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Special Edition October 2, 2013
CanChild Today

This special issue of CanChild Today is being distributed in conjunction with World CP Day (Oct 2nd, 2013) and the official launch of our CP-NET subsite

The Childhood Cerebral Palsy Integrated Neuroscience Discovery Network (CP-NET) is an exciting initiative funded by the Ontario Brain Institute. CP-NET is bringing together scientists and health professionals from institutions across Ontario to collaborate and accelerate discoveries in CP. Some examples of the research being conducted through CP-NET include investigating the mechanisms behind constraint therapy, developing new interactive computer games to provide "motor therapy" and exercise/fitness for youth with CP. We are gathering information about children with CP and their families from across Ontario. For a description of all the research projects and investigators and other great resources on CP, please go to the CP-NET website

The content on the CP-NET subsite will continue to evolve. We suggest that you bookmark the site and come back often! Feel free to share these resources and this newsletter with family, friends and colleagues! They can subscribe to CanChild Today for free by registering here.

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CP-NET is now available on the CanChild website!
CP-NET features exciting new resources about cerebral palsy. Here are some of our favourites:

How to Recognize and Refer Children with Hemiplegic (Unilateral) Cerebral Palsy
This pamphlet is designed for use by professionals working with young children in physicians' offices, early development screening clinics, and preschools. The early and typical/common first signs of hemiplegic cerebral palsy are described, along with the long-term outlook, and how families can seek early intervention for their child. Click here to view pamphlet.

"Disability" and Development: Do We Have the Right Focus?
In this Reflections On... piece, Dr. Peter Rosenbaum proposes an approach to developmental disability in which professionals focus their attention on child development as the primary guiding principle by which we offer advice, intervention, and counseling to parents. The approach's emphasis would be to promote capabilities and strengths, and encourage families to provide an environment that supports a positive view of their child's emerging capacities, even when how they do things is possibly different. It is hoped these perspectives may encourage further discussion and research into a strengths-based and developmental focus on 'developmental disability'. Click to view.

The Use of Botulinum Toxin in Children with Muscle Stiffness: An Update
In the last twenty years, Botulium Toxin (BoNT-A) has been used for children with cerebral palsy who have increased muscle tone or muscle stiffness. This Keeping Current describes BoNT-A and how it is thought to work. The research evidence for use of BoNT-A for children with muscle stiffness is reviewed, and summarized for various muscles groups. Potential side effects are also discussed. Click here to view.
Recent Publications by CanChild Scientists, Research Associates, & International Collaborators about Cerebral Palsy
Interactive computer play as "motor therapy" for individuals with cerebral palsy
Rehabilitation specialists have started to develop and evaluate interactive computer play (ICP) for therapeutic purposes. The goal of this study, published in Seminars in Pediatric Neurology, was to examine the quality of evidence for ICP to improve motor performance in individuals with cerebral palsy. The literature review demonstrated there was "probable" evidence for ICP interventions to improve lower extremity motor control or function and it was identified as an area with much promise. However, there was inadequate evidence for ICP interventions improving upper limb motor control/function or fitness and further research is warranted to evaluate the effect of ICP on these constructs. Authors: D Fehlings, L Switzer, B Findlay, S Knights. Abstract.

A systematic review of interventions for children with cerebral palsy: State of the evidence
The aim of this study published in Developmental Medicine & Child Neurology was to describe systematically the best available intervention evidence for children with cerebral palsy. One hundred and sixty-six (166) systematic reviews were reviewed across 64 discrete interventions, seeking 131 outcomes. Effective interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most evidence for intervention was lower level while 6% was ineffective. Authors: I Novak, S McIntyre, C Morgan, L Campbell, L Dark, N Morton, E Stumbles, SA Wilson, S Goldsmith. Abstract.

Botulinum toxin type A in children and adolescents with severe cerebral palsy: A retrospective chart review
Investigators conducted a retrospective chart review for 60 children with cerebral palsy (CP) whose motor function was classified Gross Motor Function Classification System (GMFCS) levels IV and V, and who received botulinum toxin A. Treatment goals were related to lower limb function, range of motion, positioning, upper limb function, and facilitating ease of care in dressing, toileting, and diapering. The treatment goals were reportedly reached in 60 - 85%. Mild transient side effects were reported. Botulinum toxin A should be considered a safe and beneficial treatment option in children with CP within GMFCS levels IV and V. Published in Journal of Child Neurology. Authors: R Mesterman, JW Gorter, A Harvey, J Lockhart, J McEwen-Hill, K Margallo, N Goldie. Abstract.

Parents' experiences with physical and occupational therapy for their young child with cerebral palsy: A mixed studies review
NetChild investigators conducted a literature review in order to understand parents' perspectives of their experiences with their child's intervention. From this review, a framework was proposed that acknowledges the various aspects in context, process and outcomes that parents reported. Key messages: the family-professional partnership is important in achieving true collaboration and takes time to develop; every family member is unique and has their own needs, preferences and perspectives that may vary over time; the broader context in which children and parents live should be acknowledged. Published inChild: Care, Health & DevelopmentAuthors: AJA Kruijsen-Terpstra, M Ketelaar, H Boeije, MJ JongmansJW Gorter, J Verheijden, E Lindeman, O VerschurenAbstract. 
Motor measures: A moving target?
This paper published in Seminars in Pediatric Neurology provides an overview of measures (current to 2013) that can be used in research or practice to determine the motor outcomes of children with cerebral palsy or other developmental disabilities. The included motor measures are classified within the International Classification of Functioning, Disability and Health (ICF), (the categories of body function, activity, and participation). The investigators reviewed and described measures that are validated, clinically feasible, readily available, and relevant for use within rehabilitation interventions. Challenges and future directions for motor measurement are described. Authors: V Wright, A Majnemer, DB Maltais, PA Burtner, H Sanders. Abstract.
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