{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:47:20Z","timestamp":1785822440403,"version":"3.56.0"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cerebral palsy (CP) remains the leading childhood motor disorder worldwide, yet rehabilitation access is severely limited across sub-Saharan Africa due to resource scarcity, workforce shortages, and profound cultural stigmatization. Family-mediated approaches offer a promising pathway to bridge this gap. To our knowledge, this study represents the first evaluation of a pediatric adaptation of the Cogni-Famille protocol \u2014 originally developed for adult post-stroke rehabilitation \u2014 applied to children with spastic CP across two dramatically different resource environments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-one children with confirmed spastic CP (GMFCS levels I\u2013III, ages 5\u201312) completed a 12-week family-mediated manual therapy (FMMT) intervention: 9 in institutional settings (France) and 12 in home-based care (Cameroon). Caregivers received progressive training in five manual therapy modules emphasizing ecological plasticity principles, delivered through twice-weekly therapist-supervised sessions (45\u201360\u2005min each) complemented by daily home practice of 2\u20133\u2005h. Primary outcome was change in Gross Motor Function Measure (GMFM-66). Secondary outcomes included spasticity (Modified Ashworth Scale), exploratory cost comparison, and qualitative social impact assessment. Statistical comparisons used Mann\u2013Whitney U tests for continuous variables and Fisher's exact test for categorical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both cohorts achieved clinically significant GMFM-66 improvements (France: +15.2\u2009\u00b1\u20093.8 points; Cameroon: +13.8\u2009\u00b1\u20094.2 points;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.28), exceeding the minimal clinically important difference by 8-fold. Spasticity decreased comparably across settings (Modified Ashworth: France \u22121.3\u2009\u00b1\u20090.4; Cameroon \u22121.1\u2009\u00b1\u20090.5;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.33). Exploratory cost comparison revealed the Cameroonian model cost one-eighth that of France (38\u20ac vs. 320\u20ac monthly) while achieving equivalent clinical outcomes. Qualitative interviews documented profound social impacts: 11 of 12 Cameroonian families reported reduced stigmatization and improved community integration. Three Cameroonian children died during follow-up from complications unrelated to the intervention, reflecting the significant health vulnerabilities faced by children with disabilities in resource-limited settings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Family-mediated manual therapy produces substantive motor improvements at dramatically reduced cost when culturally contextualized, while simultaneously addressing social exclusion. This approach demonstrates five innovative mechanisms \u2014 ecological plasticity, therapeutic motherhood, sequential micro-learning, community anchoring, and functional dignity restoration \u2014 offering a scalable and replicable model for addressing Africa's rehabilitation gap.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1797591","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:38:05Z","timestamp":1785821885000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The pediatric Cogni-Famille protocol: family-mediated manual therapy achieves comparable outcomes at one-eighth cost in children with cerebral palsy\u2014a franco-Cameroonian comparative study"],"prefix":"10.3389","volume":"14","author":[{"given":"Ibrahim","family":"Npochinto Moumeni","sequence":"first","affiliation":[{"name":"Department of Physical Therapy & Physical Medicine, Faculty of 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Dschang","place":["Dschang, Cameroon"]},{"name":"Centre de Recherche en Sant\u00e9 Humaine et D\u00e9veloppement des M\u00e9dicaments (CRESHDEM), Faculty of Medicine and Pharmaceutical Sciences, University of Dschang","place":["Dschang, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Njikam Moumeni","family":"Abdel-Nasser","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine & Osteopathy, Regional Hospital of Bafoussam","place":["Bafoussam, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1111\/j.1469-8749.2007.tb12610.x","article-title":"A report: the definition and classification of cerebral palsy April 2006","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev Med Child Neurol 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