only by a few case reports and 2 small, biased comparative studies. DMI, introduced in 2021, has no published empirical evidence beyond a single conference abstract. Thus, both interventions remain at Sackett Level 5—no evidence.

The ethical implications are substantial. Families often pay thousands for intensive, noncovered therapies that may displace meaningful participation in education and social life. 

Therapists have a professional responsibility to avoid legitimizing unproven practices and to prioritize interventions supported by robust evidence. Pediatric rehabilitation should shift toward child-led, functional, and task-specific approaches grounded in modern motor learning science, with professional bodies and insurers withholding endorsement of non evidence-based methods.

Karina A Zapata, Rosa H Cooksey, Daralyn K Fulton, Hayley B Shelton, Chan-Hee Jo, Richard C Adams

Affiliations Expand

• PMID: 40556501
• DOI: 10.1111/dmcn.16397

Abstract

Aim: To determine the baseline pediatric reference values of the 6-minute walk test (6MWT) distance (6MWD) across spina bifida functional lesion levels, the associations between the 6MWD and the distances of the 1-minute and 2-minute walk tests, and assess the impact of social determinants on the 6MWD.

Method: This prospective cohort study collected the 6MWD of 145 ambulatory children (72 male, 73 female; mean age = 11 years 2 months [range: 6 years 0 months-17 years 11 months]) with mid-lumbar-level (n = 59), low-lumbar-level (n = 28), and sacral-level (n = 58) myelomeningocele at a pediatric hospital. Proxies of social determinants included insurance type and Area Deprivation Index (ADI). Pairwise comparisons evaluated the 6MWD according to lesion level and myelomeningocele functional classification (MMFC) group.

Results: The mean 6MWD was shorter for myelomeningocele at the mid-lumbar versus low-lumbar versus sacral lesion levels (p < 0.001), and MMFC2 versus MMFC3 versus MMFC4 (p < 0.001). The mean 1-minute and 2-minute walking distances were strongly associated with the 6MWD. Children with public insurance and a high ADI walked significantly fewer meters than children with private insurance (p = 0.023) and a low ADI (p = 0.048).

Interpretation: Children with higher anatomical functional lesion levels walked shorter distances than those with lower levels and according to MMFC group. The 1-minute and 2-minute walk tests are adequate substitutes for the 6MWT. Lower socioeconomic status affecting decreased walking capacity merits interventions to maximize opportunities for activity.

Trajectories of Fidgety Movements in Infants with and without medical complexity.

This paper is a finalist for AACPDM’s highest honour - the Gayle G Arnold award, chosen and highlighted by the scientific review committee for it’s high quality.

We look ahead at The American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Conference - the 79th Annual Meeting!

“Celebrating Resilience” October 15-18, 2025, to be held in New Orleans, LA. 

Continuing our AACPDM 2025 Preview series!

Effect of high-frequency, low magnitude vibration on physical activity and physical function in children with cerebral palsy: a randomised controlled trial

This paper is a contender for the AACPDM’s highest abstract honour - the Gayle G Arnold Award!

There is still time to register for the conference in beautiful New Orleans - Visit https://www.aacpdm.org/events/2025 for all the details!

The effect of immediate weightbearing after planovalgus foot reconstruction in ambulatory children with cerebral palsy

Background and Objective(s)

Planovalgus (PV) is a common foot deformity in children with cerebral palsy (CP). Orthopedic surgery is widely established as an effective treatment for deformity correction though there is clinical variation in post-op therapy protocols. Immediate weightbearing (WB) after PV foot correction could accelerate recovery but concern for post-op complications causes reluctance. The aim of this study was to determine the prevalence of complications after PV foot surgery in children with early WB vs. non-WB (NWB).

Study Participants & Setting

135 ambulatory children with CP (GMFCS I (12%), II (58%), III (30%)) met inclusion criteria and were included from a children’s hospital setting and assessed in the gait laboratory.

Materials/Methods

This IRB-approved retrospective cohort study included ambulatory children (GMFCS I-III) with CP and PV foot deformity who underwent reconstructive surgery and pre (within 18 months) and post-op (1-3 years) gait analyses. Complications were defined in three timeframes: (1) short-term, within 6 months of surgery, by radiograph review for nonunion, hardware failure, or infection requiring return to surgery, (2) mid-term, at 1-3 years, by pedobarographic assessment, and (3) long-term, > 3 years, by recurrence requiring surgical revision. Fisher exact tests compared the prevalence of complications between immediate WB and NWB groups. Regression analysis evaluated the relationship between complications and child, surgical, and post-operative factors.

Results

140 surgical events were completed on 224 feet at age 12.7 ± 2.8 years. Following surgery, 84% of children followed an immediate WB protocol, and 16% were NWB for the first six weeks. The prevalence of short-term complications between the WB and NWB groups was no different (nonunion/hardware failure/infection, WB 3%/1%/0%; NWB, 0%/3%/0%; p>0.9). There were no between group differences in mid-term correction status (under- corrected/corrected/over-corrected, WB 31%/45%/24%; NWB, 32%/54%/14%; p>0.9). The prevalence of long-term recurrence necessitating surgery was not significantly different (WB/NWB, 3%/11%; 8.5±2.8 years post-op; p>0.9). Regression analysis demonstrated WB status was not a significant predictor of correction status or long-term recurrence requiring revision (p>0.05).

Conclusions/Significance

Complication rates were very low after planovalgus foot correction surgery in ambulatory children with CP. There were no significant differences in complications, clinical outcomes, or need for surgical revision between groups who followed immediate WB vs. NWB post-op protocols. Immediate WB after PV foot correction surgery presented no increased risks compared to NWB and should be encouraged in children with CP. Early WB, standing, and walking may prevent disuse muscle weakness and promote faster recovery of gross motor mobility, enhancing patient care. Future studies should examine the impact of early WB on recovery time and long-term functional outcomes.

Elizabeth Maus, Ben Reader, Jill C Heathcock

Abstract

Aims: To quantify the number and types of mobility devices used by children with cerebral palsy (CP) and explore the relationships between Gross Motor Functional Classification System (GMFCS) level, age, insurance, income, and number and types of devices.

Method: This was a secondary analysis of a cohort from a larger randomized controlled trial. Data from 89 children with CP (56.2% male and 43.8% female; mean = 4 years 11 months; SD = 2 years 0 months; range 2 years 0 months-8 years 10 months) were collected from electronic medical records, parent-completed medical history questionnaires, and the Hollingshead Four-Factor Index. The analysis included quasi-Poisson and logistical regressions.

Results: Most children had Medicaid insurance (83.2%). All income and GMFCS levels were represented. The most common mobility devices were lower-extremity orthoses (75.3%). The number of devices used increased by 8.2% for each 1-year increase in age. Children classified in GMFCS level V used 5.1, 2.9, and 1.6 times more mobility devices than children classified in GMFCS levels I, II, and III respectively. GMFCS level also predicted the use of wheelchairs, bath chairs, and standers. Income and insurance were not significant.

Interpretation: Children used more devices as age and GMFCS level increased. Device access is an important public health initiative.

Stina Oftedal, Simona Fiori, Kristie L Bell, Katherine A Benfer, Leanne Sakzewski, Robert S Ware, Peter S W Davies, Roslyn N Boyd

• PMID: 40745624
• DOI: 10.1111/dmcn.16427

Abstract

Aim: To investigate the relationship between growth, body composition, and the extent of brain lesion measured using structural magnetic resonance imaging (MRI) in children with cerebral palsy (CP).

Method: This prospective population-based cohort study recorded 359 assessments from 124 children with CP aged 18 months to 13 years (38% female, Gross Motor Function Classification System [GMFCS] levels I = 50, II = 24, III = 17, IV = 12, and V = 21). A neurologist assessed the extent of the brain lesion using a validated semi-quantitative scale (global, basal ganglia/brainstem, hemispheric and corpus callosum scores). Height (HTZ), weight (WTZ), and head circumference (HDZ) z-scores were calculated. The Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI) were determined using a deuterium dilution technique, bioelectrical impedance or dual-energy X-ray absorptiometry, and height. Data were analysed using mixed-effects linear regression.

Results: Greater global (β = -0.04, 95% confidence interval [CI] = -0.07 to -0.02), basal ganglia/brainstem (β = -0.06, 95% CI = -0.11 to -0.02), corpus callosum (β = -0.27, 95% CI = -0.27 to -0.12), and hemispheric (β = -0.08, 95% CI = -0.12 to -0.04) scores were associated with lower HTZ. Greater global (β = -0.03,95% CI = -0.06 to -0.01) and corpus callosum (β = -0.23, 95% CI = -0.40 to -0.06) scores were associated with lower WTZ. A greater hemispheric score (β = -0.06, 95% CI = -0.119 to -0.001) was associated with lower HDZ. Semi-quantitative MRI scores were not associated with FMI or FFMI.

Interpretation: Greater extent of the brain lesion was significantly associated with lower HDZ, HTZ, and WTZ but not body composition in children with CP aged 18 months to 13 years.

Keywords: Body composition; Brain imaging; Brain lesion; Cerebral palsy; Growth.

Our preview of the upcoming AACPDM Conference in New Orleans USA.

We look ahead at The American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Conference - the 79th Annual Meeting!

“Celebrating Resilience” October 15-18, 2025, to be held in New Orleans, LA. 

We catch up with AACPDM First Vice President Dr Theresa Sukal-Moulton and Scientific Program Committee Co-Chair Dr Paige Church.

You can still register at the link below!

https://www.aacpdm.org/events/2025

Our annual wrap-up and summary of the combined EACD / IAACD 2025 Conference, live from Heidelberg Germany!

Be sure to catch up on our entire EACD / IAACD 2025 conference series, both audio and video casts!

For information on the ResearchWorks Academy, be sure to visit the academy website (www.researchworks.academy), register for FREE for the discussion forum and check out all the tools, apps, AI powered search and chat features on the main academy website - it's FREE for the next 60 days!

We'd love to get your feedback and thoughts on the site!

We catch up with friend of the pod, Dr Wade Shrader!

Pain trajectories, care coordination, CP and surgery keynote: What are the long-term implications of orthopaedic surgery for children with cerebral palsy, and how can care coordination enhance their outcomes?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Professor Ana Carolina de Campos!

Sexuality and relationship in young adults with CP: Why is it important to address sexuality and relationships in young adults with cerebral palsy, and what are some key considerations?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Professor Jan Kirschner!

Gene therapy for childhood onset disability from neuromuscular disorders: What lessons have you learned from gene therapy in neuromuscular disorders, and how do you see this approach evolving in the future?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Professor Kaat Desloovere!

Gait Classification: How does gait classification help in tailoring rehabilitation strategies for children with cerebral palsy?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Professor Paula Chagas!

GMFR: The Gross Motor Function Family Report - GMF-FR aims to measure gross motor activity in the home and community settings, reported by the families.

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Assistant Professor Sudarshan Dayanidhi!

Muscle morphology and Macrophages: What can muscle morphology tell us about the progression of cerebral palsy, and how can this inform treatment approaches?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Associate Professor Guro Anderson!

Lessons learned from 20 years of CP registry: What have been the most significant insights gained from 20 years of cerebral palsy registry data, and how have they shaped clinical practice?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Professor Petrus De Vries!

Coaching of PWLE in LMIC with behavioral interventions: What are the key components of effective coaching programs for people with lived experience in low- and middle-income countries, particularly those focusing on behavioral interventions?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Keynote speaker: Professor Tobias Banaschewski!

Long-term impact of early life adversity on antisocial brain: What have been the most significant findings from your research on the long-term impact of early life adversity on the brain, particularly in relation to antisocial behaviour?

Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

We catch up with Keynote speaker: Professor Jill Zwicker

DCD and ADHD keynote: How do developmental coordination disorder and ADHD intersect, and what are the implications for diagnosis and treatment?

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Vice President of EACD / IAACD 2025 Dr Christian Shaaf!

A behind the scenes look at the conference and how it has all come together!

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Chair of the Intensive Therapy Session: Professor Diane Damiano!

Diane's work has been incredibly influential and has certainly shaped the field of physical therapy. We check in with her about research and what has made the most significant shift over the past few decades.

We also get Diane's thoughts about the research that is currently being done and presented in the intensive therapy space.  And amongst many other topics, we discuss the key challenges in translating CP research into clinical practice and what the future of motor interventions for childhood disabilities looks like!

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Dr Kath Benfer!

It's all about Early Intervention for CP in LMICS. We discuss what are the most effective early intervention strategies for children with cerebral palsy in low- and middle-income countries, and how can they be scaled up?

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Professor Hercules Leite!

The F-word Lens: How does the F-words lens change the way we approach intervention for children with cerebral palsy?

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Professor Thorsten Langer!

Transition of youth with Duchenne muscular dystrophy: What are the key challenges in transitioning youth with Duchenne muscular dystrophy to adult care, and how can we address them?

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Debora Claesson!

A parents perspective on Research and the real life impact of bringing the evidence to the fore! Amongst many other topics, we discuss her advocacy for evidence-based therapy has changed the landscape of rehabilitation for children with disabilities.

Join us for another brilliant conversation - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Professor Ann-Cristin Eliasson!

Remote early intervention for infants at high risk of CP: How have remote early intervention programs impacted families and their children with cerebral palsy?

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We catch up with Dr Jorn Ockerman!

We last spoke with Jorn nearly 2 year ago and pre-PhD! The now Dr Ockerman is passionate about gamerfication and how this can impact on research and clinical application!

Join us for another brilliant conversation with a brilliant researcher - live from the EACD / IAACD Conference 2025, in Heidelberg Germany!

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Fehlings and discuss all things early intervention, genetics, biomarkers, being curious, asking questions and the blend of research and clinical work and the call of implementation!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/@mconmannheim/videos

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Imms - the IAACD President, a look at how Professor Imms came to lead the IAACD, her involvement in the IAACD and her passion about all things participation!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=YxnWIR6iNio

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Boyd - the Vice President of EACD / IAACD 2025! We discuss all things early intervention, randomised control trials, collaborations and the implementation and adoption of the new, weening off what we are wedded to!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/@mconmannheim/videos

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Dr Boyer - a discussion about her incredible work in the specific area of pain research in cerebral palsy!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/@mconmannheim/videos

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Dr Cathy Morgan - we cover off AI, artificial intelligence, early intervention and early detection, developing AI models, best practice ML processes, dissecting and analysing video and Data! Data! Data!

CP360 - a bold new initiative accelerating global action for the 50 million people living with cerebral palsy!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=ph0t7Q6lZas

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Dusing - we discuss what therapy should look like, what it could look like and how we should be  incorporating PLAY in therapy (it's much more complex than you might think!). It needs to be self-generated by the child to truly be play!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=a27lVhpb6XQ

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Bleyenheuft - the Habit-ile story, it's origins and what the future holds!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=7mLUsArpXDA

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Dr Sebastian Schroeder - a look behind the scenes at EACD / IAACD 2025. Dr Schroeder is the Chair of the Scientific Committee for the conference and one of the key personnel behind the combined congress this year. Hearing his heart for the conference was a beautiful insight into the interdisciplinary and collaborative philosophies that Dr Schroeder and his team brought to the fore.

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=kH1TtdUvDCY

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Novak - State of the Evidence, traffic lights. A brilliant conversation about her seminal work and the future of stem cells and early intervention.

"...i did it myself..." "...whose brain is doing the work?..." 

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!


The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=Ql9n_jw2u88

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Ortibus - a conversation centred around CVI (cerebral visual impairment)!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=YvftmDsnx5s

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Dr Greaves - all about upper limb therapy, unilateral cerebral palsy, bimanual therapy and all things hands-off!

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=GKt_gSrWhGI

We're in Maulbronn Germany - at the pre-conference sessions!

We catch up with Professor Blank - EACD / IAACD 2025 President and a man giving voice to the international community! Professor Blank has visited a number of countries world-wide onsite in order to hear the international voices on childhood-onset disabilities. 

Be sure to visit the m:con Mannheim YouTube channel for the special video-casts we created for the Pre-Conference - all set in the beautiful location of Maulbronn Monastery - a UNESCO world heritage site!

The video-casts will be available on the mconmannheim YouTube channel over the course of the conference and mirrored to the ResearchWorks YouTube channel after the conference too!

https://www.youtube.com/watch?v=N8cvgjXr44E

Aim: To define the longitudinal trajectory of gastrocnemius muscle growth in 6- to 36-month-old children with and without spastic cerebral palsy (SCP) and to compare trajectories by levels of gross motor function (Gross Motor Function Classification System, GMFCS) and presumed brain-lesion timing.

Method: Twenty typically developing children and 24 children with SCP (GMFCS levels I-II/III-IV = 15/9), were included (28/16 females/males; mean age at first scan 15.4 months [standard deviation 4.93, range 6.24-23.8]). Three-dimensional freehand ultrasound was used to repeatedly assess muscle volume, length, and cross-sectional area (CSA), resulting in 138 assessments (mean interval 7.9 months). Brain lesion timing was evaluated with magnetic resonance imaging classification. Linear mixed-effects models defined growth rates, adjusted for GMFCS levels and presumed brain-lesion timing.

Results: At age 12 months, children with SCP showed smaller morphological muscle size than typically developing children (5.8 mL vs 9.8 mL, p < 0.001), while subsequently no differences in muscle growth were found between children with and without SCP (muscle volume: 0.65 mL/month vs 0.74 mL/month). However, muscle volume and CSA growth rates were lower in children classified in GMFCS levels III and IV than typically developing children and those classified in GMFCS levels I and II, with differences ranging from -56% to -70% (p < 0.001).

Interpretation: Muscle growth is already hampered during infancy in SCP. Muscle size growth further reduces with decreasing functional levels, independently from the brain lesion. Early monitoring of muscle growth combined with early intervention is needed.

Are we focusing too much on body structures and functions?   Should participation and the F-words—Fun, Family, Friends, Fitness, Function, and Future—be leading the way?  

Dr. Ginny Paleg is a pediatric physiotherapist specializing in children with severe motor impairments, particularly those at GMFCS Levels IV and V. She holds a Master’s in Physical Therapy from Emory University and a Doctorate from the University of Maryland Baltimore.   

Certified in the Prechtl GMA and HINE, Dr. Paleg integrates evidence-based tools with coaching and routines-based interventions. With over 60 peer-reviewed publications, her research spans standers, supported stepping, and power mobility for children with complex needs. She is the lead author of the AACPDM Hypotonia Care Pathway and serves on the AACPDM Care Pathway Council, having held key roles in both AACPDM and the EACD.  

If you’ve ever found yourself in a heated Facebook thread or a passionate discussion with colleagues about what really matters in pediatric therapy, you’re not alone. Dr. Ginny Paleg moderates some of these spaces, and what’s always clear is that therapists deeply care—they want children to thrive. But the differences in approach can be striking.   

Today, we’re diving into the heart of this tension through the lens of the ICF-CY framework. It’s a big conversation, and one we think is absolutely worth having.

Interrupting normal broadcasting for a quick announcement! The ResearchWorks team are heading to Heidelberg Germany in a few weeks time to interview guests from across Europe and around the globe!

From video-casts to audio-casts, it will be a full integration into the conference and we're excited to bring you all the latest in research from Heidelberg - with dozens of interviews!

We still have a number of episodes pre-conference to release with dozens more lined up for the months of June/July!

Also - stay tuned for an extra special announcement - it will be worth the wait, we promise! 

Children with developmental central hypotonia have reduced muscle tone secondary to non-progressive damage to the brain or brainstem. Children may have transient delays, mild or global functional impairments, and the lack of a clear understanding of this diagnosis makes evaluating appropriate interventions challenging. 

This overview aimed to systematically describe the best available evidence for tools to identify and evaluate children with developmental central hypotonia aged 2 months to 6 years. 

A systematic review of systematic reviews or syntheses was conducted with electronic searches in PubMed, Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, Google Scholar, and PEDro and supplemented with hand-searching. Methodological quality and risk-of-bias were evaluated, and included reviews and tools were compared and contrasted. Three systematic reviews, an evidence-based clinical assessment algorithm, three measurement protocols, and two additional measurement tools were identified. 

For children aged 2 months to 2 years, the Hammersmith Infant Neurological Examination has the strongest measurement properties and contains a subset of items that may be useful for quantifying the severity of hypotonia. 

For children aged 2-6 years, a clinical algorithm and individual tools provide guidance. Further research is required to develop and validate all evaluative tools for children with developmental central hypotonia.

Gross Motor Family Report: Refinement and evaluation of psychometric properties

Elton D. D. Magalhães, Peter Rosenbaum, Marilyn Wright, F. Virginia Wright, Lesley Pritchard, Kennea M. A. Ayupe, Ana Carolina de Campos, Rosane S. Morais, Hercules R. Leite, Paula S. C. Chagas

Abstract

Aim
To refine the Gross Motor Family Report (GM-FR) using parents' input and to evaluate its psychometric properties.

Method
In this measurement study, 12 parents of children and adolescents with cerebral palsy (CP), aged 2 to 18 years, classified in all levels of the Gross Motor Function Classification System (GMFCS), were interviewed about their experience completing the GM-FR (content validity). Parents' feedback was used to refine the measure which was then completed by 146 families to evaluate internal consistency, and discriminative and concurrent validity. Forty-six parents completed the GM-FR again, 7 to 30 days later, to evaluate test–retest reliability.

Results
GM-FR scoring, pictures, descriptions, and the total number of items were revised based on parents' feedback. The GM-FR version 2.0 demonstrated high internal consistency (Cronbach's α = 0.99), no floor/ceiling effects, and excellent test–retest reliability (intraclass correlation coefficient = 0.99). GM-FR scores discriminated between GMFCS levels (p less than 0.05) and were strongly negatively correlated with GMFCS level (r = −0.92; p less than 0.001). GM-FR scores correlated positively and strongly with the Gross Motor Function Measure-66 (r = 0.94; p less than 0.001) and the Pediatric Evaluation of Disability Inventory – Computer Adaptive Test mobility domain (r = 0.93; p less than 0.001).

Interpretation
Active participation of families in the GM-FR's development facilitated creation of a family-friendly instrument. This study provides strong evidence of reliability and validity to support GM-FR use in clinical practice and research for assessing gross motor performance of children and adolescents with CP.

https://onlinelibrary.wiley.com/doi/10.1111/dmcn.16042

Professor Gareth Baynam is a globally recognised clinical geneticist, researcher, and advocate for rare diseases. He is the Director of the Rare Care Centre at Perth Children's Hospital and the Head of the Western Australian Register of Developmental Anomalies. 

With a career dedicated to improving the diagnosis, management, and care of individuals with rare and genetic conditions, he has been at the forefront of integrating cutting-edge technologies such as genomics, artificial intelligence, and precision medicine into healthcare. 

Professor Baynam is also a leader in Indigenous health initiatives, championing equitable access to rare disease diagnostics and treatment. Through his work with organizations such as the Global Commission to End the Diagnostic Odyssey for Children with a Rare Disease and the European Rare Diseases Research Alliance (ERDERA),  he continues to drive global collaborations and innovations that aim to transform rare disease care.

Anita R Gross, Kenneth A Olson, Jan Pool, Annalie Basson, Derek Clewley, Jenifer L Dice, Nikki Milne

• PMID: 38855972
• PMCID: PMC11216248
• DOI: 10.1080/10669817.2024.2332026

Abstract

Introduction: An international taskforce of clinician-scientists was formed by specialty groups of World Physiotherapy - International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) & International Organisation of Physiotherapists in Paediatrics (IOPTP) - to develop evidence-based practice position statements directing physiotherapists clinical reasoning for the safe and effective use of spinal manipulation and mobilisation for paediatric populations (<18 years) with varied musculoskeletal or non-musculoskeletal conditions.

Method: A three-stage guideline process using validated methodology was completed: 1. Literature review stage (one scoping review, two reviews exploring psychometric properties); 2. Delphi stage (one 3-Round expert Delphi survey); and 3. Refinement stage (evidence-to-decision summative analysis, position statement development, evidence gap map analyses, and multilayer review processes).

Results: Evidence-based practice position statements were developed to guide the appropriate use of spinal manipulation and mobilisation for paediatric populations. All were predicated on clinicians using biopsychosocial clinical reasoning to determine when the intervention is appropriate.1. It is not recommended to perform:• Spinal manipulation and mobilisation on infants.• Cervical and lumbar spine manipulation on children.•Spinal manipulation and mobilisation on infants, children, and adolescents for non-musculoskeletal paediatric conditions including asthma, attention deficit hyperactivity disorder, autism spectrum disorder, breastfeeding difficulties, cerebral palsy, infantile colic, nocturnal enuresis, and otitis media.2. It may be appropriate to treat musculoskeletal conditions including spinal mobility impairments associated with neck-back pain and neck pain with headache utilising:• Spinal mobilisation and manipulation on adolescents;• Spinal mobilisation on children; or• Thoracic manipulation on children for neck-back pain only.3. No high certainty evidence to recommend these interventions was available.Reports of mild to severe harms exist; however, risk rates could not be determined.

Conclusion: Specific directives to guide physiotherapists' clinical reasoning on the appropriate use of spinal manipulation or mobilisation were identified. Future research should focus on trials for priority conditions (neck-back pain) in children and adolescents, psychometric properties of key outcome measures, knowledge translation, and harms.

Early Detection and Early Intervention - where are we now (and what does the future hold)?

The last time we had Alicia on the pod, we spoke about the Cochrane Review she led titled “Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants” which was published in 2024. In this week’s episode, we thought we’d ask Alicia about the state of early intervention right now and what the provision of therapy looks like within our current context of early detection and early intervention for children with cerebral palsy.

There have been some rather significant developments in the early detection and early intervention space over the past 20 years. From the rapid technological advances to the value of co-design and involvement of people with lived experience, we now have some impressive evidence to guide our clinical pathways. However, what is very clear now is the vital importance of implementation. The industry has generated substantial knowledge that now needs to be implemented into practice with one particularly important aspect that we must include - family involvement and well-being. 

Alicia speaks ever so passionately about our role as therapists and I cannot help but to feel even more compelled to ensure that the family is at the centre of everything we do. It is exciting to know that we have the evidence now, so it’s time to put it into practice and it can start in your very next session.

https://findanexpert.unimelb.edu.au/profile/27041-alicia-spittle

Implementing Clinical Practice Guidelines for Improving Function in Cerebral Palsy: Development of a Fidelity Tool

In this study, the research team developed a 21-item fidelity tool to help clinicians implement evidence-based guidelines for improving function in children with cerebral palsy. Designed for goal setting, intervention, and reflection, the tool was found to be practical and useful but faced challenges like time constraints and family expectations. The study highlights the need for education, self-reflection, and organisational support to bridge the gap between research and practice.

Abstract
Purpose: To develop a fidelity tool to support the implementation of clinical practice guidelines to improve physical function for children and young people with cerebral palsy.

Methods: Fidelity tool development followed a 5-step process: the pilot study, using a mixed-methods action research approach, and including focus groups, questionnaires, and field notes.

Results: A 21-item fidelity tool representing the core components of the clinical practice guidelines was developed, including subsections of goal setting, intervention, and elements seen throughout therapeutic intervention. Clinicians and supervisors reported this tool as acceptable and feasible, especially when used as a self-reflection tool.

Conclusions: A fidelity tool has been developed that clinicians, supervisors and organizations can use to reflect on current practice and plan for changes to align practice with guidelines to improve function in children with cerebral palsy.

https://pubmed.ncbi.nlm.nih.gov/39378353/

Professor Nick Gottardo walks us through medulloblastomas - a comprehensive master class for clinicians and researchers.  Expect to learn about early signs and symptoms, diagnosis, treatment and prognosis. Dr Nick breaks this down beautifully.

What was really clear throughout our discussion was that collaboration is key. Given the incidence of medulloblastomas and the specific subtypes that fall within this category, it would not be possible to develop effective treatments that minimise detrimental side effects without coming together with centres across the world.

This episode is truly special so if you want to know the current state of the evidence when it comes to treating medulloblastomas - this is a must listen episode.

All about knowledge translation

A special episode with our illustrious hosts before we catch up with Professor Nick Gottardo, Professor Alicia Spittle, Professor Andrew Whitehouse, Dr Gareth Baynam, Assoc. Professor Nikki Milne and Assoc. Clinical Professor Anita Gross amongst many others!