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ObjectiveTo evaluate the predictive validity of best practice early detection tools for cerebral palsy (CP) in a high-risk cohort.Study designProspective longitudinal cohort study.SettingNeonatal intensive care unit of a regional tertiary hospital in Bangladesh.ParticipantsNeonates with risk factors for CP admitted to Mymensingh Medical College Hospital Neonatal Intensive Care Unit between November 2019 and March 2020.Outcome measuresGeneral Movements Assessment (GMA) at writhing and fidgety periods; Hammersmith Infant Neurological Examination (HINE) and Peabody Developmental Motor Scales Second Edition (PDMS-2) conducted in person at 3, 12 and 24 months. The Developmental Assessment of Young Children (DAYC-2), Ages and Stages Questionnaire (ASQ-3) and Developmental Milestones Chart (DMC) were administered remotely at 6, 9, 12, 18 and 24 months. Due to the impact of COVID-19, a proportion of the cohort was not able to have GMA fidgety videos completed and the first HINE assessment was delayed.ResultsA total of 227 infants were enrolled. Of the surviving infants assessed at 24 months, 36 (29%) had a confirmed diagnosis of CP. The most accurate combination of tools for early detection was GMA and HINE at 3 months (sensitivity 0.91; specificity 1.00). The PDMS-2 Total Motor Quotient, with an optimised cut-off of 59, showed high accuracy at 24 months (sensitivity 0.94; specificity 0.99). Among the tools administered remotely, the DAYC-2 PD, DMC (Gross and Fine Motor domains) and ASQ-3 (Gross and Fine Motor domains) demonstrated strong predictive validity—both individually and in combination—at 9, 12, 18 and 24 months, supporting their use as practical alternatives when in-person assessments are not feasible.ConclusionsDespite pandemic-related disruptions, an accurate diagnosis was possible as early as 3 months of age using the best practice tools. Our findings support the practicability of scalable early detection models integrating in-person and remote assessments to improve access to timely diagnosis.

Purpose of ReviewCerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012–2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019.Recent FindingsEffective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy.SummaryWe have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

Since the 1800s, there have been calls in the literature for the early diagnosis of cerebral palsy (CP). However, diagnosis still often occurs late, from 12 to 24 months in high income countries and as late as 5 years in low resource settings. This is after the optimal timeframe for applying interventions which could harness neuroplastic potential in the developing brain. Multiple barriers exist which affect clinicians’ confidence in diagnosing CP early. These range from the lack of definitive biomarkers to a lack of curative treatments for CP. Further barriers to diagnosis are proposed including; (a) difficulty finding a congruent fit with the definition of CP in an infant, where expected activity limitations might not yet be apparent; and (b) differences in the presentation of motor type and topography classifications between infants and children. These barriers may affect a clinicians’ confidence using “pattern recognition” in the differential diagnosis process. One of the central tenets of this paper is that diagnosis and classification are different, involving different instruments, and are more accurately conducted separately in infants, whereas they are fundamentally interconnected in older children and inform therapeutic decisions. Furthermore, we need to be careful not to delay early diagnosis because of the low reliability of early classification, but instead uncouple these two processes. Ongoing implementation of best practice for early detection requires creative solutions which might include universal screening for CP. Implementation and accompanying knowledge translation studies are underway to decrease the average age of diagnosis in CP.

Cerebral palsy (CP) diagnosis is historically late, at between 12 and 24 months. We aimed to determine diagnosis age, fidelity to recommended tests and acceptability to parents and referrers of an early diagnosis clinic to implement a recent evidence-based clinical guideline for the early diagnosis of CP. A prospective observational case series of infants <12 months with detectable risks for CP attending our clinic was completed with data analysed cross-sectionally. Infants had a high risk of CP diagnosis at a mean age of 4.4 (standard deviation [SD] 2.3) months and CP diagnosis at 8.5 [4.1] months. Of the 109 infants seen, 57% had a diagnosis of CP or high risk of CP, showing high specificity to our inclusion criteria. Parent and referrer acceptability of the clinic was high. Paediatricians had the highest rate of referral (39%) followed by allied health (31%), primary carer (14%) and other health workers (16%). Fidelity to the guideline was also high. All infants referred <5 mths had the General Movements Assessment (GMA) and all except one had the Hammersmith Infant Neurological Examination (HINE) administered. N = 92 (84%) of infants seen had neuroimaging, including n = 53 (49%) who had magnetic resonance imaging (MRI), showing recommended tests are feasible. Referral to CP-specific interventions was at 4.7 [3.0] months, sometimes before referral to clinic. Clinicians can be confident CP can be diagnosed well under 12 months using recommended tools. This clinic model is acceptable to parents and referrers and supports access to CP-specific early interventions when they are likely to be most effective.

IntroductionCerebral palsy (CP) is the most common physical disability of childhood worldwide. Historically the diagnosis was made between 12 and 24 months, meaning data about effective early interventions to improve motor outcomes are scant. In high-income countries, two in three children will walk. This evaluator-blinded randomised controlled trial will investigate the efficacy of an early and sustained Goals–Activity–Motor Enrichment approach to improve motor and cognitive skills in infants with suspected or confirmed CP.Methods and analysisParticipants will be recruited from neonatal intensive care units and the community in Australia across four states. To be eligible for inclusion infants will be aged 3–6.5 months corrected for prematurity and have a diagnosis of CP or ‘high risk of CP’ according to the International Clinical Practice Guideline criteria. Eligible participants whose caregivers consent will be randomly allocated to receive usual care or weekly sessions at home from a GAME-trained study physiotherapist or occupational therapist, paired with a daily home programme, until age 2. The study requires 150 participants per group to detect a 0.5 SD difference in motor skills at 2 years of age, measured by the Peabody Developmental Motor Scales-2. Secondary outcomes include gross motor function, cognition, functional independence, social–emotional development and quality of life. A within-trial economic evaluation is also planned.Ethics and disseminationEthical approval was obtained from the Sydney Children’s Hospital Network Human Ethics Committee in April 2017 (ref number HREC/17/SCHN/37). Outcomes will be disseminated through peer-reviewed journal publications, presentations at international conferences and consumer websites.Trial registration numberACTRN12617000006347.

Levels of physical activity (PA) decrease when transitioning from adolescence into young adulthood. Evidence suggests that social support and intrapersonal factors (self-efficacy, outcome expectations, PA enjoyment) are associated with PA. The aim of the present study was to explore whether cross-sectional and longitudinal associations of social support from family and friends with leisure-time PA (LTPA) among young women living in disadvantaged areas were mediated by intrapersonal factors (PA enjoyment, outcome expectations, self-efficacy). Survey data were collected from 18-30 year-old women living in disadvantaged suburbs of Victoria, Australia as part of the READI study in 2007-2008 (T0, N = 1197), with follow-up data collected in 2010-2011 (T1, N = 357) and 2012-2013 (T2, N = 271). A series of single-mediator models were tested using baseline (T0) and longitudinal data from all three time points with residual change scores for changes between measurements. Cross-sectional analyses showed that social support was associated with LTPA both directly and indirectly, mediated by intrapersonal factors. Each intrapersonal factor explained between 5.9-37.5% of the associations. None of the intrapersonal factors were significant mediators in the longitudinal analyses. Results from the cross-sectional analyses suggest that the associations of social support from family and from friends with LTPA are mediated by intrapersonal factors (PA enjoyment, outcome expectations and self-efficacy). However, longitudinal analyses did not confirm these findings.

Background This study aimed to examine associations between aspects of the neighborhood social environment and body mass index (BMI) in youth both cross-sectionally and prospectively; and whether this association was mediated by physical activity, screen-time and sedentary time. Methods Data were collected in 2004 and 2006 in high and low socio-economic areas of Melbourne, Australia. In 2004, 185 children aged 8-9 years (47% boys) and 359 children aged 13-15 years (45% boys) participated. Parents reported their perceptions of aspects of the social environment (i.e. social networks and social trust/cohesion), and physical activity (i.e. time spent outdoors by their children; and their younger children's walking and cycling trips) and screen-time (i.e. TV viewing, computer use). The older children self-reported their walking and cycling trips and their screen-time. All children wore an accelerometer to objectively assess outside-school hours moderate- to-vigorous physical activity and sedentary time. BMI was calculated from height and weight measured in 2004 and 2006. Multilevel linear regression analyses were conducted to examine associations between the social environment and BMI. Mediation analyses using the products of coefficient method were conducted to determine whether associations between the social environment and BMI were mediated by the time spent in a range of physical activity and sedentary behaviors. Results Cross-sectional and prospective regression analyses showed that a more positive social network and higher social trust/cohesion was related to lower BMI among children. There was no evidence that time spent in physical activity or sedentary behaviors mediated this relation, despite significant associations between social networks and screen-time and between screen-time and BMI. Conclusions The findings suggest that the neighborhood social environment may be important for preventing overweight and obesity in children. Further research investigating the mechanisms through which the neighborhood social environment exerts its effect on BMI is needed.

This longitudinal study aimed to identify individual and environmental predictors of adolescents’ sports participation and to examine whether availability of sports facilities moderated the intention–behaviour relation. Data were obtained from the ENvironmental Determinants of Obesity in Rotterdam SchoolchildrEn study (2005/2006 to 2007/2008). A total of 247 adolescents (48% boys, mean age at follow-up 15 years) completed the surveys at baseline and follow-up. At baseline, adolescents completed a survey that assessed engagement in sports participation, attitude, subjective norm, perceived behavioural control and intention towards sports participation. Availability of sports facilities (availability) was assessed using a geographic information system. At follow-up, sports participation was again examined. Multiple logistic regression analyses were conducted to test associations between availability of sports facilities, theory of planned behaviour variables and the interaction of intention by availability of sports facilities, with sports participation at follow-up. Simple slopes analysis was conducted to decompose the interaction effect. A significant availability × intention interaction effect [odds ratio: 1.10; 95% confidence interval: 1.00–1.20] was found. Simple slopes analysis showed that intention was more strongly associated with sports participation when sports facilities were more readily available. The results of this study indicate that the intention–sports participation association appears to be stronger when more facilities are available.

Background. Sport participation makes an important contribution to children’s overall physical activity. Understanding influences on sports participation is important and the family environment is considered key, however few studies hav explored the mechanisms by which the family environment influences children’s sport participation. The purpose of this study was to examine whether attitude, perceived behavioural control, health belief and enjoyment mediate associations between the family environment and 10–12 year-old children’s sports participation. Methods. Children aged 10–12 years ( = 7234) and one of their parents (n = 6002) were recruited from 175 schools in seven European countries in 2010. Children self-reported their weekly duration of sports participation, physical activity equipment items at home and the four potential mediator variables. Parents responded to items on financial, logistic and emotional support, reinforcement, modelling and co-participation in physical activity. Cross-sectional single and multiple mediation analyses were performed for 4952 children with complete data using multi-level regression analyses. Results. Availability of equipment (OR = 1.16), financial (OR = 1.53), logistic (OR = 1.47) and emotional (OR = 1.51) support, and parental modelling (OR = 1.07) were positively associated with participation in ≥ 30mins/wk of sport. Attitude, beliefs, perceived behavioural control and enjoyment mediated and explained between 21-34% of these associations. Perceived behavioural control contributed the most to the mediated effect for each aspect of the family environment. Conclusions. Both direct (unmediated) and indirect (mediated) associations were found between most family environment variables and children’s sports participation. Thus, family-based physical activity interventions that focus on enhancing the family environment to support children’s sport participation are warranted.

Neighborhoods that discourage physical activity may encourage indoor activities such as television viewing; however few studies have examined associations between neighborhood characteristics and sedentary activities. This study examined cross-sectional and longitudinal associations between perceived and objective measures of the physical and social neighborhood environment and TV viewing among children and adolescents. Cross-sectional and longitudinal. Parents of 190 children and 169 adolescents completed questionnaire items regarding facilities for physical activity, neighborhood safety (general and traffic), social trust/cohesion, social networks and their child's TV viewing in 2006. Adolescents self-reported their TV viewing. Objective measures of reported crime and neighborhood destinations, road connectivity and traffic exposure were also collected. Questions about TV viewing were repeated in 2008 (longitudinal sample: 157 children; 105 adolescents). In children, cul-de-sac density and reported crime were positively and parental agreement that their neighborhood has good sporting facilities was negatively associated with TV viewing in cross-sectional analyses. There were no longitudinal associations among children. In adolescents, number of sports options and parental agreement that there is so much traffic that it is difficult/unpleasant for their child to walk were negatively associated with TV viewing 2 years later. Crime and a lack of quality sporting facilities or options may contribute to greater TV viewing among youth.