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Open research questions in Cerebral Palsy and Movement Disorders

71 unresolved questions extracted from the limitations and future-work sections of 1,267 Cerebral Palsy and Movement Disorders papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • BACKGROUND: Several inherited metabolic disorders (IMD) are associated with neurodevelopmental problems, but clinically, the infants' neurological condition during their first months has not been well described.

    General movement assessment in infants with inherited metabolic disorders · 2026 · DOI

  • Currently, there is a lack of evidence for effective training programs for this group of children [11, 64]. In particular, research evaluating inter- ventions for non-ambulant children with CP is scarce; most existing studies have focused on children classified as GMFCS levels I to III, leaving those at levels IV and V underrepresented and often without access to evidence- based interventions [65].

    Study protocol for Full Speed Ahead: an intervention for improved activities in daily life through Frame Running and Goal directed training · 2026 · DOI

  • The key strength of this study lies in its specific focus on children with severe CP (GMFCS levels IV and V), addressing a significant gap in the literature.

    Mapping Participation in Children with Severe Cerebral Palsy through Structural Equation Modeling · 2026 · DOI

  • Yet pediatric gait analysis introduces unique design considerations often underexplored in existing CGA research, as children's ongoing development shapes assessment requirements.

    Designing Computerized Gait Analysis for Pediatric Care: Clinician Perspectives on Sensing, Workflow, and Care Environments · 2026

  • Future research is needed to evaluate FitSkills in regional settings, ensuring their adaptability to a broader range of disabilities and diverse presentations.

    Feasibility of FitSkills for an Adult With Cerebral Palsy Using a Wheelchair in a Regional Setting: A Mixed Methods Case Study · 2026 · DOI

  • 2026 Akinola et al. Cureus 18(6): e111030. DOI 10.7759/cureus.111030 7 of 9 This study did not include a non-intervention control group, limiting the ability to determine the extent to which the observed improvements were attributable solely to the interventions rather than natural developmental changes or other external influences. Also, gait performance was assessed using the Edinburgh visual gait score, an observational clinical measure. Although the EVGS is a valid and reliable tool for gait assessment in children with cerebral palsy, instrumented three-dimensional gait analysis would have provided more detailed biomechanical information regarding treatment-related changes. Finally, the follow-up period was relatively short, and therefore, the long-term sustainability of treatment effects remains unknown. Future studies should incorporate longer follow-up periods and instrumented gait analysis.

    Whole-Body Vibration Training Versus Kinesiology Taping for Improving Gait Performance in Children With Spastic Cerebral Palsy: A Randomized Controlled Trial · 2026 · DOI

  • YongPing Yao 1,2* 1Tianjin University, Tianjin, China, 2Sichuan Nursing Vocational College, Chengdu, China Background: Intelligent ankle-foot orthoses (AFOs) have emerged as a promising assistive technology for improving mobility in children with cerebral palsy (CP). However, their effective development and implementation require a compre- hensive understanding of user needs from multiple stakeholders, particularly in resource-limited regions. Objective: To systematically investigate the demand characteristics for intelligent AFOs among families of children with CP and medical professionals in Sichuan Province, and to identify key determinants influencing these demands. Methods: A multicenter cross-sectional survey was conducted, including 95 families of children with CP and 39 medical professionals. Structured question- naires were used to assess functional demands, usage experiences, and per- ceived barriers. Data were collected from multiple hospitals and rehabilitation centers across different administrative regions in Sichuan Province to enhance representativeness. Group differences were analyzed using non-parametric tests, and multivariate logistic regression was applied to identify independent determinants of demand. Results: Families demonstrated the highest demand for practical and usability- oriented functions, particularly walking stability (93.69%) and ease of donning and doffing (83.16%). In contrast, medical professionals prioritized clinically oriented functions, including gait monitoring and predictive fall prevention (both 87.18%). Significant inter-group differences were observed in data monitoring (p < 0.001) and adaptive adjustment (p = 0.012). Multivariate analysis revealed that higher household income was significantly associated with increased demand for both data monitoring functions (OR = 3.13, 95% CI: 1.15–8.58, p = 0.026) and usability- related features (OR = 3.00, p = 0.033). Conclusion: Demand for intelligent AFOs exhibits clear stakeholder-specific pat- terns, reflecting a divergence between practicality-driven needs among families and clinically oriented expectations among medical professionals. Safety, com- fort, and indoor scenario adaptability represent shared priorities, while economic constraints and prior technology exposure further shape demand. These findings highlight the necessity of integrating multi-stakeholder perspectives into device design and support the development of context-specific strategies to improve accessibility and adoption in resource-limited settings.

    Determinants of demand for intelligent ankle-foot orthoses in children with cerebral palsy: a multicenter cross-sectional study from a multi-stakeholder perspective · 2026 · DOI

  • As a qualitative case study, this research is context-specific and not intended for statistical generalization [27,29]. The small participant sample, drawn from a single clinical setting, limits transferability. While including healthy children in early prototyping aligns with child-centered design practices [44,45], it may have introduced discrepancies between early feedback and the needs of children with ABIs. This study used Design Thinking within a qualitative case study to guide XR development Its 5 phases—empathize, define, ideate, prototype [47,48], and test—structured co-design workshops and ensured stakeholder insights shaped solutions focused on fatigue detection, adaptive engagement, and emotional safety. In the empathize phase, interviews, observations, and shadowing sessions with clinicians, parents, and children were conducted to understand clinical routines, fatigue triggers, and children’s emotional responses to therapy. In the define phase, these insights were synthesized into problem statements, such as the need for understanding fatigue and safeguarding mechanisms to prevent overstimulation. During the ideate phase, multidisciplinary workshops with clinicians, designers, and children generated concepts ranging from environmental cues for fatigue to customizable levels of XR immersion. In the prototyping phase, low- and mid-fidelity XR mockups were created and iteratively refined based on stakeholder feedback, focusing on interaction patterns, visual clarity, and observational insights. Finally, in the test phase, preliminary XR prototypes were trialed in simulated therapy sessions, where children and clinicians evaluated usability, comfort, and safety, directly https://www.jmir.org/2026/1/e84013 XSL•FO RenderX informing adjustments such as simplified interfaces and adaptive pacing. This approach was seen as particularly valuable in pediatric rehabilitation, where the wide variation in children’s physical, emotional, and cognitive abilities calls for personalized and context-sensitive design. Co-design is a participatory design approach that involves end users and stakeholders as active contributors in the design process, rather than passive recipients of a finished product. According to Sanders and Stappers, co-design centers on collaboration, mutual learning, and shared ownership, enabling users to bring their experiences, needs, and creativity into the creation of meaningful solutions. In our study, Design Thinking was used as an organizing framework to structure the co-design and iterative prototyping process, ensuring that stakeholder insights were translated into concrete, testable design changes.

    Opportunities and Concerns of Gamified, Extended Reality for Home-Based Motor Rehabilitation for Children With Brain Injury: Qualitative Case Study on Design Elements Related to the Engagement and Fatigue Perspectives · 2026 · DOI

  • these methods have Current conventional rehabilitation interventions for children with CP mainly include neurodevelopmental therapy (NDT, a widely used clinical approach in pediatric rehabilitation, though current evidence-based guidelines do not support its efficacy as a standalone intervention), hand function training, constraintinduced movement therapy, and physical agent modalities (PAMs, referring to adjunctive physical treatments including electrotherapy, thermotherapy, and ultrasound therapy) (11). However, such as high repetitiveness, high training intensity, easy fatigue, and poor compliance in children (12). In recent years, virtual reality (VR) technology, with its advantages of immersion, interactivity, and imagination, can construct a multi-sensory integrated training environment, significantly enhancing children’s motivation to participate in training. Studies have confirmed that positive emotional feedback in VR games can further strengthen neural stimulation (13), making it an effective alternative for upper limb function rehabilitation in CP (14, 15). Existing systematic reviews suggest that long-term VR rehabilitation training has limb motor shown potential benefits function and promoting motor recovery in children with CP, compared with traditional non-VR rehabilitation methods (16, 17).

    Cerebral cortical activation and functional connectivity characteristics of children with unilateral cerebral palsy during a single-session virtual reality throwing motor task: a functional near-infrared spectroscopy study · 2026 · DOI

  • in showed that gait and functional outcomes may continue to evolve after the early postoperative period. Some patients may maintain early improvements, whereas others may develop recurrent deformity, residual gait abnormalities, or new biomechanical problems.14-17 Follow-up limited to the first postoperative year may therefore miss clinically relevant changes in mobility, gait quality, or the need for further intervention.6,20 age at surgery, baseline gait severity, and surgical composition. Such stratification is needed because SEMLS is not a single uniform procedure, and postoperative outcomes may vary according to patient characteristics and combination soft-tissue and bony procedures of performed. Reporting the number and type of procedures, rehabilitation protocols, and previous surgeries would improve interpretability across studies. the growth-related Fourth, clinicians should interpret SEMLS as part of longitudinal orthopedic management rather than as an isolated endpoint. The need for additional surgery was reported in several long-term cohorts, and subsequent procedures may reflect changes, recurrence, residual deformity, or newly developed biomechanical problems. This should be discussed with patients and families during preoperative consult.

    Long-term functional mobility and gait-related outcomes after single-event multilevel surgery in ambulatory children with cerebral palsy: A systematic review · 2026 · DOI

  • The findings of this review have several implications for clinical practice. First, outcome evaluation after SEMLS should be multidimensional. Clinical assessment should not rely only on whether gait improves laboratory, because postoperative success may differ across gait quality, functional mobility, patient patient-centered and independence, outcomes. A patient may demonstrate improvement indices while still requiring assistive devices or wheelchair use for longer distances.36,49 Therefore, assessment postoperative should instrumented gait analysis and real-world functional mobility measures. in global gait include both Second, functional mobility should be assessed according to walking context and distance. Household ambulation, school or work mobility, and community ambulation represent different levels of functional demand. Distance-specific tools such as the FMS are particularly useful because they describe how patients move across daily environments rather than only whether they can walk under controlled testing conditions. This is especially relevant for patients with GMFCS level III, in whom household or short-distance walking may be preserved despite community mobility.5,11 limitations in showed that gait and functional outcomes may continue to evolve after the early postoperative period. Some patients may maintain early improvements, whereas others may develop recurrent deformity, residual gait abnormalities, or new biomechanical problems.14-17 Follow-up limited to the first postoperative year may therefore miss clinically relevant changes in mobility, gait quality, or the need for further intervention.6,20 age at surgery, baseline gait severity, and surgical composition. Such stratification is needed because SEMLS is not a single uniform procedure, and postoperative outcomes may vary according to patient characteristics and combination soft-tissue and bony procedures of performed. Reporting the number and type of procedures, rehabilitation protocols, and previous surgeries would improve interpretability across studies. the growth-related Fourth, clinicians should interpret SEMLS as part of longitudinal orthopedic management rather than as an isolated endpoint. The need for additional surgery was reported in several long-term cohorts, and subsequent procedures may reflect changes, recurrence, residual deformity, or newly developed biomechanical problems. This should be discussed with patients and families during preoperative consult.

    Long-term functional mobility and gait-related outcomes after single-event multilevel surgery in ambulatory children with cerebral palsy: A systematic review · 2026 · DOI

  • Several limitations should be considered: • The absence of a control group limits the ability to attribute improvements solely to intervention. • Possible influence of the placebo effect, where participants improve due to attention rather than treatment • Heterogeneity of clinical diagnoses may have influenced variability in outcome responses.

    Comparative Efficacy of GMFM and PEDI in Assessing Functional Progress in Pediatric Rehabilitation Programs · 2026 · DOI

  • Outcome - Understanding of the ICF framework - Understanding the perspectives of home rehabilitation therapists - Understanding the interactions among ICF components and related…

    Development of a collaborative rehabilitation education program for primary care: an educational action research approach · 2026 · DOI

  • The ontological framework transforms clinical observations into semantically enriched features including mobility potential indicators and developmental milestone alignments, but lacks ablation studies isolating which specific ontological components (inference rules, concept hierarchies, domain constraints) contribute most to the performance improvements observed across Random Forest and Gradient Boosting models in cerebral palsy severity prediction.

    An Ontology Driven Machine Learning Framework for Early Prediction in Children with Cerebral Palsy · 2026 · DOI

  • The paper identifies that KNN and Naive Bayes performed inconsistently with particularly poor discrimination for Level 2 GMFCS cases (Naive Bayes AUC=0.50), but provides no investigation into whether ontological semantic enrichment fails to generate discriminative features for intermediate severity levels or whether these algorithms fundamentally cannot capture the encoded clinical relationships.

    An Ontology Driven Machine Learning Framework for Early Prediction in Children with Cerebral Palsy · 2026 · DOI

  • Continuous monitoring and ontology evolution procedures are mentioned as necessary for model longevity in the GMFCS classification framework, but specific protocols for detecting when ontological concepts require updating based on emerging clinical evidence or distributional drift in pediatric cerebral palsy populations are not defined.

    An Ontology Driven Machine Learning Framework for Early Prediction in Children with Cerebral Palsy · 2026 · DOI

  • The ontological framework demonstrates domain-specific advantages over deep learning approaches in pediatric rehabilitation prediction, but lacks comparative analysis on whether ontology-driven feature engineering combined with convolutional or recurrent neural networks on infant movement data could maintain clinical interpretability while achieving the pattern recognition accuracy of standard deep learning models.

    An Ontology Driven Machine Learning Framework for Early Prediction in Children with Cerebral Palsy · 2026 · DOI

  • Linear models (logistic regression, Naive Bayes) showed modest improvements from ontological enhancement due to inability to exploit non-linear semantic relationships; systematic investigation of whether hybrid architectures combining linear discriminators with ontology-derived non-linear feature transformations could close the performance gap with ensemble methods in GMFCS level classification is absent.

    An Ontology Driven Machine Learning Framework for Early Prediction in Children with Cerebral Palsy · 2026 · DOI

  • The current framework operates with limited input modalities for early prediction in children with cerebral palsy; integration of multimodal neuroimaging data, electromyography signals, or video-based movement analysis alongside clinical observations could address whether ensemble methods and ontological inference rules can exploit richer feature diversity for improved Level 4 precision (currently 0.65 for SVM).

    An Ontology Driven Machine Learning Framework for Early Prediction in Children with Cerebral Palsy · 2026 · DOI

  • The ontology-driven machine learning framework relies on synthetic data for cerebral palsy severity assessment; validation with real-world pediatric patient datasets across multiple clinical sites is needed to confirm whether the ontological semantic enhancement maintains its performance gains (85% Random Forest accuracy, 83% Gradient Boosting) on authentic GMFCS classification data.

    An Ontology Driven Machine Learning Framework for Early Prediction in Children with Cerebral Palsy · 2026 · DOI

  • In their 2023 “Global Survey on Persons with Disabilities and Disasters” the United Nations reported that “persons with disabilities constitute 16% of the world’s population, with 80% living in the Global South”—and yet the historical experience of disability in this region has been largely understudied.

    Mobility Disabilities · 2025 · DOI

  • Even though the effect of several factors on sit-to-stand (STS) performance of children with CP has been previously explored, the potential role of lower extremity selective control, trunk control and sitting function on the performance of STS has not been examined.

    Characteristics of sit-to-stand movement are associated with trunk and lower extremity selective control in children with cerebral palsy: a cross-sectional study · 2022 · DOI

  • Future research is recommended to examine inter-rater and intra-rater reliability and responsiveness of the BoHA, as well as longitudinal studies of bimanual hand skill development in children with bilateral CP.

    Hand Function in 8- to 12-Year-Old Children with Bilateral Cerebral Palsy and Interpretability of the Both Hands Assessment · 2020 · DOI

  • is inconclusive to judge how much of an Item the child can perceive in his driven state, and since his spontaneous play is characterized by the same quality of drivenness, a combination of probing in his developmental history, his domestic behavior, his observable behavior the child's during the interview are all called upon to make the level of development recognizable.

    Evaluating the Developmental Level of Cerebral Palsy Preschool Children · 1952 · DOI

  • These findings highlight the lack of consensus in managing recurrent clubfoot and underscore the need for clearer indications and standardized treatment algorithms.

    Association between video-based Pirani Böhm Sinclair score and treatment recommendations in recurrent clubfoot in walking-age children · 2026 · DOI

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