Background: Rehabilitation following an acquired brain injury (ABI) supports recovery, adaptation, and participation in daily life. While benefits of early rehabilitation are well established, less is known about the experience of returning for a second phase after a period of stabilisation at home. This stage often provides new insights into the child’s abilities, challenges, and priorities. Exploring both child and family perspectives offers valuable understanding of motivation, readiness, and engagement in the later stages of recovery.

Methods: This reflective case study presents the lived experience of a 14-year-old boy, Leo, who returned for a second phase of inpatient rehabilitation following ABI. Leo identified his goals using the F-words framework for both rehabilitation phases (12-weeks per phase), supporting a holistic and child-centred approach. Qualitative information was gathered through observation, informal discussion, and family feedback. Key themes explored included motivation; goal setting; influence of home experiences on therapy engagement; readiness for further rehabilitation.

Results: Leo’s second inpatient rehabilitation stay demonstrated greater overall impact compared to his first admission. He displayed stronger motivation and ownership of his goals, supported by familiarity with the rehabilitation environment and team. Family reported increased confidence and understanding of how to support therapy at home. This shared readiness contributed to more focused sessions, improved functional carryover, and deeper emotional engagement.

Conclusions: Leo’s experience highlights how second-phase rehabilitation can provide renewed motivation, clearer goal direction, and meaningful progress for both child and family. Recognising this shift in readiness enables professionals to deliver individualised, family-centred, and sustainable rehabilitation following ABI.

Effective management of upper limb hypertonia (spasticity and dystonia) in children and young people (CYP) with acquired brain injury (ABI) often requires combining pharmacological treatment with physical therapy. Botulinum toxin type A (BoNT-A) is widely used to reduce focal hypertonia; however, sustaining improvements in range of movement (ROM) can be difficult without adjunctive interventions. This pilot study explored the feasibility and outcomes of serial elbow casting following BoNT-A injections in CYP with upper limb flexor hypertonia secondary to ABI.

Five CYP (mean age 14.6 years) with ABI received BoNT-A injections targeting the elbow flexors. Three received injections to the biceps brachii and brachioradialis, while two received injections to the biceps brachii only. Serial casting began within 14 days post-injection and continued for six weeks, with casts changed every 24–48 hours to gradually increase elbow extension. Outcome measures including, passive and active elbow ROM and family-reported measures were recorded before and after casting.

Participants demonstrated notable improvements in passive elbow extension ROM, with mean gains of 45°. Caregivers reported enhanced ease of daily care and hygiene tasks. No adverse events occurred.

These findings suggest that serial casting following BoNT-A is a feasible, safe and effective adjunct to support prevention of contractures, improve positioning, facilitate functional gains and optimise comfort in CYP with upper limb hypertonia following ABI. Further research with larger samples is warranted to validate outcomes and guide clinical practice.

Children with unilateral cerebral palsy (CP) have upper limb (UL) impairments that limit daily activities and participation. While videogames have gained attention as engaging tools for UL rehabilitation, their use as assessment instruments remains limited. This study aimed to develop a dedicated serious game capable of providing accurate and objective evaluation of UL impairments, and to examine its feasibility in clinical practice.

An instrumented serious game, Play2BEAPI, was created through a multidisciplinary consensus involving engineers, game designer, motion analysis specialists, and clinician. The game consists of seven targeted tasks embedded within an airplane pilot training scenario. Each task was designed to specifically assess joint movements or functional movements (e.g. hand-to-head) and the use of both hands. UL movements were recorded using a 3D motion analysis system, while the cockpit used for the gameplay was also instrumented. After completing the game, all participants filled out three questionnaires: Short Feedback Questionnaire (SFQ), User Satisfaction Evaluation Questionnaire (USEQ), and the System Usability Scale (SUS).

Data from 21 children aged 5–13 years (mean age = 9.3), including 10 with CP and 11 typically developing children, were analyzed. Twelve participants were boys and fifteen were right-handed. Mean questionnaire scores were: SFQ (25.8±3.2/30), USEQ (19.9±3.0/30), and SUS (82.1±11.0/100). The mean game duration was 40.4±5.1 minutes.

These preliminary findings indicate that Play2BEAPI is well-tolerated, enjoyable, and feasible for clinical use. The results emphasize the value of an engaging environment, particularly in children undergoing repeated evaluations. Further analyses will focus on the objective measures collected during gameplay.

Introduction: Translating research into practice is complex and challenging. Exploring the acceptability, feasibility and appropriateness of an evidence-informed model with those who will implement it is fundamental. This study aimed to explore professionals’ understanding of the Stages2Engage model, to support relationship development in disability teams, and to identify what would support its application in practice.
Participants and Methods: This study involved two qualitative phases. The first phase included 51 health and social professionals who completed a qualitative survey during a workshop, which focused on understanding and exploring meaningful engagement and relationship building between professionals and families. The second phase involved 13 health and social professionals who took part in three interviews and two focus groups six months after the workshop. Data were analysed using content analysis and thematic analysis.
Results: The views were that the model did provide a framework for engagement with families, an opportunity for reflection on relationships and helped identify the stages of the journey in collaborative working with families. However, the professionals identified the need for more guidance to implement the model, more time to plan and reflect as a team and more resources. The study provides evidence from professionals that training needs to be deliberate, the local context matters, and the uniqueness of each context is important.
Conclusion: This study adds to our knowledge about the acceptability, feasibility and appropriateness of a theoretical model and that it requires adaptation to support implementation.

Introduction: Early intervention philosophy is in line with upholding children’s participation rights and therefore it is important to discuss how voice of young children is included in the early intervention context. However, there is very little research exploring the perspectives of young children with disabilities.
Participants & Methods: Fourteen preschool children with developmental disabilities were involved in qualitative case studies. A variety of data collection tools were used, for example, auto photography, observations and interviews, to explore the experiences of the preschool children engaging and participating in interventions with health and social care professionals. Observations of the children in an intervention and in the home and the use of multiple data collection tools allowed for the exploration of participation in multiple contexts.
Results: Children’s personal preferences, abilities and learning style affected when and how they took part in activities. They were more engaged with toys and activities that they chose and with activities involving movement. In terms of the context, the individuals who interacted with the children as well as the techniques and strategies they used within activities also affected participation.

Conclusions: This research extends the discourse that we must acknowledge a child’s perspective in order to create new priorities for everyone involved and allow interventions to be both functional and inclusive.

Introduction:
Engaging families and patients in the research process fosters meaningful and culturally relevant collaboration, and evaluating engagement is essential to ensure authentic participation and prevent tokenism. This presentation describes how engagement was documented and evaluated during the participatory validation and cultural adaptation of the Brazilian version of the Family Engagement in Research Course.

Participants and Methods:
Four researchers and four family members were invited based on pre-existing collaborations. The process included prior reading of materials, definition of priorities, and three online meetings focused on conceptual review, terminology discussion, and consensus on cultural equivalence. Meetings were transcribed in real time using artificial intelligence tools to support analysis accuracy. The Involvement Matrix (IM) was used to identify participants’ roles, and the Patient and Public Engagement Evaluation Tool (PPEET) was applied to assess the engagement experience.

Results:
The IM revealed diverse roles and engagement levels, with participants acting mainly as co-thinkers and advisors, and one participant as a decision-maker. All participants actively contributed to revising terms and ensuring cultural alignment. PPEET responses were predominantly between “agree” and “strongly agree”, reflecting positive perceptions of clarity, support, and opportunities for contribution. Open-ended feedback emphasized clear communication, organization, and diversity of perspectives as strengths, with limited reading time noted for improvement.

Conclusion:
The participatory validation and adaptation process was feasible and well-received, fostering constructive exchanges between families and researchers. Documentation engagement through structured tools contributes to good practices in public involvement and reinforces the importance of clear and reflective reporting to avoid tokenism.

Introduction: Although Family Engagement in Research (FER) is internationally recognized as an essential approach, structured initiatives remain scarce in Brazil. The FER-BRAZIL represents the first Brazilian adaptation of the Canadian program, designed to share knowledge and build capacity to involve families across all stages of child health research. This presentation describes the sociodemographic profile of individuals interested in its first cohort, offering insights to advance research and practice in family engagement.

Participants and Methods: Individuals who expressed interest in the first FER-BRAZIL cohort completed an online form including sociodemographic and professional information. Recruitment occurred mainly through social media, particularly Instagram, between August 6 and August 20, 2025. Data were summarized using descriptive statistics for quality improvement purposes.

Results: The call for applications received 114 submissions from 20 of Brazil’s 27 states, including the Federal District. Applicants included family members (n = 18; 15.8%), students and professionals (n = 58; 50.9%), and researchers (n = 38; 33.3%). Most participants were female (87.7%), held a master’s degree (30.7%) or postgraduate specialization (23.7%), and identified as White (58.8%) or Mixed race (30.7%). Only seven applicants (6%), all researchers, reported any prior training related to engagement in research, mainly short online workshops.

Conclusion: The profile reveals regional and professional diversity and limited access to formal training, even among researchers, contributing to global discussions on culturally adapted approaches to family engagement in research and reinforcing the need to expand training opportunities in this field.

Introduction:
Cerebral palsy (CP) is the leading cause of childhood-onset disability, and many children develop fixed muscle contractures requiring orthopedic procedures with limited long-term benefit. The biological reasons CP muscle fails to grow and adapt remain unclear. This study examined whether muscle resident stem cells (MuSCs) show premature ageing and metabolic stress that may impair muscle development in CP.

Patients and Methods:
Muscle biopsies were collected during contracture surgery from children with spastic CP and typically developing (TD) peers. Isolated and cultured MuSC-derived myoblasts were assessed for gene expression (RNA sequencing), ageing markers (proliferation, telomere length), targeted metabolomics (HPLC-MS/MS), and cellular bioenergetics (Seahorse ATP-rate assays).

Results:
At early cell culture passages, CP myoblasts proliferated faster than TD (22.6±1.9 h vs. 32.9±2.0 h) and had shorter telomeres (11.52±0.55 vs. 14.58±0.69 RTL). With serial passaging to recapitulate ageing, TD telomeres shortened, whereas CP telomeres remained short but stable (12.62±0.59 vs. 12.28±0.59 RTL). RNA sequencing showed upregulation of DNA repair and telomere-related genes (WRN, FANCM, SMC5/6), indicating a response to preserve telomere stability in CP. Metabolomics revealed differences between CP and TD cells. With passaging, CP cells showed greater glycolytic reliance and minimal increase in mitochondrial respiration, while TD cells exhibited expected 3–5-fold increases in OCR and ECAR. Collectively, these data indicate a prematurely aged, metabolically constrained progenitor population in CP muscle.

Conclusions:
CP MuSCs show premature ageing and impaired metabolic adaptability that may contribute to contracture formation.

Relevance:
Restoring MuSC health could improve long-term rehabilitation and surgical outcomes in children with CP.

Introduction: Shared decision making (SDM) in health care teams involves partnering with the patient and family to consider treatment options, prioritizing their values and preferences while collaboratively determining the best care plan. Previous research on SDM in rural South India has only focused on adult populations receiving in-person care. This study aimed to understand parent perception of the SDM approach implemented in telerehabilitation services offered by Amar Seva Sangam, Ayikudy to children with disabilities in a rural Southern Indian setting.
Methods: A concurrent triangulation (convergent) mixed-methods design was utilized. Quantitative data was collected from 187 participants using a SDM measure examining parents’ perceptions of whether SDM was implemented. Additional qualitative data was gathered from through 3 virtual focus groups. Results: Most participants (71.7%) reported engaging in SDM, a finding also shared by parents in the focus groups. Thematic analysis of focus group responses revealed four themes: intentionally positioning the parent as an expert within the care team, building capacity and transferring knowledge, enhancing participation through in-person community resource worker support, and valuing the family context in making decisions. Additionally, parents requested more treatment sessions to address their children’s needs.
Conclusions: This study enhances understanding of parent engagement in the SDM process with the team providing telerehabilitation services. These insights may guide virtual service provision in other settings..

Introduction:
Functional mobility is often affected following acquired brain injury (ABI) in childhood and may limit community participation. The F-Words Life Wheel (FWLW) was implemented in a paediatric neurorehabilitation setting to support collaborative goal setting and measure satisfaction with progress. The Gross Motor Function Measure-88 (GMFM-88) is used to assess changes in motor function. This study explored whether improvements in motor function directly correlated with children and their families’ satisfaction with their progress toward mobility goals.

Methods:
The FWLW was used with all children over one year to set rehabilitation goals. A Clinical Specialist Physiotherapist analysed 308 goals from 46 children to identify which were mobility related. The GMFM-88 was administered, where appropriate, to assess changes in functional mobility.

Results:
56 mobility-related goals were identified; each child had at least one. 19 children had admission and discharge GMFM-88 scores (mean age=10.4 years, range 3.4–17.9). Children had 21 FWLW goals. Satisfaction with mobility goals improved by 137.8% from admission to discharge (mean change =4.3, range 0–9). Mean GMFM improvement =12.0% (range 1.1–46.0%). No significant correlation was found between increased GMFM scores and improved satisfaction with progress toward mobility goals.

Conclusions:
Mobility was a universal priority post-ABI, with goals spanning all F-Word domains. To definitively determine the extent to which functional gains correlate with satisfaction with progress, larger sample sizes are needed. Many mobility goals focused on participation, which is not captured by the GMFM-88, and therefore it should be considered that a participation-based outcome measure may better correlate with goal satisfaction.

Introduction: CanChild’s F-words aid goal setting and promote patient-centred outcomes. We aimed to trial the F-words to support transition in Osteogenesis Imperfecta (OI).

Participants and Methods: Young people (YP) completed the F-words Goal Sheet and a Transition Key Question (KQ) at their final appointment in the Paediatric OI Clinic: “If you were meeting your OI Transition team for the first time, what information about you would you like them to know?” These were used to support transition appointments in the multidisciplinary OI Transition Clinic from April 2024-October 2025. Transition Team Clinicians/6 YP completed feedback questionnaires.

Results: The F-words/KQ supported transition appointments for 12 YP (58% male), aged 16-18 years. 15 clinicians responded: 60% medics; 16% clinical nurse specialists; 24% physiotherapists. 84% of clinicians found the F-words helpful to support transition, since establishing rapport with the YP was easier (75%), they could adopt a more holistic approach (64%), the consultation was more personalised (52%), and they could discuss YP’s individual goals (52%). 96% of clinicians would be happy to use the F-words in future transition appointments; 84% would recommend them to other clinicians involved in transition. 83% of YP found it helpful that the OI Transition Team had access to their F-words to support transition, and 83% would recommend them to other YP transferring to the Transition Clinic.

Conclusion: Healthcare transition in OI can provoke anxiety for YP and their families. The F-words and Transition KQ are helpful to ensure a tailored, positive transition experience which focuses on YP’s participation.

Introduction
The Canadian Occupational Performance Measure (COPM) is increasingly used to capture client-centered goals and outcomes in pediatric rehabilitation. However, data regarding its use in very young children (aged 0–4 years) remains limited. In a large rehabilitation organization with different locations in the Netherlands, we examined whether applying the COPM within the 0–4-year-old population provides meaningful insight into changes in performance and satisfaction during rehabilitation. The main research question was: Does the use of the COPM contributes to relevant improvement of meaningful activities that, in the context of the individual patient, are most important to the parents.
Participants and Methods
Of a total of 159 children (0–4 years), who receiving multidisciplinary rehabilitation, the COPM was administered at the start of treatment and periodically during the rehabilitation process, with parents or caregivers serving as respondents. Changes in performance and satisfaction scores were analyzed.
Results
All children showed improvements in both performance and satisfaction scores. Parents reported that the COPM supported collaborative goal setting and enhanced awareness of their child’s progress throughout the rehabilitation process. Consistent improvements in both domains were observed across all four participating locations.
Conclusion (interpretation and perspectives)
During rehabilitation, both performance and satisfaction improved within the 0–4-year-old population. The COPM thus provides meaningful, individualized outcome data and contributes to value-based health care by monitoring and goal setting in pediatric rehabilitation. Further research into specific subgroups, in close collaboration with Rehabilitation Impact, is recommended to deepen understanding and optimize client-centered pediatric rehabilitation.

Introduction: Skeletal muscle growth in children with CP are impaired. We investigated 1) if peripheral nuclear and central nuclear abundance in myofibers are different across muscles of children with CP, and TD children following ACL-tear, 2) if MuSC (muscle stem cells) and macrophage (immune cells) abundance are associated with central nuclei, suggestive of ongoing repair, or peripheral nuclei, suggestive of muscle growth.
Patients and Methods: Thirty-six subjects participated in this study (CP: 11.2 ±0.7, 18M/10F, TD: 13.5 ±0.8, 3M/3F, 14 GMFCS I-III, 16 GMFCS IV-V ). Muscle biopsies were obtained from adductors, gastrocnemius, vastus lateralis during surgery. Myofiber-associated nuclei, MuSC and macrophages were identified by immunohistochemistry. Automated segmentation and quantification of peripheral and central nuclei were performed using MuscleJ software.
Results: Myofibers with central nuclei were higher in the CP adductor contractures than CP VL (15.4 ± 1.7% vs. 10.7 ± 1.3, p<0.05), although CP VL was similar to those with ACL-injury, which undergoes robust repair after injury. Within CP muscle there were positive associations between MuSC and central nuclei (r=0.42, p<0.05) as well as peripheral nuclei (r=0.33, p=0.067), and between macrophages and peripheral nuclei in fibers (r=0.41, p<0.05)
Conclusion: Muscles in children with CP show numerous centralized myonuclei, similar to those with ACL-injury, indicative of muscle repair. MuSC also show linear associations with central nuclei, the canonical marker for repair. MuSC and macrophages show associations with peripheral nuclei in myofibers, potentially suggesting ongoing growth by addition of myonuclei as well as repair.

Introduction
Muscles are the primary drivers of movement and can change depending on their use. For instance, children with cerebral palsy have smaller muscle sizes. However, it remains unclear whether muscle growth is associated with the onset of independent weight-bearing locomotion. This study explored muscle morphology in typically developing infants with different locomotor behaviors.

Participants and methods
This prospective pilot study included 14 typically developing infants around age 12 months. Medial gastrocnemius muscle morphology was assessed using 3D ultrasound. Muscle volume (mL) and muscle belly length (mm) were quantified. Between-group comparisons were performed using unpaired t-test with Welch’s correction (p<0.05).

Results
Eight infants were walking independently (W) (12.0 months ± 0.3, walking experience of max. 2 months), while 6 infants were not yet walking independently but could stand with support (NW) (12.2 mo ± 0.5). Body length and weight were comparable between groups. Mean muscle volume and belly length did not differ significantly (W: 7.5 ± 1.1 mL vs. NW: 7.8 ± 2.8 mL, p=0.79; W: 65.4 mm ± 5.6 vs. NW: 69.5 mm ± 9.1, p=0.31). Muscle volume variance was significantly higher in the NW-group (F= 6.989, p=0.048).

Conclusion
This pilot study suggests no differences in muscle growth related to locomotor behavior in typical development. The greater variance observed in non-walkers warrants further investigation in larger cohorts. To deepen understanding of muscle–movement interactions, future studies could incorporate muscle synergy analysis. Expanding normative datasets may provide valuable insights into altered muscle development in infants with (high-risk for) neuromotor disabilities.