IMPORTANCECerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEWThe literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument.FINDINGS Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5).CONCLUSIONS AND RELEVANCE When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.

This study evaluates kinematic movements of the jaw and lips in six children (3-11 years) with moderate-to-severe speech impairment associated with cerebral palsy before, during, and after participation in a motor-speech (PROMPT) intervention program. An ABCA single subject research design was implemented. Subsequent to the baseline phase (A), phase B targeted each participant's first intervention priority on the PROMPT motor-speech hierarchy. Phase C then targeted one level higher. A reference group of 12 typically-developing peers, age- and sex-matched to each participant with CP, was recruited for comparison in the interpretation of the kinematic data. Jaw and lip measurements of distance, velocity, and duration, during the production of 11 untrained stimulus words, were obtained at the end of each study phase using 3D motion analysis (Vicon Motus 9.1). All participants showed significant changes in specific movement characteristics of the jaw and lips. Kinematic changes were associated with significant positive changes to speech intelligibility in five of the six participants. This study makes a contribution to providing evidence that supports the use of a treatment approach aligned with dynamic systems theory to improve the motor-speech movement patterns and speech intelligibility in children with cerebral palsy.

This paper presents findings of a study of high school students participating in a tablet PC (TPC) programme. Primary areas of interest were students' experiences with and attitudes about the TPCs, physical discomfort associated with use of TPCs and temporal and task-driven patterns of TPC use. Data were collected via questionnaire and computer use-monitoring software. Results showed students' attitudes were generally quite positive towards the TPCs, although they did not tend to think TPCs had improved their grades, few disagreed that TPCs were a distraction in class, and visual and musculoskeletal discomfort was prevalent. Understanding how to use the TPC and recognizing its organizational capacity were associated with several positive attitudes towards the TPC, including making school more enjoyable. Children's exposure to computers will only increase, so study of the many dimensions of their impact is critical in order to understand what is effective, constructive and healthful for children.

Parent educat*.mp Parent train*.mp Parent-implement*.mp Occupational performance.mp (OT) Adult train*.mp Participat*.mp Collaborat*.mp Self-reflect*.mp Learner acquisition.mp Participat*.mp Practice characteristics.mp Self discover*.mp Competenc*.mp Self efficacy.mp Capacity Build*.mp (OT) Child Limit to: Birth-5 years Mentor*.mp Parent-Mediated.mp Family Support.mp Early Childhood Intervention.mp Family Cent*red.mp SupplementalTable 2: Description of Coaching Components Reported in Individual Details Coaching Components Reported to form the Intervention Author Year Program Coaching Definition joint planning Observation /demonstration (teaching) Action/Practice Reflection Feedback Clawson et al. (45)