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Telerehabilitation for Cerebral Palsy

Original Editor - Muhammad Arslan Top Contributors - Muhammad Arslan, Alexandra Stead and Vidya Acharya

Introduction

Cerebral palsy (CP) is an umbrella term for a group of permanent conditions involving the development of movement and posture which cause activity limitation due to non-progressive neurological condition that occurs in the developing foetal or infant brain.[1] Children with CP, especially those with higher functional impairments, are at higher risk of poor growth, nutritional compromise and poor health outcomes.[2] CP child with increased weight percentiles are strongly linked to demanding more health services and are putting a significant impact on the economy.[3] Children with CP can also have associated sensory, cognitive, communication, perceptive, behavioural, epilepsy and secondary musculoskeletal disorders.[4] CP is a life-long condition, there is a need for people to receive continued rehabilitation to maximise participation in activities at home, in the classroom, in their work and community, to optimise functional abilities and to minimise secondary impairments.[5] Physiotherapy is the main recommended management of CP with a key emphasis on enhancing motor function, postural control, mobility and independence based on evidence-based interventions.[6] Telerehabilitation has become an important delivery method for rehabilitation, which can complement traditional face-to-face rehabilitation by allowing therapists to assess, treat, educate and follow up the person at home, thereby helping to ensure continuity of care and promote family-centred rehabilitation.[7]

Effectiveness of Telerehabilitation for Cerebral Palsy

Children with CP need lifelong rehabilitation and regular attendance at rehabilitation centre may be limited due to geographical distance, transport issues, financial problems, responsibility of attendants, or lack of access to specialists and clinicians with expertise in paediatric cerebral palsy and rehabilitation.[8] Telerehabilitation can overcome many of these barriers by providing rehabilitation directly in the home environment, minimise travel time, and associated costs, and increase access to rehabilitation services that can be provided continuously.[9] Telerehabilitation is home-based which allows physical therapists to create interventions that are relevant to the patient in their normal environment and activity patterns, which may lead to better participation and functioning.[10] Further, telerehabilitation facilitates family centred practise as it actively engages caregivers in goal setting, supervision of exercises and home exercise programmes, which can enhance adherence, caregiver confidence and long-term rehabilitation outcomes.[11] Current evidence suggests that using telerehabilitation as an additional tool to conventional rehabilitation is effective in improving gross motor function, functional mobility, participation and satisfaction for the person with cerebral palsy.[12][13][14]

Recent studies suggest that telerehabilitation is a feasible and effective adjunct to conventional rehabilitation for children with cerebral palsy.[15][16][17] [18][19][20] Improvements have been reported in gross motor function, functional mobility, balance, participation and caregiver satisfaction, particularly when interventions are goal-oriented, family-centred and delivered consistently.[21] Although telerehabilitation should not replace interventions that require hands-on assessment or manual therapy, current evidence supports its use as part of a hybrid rehabilitation model to improve access and continuity of care, especially for families living in rural or underserved areas.[22]

Modes of Telerehabilitation Delivery

Telerehabilitation interventions for cerebral palsy are commonly delivered using synchronous, asynchronous or hybrid models.[21] Synchronous delivery involves real-time interaction through videoconferencing platforms, allowing therapists to assess movement, provide feedback and modify interventions during treatment sessions.[23] Asynchronous approaches include recorded exercise videos, mobile applications, electronic home exercise programmes and secure messaging, enabling individuals and caregivers to complete rehabilitation activities at convenient times.[24] Hybrid models combine periodic face-to-face appointments with remote follow-up and are increasingly recommended to optimise clinical outcomes while maintaining flexibility and accessibility.[25]

Patient and Family Eligibility For Telerehabilitation

Clinical Eligibility

Appropriate patient and family selection is essential for the successful implementation of telerehabilitation in children with cerebral palsy. When evaluating the child for rehabilitation, a medical examination, fit for work assessment, rehabilitation objectives, home assessment and family support for a telerehabilitation programme should be completed.[26] Generally, children who are medically stable and need continued rehabilitation, home exercise progression, functional training, caregiver training or long-term follow-up are well suited to telerehabilitation. Telerehabilitation can be implemented at all levels of the Gross Motor Function Classification System (GMFCS) however children with more motor impairments (GMFCS IV and V) may need more support from caregivers and benefit most from a hybrid model of telerehabilitation with face-to-face reviews every few sessions.[27]

Child and Caregiver Factors

The cognitive, communication, behavioural, visual and auditory skills of the child should also be taken into account, as this will impact their participation and the ability to follow instructions during a virtual session.[28] Younger children socially those with severe communication and/or cognitive disabilities may need ongoing support from a caregiver during therapy.[29] The caregiver is one of the main actors in paediatric telerehabilitation, contributing to the positioning, handling, supervision of exercises, safety and the use of assistive devices.[30] Thus, the availability of the caregiver, their physical skills, willingness to participate and confidence in their role as a rehab supporter in the telerehabilitation process are all key components to consider when determining suitability for telerehabilitation.[31] Secure home environment, space for therapeutic activities, equipment availability and access to a reliable internet connection are also factors to consider prior to starting telerehabilitation.[32]

When Face-to-Face Care is Required

Telerehabilitation has numerous advantages, but there are children and situations where it is not suitable. Children with unstable medical conditions, acute illness, uncontrolled seizures, severe pain, recent surgery which requires hands on assessment, or where specialised physical examination or orthotic assessment and fitting is necessary will require face to face assessment and treatment.[22][33] Children whose safety cannot be guaranteed in their home environment, or who are not being cared for by their caregivers who could provide the necessary supervision, may need intensive in-person rehabilitation or a hybrid approach of in-person and remote rehabilitation.[27][34] The careful selection of patients can lead to the delivery of safe, effective and individualised telerehabilitation care to each child and family.[35]

Safety Consideration

Available evidence indicates that telerehabilitation is generally safe for children with cerebral palsy when appropriate patient selection, caregiver supervision and environmental safety measures are implemented.[36] Therapists should assess the home environment before initiating treatment, provide clear instructions regarding exercise performance, and ensure that caregivers are available to assist children requiring physical support. Serious adverse events related to telerehabilitation have rarely been reported in the published literature.[37]

Cost-Effectiveness

Telerehabilitation has the potential to reduce healthcare costs by decreasing travel expenses, minimising time away from school and work, and improving access to specialist rehabilitation services. It may also increase treatment adherence by allowing therapy to be integrated into daily routines within the home environment. Although several studies have reported positive economic and practical benefits, further high-quality research is required to establish the long-term cost-effectiveness of telerehabilitation programmes for individuals with cerebral palsy.[38][39][40][41]

Physiotherapy Assessment via Telerehabilitation

A thorough physiotherapy evaluation is an essential part of the telerehabilitation of children with cerebral palsy. The therapists can use secure video conferencing platforms to remotely assess functional abilities, pinpoint impairments and track progress and formulate individualised rehabilitation objectives.[33] While it may not be possible to completely substitute for in-person physical assessment, remote assessment can be used to reliably capture the quality of movement, functional performance and participation of the child in their home environment.[42] Assessment should be done alongside the caretaker as they are a vital part in helping position the child, complete certain tasks and keep the child safe during the assessment.[8]

Gross Motor Assessment

Commonly used gross motor assessment include assessing developing milestones and age-appropriate activities such as rolling, sitting, crawling, standing, walking, negotiating stairs and changes of position.[43] Physical therapists assess how well the movement is done, if it is moving symmetrically, how it is positioned, motor control and the amount of assistance needed to perform functional task.[44] Gross Motor Function Measure (GMFM-66) is a valid, reliable outcome measure that can be interpreted virtually by physical therapist by analysing video recordings and do show acceptable feasibility and reliability in a virtual environment.[45]

Balance Assessment

The balance assessment includes static and dynamic balance. In the video consultations, therapists can watch sitting balance, standing balance, reaching activities, weight shifting, tandem standing and single-leg standing (if applicable).[46] During walking, turning and transitional movements, functional balance can be assessed as well with close supervision to minimise fall risk by the caregiver.[47]

Gait Analysis

Video gait analysis can be utilised to evaluate gait with the help of video camera place by caregiver. [48] The child walks a few metres within the home, with the caregiver positioning the camera to get a view of the child's walking from the front, back and side.[49] Gait speed, cadence, stride length, foot placement and toe walking, crouch gait, limb symmetry, assistive devices and compensatory movement patterns are observed.[50] The video can be played frame-by-frame for more detailed analysis of motion.[51]

Assessment of Functional Mobility and Activities

Functional mobility is measured by ability to move around in the home without assistance. Therapists assess bed mobility, floor mobility, transfers from one surface to another, walking stamina, and stair climbing and wheelchair mobility (if applicable).[51] Remotely administered standardised functional performance tests, such as the Timed Up and Go (TUG) and the Five Times Sit-to-Stand Test (5xSTS) can be used for children who can safely perform these tasks.[52]

Assessment of Postural Control and Functional Transitions

Assessment of sitting and standing skills involves observation of postural alignment, postural control, trunk control, weight distribution, head control and the time spent being able to sit and stand independently.[53] Physical therapists also observe the quality of transitions between sitting, standing and floor positions which also give a lot of information on postural stability and functional independence.[54]

Assessment of Upper Limb Functional Movements and Activities

Functional mobility and activity of the upper limbs is assessed by direct observation of reaching and grasping, releasing, bilateral hand use, and object manipulation and functional activities (such as drawing, feeding or playing).[55] Movement quality, coordination, and range of motion (ROM) and hand preference is measured, while therapists will encourage children to participate in meaningful activities in their home.[56]

Pain Assessment

Assessment of pain should be included in all the sessions of telerehabilitation. Children who are able to communicate can self-report their pain according to age-appropriate pain scales.[57] Caregivers can provide behavioural observations for younger children or children who have communication impairments.[58] Therapists should determine movement and positioning-related pain, use of orthotics, and/or pain with daily activities as these aspects can impact functional performance and participation. [59]

Remote Assessment of Range of Motion

While the direct measurement of the ROM is not feasible remotely, the therapist can make a ballpark estimate of the ROM by visual inspection during active and assisted passive movement.[60] When performing functional movement patterns, they may provide adequate information for performing a clinical evaluation to identify movement limitations, contractures or changes in flexibility that need to be addressed in a face-to-face assessment. [46]

Environmental Assessment in Telerehabilitation

One of the benefits of telerehabilitation is that the home environment can be evaluated. Therapists can pinpoint barriers and facilitators in the environment that impact mobility and participation such as space available, floor surfaces, steps, furniture, lighting, accessibility, positioning equipment and assistive devices. This allows rehabilitation programmes to be individualised to the child's normal environment to facilitate functional activities into the home.[61]

Collaborative Goal Setting and Outcome Measurement

Collaborative goal setting is an integral part of family-centred telerehabilitation. Therapists collaborate with children and caregivers to set personalised, meaningful and attainable rehabilitation goals in relation to the child's priorities and his/her daily living activities.[62] Patient-centred outcomes are typically measured with the Canadian Occupational Performance Measure (COPM) and used to track their progress and the effectiveness of interventions over time with Goal Attainment Scaling (GAS).[63]

Table 1: Outcome measures that could be used in telerehabilitation assessment
Outcome Measure Objective
Gross Motor Function Measure (GMFM-66) Assesses gross motor function in children with cerebral palsy
paediatric Evaluation of Disability Inventory (PEDI) Evaluates functional capabilities, self-care, mobility and social function
Canadian Occupational Performance Measure (COPM) Measures caregiver- and child-identified performance problems and satisfaction with performance
Goal Attainment Scaling (GAS) Quantifies achievement of individualised rehabilitation goals
Timed Up and Go (TUG) Assesses functional mobility and dynamic balance
Five Times Sit-to-Stand Test (5xSTS) Evaluates lower-limb functional strength and transitional mobility

While some interventions have to be evaluated in person, much telerehabilitation intervention can be done remotely by videoconference, digital platforms, home-based exercise programmes, or mobile applications. [64][28]

Physical Therapy Interventions Via Telerehabilitation

Management of Spasticity Via Telerehabilitation

The physiotherapist-led telerehabilitation programme can include multiple neurorehabilitation strategies to control spasticity in paediatric cerebral palsy patients through caregiver-led interventions and ongoing supervision. The Bobath approach or neurodevelopmental techniques in paediatric rehabilitation is designed to reduce abnormal muscle tone and abnormal movement patterns and promote normal postural control, selective movement and functional activities through guided handling, positioning, weight shifting and task-oriented training, with the caregiver instructed to do these activities at home.[65] The use of sensory integration to effect muscle tone is used as a method to diminish spasticity and inhibit techniques, such as prolonged stretching, slow rhythmic rocking, maintained pressure, and prolonged weight-bearing are frequently used to reduce spasticity, while activating techniques, such as facilitatory, are used with caution when weak muscle activity is desired.[66]

Rood approach involves using sensory stimulation techniques to modulate muscle tone, inhibitory techniques (prolonged stretching, slow rhythmic rocking, maintained pressure, warmth, and prolonged weight bearing) are typically employed to decrease spasticity, while facilitatory techniques are used delicately when weak muscles need to be activated.[67] Motor learning and task-oriented methods focus on functional activities (sitting, standing, transfers, walking and reaching) that are practiced repeatedly with a goal in mind in the child's natural home environment to facilitate motor control and functional independence.[68][69]

These approaches should be routinely supervised through videoconferencing to maintain muscle length, reduce secondary complications, improve functional mobility, and encourage long-term participation in daily activities. Together, these approaches enable family-centred, individualised management of spasticity while maintaining continuity of physiotherapy care in the home environment.

Strength Training

For children with CP, progressive strength training is advised to develop muscle strength and functional ability. During the live video sessions, therapists can instruct patients to perform resistance training with their own body weight, resistance bands, ankle weights, household items, or functional activities like repeated sit-to-stand, step-ups, squats, and stair climbing. Therapists observe exercise technique, modify resistance levels and gradually increase levels of intensity as long as exercises are safe and appropriate for the child's ability.[70]

Balance Training

Balance exercises are designed to enhance the stability of the body and prevent falls. Some activities that can be supervised via telerehabilitation are sitting balance, standing balance, weight shifting, reaching tasks, tandem standing, single-leg standing (when appropriate), stepping activities, and dynamic balance games. Caregivers have a key role in assuring safety and physical assistance as needed.[71]

Task Oriented Training

Task-oriented training is important in neurorehabilitation and targets meaningful activities that are directly relevant to the child's life. Therapists can include transfers, floor to stand transitions, indoor walking, negotiating stairs, self-care skills (e.g. dressing, feeding), play, and school-related tasks during the telerehabilitation session.[72] These activities are done in the child's natural home setting for increased carry over into the home setting. [73]

Motor Learning Approaches

Many telerehabilitation programmes use motor learning principles. Therapists will encourage repeated practice of functional tasks, give real-time feedback, change the difficulty, and gradually decrease the level of support to encourage independent motor control. Intensive practice supports motor execution and skill consolidation. Activities like motor coordination, functional performance, adaptive target throwing, toy sorting, and adaptive dressing practice facilitates active involvement of the child and caregiver.[74]

Gait Training

The form of gait training that can be done remotely can involve walking practice in the home, stepping exercises, walk-through obstacles, treadmill training (if available) or endurance walking. Biomechanical video analysis of gait to observe gait patterns will provide accurate feedback and progression of gaits, including stride length, cadence, balance, foot placement and compensatory movement.[75][76][77]

Stretching Exercises

Stretching exercises help keep their joints more mobile and to prevent children with CP developing contractures. Physical therapists demonstrate appropriate positioning and stretching skills via a video consultation and caregivers support with passive or active-assisted stretching as indicated. Daily activities may also incorporate functional positioning to help keep the child flexible.[78]

Home Exercise Programmes

There are essential elements of telerehabilitation such as home exercise programmes. Individual therapists create exercise regimen programmes that incorporate rehabilitation exercises into the child's daily activities. Written instructions, video, mobile apps and reminders can help with adherence, and repeated virtual follow-up sessions can be used to review and progress exercises based on the child's needs.[79][80]

Upper Limb Training

The activities used in telerehabilitation can be successfully utilised for upper limb rehabilitation with activities that improve reaching, grasping, object manipulation, bilateral hand use, coordination exercises and fine motor control. Functional tasks like drawing, building blocks, self-feeding and play activities promote participation and enhance upper extremity function in the context of meaningful tasks.[81]

Constraint-induced Movement Therapy (CIMT)

Constraint-Induced Movement Therapy can be administered remotely under therapist supervision for children who have unilateral cerebral palsy. The less affected upper limb is temporarily immobilised and structured activities promote intensive use of the affected upper limb. Support from caregivers is critical to make sure that exercises are performed safely and following the programme.[82][83]

Bimanual Therapy

Bimanual training involves the training of coordination between both upper limbs in functional tasks. Children are trained to do age-appropriate bilateral tasks with containers, carrying, dressing, catching the ball, putting blocks together and doing household tasks. Active caregiver involvement and adjusting task difficulty can be done remotely by the therapist.[84]

Action Observation Therapy

Action Observation Therapy involves observation of goal-directed movements and immediate action of the task. During telerehabilitation sessions, a video or a live demonstration of certain movements is shown to the child before he or she tries to execute the movement. This could lead to better motor learning and function of the upper limb, by stimulating the mirror neuron system.[85]

Virtual Reality and Exergaming

Virtual reality (VR) and exergaming systems create fun settings that promote overlearning of motor skills.[86] Low-cost VR setups, commercial gaming consoles, and interactive rehabilitation software can be integrated into telerehabilitation protocols to enhance balance, coordination, physio function and physical activity, and increase motivation and adherence to rehabilitation.[87]

Respiratory Physiotherapy

Children with severe cerebral palsy with decreased mobility or respiratory issues may be able to receive respiratory physiotherapy via remote supervision.[88] This can involve breathing exercises, thoracic expansion exercises, airway clearance exercises, active cycle of breathing technique, positioning and education for caregivers to optimise respiratory function. These should be targeted to the clinical presentation and medical status of the child.[89]

Caregiver Education and Coaching

A key component of the successful telerehabilitation is caregiver education. Physiotherapists give instruction in safe handling, positioning, transferring, exercise supervision, orthoses/assistive devices, environmental modification and how to implement therapeutic activities into daily routines. Continuing coaching helps caregivers feel confident in their support of rehabilitation between therapy sessions, maximising adherence and functional outcomes.[90]

Barriers and Facilitators to Telerehabilitation

Barriers

The benefits of telerehabilitation for children with cerebral palsy have increased access to physiotherapy services for many children with CP, but some barriers can impact the potential for successful implementation. Inadequate internet connection, digital devices, and audio-visual issues can make it difficult to use the therapy sessions or accurately assess a patient remotely.[91] Disparities in digital literacy can hinder the use of video conferencing tools, instruction on digital processes, or resolving technical issues.[92] Other factors such as language differences, socioeconomic factors, and the lack of a separate therapy area within the home may limit participation and adherence.[93] If children have severe cognitive, behavioural, visual or hearing impairments, they may need more assistance from a caregiver or may not be appropriate for exclusive telerehabilitation, thus requiring periodic face-to-face assessment.[94]

Facilitators

There are a few facilitators that enhance the effectiveness of telerehabilitation. There is a strong overall association between successful home-based rehabilitation and active participation by the caregiver, who supports the patient in positioning, handling, supervision of this exercise, safety, and the incorporation of the rehabilitation exercise into the patient's daily activities.[95] Accessible technology, secure videoconferencing systems, written and video instructions, reminders, and frequent therapist follow-up increase adherence and engagement.[96] Implementing rehabilitation in a child's natural home environment allows for personalisation of interventions based on child's available home resources, and intervention to address environmental barriers that impact participation and functional mobility.[34] The feasibility and acceptability of telerehabilitation is further increased by flexible scheduling, less travel time and costs, and better access to specialist services for rural or underserved families. Support should be provided to the development of digital infrastructure, digital literacy of caregivers, and access to technology in order to reduce the digital divide and optimise outcomes for children with cerebral palsy from telerehabilitation services.[97]

Conclusion

Telerehabilitation is a safe and effective adjunct to conventional physiotherapy for many children with cerebral palsy when appropriate patient selection, caregiver support and suitable technology are available. There is current evidence for its use in assessment, home exercise programme, motor learning and caregiver education and long term follow-up, especially in the hybrid model of care. While for some children face-to-face assessment and hands-on interventions are necessary, telerehabilitation enhances access to rehabilitation services, the promotion of family-centred practice and continuity of services. Future research should focus on long-term outcomes, cost-effectiveness and strategies to improve equitable access to telerehabilitation.

References

  1. ↑ Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Transl Pediatr. 2020;9(Suppl 1):S125-S135.
  2. ↑ Kuperminc MN, Stevenson RD. Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev. 2008;14(2):137-46.
  3. ↑ Stevenson RD, Conaway MR, Worley G, Stallings VA. Growth of children with cerebral palsy and health outcomes. Pediatrics. 2026 Apr 1;157(4):e2025072504.
  4. ↑ Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatr Dis Treat. 2020;16:1505-1518. doi:10.2147/NDT.S235165.
  5. ↑ Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, Toovey RAM, Greaves S, Thorley M, Novak I. Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Dev Med Child Neurol. 2022;64(5):536-549.
  6. ↑ Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, Cappetta G, Borelli G, Farella GM, Foscan M, Viganò M, Sghedoni S, Perazza S, Sassi S. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Front Neurol. 2023;14:1171224. doi:10.3389/fneur.2023.1171224.
  7. ↑ Maia O, Moreira Gonçalves D, Vilarinho R. Effects of telerehabilitation on gross motor function in children with cerebral palsy: a systematic review. Healthcare (Basel). 2026;14(7):942.
  8. ↑ 8.0 8.1 Salahshoori F, Jangi M, Sadeghi-Demneh E, Fatehi F, Rahimi A. Toward home-based telerehabilitation for cerebral palsy patients: a qualitative study on feasibility, barriers and facilitators. Health Sci Rep. 2025 Aug 18;8(8):e71131. doi:10.1002/hsr2.71131. PMID: 40837718; PMCID: PMC12361637.
  9. ↑ Camden C, Pratte G, Fallon F, Couture M, Berbari J, Tousignant M. Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review. Disabil Rehabil. 2020;42(24):3424-36.
  10. ↑ Nicolas B, Leblong E, Fraudet B, Gallien P, Piette P. Telerehabilitation solutions in patient pathways: An overview of systematic reviews. Digital health. 2024 Nov;10:20552076241294110.
  11. ↑ Beckers LWME, Geijen MME, Kleijnen J, Rameckers EAA, Schnackers MLAP, Smeets RJEM, et al. Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: a systematic review. BMJ Open. 2020;10(10):e035454.
  12. ↑ Sel SA, Günel MK, Erdem S, Tunçdemir M. Effects of telerehabilitation-based structured home program on activity, participation and goal achievement in preschool children with cerebral palsy: a triple-blinded randomized controlled trial. Children (Basel). 2023;10(3):424.
  13. ↑ Celikel R, Ramazanoglu E, Talu B. The effect of motor learning-based telerehabilitation on quality of life of children with cerebral palsy during the COVID-19 pandemic. Arch Pediatr. 2023 Aug;30(6):383-388.
  14. ↑ Gatica-Rojas V, Cartes-Velásquez R, Soto-Poblete A, Lizama LE. Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: protocol for a clinical trial. PLoS One. 2023 Aug 17;18(8):e0268163.
  15. ↑ Calcaterra V, Marin L, Guardamagna L, Gatti A, Rossi V, Patanè P, Vandoni M, Zuccotti G. Home-based telerehabilitation for pediatric neurological motor disorders: Current trends and future perspectives. A systematic review and meta-analysis. Digital Health. 2025 Oct;11:20552076251357504.
  16. ↑ Molinaro A, Micheletti S, Pagani F, Garofalo G, Galli J, Rossi A, Fazzi E, Buccino G. Action Observation Treatment in a tele-rehabilitation setting: a pilot study in children with cerebral palsy. Disabil Rehabil. 2022;44(7):1107-1112.
  17. ↑ dos Santos AN, Schlichting T, da Silva Cardoso P, Longo E, Boyd R, Cicuto Ferreira Rocha NA. Functional physical therapy applied by telerehabilitation or in-person in infants at risk of cerebral palsy: feasibility and preliminary efficacy. Disability and Rehabilitation. 2026 Apr 9:1-4.
  18. ↑ Pagaki-Skaliora M, Morrow E, Theologis T. Telehealth and remote interventions for children with cerebral palsy: scoping review. JMIR Rehabilitation and Assistive Technologies. 2022 Oct 17;9(4):e36842.
  19. ↑ Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy. Archives of physical medicine and rehabilitation. 2010 Jan 1;91(1):1-8.
  20. ↑ Cristinziano M, Assenza C, Antenore C, Pellicciari L, Foti C, Morelli D. Telerehabilitation during COVID-19 lockdown and gross motor function in cerebral palsy: an observational study. European journal of physical and rehabilitation medicine. 2021 Dec 16;58(4):592.
  21. ↑ 21.0 21.1 Tamboosi ME, Al-Khathami SS, El-Shamy SM. The effectiveness of tele-rehabilitation on improvement of daily living activities in children with cerebral palsy: narrative review. Bulletin of Faculty of Physical Therapy. 2021 Dec;26(1):40.
  22. ↑ 22.0 22.1 Lee AC, Deutsch JE, Holdsworth L, Kaplan SL, Kosakowski H, Latz R, McNeary LL, O'Neil J, Ronzio O, Sanders K, Sigmund-Gaines M, Wiley M, Russell T. Telerehabilitation in physical therapist practice: a clinical practice guideline from the American Physical Therapy Association. Phys Ther. 2024;104(5):pzae045.
  23. ↑ Lee AC, Deutsch JE, Holdsworth L, Kaplan SL, Kosakowski H, Latz R, McNeary LL, O'Neil J, Ronzio O, Sanders K, Sigmund-Gaines M, Wiley M, Russell T. Telerehabilitation in physical therapist practice: a clinical practice guideline from the American Physical Therapy Association. Phys Ther. 2024;104(5):pzae045.
  24. ↑ Rabatin AE, Lynch ME, Severson MC, Brandenburg JE, Driscoll SW. Pediatric telerehabilitation medicine: making your virtual visits efficient, effective and fun. J Pediatr Rehabil Med. 2020;13(3):355-70.
  25. ↑ Kringle E, Trammell M, Brown ED, American Congress of Rehabilitation Medicine Stroke International Special Interest Group. Telerehabilitation strategies and resources for rehabilitation professionals. Arch Phys Med Rehabil. 2023;104(12):2191-2197.
  26. ↑ Rabatin AE, Lynch ME, Severson MC, Brandenburg JE, Driscoll SW. Pediatric telerehabilitation medicine: making your virtual visits efficient, effective and fun. J Pediatr Rehabil Med. 2020;13(3):355-370. doi:10.3233/PRM-200748.
  27. ↑ 27.0 27.1 Aarabi MA, Abdi K, Soleimani F. Tele-rehabilitation for children with physical disabilities: qualitative exploration of challenges in Iran. BMC pediatrics. 2025 Jan 7;25(1):11.
  28. ↑ 28.0 28.1 Uzun, N., 2024. Telerehabilitation Methods in Pediatric Rehabilitation. In Telerehabilitation (pp. 109-122). Cham: Springer Nature Switzerland.
  29. ↑ Tkach MM, Earwood JH. Roles caregivers take on in pediatric rehabilitation telehealth services: A scoping review. OTJR: Occupational Therapy Journal of Research. 2025 Oct;45(4):507-18.
  30. ↑ Ogourtsova T, Boychuck Z, O’Donnell M, Ahmed S, Osman G, Majnemer A. Telerehabilitation for children and youth with developmental disabilities and their families: a systematic review. Physical & Occupational Therapy in Pediatrics. 2023 Mar 4;43(2):129-75.
  31. ↑ Tindall LR, Huebner RA. The impact of an application of telerehabilitation technology on caregiver burden. International Journal of Telerehabilitation. 2009 Sep 4;1(1):3.
  32. ↑ Tkach MM, Earwood JH. Roles caregivers take on in pediatric rehabilitation telehealth services: a scoping review. OTJR: Occupation, Participation and Health. 2025;45(4):507-518.
  33. ↑ 33.0 33.1 Anil K, Freeman JA, Buckingham S, Demain S, Gunn H, Jones RB, et al. Scope, context and quality of telerehabilitation guidelines for physical disabilities: a scoping review. BMJ Open. 2021;11(8):e049603.
  34. ↑ 34.0 34.1 Stampa S, Thienel C, Tokgöz P, Razum O, Dockweiler C. Factors Facilitating and Inhibiting the Implementation of Telerehabilitation—A Scoping Review. InHealthcare 2024 Mar 8 (Vol. 12, No. 6, p. 619). MDPI.
  35. ↑ World Health Organization. How to plan and conduct telehealth consultations with children and adolescents and their families. Geneva: World Health Organization; 2021. 39 p. ISBN: 9789240038073.
  36. ↑ Yau T, Chan J, McIntyre M, Bhogal D, Andreoli A, Leochico CFD, Bayley M, Kua A, Guo M, Munce S. Adverse events associated with the delivery of telerehabilitation across rehabilitation populations: a scoping review. PLoS One. 2024;19(11):e0313440.
  37. ↑ Kashif M, Albalwi A, Mehdi Kazmi SA, Alharbi AA, Bashir K, Aqeel Aslam M, Ghaffar T. Role of telerehabilitation in the rehabilitation of children with cerebral palsy during COVID-19: a review. Medicine (Baltimore). 2024;103(9):e37214.
  38. ↑ Grigorovich, A., Xi, M., Lam, N., Pakosh, M., & Chan, B. C. F. (2022). A systematic review of economic analyses of home-based telerehabilitation. Disability and rehabilitation, 44(26), 8188–8200.
  39. ↑ Lang S, McLelland C, MacDonald D, Hamilton DF. Do digital interventions increase adherence to home exercise rehabilitation? A systematic review of randomised controlled trials. Arch Physiother. 2022;12(1):24.
  40. ↑ Del Pino R, Díez-Cirarda M, Ustarroz-Aguirre I, Gonzalez-Larragan S, Caprino M, Busnatu S, Gand K, Schlieter H, Gabilondo I, Gómez-Esteban JC. Costs and effects of telerehabilitation in neurological and cardiological diseases: a systematic review. Front Med (Lausanne). 2022;9:832229.
  41. ↑ Salahshoori F, Jangi M, Sadeghi-Demneh E, Fatehi F, Rahimi A. Toward home-based telerehabilitation for cerebral palsy patients: a qualitative study on feasibility, barriers and facilitators. Health Sci Rep.
  42. ↑ Steinhart S, Gilboa Y, Sinvani RT, Gefen N. Home videos for remote assessment in children with disabilities: a scoping review. Telemed J E Health. 2024;30(6):1629-1648.
  43. ↑ Clutterbuck GL, Auld ML, Johnston LM. High-level motor skills assessment for ambulant children with cerebral palsy: a systematic review and decision tree. Dev Med Child Neurol. 2020;62(6):693-699.
  44. ↑ Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the Gross Motor Function Measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000;80(9):873-885.
  45. ↑ Sel SA, Günel MK, Erdem S, Tunçdemir M. Effects of telerehabilitation-based structured home program on activity, participation and goal achievement in preschool children with cerebral palsy: a triple-blinded randomized controlled trial. Children (Basel). 2023;10(3):424.
  46. ↑ 46.0 46.1 Noutsios CD, Boisvert-Plante V, Laberge E, Perez J, Ingelmo P. The telemedicine-based pediatric examination of the back and lower limbs: a narrative review. J Pain Res. 2021;14:2959-79.
  47. ↑ Zischke C, Simas V, Hing W, Milne N, Spittle A, Pope R. The utility of physiotherapy assessments delivered by telehealth: A systematic review. J Glob Health. 2021 Dec 18;11:04072. doi: 10.7189/jogh.11.04072. PMID: 34956637; PMCID: PMC8684795.
  48. ↑ Aroojis A, Sagade B, Chand S. Usability and reliability of the Edinburgh Visual Gait Score in children with spastic cerebral palsy using smartphone slow-motion video technology and a motion analysis application: a pilot study. Indian J Orthop. 2021;55(4):931-938.
  49. ↑ Noutsios CD, Boisvert-Plante V, Laberge E, Perez J, Ingelmo P. The telemedicine-based pediatric examination of the back and lower limbs: a narrative review. J Pain Res. 2021;14:2959-2979.
  50. ↑ Harvey A, Gorter JW. Video gait analysis for ambulatory children with cerebral palsy: Why, when, where and how!. Gait & posture. 2011 Mar 1;33(3):501-3.
  51. ↑ 51.0 51.1 Pantzar-Castilla E, Balta D, Della Croce U, Cereatti A, Riad J. Feasibility and usefulness of video-based markerless two-dimensional automated gait analysis, in providing objective quantification of gait and complementing the evaluation of gait in children with cerebral palsy. BMC Musculoskelet Disord. 2024;25(1):747.
  52. ↑ Zischke C, Simas V, Hing W, Milne N, Spittle A, Pope R. The utility of physiotherapy assessments delivered by telehealth: a systematic review. J Glob Health. 2021;11:04072.
  53. ↑ Üneş S, Tunçdemir M, Özal C, Delioğlu K, Seyhan Bıyık K, Günel MK. Tele-assessment of trunk control in children with cerebral palsy: intra- and inter-rater reliability, and validity of the Trunk Control Measurement Scale. J Telemed Telecare. 2026;32(3):266-274.
  54. ↑ Üneş S, Tunçdemir M, Özal C, Delioğlu K, Seyhan Bıyık K, Günel MK. Tele-assessment of trunk control in children with cerebral palsy: intra- and inter-rater reliability, and validity of the Trunk Control Measurement Scale. J Telemed Telecare. 2026;32(3):266-74.
  55. ↑ Usman JS, Wong TW, Ng SSM. Effects of telerehabilitation monitored home-based therapies on upper extremity function-related outcomes in children and adolescents with unilateral cerebral palsy: a systematic review. J Telemed Telecare. 2026:1357633X261420104.
  56. ↑ Usman JS, Wong TW, Ng SSM. Effects of telerehabilitation monitored home-based therapies on upper extremity function-related outcomes in children and adolescents with unilateral cerebral palsy: a systematic review. J Telemed Telecare. 2026:1357633X261420104.
  57. ↑ Caravau H, Rosa AF, Rocha NP, Silva AG. Pain assessment in cerebral palsy: a systematic review of measurement properties and evaluation using the COSMIN checklist. Disabil Rehabil. 2022;44(6):910-20.
  58. ↑ McKinnon CT, Meehan EM, Harvey AR, Antolovich GC, Morgan PE. Prevalence and characteristics of pain in children and young adults with cerebral palsy: a systematic review. Dev Med Child Neurol. 2019;61(3):305-14.
  59. ↑ Hadden KL, von Baeyer CL. Global and specific behavioral measures of pain in children with cerebral palsy. Clin J Pain. 2005;21(2):140-6.
  60. ↑ Zischke C, Simas V, Hing W, Milne N, Spittle A, Pope R. The utility of physiotherapy assessments delivered by telehealth: a systematic review. J Glob Health. 2021;11:04072.
  61. ↑ Cason J. Telehealth opportunities in occupational therapy through the Affordable Care Act. The American Journal of Occupational Therapy. 2012;66(2):131-6.
  62. ↑ Krasny-Pacini A, Hiebel J, Pauly F, Godon S, Chevignard M. Goal attainment scaling in rehabilitation: a literature-based update. Annals of physical and rehabilitation medicine. 2013 Apr 1;56(3):212-30.
  63. ↑ Cusick A, Lannin NA, Lowe K. Adapting the Canadian Occupational Performance Measure for use in a paediatric clinical trial. Disability and rehabilitation. 2007 Jan 1;29(10):761-6.
  64. ↑ Salahshoori F, Jangi M, Sadeghi‐demneh E, Fatehi F, Rahimi A. Identification and Prioritization of Requirements for a Home‐Based Tele‐Rehabilitation Information System for Cerebral Palsy Patients: A Delphi Study. Health Science Reports. 2026 May;9(5):e71970.
  65. ↑ Zanon MA, Pacheco RL, Latorraca CD, Martimbianco AL, Pachito DV, Riera R. Neurodevelopmental treatment (Bobath) for children with cerebral palsy: a systematic review. Journal of child neurology. 2019 Oct;34(11):679-86.
  66. ↑ Zanon MA, Pacheco RL, Latorraca C de OC, Martimbianco ALC, Pachito DV, Riera R. Neurodevelopmental treatment (Bobath) for children with cerebral palsy: a systematic review. Journal of Child Neurology. 2019;34(11):679-686.
  67. ↑ Prakash S, Singh JN. Effect of Neuro-Development Treatment with Roods Approach on Posture Control and Balance in Cerebral Palsy Children. International Journal of Convergence in Healthcare. 2024 Jan 31;4(1):40-54.
  68. ↑ Zai W, Xu N, Wu W, Wang Y, Wang R. Effect of task-oriented training on gross motor function, balance and activities of daily living in children with cerebral palsy: a systematic review and meta-analysis. Medicine (Baltimore). 2022;101(44):e31565.
  69. ↑ McLeod KL, Thorley M, Reedman SE, Chatfield MD, Sakzewski L. Effect of active motor learning interventions on gross motor function and mobility in children aged 2 to 6 years with bilateral cerebral palsy: a systematic review and meta-analysis. Pediatr Phys Ther. 2023;35(4):412-428.
  70. ↑ Shilesh K, Karthikbabu S, Rao PT. The impact of functional strength training on muscle strength and mobility in children with spastic cerebral palsy: a systematic review and meta-analysis. Dev Neurorehabil. 2023;26(4):262-277.
  71. ↑ Xiao J, Liu L, Tang N, Yi C. Effects of exercise intervention on balance function in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. BMC Sports Sci Med Rehabil. 2024;16(1):164.
  72. ↑ Salem Y, Godwin EM. Effects of task-oriented training on mobility function in children with cerebral palsy. NeuroRehabilitation. 2009 Jul 7;24(4):307-13.
  73. ↑ Katz-Leurer M, Rotem H, Keren O, Meyer S. The effects of ahome-based'task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury. Clinical Rehabilitation. 2009 Aug;23(8):714-24.
  74. ↑ Foscan M, Luparia A, Molteni F, Bianchi E, Gandelli S, Pagliano E, Fedrizzi E. Development of a play-based motor learning approach (A. MO. GIOCO) in children with bilateral cerebral palsy: theoretical framework and intervention methodology. Children. 2024 Jan 19;11(1):127.
  75. ↑ Wang Y, Tan Y, Zheng X, Wang M, Li H, Zhou X. A scoping review of the application scope of digital technologies in lower limb rehabilitation and balance training for children with cerebral palsy. Frontiers in Pediatrics. 2026 Mar 18;14:1786311.
  76. ↑ Booth AT, Buizer AI, Meyns P, Oude Lansink IL, Steenbrink F, van der Krogt MM. The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology. 2018 Sep;60(9):866-83.
  77. ↑ Aycardi LF, Cifuentes CA, Múnera M, Bayón C, Ramírez O, Lerma S, Frizera A, Rocon E. Evaluation of biomechanical gait parameters of patients with Cerebral Palsy at three different levels of gait assistance using the CPWalker. Journal of neuroengineering and rehabilitation. 2019 Jan 28;16(1):15.
  78. ↑ Barry C, Wood H, Hopewell S, Keene DJ, Rapson R, Ryan JM, Katchburian L, Kwok CW, Ye K, Theologis T. Development and implementation of a child-specific dynamic stretching exercise programme for ambulant children with spastic cerebral palsy: the SPELL trial. Physiotherapy. 2026 Jan 21:101893.
  79. ↑ Sieczkowska SM, Coimbra DR, Smaira FI, Mazzolani BC, Paticcié G, Astley C, Iraha A, Roschel H, Peçanha T, Gualano B. Effectiveness and feasibility of home-based physical exercise interventions for children and adolescents with chronic diseases: a systematic review and meta-analysis. British Journal of Sports Medicine. 2026 May 22.
  80. ↑ Lirio-Romero C, Feys H, López-Muñoz P, Boyd RN, Coello-Villalón M, Romay-Barrero H, Basco-López JÁ, Sgandurra G, Beani E, Palomo-Carrión R. Home-based therapy for upper limb activity in children and adolescents with unilateral cerebral palsy: systematic review and meta-analysis. Disability and Rehabilitation. 2026 May 8:1-4.
  81. ↑ Karabulut DG, Maden Ç, Karabulut Y, Aslan M. Effects of video-based exercises and conventional physiotherapy on upper extremity functionality, selective motor control, and proprioception in unilateral cerebral palsy: a randomized controlled trial. Games Health J. 2024;13(4):259-268.
  82. ↑ Svensson K, Sundelin H, Eliasson AC. Outcomes of a parent-delivered Baby-modified Constraint-Induced Movement Therapy model for infants at high risk of unilateral cerebral palsy using remote coaching in telerehabilitation. Children (Basel). 2024;11(1):101.
  83. ↑ Reidy TG, Andrejow NW, Naber E, Carney J. Hybrid Telehealth Pediatric Constraint Induced Movement Therapy Compared to In-person Intervention: A Case Series. Int J Telerehabil. 2023;15(2):e6567.
  84. ↑ Jagriti M, Sharma P, Bansal A, Choudhary A, Himani K. Comparative Evaluation of Hand-Arm Bimanual Intensive Therapy and Mental Imagery in Cerebral Palsy: A Study of Efficacy in ClinicBased and Telerehabilitation Settings. Journal of Health & Allied Sciences NU. 2025 Oct 1;15(4).
  85. ↑ Fierro-Marrero J, Cabrera-López CD, Rodríguez de Rivera-Romero B, López-Mejías A, Ochandorena-Acha M, Lerma-Lara S, La Touche R. Action Observation for Children and Adolescents with Cerebral Palsy: Hope or Hype? A Systematic Review with Meta-Analysis. Children. 2025 Jun 20;12(7):810.
  86. ↑ Kumar N, Kataria C, Sankhyan N, Saini L, Mehta A. Efficacy analysis of psychomotor impairment using virtual reality-based exergames for rehabilitation of congenital hemiplegic cerebral palsy children. Virtual Reality. 2025 May 12;29(2):81.
  87. ↑ Stevenson J, Martin SE, English MG, Pawliuk C, Robillard JM. Gaming Technology in Pediatric Cerebral Palsy and Related Neuromuscular Conditions: A Scoping Review. NeuroRehabilitation. 2026 May 28:10538135261445647.
  88. ↑ Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and management of respiratory illness in children with cerebral palsy. Front Pediatr. 2020;8:333.
  89. ↑ de Lima Crispim TR, Neto MG, Crispim TRL, Dias RB, de Albuquerque MDM, Saquetto MB, Magalhães PAF. Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis. World J Pediatr. 2023;19(4):340-355.
  90. ↑ Poojari DP, Umakanth S, Maiya GA, Rao BK, Khurana S, Kumaran DS, Attal R, Brien M. Effect of family-centered care interventions on well-being of caregivers of children with cerebral palsy: a systematic review. F1000Research. 2024;12:790.
  91. ↑ Zischke C, Simas V, Hing W, Milne N, Spittle A, Pope R. The utility of physiotherapy assessments delivered by telehealth: A systematic review. Journal of global health. 2021 Dec 18;11:04072.
  92. ↑ Padmavathi J, Gandhi S, Siva Kumar T. Systematic review on end-users’ perception of facilitators and barriers in accessing tele-rehabilitation services. Journal of psychosocial rehabilitation and mental health. 2023 Sep;10(3):377-88.
  93. ↑ Sia LL, Sharma S, Ing JB, Kumar S, Singh DK. Physiotherapists’ perceptions, readiness, enablers, and barriers to use telerehabilitation: A scoping review. Journal of Back and Musculoskeletal Rehabilitation. 2024 Nov;37(6):1441-54.
  94. ↑ Edirippulige S, Reyno J, Armfield NR, Bambling M, Lloyd O, McNevin E. Availability, spatial accessibility, utilisation and the role of telehealth for multi-disciplinary paediatric cerebral palsy services in Queensland. Journal of Telemedicine and Telecare. 2016 Oct;22(7):391-6.
  95. ↑ Salahshoori F, Jangi M, Sadeghi-Demneh E, Fatehi F, Rahimi A. Toward home-based telerehabilitation for cerebral palsy patients: a qualitative study on feasibility, barriers and facilitators. Health Sci Rep. 2025;8(8):e71131. PMID: 40837718; PMCID: PMC12361637.
  96. ↑ Stark AL, Krayter S, Dockweiler C. Competencies required by patients and health professionals regarding telerehabilitation: A scoping review. Digital Health. 2023 Dec;9:20552076231218841.
  97. ↑ O’Neil ME, Gannotti ME, Winterbottom L, Byrnes J, Russo J, DeMartini N, Shatsky N, Bellissimo E, Spinner M, Kim H. A Tele-Rehabilitation Home Exercise Program for Ambulatory Adults with Cerebral Palsy: A Feasibility Study. Physical & Occupational Therapy In Pediatrics. 2026 Jan 2;46(1):30-50.
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