Aim: To define the longitudinal trajectory of gastrocnemius muscle growth in 6- to 36-month-old children with and without spastic cerebral palsy (SCP) and to compare trajectories by levels of gross motor function (Gross Motor Function Classification System, GMFCS) and presumed brain-lesion timing.

Method: Twenty typically developing children and 24 children with SCP (GMFCS levels I-II/III-IV = 15/9), were included (28/16 females/males; mean age at first scan 15.4 months [standard deviation 4.93, range 6.24-23.8]). Three-dimensional freehand ultrasound was used to repeatedly assess muscle volume, length, and cross-sectional area (CSA), resulting in 138 assessments (mean interval 7.9 months). Brain lesion timing was evaluated with magnetic resonance imaging classification. Linear mixed-effects models defined growth rates, adjusted for GMFCS levels and presumed brain-lesion timing.

Results: At age 12 months, children with SCP showed smaller morphological muscle size than typically developing children (5.8 mL vs 9.8 mL, p < 0.001), while subsequently no differences in muscle growth were found between children with and without SCP (muscle volume: 0.65 mL/month vs 0.74 mL/month). However, muscle volume and CSA growth rates were lower in children classified in GMFCS levels III and IV than typically developing children and those classified in GMFCS levels I and II, with differences ranging from -56% to -70% (p < 0.001).

Interpretation: Muscle growth is already hampered during infancy in SCP. Muscle size growth further reduces with decreasing functional levels, independently from the brain lesion. Early monitoring of muscle growth combined with early intervention is needed.

Are we focusing too much on body structures and functions? Should participation and the F-words—Fun, Family, Friends, Fitness, Function, and Future—be leading the way?

Dr. Ginny Paleg is a pediatric physiotherapist specializing in children with severe motor impairments, particularly those at GMFCS Levels IV and V. She holds a Master’s in Physical Therapy from Emory University and a Doctorate from the University of Maryland Baltimore.

Certified in the Prechtl GMA and HINE, Dr. Paleg integrates evidence-based tools with coaching and routines-based interventions. With over 60 peer-reviewed publications, her research spans standers, supported stepping, and power mobility for children with complex needs. She is the lead author of the AACPDM Hypotonia Care Pathway and serves on the AACPDM Care Pathway Council, having held key roles in both AACPDM and the EACD.

If you’ve ever found yourself in a heated Facebook thread or a passionate discussion with colleagues about what really matters in pediatric therapy, you’re not alone. Dr. Ginny Paleg moderates some of these spaces, and what’s always clear is that therapists deeply care—they want children to thrive. But the differences in approach can be striking.

Today, we’re diving into the heart of this tension through the lens of the ICF-CY framework. It’s a big conversation, and one we think is absolutely worth having.

Interrupting normal broadcasting for a quick announcement! The ResearchWorks team are heading to Heidelberg Germany in a few weeks time to interview guests from across Europe and around the globe!

From video-casts to audio-casts, it will be a full integration into the conference and we're excited to bring you all the latest in research from Heidelberg - with dozens of interviews!

We still have a number of episodes pre-conference to release with dozens more lined up for the months of June/July!

Also - stay tuned for an extra special announcement - it will be worth the wait, we promise!