DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY
Foreword This special issue includes a group of short articles based on the lectures presented at a symposium in Paris in November 2013, as the conclusion of the work of an international scientific group and a pilot research study, both around Perception, Action, Cognition, Environment (PACE) in cerebral palsy (CP). La Fondation Motrice, a French organization comprising parents and experts, devoted to research into CP, promoted the scientific group and the pilot study. Alain Chatelin and Lucie Hertz-Pannier describe in more detail in the other part of this foreword the history of the project, its main actors, and initiatives. The main concepts of PACE include and expand the updated definition (and classification) that describes CP ‘as a group of disorders of the development of movement and posture. . . often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.’1 For the first time, the association with ‘not primarily motor’ disorders such as cognition, communication, perception, and others has been mentioned in the definition, pointing out that these ‘accompanying’ disorders are strongly linked to motor disorders and might be the major cause of activity limitation for people with CP. The recent excellent book edited by Dan et al.2 acknowledges this concept and largely covers cognition and all the other non-motor aspects of CP. These disorders are reported as very frequent in people with CP (see Novak et al.3). However, not having homogeneous definitions, they lack dedicated and specific assessment tools, and precise data on the total incidence and distribution in the subtypes of CP (for visual perceptual disorders see Ego et al., this issue). People with CP were interviewed by La Fondation Motrice, with the aim of identifying the most relevant topics to be selected for the research supported by the association. Perception and cognition were identified as key factors that account for their disabilities making their study worthwhile. The opinion of stakeholders has a correspondence with new models of motor control and learning in typical development, and in various neurological disorders, based on strong interaction with cognitive, perceptual, and emotional functions. The PACE approach indicates that perception, action, cognition, and interaction with the environment should not be seen as separate ‘functions’, to be isolated and analysed in uni-modular, poorly ecological experimental conditions. Although such a traditional way of focusing on the possible dissociations of each function from the others has proved effective in many respects, it does not address some key questions emerging from clinical and daily-life settings. In the past decade, new discoveries and models in neuroscience have led most researchers to consider these aspects of brain functioning as deeply blended and to some extent co-emerging throughout development. A paradigm shift from isolated, modular functions to functional integration has taken place. This, in turn, now challenges our mission as basic and clinical researchers, health professionals, and care-givers, in that we are confronted with a complex, multi-faceted, and highly interconnected brain, whose disturbances cannot be fully understood or treated, except in a complex, multi-faceted, and integrated way. New research protocols are thus needed, acting in an integrative perspective, in addition to more traditional research addressing specifically isolated functions independently from one another. The papers included in this issue highlight some of the theoretical background of the PACE approach as well as reviews of its translation into new diagnostic and rehabilitation studies, for CP and other neurodevelopmental disorders. In this issue, Alain Berthoz and M Zaoui report examples of brain perceptual and cognitive systems, such as spatial memory and executive functions, that are involved in children’s ‘navigation’ in their environment to fulfil their adaptive needs. Children with CP may suffer several disorders in these abilities, as hypothesized in the paper, with possible pathophysiological profiles that may potentially lead to tailored remediation approaches. To test these and other challenging hypotheses, we need to develop tools to explore these cognitive functions in action. Some of these tests are described in this issue, such as the ‘magic carpet’, a test derived from the Corsi Block-Tapping Task, to analyse spatial memory and representations during navigation, whereas available tests to investigate manual action in infancy are reviewed in another paper (Krumlinde-Sundholm et al.). As indicated by Dan et al., although the main focus of the PACE research group has been on CP, this approach can also be useful for other disorders that, at the symptom level, seem to share similar behavioural and diagnostic criteria. In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition4 a new cluster of neurodevelopmental disorders is proposed, which includes six categories: intellectual developmental disorders, communication disorders, autism spectrum disorders, attention-deficit–hyperactivity disorder (ADHD), learning disorders, and motor disorders. This new cluster has as several main features to highlight the characteristics of deficits/delays in ‘maturationally-influenced’ psychological features, cognitive impairment, genetic influences, and overlap among the neurodevelopmental disorders. © 2015 The Authors. Developmental Medicine & Child Neurology © 2015 Mac Keith Press, 57 (Suppl. 2): 1–3
DOI: 10.1111/dmcn.12700 1
As an example, Borst et al. emphasize the crucial role of ‘inhibition for action’ to accomplish cognitive tasks, namely the general ability to inhibit our previously acquired knowledge, necessary for avoiding mistakes in action. Imaging studies have indicated the brain circuits involved in this function, probably deeply involved in ADHD, obsessive-compulsive disorder, and CP, as they should be studied by tailored tools for recognising and rehabilitating this inhibition skill. ‘Enrich the environment to cure the brain’: an environment full of appropriate affordances and stimuli is necessary for children with CP, in order to develop as well as possible their functions through perceptual, cognitive, and communication processing. Basic neuroscience research, summarized by Berardi et al., has now indicated the neural mechanisms by which experience and interaction between brain and environment are able to induce developmental changes in brain structures, especially, but not exclusively, in critical periods. Many cellular and molecular mechanisms of this brain plasticity have begun to be identified. For instance, in preclinical models, the mesocortical dopaminergic system seems to play an important modulating role in motor skill learning, with potential influence on the outcome of motor learning intervention in CP (Diaz Heijtz and Forssberg). Attempts to translate the concepts of PACE into rehabilitation procedures are still preliminary. In this respect, the Action-Observation Therapy is a promising approach. Learning by imitation, namely children taking advantage of observing in the environment the actions performed by their friends or adults to learn new skills, is known to play a key role for developing many functions. Nadel, discussing the importance of imitation in Autism Spectrum Disorders, defines imitation as a ‘booster’ for development. Moreover, evidence is available of precocious signs, from the first months of life, for direct visual-motor matching processes, suggesting a matching between action-perception and execution already in infancy (see Burzi et al.). These findings have suggested the possibility of applying, also in children with CP, novel rehabilitation strategies based on Action-Observation Therapy and Observation-to-Imitate, recently tested in adults with various motor disorders (see Bassolino et al.). I believe that we will see in the future the results of many studies, translating the concepts of perceptual, cognitive, and communication processing and their integration into new pathophysiological modelling, and into evaluation and remediation tools in CP and other neurodevelopmental disorders. Giovanni Cioni Guest Associate Editor University of Pisa and Stella Maris Scientific Institute Chair, European Academy of Childhood Disability [email protected] REFERENCES 1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. The definition and classification of cerebral palsy. Dev Med Child Neurol 2007; 49: 1–44. 2. Dan B, Mayston M, Paneth N, Rosenbloom L, editors. Cerebral Palsy: Science and Clinical Practice. London: Mac Keith Press, 2014. 3. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130: e1285–312. 4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edn. Arlington, VA: American Psychiatric Publishing, 2013.
La Fondation Motrice, the French Foundation dedicated to research into and improving of quality of care for those with Cerebral Palsy (CP), was initiated by parents and professionals who identified the lack of research into CP, the lack of funding for research, and the lack of scientific initiative in the field in their country, as a major concern for their children and those to come. La Fondation Motrice was positioned as a crossroads of three groups of stakeholders: people with CP and their families, researchers, and donators; ‘crossroads’ meant not as parting away but the point where they concentrate. The scientific committee as well as the outreach of the Foundation had to be European. Soon afterwards, the relevance of the priorities to be decided was considered unsubstantiated in such a heterogeneous condition as CP if people with it and their families had not expressed their opinion and were not given the opportunity to meet other stakeholders. A series of focus groups was organized to elicit views of adults with CP, parents, professionals, and researchers and to forecast improvements needed for people with CP in three predefined areas: medicine, technology, and social sciences. Cognitive, mobility, and speech impairments were, unsurprisingly, major concerns, although they ranked second to pain, and were followed by various other concerns (e.g. prevention of brain damage, life trajectories with transition periods from childhood to adulthood, etc). CP is not only a movement disorder, as perception and cognition impairments play key roles in the disability. This was clearly expressed by people with CP in the focus groups, and was a main point for the international workgroup who for2 Developmental Medicine & Child Neurology 2015, 57 (Suppl. 2): 1–3
mulated the updated definition of CP.1 This led our Scientific Committee to organize a session entitled ‘CP, from motor disorder to perceptual-motor disorder’ during our 2009 symposium. Four disciplines were called upon: neurophysiology, neuropaediatrics, psychology, and philosophy; and a putative sponsor was invited. An international workgroup comprising researchers from a large array of disciplines was set up under the scientific coordination of Professor Giovanni Cioni with a team at La Fondation Motrice. Our sponsor gave an unrestricted grant except for one recommendation, which proved relevant: ‘you can only get focused if your approach is multidisciplinary’. The project was named Perception, Action, Cognition, Environment, as the acronym PACE means both the speed of movement in English and, in Latin, the peace you wish to others, be it inner peace with oneself or peace with others. What better wish when conjunction of cognitive and motor impairment affects both the arrangement of the child’s life and their relations with others? The workgroup developed into an international network, ideas were shared and confronted, collaborations emerged or got reinforced, projects receiving various sources of support were combined with projects supported by La Fondation Motrice, and eventually results and conclusions were discussed in a symposium, the presentations of which are gathered in this issue. We are indebted to all those who conducted research, presented results in this symposium or who shared ideas in network meetings on a topic of such importance for children and adults who live with CP. Alain Chatelin Chairman, La Fondation Motrice [email protected]
Lucie Hertz-Pannier Board member, Vice-chairman 2012–2014, La Fondation Motrice [email protected]
A CK N O W L E D G M E N T S
We are very grateful to Prof. Cioni for tireless scientific coordination over the past four years, to Dr Gaillard for her involvement as project manager, to Dr Ejnes at our Foundation and to all those who contributed in the network. We thank very much all donators; on top of them is Cooperative Sodiaal represented by Mr Attali whose constant support and questions, kept us moving forward. We thank all volunteers and staff who dedicate their time to helping the foundation to perform its daily duties and collect funds. The ‘PACE for CP’ program with La Fondation Motrice is the collaboration of a vast network (alphabetical order): PACE Network–Scientific coordinator: Prof. Cioni. Project management: Dr Gaillard. PACE Scientific Workgroup: Prof. Ancet, Prof. Berthoz, Dr Cans, Prof. Cioni, Prof. Dan, Dr Ejnes, Dr Esben-Bilde, Prof. Forssberg, Dr Gonzalez-Monge, Dr Hertz-Pannier, Prof. von Hofsten, Dr Jouen, Prof. Kemoun, Ms Ladet, Prof. Nielsen and invited participants. PACE Pilot study – Coordinators: Prof. Berthoz, Prof. Cioni. Workpackage leaders: Dr Cans, Prof. Forssberg, Prof. von Hofsten. Other researchers: Dr Belmonti, Prof. Dan, Dr Ego, Dr Eliasson, Dr Esben-Bilde, Dr Gonzalez-Monge, Prof. Houde, Prof. Kemoun, Prof. Kr€ageloh-Mann, Dr Krumlinde-Sundholm, Dr Lidzba, Prof. Laschi, Dr Olivier and coworkers. PACE International research Prize – Laureate: Dr Dehaene-Lambertz – Jury’s co-chair: Prof. Kr€ageloh-Mann & Prof. von Hofsten. Members: Mr Attali, Prof. Berthoz, Dr Gonzalez, Prof. H€ uppi, Mr LeMetayer. PACE Call for project–Laureate: Dr Bassolino, Prof. Pozzo, Prof. Sandini. Jury: Dr Berard, Prof. Nielsen, Dr Cans, Prof. Cioni, Prof. Forssberg, Dr Hertz-Pannier, Prof. Kr€ageloh Mann, Mr Le Metayer, Prof. Zalc. PACE symposium 2013: PACE Approach – New tools for an integrative and developmental approach to Cerebral Palsy and other neurodevelopmental disorders (presentations are gathered in this special issue). The Scientific Committee of La Fondation Motrice (2006–2012): Prof. Benabid, Dr Berard, Dr Cans, Prof. Cioni, Prof. Gressens, Prof. H€ uppi, Dr Jacotot, Prof. Kr€ageloh Mann, Mr Le Metayer, Prof. Pons, Prof. Vallee, Prof. Vidailhet, Prof. Zalc. PACE supporting team at La Fondation Motrice: Dr Genes, Ms de Oliveira, Ms Choplin. REFERENCE 1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. The definition and classification of cerebral palsy. Dev Med Child Neurol 2007; 49: 1–44.
Foreword
3
Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Foreword This special issue includes a group of short articles based on the lectures presented at a symposium in Paris in November 2013, as the conclusion of the work of an international scientific group and a pilot research study, both around Perception, Action, Cognition, Environment (PACE) in cerebral palsy (CP). La Fondation Motrice, a French organization comprising parents and experts, devoted to research into CP, promoted the scientific group and the pilot study. Alain Chatelin and Lucie Hertz-Pannier describe in more detail in the other part of this foreword the history of the project, its main actors, and initiatives. The main concepts of PACE include and expand the updated definition (and classification) that describes CP ‘as a group of disorders of the development of movement and posture. . . often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.’1 For the first time, the association with ‘not primarily motor’ disorders such as cognition, communication, perception, and others has been mentioned in the definition, pointing out that these ‘accompanying’ disorders are strongly linked to motor disorders and might be the major cause of activity limitation for people with CP. The recent excellent book edited by Dan et al.2 acknowledges this concept and largely covers cognition and all the other non-motor aspects of CP. These disorders are reported as very frequent in people with CP (see Novak et al.3). However, not having homogeneous definitions, they lack dedicated and specific assessment tools, and precise data on the total incidence and distribution in the subtypes of CP (for visual perceptual disorders see Ego et al., this issue). People with CP were interviewed by La Fondation Motrice, with the aim of identifying the most relevant topics to be selected for the research supported by the association. Perception and cognition were identified as key factors that account for their disabilities making their study worthwhile. The opinion of stakeholders has a correspondence with new models of motor control and learning in typical development, and in various neurological disorders, based on strong interaction with cognitive, perceptual, and emotional functions. The PACE approach indicates that perception, action, cognition, and interaction with the environment should not be seen as separate ‘functions’, to be isolated and analysed in uni-modular, poorly ecological experimental conditions. Although such a traditional way of focusing on the possible dissociations of each function from the others has proved effective in many respects, it does not address some key questions emerging from clinical and daily-life settings. In the past decade, new discoveries and models in neuroscience have led most researchers to consider these aspects of brain functioning as deeply blended and to some extent co-emerging throughout development. A paradigm shift from isolated, modular functions to functional integration has taken place. This, in turn, now challenges our mission as basic and clinical researchers, health professionals, and care-givers, in that we are confronted with a complex, multi-faceted, and highly interconnected brain, whose disturbances cannot be fully understood or treated, except in a complex, multi-faceted, and integrated way. New research protocols are thus needed, acting in an integrative perspective, in addition to more traditional research addressing specifically isolated functions independently from one another. The papers included in this issue highlight some of the theoretical background of the PACE approach as well as reviews of its translation into new diagnostic and rehabilitation studies, for CP and other neurodevelopmental disorders. In this issue, Alain Berthoz and M Zaoui report examples of brain perceptual and cognitive systems, such as spatial memory and executive functions, that are involved in children’s ‘navigation’ in their environment to fulfil their adaptive needs. Children with CP may suffer several disorders in these abilities, as hypothesized in the paper, with possible pathophysiological profiles that may potentially lead to tailored remediation approaches. To test these and other challenging hypotheses, we need to develop tools to explore these cognitive functions in action. Some of these tests are described in this issue, such as the ‘magic carpet’, a test derived from the Corsi Block-Tapping Task, to analyse spatial memory and representations during navigation, whereas available tests to investigate manual action in infancy are reviewed in another paper (Krumlinde-Sundholm et al.). As indicated by Dan et al., although the main focus of the PACE research group has been on CP, this approach can also be useful for other disorders that, at the symptom level, seem to share similar behavioural and diagnostic criteria. In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition4 a new cluster of neurodevelopmental disorders is proposed, which includes six categories: intellectual developmental disorders, communication disorders, autism spectrum disorders, attention-deficit–hyperactivity disorder (ADHD), learning disorders, and motor disorders. This new cluster has as several main features to highlight the characteristics of deficits/delays in ‘maturationally-influenced’ psychological features, cognitive impairment, genetic influences, and overlap among the neurodevelopmental disorders. © 2015 The Authors. Developmental Medicine & Child Neurology © 2015 Mac Keith Press, 57 (Suppl. 2): 1–3
DOI: 10.1111/dmcn.12700 1
As an example, Borst et al. emphasize the crucial role of ‘inhibition for action’ to accomplish cognitive tasks, namely the general ability to inhibit our previously acquired knowledge, necessary for avoiding mistakes in action. Imaging studies have indicated the brain circuits involved in this function, probably deeply involved in ADHD, obsessive-compulsive disorder, and CP, as they should be studied by tailored tools for recognising and rehabilitating this inhibition skill. ‘Enrich the environment to cure the brain’: an environment full of appropriate affordances and stimuli is necessary for children with CP, in order to develop as well as possible their functions through perceptual, cognitive, and communication processing. Basic neuroscience research, summarized by Berardi et al., has now indicated the neural mechanisms by which experience and interaction between brain and environment are able to induce developmental changes in brain structures, especially, but not exclusively, in critical periods. Many cellular and molecular mechanisms of this brain plasticity have begun to be identified. For instance, in preclinical models, the mesocortical dopaminergic system seems to play an important modulating role in motor skill learning, with potential influence on the outcome of motor learning intervention in CP (Diaz Heijtz and Forssberg). Attempts to translate the concepts of PACE into rehabilitation procedures are still preliminary. In this respect, the Action-Observation Therapy is a promising approach. Learning by imitation, namely children taking advantage of observing in the environment the actions performed by their friends or adults to learn new skills, is known to play a key role for developing many functions. Nadel, discussing the importance of imitation in Autism Spectrum Disorders, defines imitation as a ‘booster’ for development. Moreover, evidence is available of precocious signs, from the first months of life, for direct visual-motor matching processes, suggesting a matching between action-perception and execution already in infancy (see Burzi et al.). These findings have suggested the possibility of applying, also in children with CP, novel rehabilitation strategies based on Action-Observation Therapy and Observation-to-Imitate, recently tested in adults with various motor disorders (see Bassolino et al.). I believe that we will see in the future the results of many studies, translating the concepts of perceptual, cognitive, and communication processing and their integration into new pathophysiological modelling, and into evaluation and remediation tools in CP and other neurodevelopmental disorders. Giovanni Cioni Guest Associate Editor University of Pisa and Stella Maris Scientific Institute Chair, European Academy of Childhood Disability [email protected] REFERENCES 1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. The definition and classification of cerebral palsy. Dev Med Child Neurol 2007; 49: 1–44. 2. Dan B, Mayston M, Paneth N, Rosenbloom L, editors. Cerebral Palsy: Science and Clinical Practice. London: Mac Keith Press, 2014. 3. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130: e1285–312. 4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edn. Arlington, VA: American Psychiatric Publishing, 2013.
La Fondation Motrice, the French Foundation dedicated to research into and improving of quality of care for those with Cerebral Palsy (CP), was initiated by parents and professionals who identified the lack of research into CP, the lack of funding for research, and the lack of scientific initiative in the field in their country, as a major concern for their children and those to come. La Fondation Motrice was positioned as a crossroads of three groups of stakeholders: people with CP and their families, researchers, and donators; ‘crossroads’ meant not as parting away but the point where they concentrate. The scientific committee as well as the outreach of the Foundation had to be European. Soon afterwards, the relevance of the priorities to be decided was considered unsubstantiated in such a heterogeneous condition as CP if people with it and their families had not expressed their opinion and were not given the opportunity to meet other stakeholders. A series of focus groups was organized to elicit views of adults with CP, parents, professionals, and researchers and to forecast improvements needed for people with CP in three predefined areas: medicine, technology, and social sciences. Cognitive, mobility, and speech impairments were, unsurprisingly, major concerns, although they ranked second to pain, and were followed by various other concerns (e.g. prevention of brain damage, life trajectories with transition periods from childhood to adulthood, etc). CP is not only a movement disorder, as perception and cognition impairments play key roles in the disability. This was clearly expressed by people with CP in the focus groups, and was a main point for the international workgroup who for2 Developmental Medicine & Child Neurology 2015, 57 (Suppl. 2): 1–3
mulated the updated definition of CP.1 This led our Scientific Committee to organize a session entitled ‘CP, from motor disorder to perceptual-motor disorder’ during our 2009 symposium. Four disciplines were called upon: neurophysiology, neuropaediatrics, psychology, and philosophy; and a putative sponsor was invited. An international workgroup comprising researchers from a large array of disciplines was set up under the scientific coordination of Professor Giovanni Cioni with a team at La Fondation Motrice. Our sponsor gave an unrestricted grant except for one recommendation, which proved relevant: ‘you can only get focused if your approach is multidisciplinary’. The project was named Perception, Action, Cognition, Environment, as the acronym PACE means both the speed of movement in English and, in Latin, the peace you wish to others, be it inner peace with oneself or peace with others. What better wish when conjunction of cognitive and motor impairment affects both the arrangement of the child’s life and their relations with others? The workgroup developed into an international network, ideas were shared and confronted, collaborations emerged or got reinforced, projects receiving various sources of support were combined with projects supported by La Fondation Motrice, and eventually results and conclusions were discussed in a symposium, the presentations of which are gathered in this issue. We are indebted to all those who conducted research, presented results in this symposium or who shared ideas in network meetings on a topic of such importance for children and adults who live with CP. Alain Chatelin Chairman, La Fondation Motrice [email protected]
Lucie Hertz-Pannier Board member, Vice-chairman 2012–2014, La Fondation Motrice [email protected]
A CK N O W L E D G M E N T S
We are very grateful to Prof. Cioni for tireless scientific coordination over the past four years, to Dr Gaillard for her involvement as project manager, to Dr Ejnes at our Foundation and to all those who contributed in the network. We thank very much all donators; on top of them is Cooperative Sodiaal represented by Mr Attali whose constant support and questions, kept us moving forward. We thank all volunteers and staff who dedicate their time to helping the foundation to perform its daily duties and collect funds. The ‘PACE for CP’ program with La Fondation Motrice is the collaboration of a vast network (alphabetical order): PACE Network–Scientific coordinator: Prof. Cioni. Project management: Dr Gaillard. PACE Scientific Workgroup: Prof. Ancet, Prof. Berthoz, Dr Cans, Prof. Cioni, Prof. Dan, Dr Ejnes, Dr Esben-Bilde, Prof. Forssberg, Dr Gonzalez-Monge, Dr Hertz-Pannier, Prof. von Hofsten, Dr Jouen, Prof. Kemoun, Ms Ladet, Prof. Nielsen and invited participants. PACE Pilot study – Coordinators: Prof. Berthoz, Prof. Cioni. Workpackage leaders: Dr Cans, Prof. Forssberg, Prof. von Hofsten. Other researchers: Dr Belmonti, Prof. Dan, Dr Ego, Dr Eliasson, Dr Esben-Bilde, Dr Gonzalez-Monge, Prof. Houde, Prof. Kemoun, Prof. Kr€ageloh-Mann, Dr Krumlinde-Sundholm, Dr Lidzba, Prof. Laschi, Dr Olivier and coworkers. PACE International research Prize – Laureate: Dr Dehaene-Lambertz – Jury’s co-chair: Prof. Kr€ageloh-Mann & Prof. von Hofsten. Members: Mr Attali, Prof. Berthoz, Dr Gonzalez, Prof. H€ uppi, Mr LeMetayer. PACE Call for project–Laureate: Dr Bassolino, Prof. Pozzo, Prof. Sandini. Jury: Dr Berard, Prof. Nielsen, Dr Cans, Prof. Cioni, Prof. Forssberg, Dr Hertz-Pannier, Prof. Kr€ageloh Mann, Mr Le Metayer, Prof. Zalc. PACE symposium 2013: PACE Approach – New tools for an integrative and developmental approach to Cerebral Palsy and other neurodevelopmental disorders (presentations are gathered in this special issue). The Scientific Committee of La Fondation Motrice (2006–2012): Prof. Benabid, Dr Berard, Dr Cans, Prof. Cioni, Prof. Gressens, Prof. H€ uppi, Dr Jacotot, Prof. Kr€ageloh Mann, Mr Le Metayer, Prof. Pons, Prof. Vallee, Prof. Vidailhet, Prof. Zalc. PACE supporting team at La Fondation Motrice: Dr Genes, Ms de Oliveira, Ms Choplin. REFERENCE 1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. The definition and classification of cerebral palsy. Dev Med Child Neurol 2007; 49: 1–44.
Foreword
3
Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
