An evaluation of factors contributing to employment in adults with cerebral palsy.

PURPOSE: To explore the impact of a selection of contributing factors on employment in adults with cerebral palsy (CP). METHOD: Eighty adults with CP (39 male, median age 31, IQ > 70) were evaluated using standardized tests and questionnaires for hand function, gross motor function, pain, depressive symptoms, fatigue, social participation, performing daily activities, supportive materials, and mobility aids. Two separate analyses were performed. Firstly, differences between three subgroups were investigated: employee (n = 43), volunteer/sheltered (n = 14), and unemployed (n = 23). Secondly, multivariable regression analysis was applied to investigate the association between functional factors and employment hours. RESULTS: Compared to employees, volunteer/sheltered workers performed significantly slower hand function tasks (p < 0.001). Participants in the employee group had primarily MACS I (55.8%) or MACS II (44.9%) scores. The employee group showed significantly (p < 0.001) higher social participation and performance in daily activities. Thirty-eight percent of the variance in working hours could be explained by social participation, daily activities, fatigue, and gross motor function. INTERPRETATION: Employees are more likely adults with CP with better manual abilities. Sheltered/volunteer workers showed slower execution in hand function and higher limitations in fine motor skills. Social participation, performing daily activities, fatigue, and gross motor function are functional factors associated with hours of employment.IMPLICATIONS FOR REHABILITATIONUpper limb evaluation on ability and speed gives valuable information to decide whether to work on the regular labour market or choose for volunteer or sheltered work.The use of supportive materials on the work floor is low; however, they may compensate for less manual abilities of adults with cerebral palsy compared to their healthy peers.Improving social participation and daily activities, fatigue, and gross motor function may lead to higher working hours.

[Formula: see text] Quantifying visuoperceptual profiles of children with cerebral visual impairment.

The aim was to develop a visuoperceptual profile schema reflecting visuoperceptual strengths and weaknesses, using neuropsychological tests. Secondly, this schema was used to quantify individual visuoperceptual profiles of children with and without cerebral visual impairment (CVI), and to identify differences in their profiles. Clinical records (2001-2018) of 630 children (386 males, 244 females; median age 77 months; interquartile range 63-98 months) suspected for CVI were reviewed. Neurological history, visuoperceptual results, ophthalmological, and neuroimaging data were retrieved. To develop the visuoperceptual schema, exploratory factor analyses (EFAs) were performed, followed by a Delphi study. In individual interviews, six experts were asked to "name the different visuoperceptual dimensions" and "what visuoperceptual dimensions are targeted by each of the 24 visuoperceptual subtests." To reach consensus, two questionnaire rounds (44 statements and 20 statements, respectively, five experts) followed. EFAs showed clinically uninterpretable results. The Delphi study revealed seven visuoperceptual dimensions; (1) visual discrimination and matching, (2) object or picture recognition, (3) visual spatial perception, (4) figure-ground perception, (5) motion perception, (6) visual short-term memory, and (7) scene perception. The most discriminating dimensions between CVI and no CVI were object/picture recognition (r = 0.56), visual spatial perception (r = 0.52), visual discrimination and matching (r = 0.47), and figure-ground perception (r = 0.39). Motion perception and visual short-term memory (both r = 0.22) were less discriminating. Two case studies illustrate how to apply the visuoperceptual schema to characterize dysfunction and intact functions. Visuoperceptual profiling can serve as a basis for individualized therapies in heterogeneous disorders.

The Effect of a Rehabilitation Specific Gaming Software Platform to Achieve Individual Physiotherapy Goals in Children with Severe Spastic Cerebral Palsy: A Randomized Crossover Trial.

Cerebral palsy (CP) is the most common cause of permanent neurological disabilities in children. Many children require long-term daily physiotherapy (PT), and videogaming is a promising tool to increase motivation in rehabilitation. The short- and medium-term effects of an intervention with rehabilitation specific videogames were evaluated on individually defined therapy goals, gross motor function, and motivation. Thirty-two children with bilateral spastic CP, Gross Motor Function Classification level III-IV, and 6-15 years were randomized into an intervention group (regular PT and gaming) or a control group (regular PT), followed by a crossover. The effects of both training periods (each 12 weeks) were compared using the Goal Attainment Scale (GAS), Trunk Control Measurement Scale (TCMS), Pediatric Balance Scale (PBS), Gross Motor Function Measure-88 (GMFM-88), and Dimensions of Mastery Motivation Questionnaire (DMQ). After 3 months follow-up, children were retested using the GMFM, TCMS, and PBS. The GAS change scores were significantly higher after the intervention compared to the control period (8.5 and 2.4, P < 0.001). The change scores for standing exercises (3.85 and 0.22, P = 0.04) and dynamic sitting balance (5.9 and -1.7, P < 0.001) were also significantly higher. After 3 months follow-up the results did not persist. A combined approach of regular PT and rehabilitation specific gaming showed significant effects on individually defined therapy goals, dynamic sitting balance, and standing exercises. However, the lack of persistent effect indicates that continuous individual goal-oriented PT with the addition of gaming is needed.

The relationship between neuroimaging and motor outcome in children with cerebral palsy: A systematic review - Part A. Structural imaging.

BACKGROUND: Conventional Structural Magnetic Resonance Imaging (sMRI) is a mainstay in Cerebral Palsy (CP) diagnosis. AIMS: A systematic literature review was performed with the aim to investigate the relationship between structural brain lesions identified by sMRI and motor outcomes in children with CP. METHODS: Fifty-eight studies were included. The results were analysed in terms of population characteristics, sMRI (classified according to Krägeloh-Mann & Horber, 2007), gross and fine motor function and their interrelation. OUTCOMES: White matter lesions were the most common brain lesion types and were present in 57.8 % of all children with uCP, in 67.0 % of all children with bCP and in 33 % of the group of mixed subtypes. Grey matter lesions were most frequently registered in children with dyskinesia (n = 42.2 %). No structural anomalies visualized by sMRI were reported in 5.7 % of all cases. In all lesion types, an equal distribution over the different gross motor function classification system categories was present. The included studies did not report sufficient information about fine motor function to relate these results to structural imaging. CONCLUSIONS AND IMPLICATIONS: The relationship between brain structure and motor outcome needs to be further elucidated in a representative cohort of children with CP, using a more standardized MRI classification system.

The relationship between neuroimaging and motor outcome in children with cerebral palsy: A systematic review-Part B diffusion imaging and tractography.

BACKGROUND: Diffusion magnetic resonance imaging (dMRI) is able to detect, localize and quantify subtle brain white matter abnormalities that may not be visible on conventional structural MRI. Over the past years, a growing number of studies have applied dMRI to investigate structure-function relationships in children with cerebral palsy (CP). AIMS: To provide an overview of the recent literature on dMRI and motor function in children with CP. METHODS: A systematic literature search was conducted in PubMed, Embase, Cochrane Central Register of Controlled trials, Cinahl and Web of Science from 2012 onwards. RESULTS: In total, 577 children with CP in 19 studies were included. Sixteen studies only included unilateral CP, while none included dyskinetic CP. Most studies focused on specific regions/tracts of interest (n = 17) versus two studies that investigated the whole brain. In unilateral and bilateral CP, white matter abnormalities were widespread including non-motor areas. In unilateral CP, consistent relationships were found between white matter integrity of the corticospinal tract and somatosensory pathways (e.g. thalamocortical projections, medial lemniscus) with upper limb sensorimotor function. The role of commissural and associative tracts remains poorly investigated. Also results describing structure-function relationships in bilateral CP are scarce (n = 3). CONCLUSIONS: This review underlines the importance of both the motor and somatosensory tracts for upper limb sensorimotor function in unilateral CP. However, the exact contribution of each tract requires further exploration. In addition, research on the relevance of non-motor pathways is warranted, as well as studies including other types of CP.

Visuoperceptual profiles of children using the Flemish cerebral visual impairment questionnaire.

AIM: To investigate the underlying factor structure of the 46-item Flemish cerebral visual impairment (CVI) questionnaire, differentiate the factor scores of children with and without CVI, and examine the impact of comorbidities on factor scores. METHOD: The records of 630 children (386 males, 244 females; median age 77mo; interquartile range 63-98mo) who visited the CVI clinic and the Centre for Developmental Disabilities at the University Hospitals of Leuven from 2001 to 2018 were reviewed systematically. Inclusion criteria included an up-to-date questionnaire, a definitive diagnosis, and clinical assessment. RESULTS: Three hundred and forty-five children (179 with CVI [108 males, 71 females; median age 74mo; interquartile range 61-93mo] and 166 without CVI [110 males, 56 females; median age 88mo; interquartile range 70-107mo]) were included. An exploratory factor analysis resulted in a 5-factor (object and face processing impairments; visual (dis)interest; clutter and distance viewing impairments; moving in space impairments; and anxiety-related behaviours) biologically and clinically plausible model, which retained 35 items and explained 56% of the total variance. Mann-Whitney U tests indicated that factors 1 to 4 were significantly higher in children with CVI compared to children without CVI (p-values ranged from p<0.001 to p<0.05; effect sizes ranged from 0.11 to 0.33); factor 5 showed no differences. Autism, developmental coordination disorder, epilepsy, and cerebral palsy impacted factor scores. INTERPRETATION: A 5-factor structure of the Flemish CVI questionnaire differentiates children with and without CVI. Comorbidities should be accounted for when researching CVI. WHAT THIS PAPER ADDS: Cerebral visual impairment (CVI) is characterized by impaired object and face processing and impaired visual interest. CVI is also characterized by impaired clutter and distance viewing, and impaired moving in space. All children (with or without CVI) demonstrated anxiety-related behaviours. Autism affected object/face processing, whereas developmental coordination disorder, epilepsy, and cerebral palsy affected visual interest.

Perfis visuoperceptuais de crianças usando o questionário Flemish de deficiência visual cerebral OBJETIVOS: Investigar a estrutura de fator do questionário Flemish de deficiência visual cerebral (DVC) com 46 itens, diferenciar os escores de fator de crianças com e sem DVC, e examinar o impacto de comorbidades nos escores de fator. MÉTODO: Os prontuários de 630 crianças (386 do sexo masculino, 244 do sexo feminino; idade mediana 77m; intervalo interquartil 63-98m;) que visitaram a clínica de DVC e o Centro para Desordens do Desenvolvimento nos Hospitais Universitários de Leuven de 2001 a 2018 foram sistematicamente revisados. Os critérios de inclusão foram um questionário atualizado, um diagnóstico definitivo, e uma avaliação clínica. RESULTADOS: Trezentas e quarenta e cinco crianças (179 com DVC [108 do sexo masculino, 71 do sexo feminino; idade mediana 74m; intervalo interquartil 61-93m] e 166 sem DVC [110 do sexo masculino, 56 do sexo feminino; idade mediana 88m; intervalo interquartil 70-107m]) foram incluídas. Uma análise exploratória de fator resultou em um modelo com 5 fatores (deficiências no processamento de objeto e face; (des)interesse visual; deficiências na visão de espaços abarrotados e distância; deficiências na movimentação no espaço; e comportamentos relacionados a ansiedade) biológica e clinicamente plausível, que reteve 35 itens e explicou 56% da variância total. Os testes U de Mann-Whitney indicaram que fatores de 1 a 4 foram significativamente mais altos nas crianças com DVC comparadas com aquelas sem (valores de p variaram de p<0,001 a p<0,05; os tamanhos de efeito variaram de 0,11 a 0,33); o fator 5 não mostrou diferenças. Autismo, transtorno do desenvolvimento da coordenação, epilepsia e paralisia cerebral impactaram os escores de fator. INTERPRETAÇÃO: Uma estrutura com 5 fatores do questionário Flemish para DVC diferencia crianças com e sem DVC. Comorbidades devem ser consideradas quando se pesquisar a DVC.

Perfis visuoperceptuais de crianças usando o questionário Flemish de deficiência visual cerebral OBJETIVOS: Investigar a estrutura de fator do questionário Flemish de deficiência visual cerebral (DVC) com 46 itens, diferenciar os escores de fator de crianças com e sem DVC, e examinar o impacto de comorbidades nos escores de fator. MÉTODO: Os prontuários de 630 crianças (386 do sexo masculino, 244 do sexo feminino; idade mediana 77m; intervalo interquartil 63-98m;) que visitaram a clínica de DVC e o Centro para Desordens do Desenvolvimento nos Hospitais Universitários de Leuven de 2001 a 2018 foram sistematicamente revisados. Os critérios de inclusão foram um questionário atualizado, um diagnóstico definitivo, e uma avaliação clínica. RESULTADOS: Trezentas e quarenta e cinco crianças (179 com DVC [108 do sexo masculino, 71 do sexo feminino; idade mediana 74m; intervalo interquartil 61-93m] e 166 sem DVC [110 do sexo masculino, 56 do sexo feminino; idade mediana 88m; intervalo interquartil 70-107m]) foram incluídas. Uma análise exploratória de fator resultou em um modelo com 5 fatores (deficiências no processamento de objeto e face; (des)interesse visual; deficiências na visão de espaços abarrotados e distância; deficiências na movimentação no espaço; e comportamentos relacionados a ansiedade) biológica e clinicamente plausível, que reteve 35 itens e explicou 56% da variância total. Os testes U de Mann-Whitney indicaram que fatores de 1 a 4 foram significativamente mais altos nas crianças com DVC comparadas com aquelas sem (valores de p variaram de p<0,001 a p<0,05; os tamanhos de efeito variaram de 0,11 a 0,33); o fator 5 não mostrou diferenças. Autismo, transtorno do desenvolvimento da coordenação, epilepsia e paralisia cerebral impactaram os escores de fator. INTERPRETAÇÃO: Uma estrutura com 5 fatores do questionário Flemish para DVC diferencia crianças com e sem DVC. Comorbidades devem ser consideradas quando se pesquisar a DVC.

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy.

The aim of this paper is to provide a clinically applicable overview of different tone reducing modalities and how these can interact with or augment concurrent physical therapy (PT). Botulinum toxin (BoNT), oral tone-regulating medication, intrathecal baclofen (ITB), and selective dorsal rhizotomy are discussed within a physiotherapeutic context and in view of current scientific evidence. We propose clinical reasoning strategies to identify treatment goals as well as the appropriate and corresponding treatment interventions. Instrumented measurement of spasticity, standardized clinical assessment, and 3D clinical motion analysis are scientifically sound tools to help select the appropriate treatment and, when needed, to selectively target or spare individual muscles. In addition, particular attention is given to strength training as a necessary tool to tackle muscle weakness associated with specific modalities of tone reduction. More research is needed to methodologically assess the long-term effectiveness of such individualized tone treatment, optimize parameters such as medication dosage, and gain more insight into the kind of PT techniques that are essential in conjunction with tone reduction.

A study of whether video scoring is a reliable option for blinded scoring of the Gross Motor Function Measure-88.

OBJECTIVE: To investigate the agreement between live and video scores of the Gross Motor Function Measure-88. DESIGN: Reliability study. SUBJECTS: Forty children with bilateral spastic cerebral palsy. INTERVENTIONS: Fifty evaluations were administered according to the test guidelines, and were videotaped. After a minimum interval of one month, the video recordings were again rated by the same assessor. Two physical therapy students also each scored the recordings twice, with a minimal interval of one month. MAIN MEASURES: Agreement between live and video scores as well as inter-rater and intra-rater agreement of the video scores were assessed using intra-class correlation coefficients (ICC), standard error of measurements (SEM), and smallest detectable changes (SDC). Weighted kappa coefficients were used to analyse individual items. RESULTS: The live and video scores from the same assessor showed good to very good agreement for the total score (ICC, 0.973; SEM, 2.28; SDC, 6.32) and dimensions B (ICC, 0.938), D (ICC, 0.965), and E (ICC, 0.992) but lower agreement for A (ICC, 0.720) and C (ICC, 0.667). Live-versus-video agreement for the total score was higher than inter-rater agreement by video (ICC, 0.949; SEM, 3.15; SDC, 8.73) but lower than intra-rater agreement by video (ICC, 0.989; SEM, 1.42; SDC, 3.96). CONCLUSION: The Gross Motor Function Measure-88 can be reliably scored using video recordings. The agreement between live and video scores is lower than the intra-rater reliability using video recordings only. Future clinical trial results should be interpreted using the appropriate SEM and SDC values.

A randomized, single-blind cross-over design evaluating the effectiveness of an individually defined, targeted physical therapy approach in treatment of children with cerebral palsy.

OBJECTIVE: A pilot study to compare the effectiveness of an individual therapy program with the effects of a general physical therapy program. DESIGN: A randomized, single-blind cross-over design. PARTICIPANTS: Ten ambulant children with bilateral spastic cerebral palsy, age four to nine years. INTERVENTION: Participants were randomly assigned into a ten-week individually defined, targeted or a general program, followed by a cross-over. MAIN OUTCOME MEASURES: Evaluation was performed using the Gross Motor Function Measure-88 and three-dimensional gait analysis. General outcome parameters were Gross Motor Function Measure-88 scores, time and distance parameters, gait profile score and movement analysis profiles. Individual goal achievement was evaluated using z-scores for gait parameters and Goal Attainment Scale for gross motor function. RESULTS: No significant changes were observed regarding gross motor function. Only after individualized therapy, step- and stride-length increased significantly (p = 0.022; p = 0.017). Change in step-length was higher after the individualized program (p = 0.045). Within-group effects were found for the pelvis in transversal plane after the individualized program (p = 0.047) and in coronal plane after the general program (p = 0.047). Between-program differences were found for changes in the knee in sagittal plane, in the advantage of the individual program (p = 0.047). A median difference in z-score of 0.279 and 0.419 was measured after the general and individualized program, respectively. Functional goal attainment was higher after the individual therapy program compared with the general program (48 to 43.5). CONCLUSION: The results indicate slightly favorable effects towards the individualized program. To detect clinically significant changes, future studies require a minimal sample size of 72 to 90 participants.

A clinical decision framework for the identification of main problems and treatment goals for ambulant children with bilateral spastic cerebral palsy.

The primary aim of the study was to investigate how a clinical decision process based on the International Classification of Function, Disability and Health (ICF) and the Hypothesis-Oriented Algorithm for Clinicians (HOAC-II) can contribute to a reliable identification of main problems in ambulant children with cerebral palsy (CP). As a secondary aim, to evaluate how the additional information from three-dimensional gait analysis (3DGA) can influence the reliability. Twenty-two physical therapists individually defined the main problems and specific goals of eight children with bilateral spastic CP. In four children, the results of 3DGA were provided additionally to the results of the clinical examination and the GMFM-88 (gross motor function measure-88). Frequency analysis was used to evaluate the selected main problems and goals. For the main problems, pair-wise agreement was calculated by the number of corresponding problems between the different therapists and using positive and negative agreement per problem. Cluster analysis using Ward's method was used to evaluate correspondence between the main problems and specific goals. The pair-wise agreement revealed frequencies of 47%, 32% and 3% for the identification of one, two or three corresponding main problems. The number of corresponding main problems was higher when additional information of 3DGA was provided. Most of the specific goals were targeting strength (34%), followed by range of motion (15.2%) and GMFM-D (11.8%). In 29.7% of the cases, therapists could not prioritize and exceeded the number of eight specific goals. Cluster analysis revealed a logic connection between the selection of strength as a main problem and as specific goal parameters. Alignment as a main problem was very often associated with specific parameters like ROM and muscle length and with hypertonia as a main problem. The results show a moderate agreement for the selection of main problems. Therapists are able to use the proposed model for a logic and structured clinical reasoning. Setting priorities in the definition of specific goals is revealed as a remaining difficulty. Further research is required to investigate the additional value of 3DGA and to improve priority setting.

The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: a systematic review using the International Classification of Functioning, Disability and Health as a conceptual framework.

OBJECTIVE: This systematic review provides an overview of the effectiveness of basic techniques used in lower limb physical therapy of children with cerebral palsy. It aims to support the development of clinical guidelines for evidence-based physical therapy planning for these children. DATA SOURCES AND STUDY SELECTION: A literature search in 5 electronic databases extracted literature published between January 1995 and December 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health. DATA EXTRACTION: Three independent evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system. DATA SYNTHESIS: A total of 83 studies was selected and divided into categories (stretching, massage, strengthening, electrical stimulation, weight-bearing, balance-, treadmill- and endurance training). Interventions targeting problems at body function and structure level generally influenced this level without significant overflow to activity level and vice versa. CONCLUSION: The more recent studies evaluating strength training mainly demonstrated level II evidence for improved gait and gross motor function. There was limited evidence for specific information on intensity, duration and frequency of training.

The evidence-base for conceptual approaches and additional therapies targeting lower limb function in children with cerebral palsy: a systematic review using the ICF as a framework.

OBJECTIVE: This systematic review provides an overview of the effectiveness of conceptual approaches and additional therapies used in lower limb physical therapy of children with cerebral palsy and supports the development of clinical guidelines. DATA SOURCES AND STUDY SELECTION: A literature search in 5 electronic databases was performed, extracting literature published between 1995 and 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health (ICF). DATA EXTRACTION: Three evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system. DATA SYNTHESIS: A total of 37 studies used conceptual approaches (neurodevelopmental treatment (NDT), conductive education, Vojta therapy, sensory integration, functional training and goal-oriented therapy) and 21 studies focused on additional therapies (aquatic therapy and therapeutic horse-riding). CONCLUSION: Level II evidence was found for the effectiveness of therapeutic horse-riding on posture and for NDT and functional training on gross motor function. Goal-oriented therapy and functional training were effective on the attainment of functional goals and participation. With level IV evidence, NDT was effective on all levels of the ICF.

Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population.

The aim of the study is to evaluate the predictive value of various types of brain injury detected by ultrasound in the neonatal period for the occurrence of cerebral palsy and its characteristics in a large cohort of high-risk infants. Thousand twenty-one consecutively NICU-admitted high-risk infants were assessed up to the corrected age of at least 2 years. Cerebral palsy (CP) was categorised into spastic or non-spastic, bilateral or unilateral and mild, moderate or severe CP. Different types of brain injury were identified by serial cranial ultrasound (US) during the NICU stay: white matter disease (WMD), haemorrhage, cerebral infarction, deep grey matter and parasagittal cerebral injury. There is a significant overall association between different types of brain injury and gestational age. Only 4% of the children with normal US develop CP. In the presence of any abnormal US image, the likeliness to develop CP is at least seven times higher. Within the group of infants with WMD and haemorrhage, the degree of brain involvement has a clear impact on the occurrence of CP. Concerning the characteristics of CP, deep grey matter lesion predict non-spastic CP versus spastic CP (OR = 31, P < 0.001). Cerebral infarction and haemorrhage grade IV are strong predictors of unilateral spastic CP versus bilateral spastic CP (OR = 49 and 24, respectively, P < 0.001). Deep grey matter lesion is a significant predictor for severe versus mild and moderate CP (OR = 6). In conclusion, neonatal cranial US is a useful tool in predicting CP and its characteristics.

Influence of gestational age on nosologic CP characteristics in a high-risk population.

The aim of this study is to investigate the interrelationship between gestational age (GA) and nosologic characteristics (type, distribution and severity) of cerebral palsy (CP) in a cohort of high-risk infants. One thousand ninety-nine consecutively neonatal intensive care unit-admitted high-risk infants (i.e., all infants with a GA less than 30 weeks and specified infants with GA >or= 30 weeks with a complicated neonatal course and/or brain lesion) were prospectively assessed up to the corrected age of 2 years or more. In 177 (16%) of these infants, CP was diagnosed. Of these infants, 26 were extremely preterm infants (GA 23-27 weeks), 62 very preterm (28-31 weeks), 36 moderately preterm (32-36) and 53 term infants (GA >or= 37 weeks). Spastic CP was significantly more present in the three preterm groups (77%, 90% and 72%, respectively) compared with the term ones (42%). At variance, dyskinetic CP was present in nearly half of the term group (47%) and remarkably less in all three preterm age groups (12%, 7% and 22%, respectively). Ataxic CP (7%) was of rare occurrence in all age groups. Distributive classification showed that bilateral spastic CP gradually dropped from 100% in the extremely preterm group down to 50% in the term infants. Inversely, unilateral spastic CP rises steeply with advancing GA. Severity of CP was significantly associated with birth year period in favour of mild CP. In high-risk neonates, dyskinetic CP increases steeply with increasing GA, whereas spastic CP decreases. Bilateral and unilateral involvements are gradually and oppositely changing with gestational age. It is tempting to explain the maturity-related association by gestational age-specific brain injuries.