Development and Treatment
With our research, we want to increase knowledge about how child development and different treatment interventions can affect the lives of children diagnosed with cerebral palsy (CP). Our research group has a broad interdisciplinary approach and is closely connected to the Neuropediatric Clinic at Astrid Lindgren's Children's Hospital, with many international partners.
The primary focus of our research is to gain a deeper understanding of how development and interventions can influence the lives of children with cerebral palsy (CP). Our research group takes a broad, multidisciplinary approach and is closely connected to the Neuropediatric Clinic at Astrid Lindgren Children's Hospital, with many international collaborators
To develop methods for the treatment of children with cerebral palsy based on motor control and motor learning principles, with a particular focus on understanding how these children acquire new skills.
To develop assessment tools for measuring the effects of treatment and tracking the children's developmental progress.
To describe factors that influence children's abilities in daily life.
To gain a deeper understanding of the parents' perspective when they are involved in their child's training.
Research projects - Intervention
Constraint Induced Movement Therapy (CIMT) for Children and Infants
Our research group has developed Constraint Induced Movement Therapy (CIMT) specifically for young children and infants with unilateral cerebral palsy (CP). This treatment is based on two key principles: restricting the use of the non-affected hand and providing intensive training over a designated period. CI-therapy is one of the few evidence-based treatments that has been proven to enhance hand function in children with unilateral CP, and our research has played a crucial role in this development. To support the implementation of CIMT, we have made the manual freely accessible.
Recent research has focused on early intervention for infants under one year of age. Following the positive results of our first randomized controlled trial (RCT), we continue to investigate whether parents can effectively guide their child’s training through digital coaching. The study shows that digital coaching is as effective as in-person coaching and supervision at home when parents serve as the primary trainers. We have also explored the challenges parents face when they take on the role of primary trainers on a daily basis.
Small-Step Program: Developing New Treatment Principles for Children with Cerebral Palsy and Neurodevelopmental Disorders
Preterm children or those at risk of functional limitations need early intervention, yet evidence of long-term effectiveness is limited. In our first randomized controlled trial, we compared a 30-week home intervention program focused on motor function, hand use, and communication with standard care. While the program showed no significant differences in motor development, secondary analyses suggested it may benefit the most severely affected children. Our results, consistent with a collaborative project with Trondheim University, highlight significant variation in outcomes among individual infants, underscoring the need for further research.
In an ongoing project, we have refined the Small-Step Program and adapted it to an eHealth format, incorporating specific goal-setting to better measure its impact, given that standard assessments may not fully capture changes in children with cerebral palsy.
Full Speed Ahead
The project we call "Full Speed Ahead" marks the beginning of a new line of research at our unit, an area that is surprisingly under-researched. Our goal is to enable mobility at an early age for children with impaired mobility due to CP. Many of the children eventually learn to walk, but often later and with balance difficulties. This limits their ability to be physically active, which increases the risk of poor health later in life. Movement and the joy of movement are also crucial for general well-being, and through activity and play, the child’s social and cognitive development is promoted. We have observed the joy of movement in previous Frame Running projects. Frame Running involves using a three-wheeled bike and will be part of the children's training.
This project is in its initial phase, and we will work with both group training and home training for children aged 2-5 years. The children will receive mobility and walking training, with or without assistive devices, depending on their individual needs. The three-wheeled Frame Running bike will be included as part of the training.
This project is being conducted in collaboration with researchers from our unit: Kristina Löwing, Ferdinand van Walden, Cecilia Lidbeck, and Eva Broström.
Development of Assessment Tools for Children with Cerebral Palsy
Our research group has developed several key assessment tools for children with cerebral palsy. Among them is the Manual Ability Classification System (MACS), a classification system that describes children's manual abilities across five levels. MACS is today used as international standard has been translated into approximately 25 languages. It provides a standardized method for understanding and communicating the functional abilities of children with CP.
In addition, we have developed the Assisting Hand Assessment (AHA), the Hand Assessment for Infants (HAI), and the Children's Hand-use Experience Questionnaire (CHEQ), which are specifically designed for assessing children with unilateral CP. We are currently working on a screening version of the HAI (s-HAI) to facilitate the early identification of children at high risk for unilateral CP. We are also in the process of validating the HAI for use with children who have bilateral CP. These efforts aim to improve early detection and intervention, ultimately enhancing outcomes for children with CP.
Longitudinal Development
Since 2000, we have conducted a long-term study on hand function in children with unilateral cerebral palsy (CP), following them from 3 months to 18 years of age. Utilizing the Assisting Hand Assessment (AHA) and the Hand Assessment for Infants (HAI), our research shows that developmental trajectories vary with the severity of impairment. We have learned that children generally develop faster in early childhood, with even those severely affected showing improvement over time. Infants who develop grasping skills by 6 months tend to have better outcomes, while those lacking hand development in their first year often face more severe challenges. A continuation of this project is being carried out in collaboration with Brisbane University.
To understand the factors that influence children's development, large groups are needed. To achieve larger groups, we have established a collaboration with additional research groups. We are part of a large international study led by the University of Sydney, which investigates development from a broad perspective—including gross and fine motor function, cognition, and daily life activities in children aged 6 months to 2 years.
Prediktion och tidig diagnos av ensidig cerebral pares
Infants at risk for cerebral palsy often go undiagnosed until their second year of life or later. However, recent advancements in early intervention and the development of the Hand Assessment for Infants (HAI) by our research group have made it possible to identify and treat infants with unilateral CP as early as 3,5 months of age. The HAI not only facilitates early diagnosis but also provides valuable insights into the early development of high-risk infants.
To improve accessibility and cost-effectiveness, we are in the process of developing a screening version of the HAI, known as the s-HAI. This new version is designed to be easier to administer while maintaining the accuracy and reliability of the original assessment. This will be further investigated in collaboration with Köpenhamns university. To ensure that s-HAI reaches a wider audience, we are offering it through a free online course. The course has already garnered significant interest, attracting over 500 participants in its first year. This initiative aims to equip healthcare professionals and caregivers with the skills needed to identify early signs of cerebral palsy, ultimately leading to earlier interventions and better outcomes for infants at risk. To make the HAI even more user-friendly, we have also partnered with KTH to explore how AI technology can simplify the analysis.
PhD student: Johanna Kembe