Cerebral Palsy: from Motor Skills to Social Prediction

This PhD program stems from my need as a Physiatric physician specialising in the management of Cerebral Palsy (CP), to better answer some of the questions that have been partially addressed in the course of my18 years of clinical practice and, above all, can contribute to improving the care and quality of life for children with cerebral palsy and their families. CP represents the most common congenital physical disability in the paediatric setting. Neuromotor impairment has always been the connotative element, but the complexity and variability of clinical expression of this condition is now well accepted. It follows that children with CP require comprehensive and multidisciplinary care that is time-consuming and often onerous for the family. So, the aim of my studies is to test various solutions that optimise the benefits of time-limited treatments in school-age patients. We know that, at school age, children's interests diversify and their compliance with treatment gradually declines, with high dropout rates and rehabilitation failure. It is becoming increasingly important for rehabilitation services to understand and adapt their programs and initiatives to meet evolving needs for children and their families. The first chapter offers a narrative excursus of the medical-scientific and socio-cultural evolution about CP. It is a condition that has been considered a deficit or an exclusive physical impairment for many years. We now understand it to be a health condition in an adverse environment. The rehabilitation approach has shifted its focus from the segmented to the whole person, seeking to implement increasingly personalised medicine that also uses technological tools to enhance outcomes and increase treatment compliance. Two of the three research projects presented are related to rehabilitation treatment protocols designed from a goal directed perspective. The first utilises a brain neurostimulation technique; the second uses robotic instrumentation; the third project investigates social and non-social prediction skills, never explored on a population of children with CP thus far. The second chapter describes in detail the non-invasive vagus nerve stimulation (tVNS) application in a double blind randomised controlled trial. This is combined with a bimanual treatment protocol in children with unilateral CP. We just published the protocol and started the enrollment process. The third chapter presents a project investigating the integrated instrumental assessment with the upper limbs kinematic and robotic treatment (ARMEO-spring) of the upper limb in the rehabilitation process of children with hemiparesis and the preliminary data analysis. The fourth chapter reports the results of a multidimensional assessment of social and non-social prediction regarding the abilities of children with unilateral and bilateral CP. Lastly, the interpretation of this data and implications for future research and for clinical management of CP children are discussed.